Mucormycosis is a rare and invasive fungal disease with high mortality rate caused by members of the order Mucorales. Mucorales species are vasotrophic organisms that may cause angioinvasive disease in immunosuppressed hosts. Risk factors include diabetic ketoacidosis, chronic kidney disease, organ or bone marrow transplantation, neutropenia, burns, malignancies, and steroid therapy. There are six different clinical presentations of mucormycosis, which includes rhino-orbital cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and miscellaneous infection. Here, we report a case of a 57-year-old male with stage-IV sarcoidosis on long-term steroids presenting with upper gastrointestinal bleeding and obstructive uropathy who was diagnosed with systemic mucormycosis. Biopsy obtained by endoscopy revealed necrotic debris with acute leukocytic exudate and numerous variably sized, 90-degree angulated fungal hyphae favoring mucormycosis-causing species. Imaging studies showed hydronephrosis, and cystoscopy findings were consistent with fungal infection of the bladder. Isavuconazonium sulfate was used as systemic salvage therapy along with continuous bladder irrigation with amphotericin-B for localized bladder infection after a trial with first-line systemic treatment with intravenous liposomal amphotericin-B failed. A repeat endoscopy showed inflammatory changes with a pathology report in which mucormycosis was no longer appreciated. The patient was discharged home to complete 6 months of antifungal therapy with monthly follow-ups. The patient has been asymptomatic after 12-month completion of therapy.

This presentation reports a case of a 67-year-old former smoker who presented to the emergency department with new-onset hemoptysis. During the workup, a left lung mass was identified. During the biopsy, he experienced a pneumothorax. The procedure had to be aborted, and a small-sized chest tube was placed. The following day, the patient underwent a successful second lung biopsy, but a day later he developed significant subcutaneous emphysema despite having a chest tube. The same day, the smaller chest tube was removed and a larger chest tube was inserted. While small chest tubes are preferred for patient comfort, in some patients with risk factors, a large chest tube is recommended. Over the course of a few days, the emphysema improved.

Exercise is an important part of a healthy lifestyle. However, there is a subset of the population who are allergic to exercise. Exercise-induced urticaria is a rare clinical condition, which, as the name suggests, manifests as flushing, pruritus, and hives following physical exercise. A minority of patients even develop more severe reactions including angioedema and anaphylaxis induced by exercise. Some patients are affected by certain cofactors that constitute food-dependent exercise-induced urticaria, which is relatively more common when compared to exercise-induced urticaria without other cofactors. This case report documents a healthy 27-year-old Asian male, with no other allergies or cofactors, who was diagnosed with exercise-induced urticaria. He was diagnosed based on history and a positive exercise challenge test. Avoidance of exercise is the mainstay of prophylactic treatment for this condition. Modification of physical activity proved to be effective for treating this patient. We intend to increase awareness about this rare condition through this case report and literature review.

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1 2 3 the brooklyn hospital center, brooklyn, NY, United States of America Corresponding author's email: auvieghara@yahoo.co.uk Rationale: It is a standard practice to report absolute Diffusion Capacity (DLCO) and also Volume corrected DLCO i.e. Transfer coefficient Kco = (DLCO/VA) in Pulmonary Function test (PFT) reports. However, alveolar volume (VA) measurement done concurrently during DLCO measurement by single breath holding can be considerably lower than the true lung volume i.e. total lung capacity (TLC) measurement done by either N2 washout or Body plethysmography. Transfer coefficient Kco to separate patients with and without parenchymal lung disease. However use of volume correction is controversial. We tested the hypothesis that in patients with reduced absolute DLCO, whether Volume correction with TLC would accurately diagnose underlying disease.: Retrospective review of all PFTs done between 1/1/9 and 9/1/9. PFTs of 230 male and female patients between the ages of 18 Methods and 75 yrs with reduced DLCO were analyzed. The interpretive strategy of ATS/ERS 2005 standards was used to classify the nature and severity of underlying defect. Absolute reduction in DLCO was correlated with DLCO/VA and DLCO/TLC for concordance and discordance. Also the correlation coefficient between VA and TLC was calculated.The correlation coefficient between VA and TLC was .59 in patients with severe obstructive lung disease. In the other groups of Results patients the correlation coefficient between VA and TLC ranges from .78 to .95. There was a high degree of discordance between DLCO and DLCO/VA in all groups of patients. However 69% of patients with severe obstructive lung disease show concordance between low DLCO and DLCO/TLC, Disease