By vgreene, 12 April, 2016

CABG

(BMJ)—A woman presented w/ weight loss, jaundice, and silver-colored stools. Labs: elevated CA19-9. CT scan suggested the dx. What is it?
Gallstone pancreatitis
Inhalant abuse (“huffing”)
Carcinoma of the ampulla of Vater
Hypothyroidism
Ovarian cancer
You are correct. Silver-colored stool, or Thomas’ sign, is pathognomonic of carcinoma of the ampulla of Vater. The metallic color is caused by the mixture of melena and cholestatic pale stools. Ampullary cancers comprise about 0.2% of all GI cancers. Although silver stools are thought to be a classic sign, data are limited. If caught early, prognosis is thought to be good, highlighting the importance of obtaining an accurate hx of stool color change.
(BMJ)—A 65-yo man had a 6-wk hx of rapidly progressive cognitive decline, fever, and ataxia. Exam: R ear: red swollen pinna w/ lobe spared; ocular inflammation; symmetrical small joint polyarthropathy. MRI and biopsy confirmed the dx. What is it?
Syphilis
Tuberculous brain abscess
Cogan syndrome
MAGIC syndrome
Relapsing polychondritis w/ cerebral vasculitis
You are correct. Relapsing polychondritis causing cerebral vasculitis was suspected clinically and confirmed histologically by brain and auricular biopsy. T2-weighted MRI showed diffuse, white-matter, hyperintense lesions, and CSF analysis revealed lymphocytic pleocytosis. Relapsing polychondritis is a rare, severe inflammatory condition of cartilaginous structures. Rarely, it causes cerebral vasculitis, and is a potentially treatable cause of cognitive decline.