Lymphoma, a term encompassing tumor masses in the lymph nodes, is often classified into Hodgkin and non-Hodgkin lymphomas, each with distinct subtypes. We present the unique case of an HIV-positive patient diagnosed with Burkitt lymphoma and classical Hodgkin lymphoma simultaneously as a composite lymphoma. Over the course of five years, a variety of dose-adjusted chemotherapy regimens were used that ultimately proved highly effective. The successful management of this rare case reinforces the significance of considering unexpected combinations of neoplastic processes during diagnosis and treatment planning.

Autoimmune diseases, a term encompassing conditions where the immune system targets its own cells, consist of various pathologies, two of which are systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). We present the unique case of an anti-ribonucleoprotein (RNP)-positive patient exhibiting renal pathology consistent with lupus nephritis and an additional collapsing variant of focal segmental glomerulonephropathy, who initially presented to the emergency department with signs and symptoms of pneumonia and portal vein thrombosis that were subsequently treated. Conflicting accounts of her autoimmune history led to an extensive workup during her stay, which yielded a tentative diagnosis of SLE vs. MCTD during her current hospitalization for pneumonia. The diagnostic labs revealed conflicting serological markers, with delayed anti-Smith positive results favoring lupus due to its high specificity. A subsequent renal biopsy showed complex renal involvement, suggesting SLE, despite initial positive anti-RNP antibodies known to be protective against renal pathology and classic for MCTD. Complicating matters further, the renal biopsy findings extended beyond common SLE pathology, including additional focal segmental glomerulonephritis (FSGS) involvement. Despite this uncertainty, the patient was treated as if solely having SLE, and immunosuppressives that could have been utilized for the possible MCTD component were avoided due to minimal signs of inflammation/immune response and normal kidney function. This case highlights the difficulty in accurately classifying lupus and MCTD, emphasizing the need for precise diagnosis for tailored patient care. Ongoing research is crucial to refine diagnostic criteria and improve patient outcomes.

Shewanella algae is an opportunistic Gram-negative bacillus primarily found in marine environments. It can cause a range of infections in humans, from superficial soft tissue infections to more severe conditions like bacteremia, otitis, and hepatobiliary infections. While infections are rare, they can be significant, leading to complications such as sepsis and tissue necrosis. We present the case of severe cellulitis caused by Shewanella in an 88-year-old patient with multiple comorbidities. Following a blue crab pinch and consequent saltwater exposure, the patient developed severe cellulitis, sepsis, delirium, and atrial fibrillation. Despite these complications and the patient's age, a prompt diagnosis and a combination of antibiotic treatments led to a successful recovery. This case is notable for its illustration of the potential severity and diverse clinical presentation of Shewanella infections. It highlights the importance of considering Shewanella as a possible pathogen in cases of saltwater exposure and teaches management in elderly, multi-morbid patients.

Psoriasis is a chronic inflammatory skin condition with many associated co-morbidities, making timely diagnosis key in patient care. This study investigates racial, ethnic, gender, and insurance disparities in the time to diagnosis of psoriasis in adolescent patients. It is hypothesized that health disparities will lead to increased time to diagnosis in patients of color and those with no insurance or public insurance as compared to private insurance. Retrospective chart review of consecutive patients (n=83) diagnosed with psoriasis between 2012 and 2022 was conducted. The study found a considerable delay in time to diagnosis for pediatric patients, averaging 371.5 days. Females exhibited longer times to diagnosis than males. This prolonged period can lead to increased physical discomfort and a greater risk of developing complications. While no statistically significant differences were found based on race or ethnicity, patients with no insurance experienced significantly longer times to diagnosis compared to their insured counterparts. Patients with a previous misdiagnosis (i.e., eczema, fungal infection, atopic dermatitis) had significantly longer times to diagnosis as well. The fact that race and ethnicity did not significantly influence time to diagnosis suggests strides in reducing health disparities within medical institutions. However, the fact that social determinants of health significantly influenced time to diagnosis suggests that low socioeconomic status correlates to delayed diagnoses and poorer health outcomes, highlighting the need for more equitable access to timely medical care for uninsured populations. Overall, this study contributes valuable insights into health disparities affecting time to diagnosis of psoriasis in adolescent patients.