Nitrofurantoin is a frequently used antibiotic for treatment and prophylaxis of urinary tract infections in both the inpatient and outpatient settings. However, there have been adverse effects associated with a prolonged course. A notable adverse event reported in the literature is acute lung toxicity. Traditional treatment modalities include cessation of the drug. After this, lung injury often resolves within weeks. Glucocorticoids are an adjunctive therapy that has been used but has not been definitively demonstrated to decrease recovery time or improve other outcomes. Although it is believed that resolution can occur solely with drug cessation there have been individual reports of steroids resulting in rapid improvement. We present two cases of patients who developed interstitial pneumonitis secondary to prolonged nitrofurantoin usage that resolved or improved with combined drug cessation and systemic corticosteroid administration.

Neuroendocrine tumors in the gastrointestinal tract, formerly known as carcinoid tumors, are benign in presentation but can quickly metastasize if not diagnosed during regular screenings, such as colonoscopies. Unfortunately, most patients do not present for treatment until late with metastasis when symptoms become severe. We report a 65-year-old Caucasian man who presented with chronic diarrhea for over 2 months; this presentation suggested liver metastasis, but he had no metastasis on evaluation.   Keywords: Gastrointestinal carcinoid tumor, colonoscopy, ileal metastasis, neuroendocrine tumor

Thyrotoxic periodic paralysis is a rare but life-threatening complication of hyperthyroidism. Characteristic features involve thyrotoxicosis, acute paralysis, and hypokalemia. Mild hypomagnesemia and hypophosphatemia are also present in most cases due to the resulting transcellular shift of electrolytes. Complications of thyrotoxic periodic paralysis reported in the literature have included cerebral venous thrombosis as well as lower extremity deep venous thrombosis. We present a patient with an unusual presentation of thyrotoxic periodic paralysis as reflected by hyperphosphatemia, upper extremity deep venous thrombosis and severe hypomagnesemia. This is the first reported case of upper extremity deep vein thrombosis in association with a peripherally inserted central catheter line secondary to thyrotoxicosis.