Background: Peritoneal-dialysis-associated peritonitis is a serious complication of peritoneal dialysis; prevention and treatment are crucial to reduce patient morbidity and mortality. Staphylococcus sciuri is an organism that, although present in several animal species, rarely causes disease in humans, particularly in patients undergoing peritoneal dialysis. Case presentation: A 54-year-old man with end-stage kidney disease on continuous ambulatory peritoneal dialysis was admitted to the emergency department with nausea, vomiting, slight abdominal distention, and cloudy peritoneal dialysis effluent. Relevant medical history included occupational exposure to different animal species. The white blood cell count in the peritoneal dialysis fluid sample was 11,200 cells/mm³ with 90% polymorphonuclear cells. Peritoneal-dialysis-associated peritonitis was diagnosed. Empirical antibiotic treatment was started according to the International Society for Peritoneal Dialysis guidelines. Staphylococcus sciuri was identified in the peritoneal dialysis effluent culture by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The treatment was modified on the basis of the sensitivity results. Medical cure was established on the basis of the negative result of the dialysate culture and absence of alterations in the cell count with differential after the end of treatment. The patient was instructed to be careful when administering peritoneal dialysis, especially in the care involved in being in contact with animals. Conclusions: This article highlights the importance of Staphylococcus sciuri as a significant pathogen due to its virulence and antibiotic resistance, especially in patients undergoing peritoneal dialysis. Prevention strategies as well as timely diagnosis and treatment compliance according to the International Society for Peritoneal Dialysis are essential for successful outcomes.

Background: Hepatocellular carcinoma is a major public health problem, as is considered the fastest growing cause of cancer-related death. Cannonball metastases as an initial finding in hepatocellular carcinoma are considered a rare phenomenon. Case Presentation: A 59-year-old man presented to the outpatient clinic for subacute cough, asthenia, and involuntary weight loss. Chest X-ray showed multiple, round, bilateral pulmonary solid lesions. Contrast-enhanced computed tomography of the chest and abdomen revealed multiple bilateral, contrast-enhanced pulmonary nodules known as "cannonball" lesions and a heterogeneous lesion located in the right lobe of the liver with retroperitoneal lymphadenopathy. A biopsy was performed, and the histopathological result was compatible with metastatic poorly differentiated hepatocellular carcinoma. Due to the advanced stage of the disease, the patient received palliative care and expired two months later. Conclusion: Cannonball metastases in hepatocellular carcinoma are considered a rare finding and represents a poor prognosis. It is important to awaken the interest of clinicians in a timely diagnosis, as well as a possible suspicion of hepatocellular carcinoma in patients with this radiographic pattern.

Background: Heyde syndrome is an uncommon clinical condition characterized by the triad of aortic stenosis, gastrointestinal angiodysplasia, and acquired von Willebrand syndrome. Its occurrence in the context of hypertrophic obstructive cardiomyopathy is rare. Common in individuals over 65, diagnosis is challenging due to the prevalence of these conditions. Hypertrophic obstructive cardiomyopathy increases shear stress, leading to von Willebrand Factor degradation and a higher risk of gastrointestinal bleeding. Case presentation: A 69-year-old male presented to the outpatient clinic with melena, abdominal cramping, and fatigue, along with a history of anemia requiring blood transfusions. Despite a negative upper gastrointestinal endoscopy, further tests revealed angiodysplasias with recent bleeding. He was also diagnosed with hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. After being treated with octreotide and nadolol, his condition improved markedly, with hemoglobin levels rising and no further episodes of bleeding. Conclusion: Recognizing hypertrophic obstructive cardiomyopathy as a new variant of Heyde syndrome broadens our understanding of this complex disorder. It emphasizes the need to consider hypertrophic obstructive cardiomyopathy in patients with unexplained gastrointestinal bleeding and cardiac murmurs, prompting a more tailored approach to diagnosis and treatment.

Background: Croup is a common respiratory disease during childhood and very rare in adulthood. Although the cause of croup is usually viral, influenza A virus (IAV) is considered a rare etiologic agent. Case Description: We describe the case of a 35-year-old man who presented to the emergency department with agitation due to fever, “barking” cough and progressive dyspnea during the last 12 hours. Physical examination revealed tachypnea, use of accessory respiratory musculature and auscultation of biphasic stridor at rest. A chest X-ray revealed the so-called steeple sign. Laboratory tests showed leukocytosis. A nasopharyngeal swab was sent for a rapid molecular test which was positive for IAV. A diagnosis of croup due to IAV was made. Treatment was started with dexamethasone, nebulized racemic epinephrine, humidified oxygen, and oseltamivir. The patient was admitted to the intensive care unit (ICU), where he showed clinical improvement, transferred to regular nursing floor 24 hours after admission and discharged on the third day with complete resolution of symptoms. Conclusions: Croup in adults caused by influenza A represents an uncommon clinical entity. Our case reinforces the importance of understanding this disease, since it requires early diagnosis and treatment, and unlike croup in pediatric patients, in adults it is a severe disease and has an impact on the patient’s outcome and prognosis.