Introduction: Cocaine is a highly addictive substance that stimulates the sympathetic nervous system and cardiovascular system. A multitude of adverse cardiovascular events are associated with cocaine use including arrhythmia, congestive heart failure, coronary artery spasm and myocarditis. <br/> Case Report: We present a rare case of Takotsubo cardiomyopathy after recent use of cocaine in a female without any other identifiable risk factor.<br/> Discussion: Takotsubo cardiomyopathy (TCM) is a reversible cause of cardiomyopathy characterized by transient decrease in ejection fraction. Cocaine is a sympathomimetic that causes catecholamine surge and a variety of cardiovascular abnormalities. The association of cocaine use with Takotsubo cardiomyopathy is a rare occurrence, however the prognosis is generally good if diagnosis is made promptly. <br/> Conclusion: Physician vigilance is required to diagnose this rare cause of cardiomyopathy and reduce morbidity and mortality.

Diabetic ketoacidosis (DKA) is a significant complication of poorly controlled diabetes. In diabetics, it typically occurs due to insulin deficiency resulting in lipolysis and subsequent ketone body formation and acidosis. The emergence of the COVID-19 infection has been associated with several complications, with the most prominent being pulmonary and cardiovascular-related. However, in some cases, patients with COVID-19 infection present with diabetic ketoacidosis. The pathophysiology of DKA in COVID-19 infection is different and currently not completely understood. The manifestation of DKA in COVID-19 patients is associated with increased severity of mortality and length of stay in these patients. Here, we describe a patient with no past medical history who presented with COVID-19 symptoms and was found to be in DKA. This case report highlights the possible underlying pathophysiology associated with this complication.

McKittrick–Wheelock syndrome commonly presents with a triad of chronic secretory diarrhea, electrolyte disturbances, and renal failure. Secretory diarrhea is due to active ion secretion secondary to secretagogue secretion (cyclic adenosine monophosphate and prostaglandin E2). The mainstay of treatment for these lesions is surgical since it will arrest the loss of electrolytes that may lead to serious clinical consequences. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin may be used to decrease electrolyte secretion in patients that desire a nonsurgical approach. Our patient is unique in that this is the first case of a tubular adenoma with high-grade dysplasia leading to MWS and progressing to circulatory collapse with severe electrolyte disturbances. Aggressive replacement of fluids and electrolytes is essential to the survival of these patients.

Coronavirus disease 2019 and influenza B can have similar presentations and are self-limited in most cases. They are rarely associated with fatal cardiovascular complications. Coronavirus and influenza B-induced myocarditis is a rare but reversible cause of cardiogenic shock. Early detection plus administration of antiviral agents and supportive care with mechanical circulatory support in the form of an intra-aortic balloon pump can be a lifesaving measure in myocarditis.

Introduction: Neuroendocrine tumors (NETs) of the biliary tract account for less than 2% of all gastrointestinal cancers with an incidence of 0.32%. 1,2 Extrahepatic biliary NETs are mostly found incidentally in the distal common bile duct (CBD) but in rare cases they may present with obstructive jaundice. We present a case of an elderly male with symptoms of biliary obstruction and acute cholangitis secondary to a NET in the proximal bile duct. Case Description/Methods: A 64-year-old male with hypertension presented with epigastric abdominal pain, vomiting and fever. Patient reported an unintentional 50-pound weight loss over the past year. Vital signs were remarkable for heart rate of 118 beats/min. Labs revealed White blood cell count of 21,000 uL, AST 303 U/L, ALT 563 U/L, alkaline phosphatase 300 U/L, total bilirubin 1.9 mg/dL. CT abdomen showed intrahepatic ductal dilatation to 1.1 cm, and a 1.2 x 1.1 cm low attenuating lesion within the left lobe of the liver and wall thickening of the proximal jejunal loops. Piperacillin-tazobactam was started for acute cholangitis. Endoscopic ultrasound showed duct dilation in the left hepatic lobe and ERCP showed ulceration of major papillae. Following biliary sphincterotomy, exploration revealed severe stenosis of the main bile duct and a 12 mm polypoid lesion in the upper third of the CBD. Histology showed well differentiated NET with trabecular and organoid pattern, positive chromogranin and synaptophysin with Ki-67 index of 3%. Special staining was also positive for reticulin and trichrome. A 10fr x 9cm stent was placed. Following a 7-day course of antibiotics and symptom resolution, the patient was discharged with a plan for elective surgery. Left hepatectomy, CBD resection, and Roux-en-Y hepaticojejunostomy were performed 6 months after hospitalization. At 2 months follow up in clinic, the patient was asymptomatic. Discussion: Biliary NETs are found in the common hepatic duct, CBD and the cystic duct. 3 Biliary NETs are twice more common in females, with a mean age of 47 years old. Although most cases are incidental, presenting symptoms are jaundice and pruritis. Diagnosis requires histologic evidence and positive expression of chromogranin A, synaptophysin, CD56, or neural cell adhesion molecule. 4 Treatment is surgical excision with Roux-en-Y hepaticojejunostomy. Since biliary NETs uncommonly present with obstructive jaundice, this case presentation highlights the need for a broad differential diagnosis in evaluating patients with obstructive jaundice.