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We present the case of an 86-year-old African American gentleman who presented with fatigue, diarrhea, and weight loss. He had elevated liver enzymes in an obstructive pattern. A magnetic resonance cholangiopancreatography scan showed edema around the stomach and duodenum, which prompted evaluation with an esophagogastroduodenoscopy. A large enteric fistula between the duodenum and colon was visible, and biopsies returned positive for cytomegalovirus (CMV). The patient did not have any known risk factors for immunodeficiency and was successfully treated with medical therapy. Our case is unique in the severity of CMV infection in an otherwise healthy individual.

A 26-year-old woman with recurrent unexplained syncope in the postpartum period was diagnosed with long QT syndrome type 2. Traditional implantation of defibrillator using fluoroscopy became contraindicated after she again became pregnant prior to device implantation. A subcutaneous defibrillator was successfully implanted in the second trimester, after a multidisciplinary evaluation. ( Level of Difficulty: Intermediate. )

Cancer-associated retinopathy (CAR) is a rare cause of vision loss that was first reported in 1976. It is reported that the retinopathy associated with cancer occurs due to antibodies against the tumor antigens that cross-react with retinal cell layers. We present the case of a young male who came to the emergency department with sudden onset of bilateral vision loss. He had a large-sized testicular seminoma with metastatic retroperitoneal lymphadenopathy. Several primary ophthalmological and systemic conditions were considered. He had multiple, positive anti-retinal antibodies. The cancer was felt to be the cause of the vision loss based on the clinical presentation and the presence of anti-retinal antibodies. He was treated with intravenous steroids, plasmapheresis, and curative chemotherapy, but there was no improvement in vision. Unfortunately, he died due to multiorgan failure. Our case is the second on seminoma-associated retinopathy in the literature.

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