Streptococcus agalactiae is a common constituent of the human flora. However, infection in immunocompetent adults is uncommon and the involvement of the central nervous system (CNS) or development of septic arthritis are exceedingly rare and by our knowledge, were only described simultaneously once in a retrospective study. We present the case of a 66-year-old woman with S. agalactiae bacteremia presenting meningitis and septic arthritis of the left shoulder. The patient presented to the emergency department with altered mental status and fever. Lumbar puncture revealed cerebral spine fluid (CSF) pleocytosis and elevated proteins. Blood and CSF cultures identified the presence of a susceptible strain of S. agalactiae . During hospitalization, the patient complained of left shoulder pain, enabling the identification of articular fluid collections, which were drained confirming their infectious origin. Colic ulcers were found to be the starting point of this infection with posterior involvement of the CNS and the development of septic arthritis by hematogenous dissemination.

Postprandial hypoglycemia is a rare complication after Roux-en-Y gastric bypass (RYGB). The underlying pathophysiology remains to be fully understood.We present a case of a 49-year-old woman with a past medical history of mesenteric thrombosis due to prothrombin-related thrombophilia, which culminated in RYGB 10 years prior to presentation. The patient had been given anticoagulation treatment for several years, which she abandoned one year prior to presentation. She presented to our consultation with episodes of postprandial hypoglycemia and severe anemia due to iron and vitamin B12 deficiencies.Dietary adjustments were set in place to prevent hypoglycemia and neuroglycopenic symptoms. Intravenous iron and intramuscular vitamin B12 supplementation led to full recovery of hemoglobin levels, allowing restart of oral anticoagulation to prevent recurrence of thrombotic events.

Urinothorax is a rare type of pleural effusion and usually the result of genitourinary tract disease. An accurate and early diagnosis is crucial as resolution of the underlying pathology is the mainstay of treatment. We report the case of a 69-year-old man who was admitted to the Internal Medicine ward due to obstructive acute kidney injury of unknown origin. The patient was submitted to urinary catheterization and to right percutaneous nephrostomy. Two weeks after admission he developed a large left pleural effusion; a left urinoma was also visible on computed tomography. After thoracentesis, pleural fluid analysis demonstrated a paucicellular transudate with pH <7.40 and pleural fluid/serum creatinine ratio >1.0. The diagnosis of urinothorax was made and further study allowed the diagnosis of prostate cancer as the aetiology of the obstruction. When bilateral percutaneous nephrostomy was performed, resolution of the urinothorax and normalization of renal function occurred.

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