A 10-year-old girl with attention-deficit hyperactivity disorder (ADHD) is diagnosed with hypertrophic cardiomyopathy. The stimulant medications used to control her ADHD pose possibly fatal risks to her cardiovascular health, so stimulant medication is stopped. Due to very poor quality of life off of medication, alternative therapies are used without improvement. The patient's caretakers decide that the benefits of stimulant medication outweigh the risks to the patient. The healthcare team clears the patient to be put back on stimulant medication with a signed waiver of liability by her caretakers.

ObjectiveTo report the management of a large uterine leiomyoma with diffuse cystic degeneration in a patient with autosomal dominant polycystic kidney disease (ADPKD).DesignCase Report.SettingCleveland Clinic Florida, Department of Gynecology, Section of Minimally Invasive Gynecologic surgery, Weston Florida.Patient(s)A 52-year old woman with ADPKD with a large abdominal mass, abnormal uterine bleeding and symptomatic anemia. Imaging revealed a giant intramural cystic lesion of the uterus compressing the inferior vena cava.Intervention(s)Uterine artery embolization and blood transfusion followed by a computed tomography guided cyst aspiration were performed on admission to alleviate anemia and abdominal pain and distension. Total laparoscopic hysterectomy with bilateral salpingectomy was performed in an outpatient setting.Main Outcome Measure(s)Management of large cystic degeneration of leiomyoma.ResultsNormal recovery from definitive surgery. Surgical pathology confirmed a benign, cystically dilated leiomyoma.ConclusionThis case demonstrates the management of giant intramural cyst lesion of the uterus using a minimally invasive surgical approach, as opposed to emergency surgery via laparotomy.CapsuleLarge uterine leiomyoma with diffuse cystic degeneration in a patient with autosomal dominant polycystic kidney disease, in which step-wise treatments allows successful minimally invasive hysterectomy.

DescriptionA 64-year-old woman with no dermatological history presents with a rash over her left eyebrow for the past 3 months with associated itching. The patient also states she has a bruise on her scalp from an accidental injury 1 year previously that continues to be sore. She was previously seen by her primary care physician after her injury, who dismissed the lesion as a haematoma.On physical examination, the patient has a single erythematous papule on the left eyebrow with grey dot granules and mild telangiectasia (figure 1). On examination of the right frontal scalp, the patient has a well-demarcated, erythematous lesion with induration and overlaying alopecia (figure 2). Remaining dermatological examination is unremarkable.A punch biopsy of both lesions was taken. Pathology showed scarring alopecia of the scalp associated with cutaneous lupus erythematosus and corresponding results for the eyebrow lesion.With suspicions of discoid lupus erythematosus confirmed by biopsy, proper management of the patient could commence. The patient was referred to rheumatology where workup for systemic lupus erythematosus was negative. The patient was then prescribed clobetasol propionate 0.05% foam and hydrocortisone 2.5% cream for topical application.On follow-up dermatology visit 21 days after initiation of treatment, the patient reports complete resolution of the lesion on the left eyebrow and decreased irritation and redness of the scalp lesion.