IntroductionStatin belongs to a medication class of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) inhibitor. It is the most significant drug used for lipid-lowering and cardiovascular disease prevention1. A wide range of statin myopathy has been reported including myalgia, myopathy, myositis, or rhabdomyolysis. Statin-induced immune-mediated necrotizing myopathy (IMNM) is a relatively rare side effect with an incidence of 2 or 3 of every 100,000 patients taking statins2. Many different findings help differentiate toxic non-inflammatory effects from immune-mediated myopathy due to statins1. We report a case of statin-induced IMNM with oropharyngeal involvement.

IntroductionCoccidioidomycosis, known as Valley Fever, is the disease caused by the inhalation of arthroconidia from the soil-dwelling dimorphic fungi,Coccidioides immitis and Coccidioides posadasii [1]. In the United States, coccidioidomycosis is endemic to the southwestern part of the country, with most cases located in the San Joaquin Valley of California and Southern Arizona. The incidence of coccidioidomycosis is approximately 10,000 cases reported annually [1,2]. Coccidioidomycosis may affect any demographic, but primarily affects those aged 40-60 years old and has a slight male predominance. Clinical manifestations range from asymptomatic to disseminated infection depending on the patient’s immune status.Cutaneous manifestations in coccidioidomycosis can be classified as reactive or organism-containing lesions in secondary or primary cutaneous infection [3]. Sweet syndrome, or acute febrile neutrophilic dermatosis, is an inflammatory, non-infectious skin reaction rarely observed as one of the reactive skin manifestations of coccidioidomycosis. Patients with Sweet syndrome clinically present with fever, leukocytosis with neutrophilia, and painful erythematous papules, plaques, pustules, and nodules commonly appearing on the upper limbs, trunk, head, and neck [4]. Here, we present a case of coccidioidomycosis associated with Sweet’s syndrome.

Chronic Diarrhea as a Presentation of Behçet’s DiseaseMarawan Elmassry MD1*, Sayed Matar MD2, Jerapas Thongpiya MD1, Pitchaporn Yingchoncharoen MD1, Mostafa Abohelwa MD1, Sameer Islam MD31-Department of Internal Medicine, Texas Tech university Health Sciences Centre, Lubbock, TX, USA.2- Department of Pathology, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA.3- Department of Gastroenterology and Hepatology, Texas Tech university Health Sciences Centre, Lubbock, TX, USA.*Corresponding Author: Marawan Elmassry MDTexas Tech University Health Sciences Centre at Lubbock, Texas, USA.3601 4th street, Lubbock, TX 79430.Telephone/ Fax: +1-806-773-2831E-mail: [email protected] of interest: The authors have no financial conflicts to disclose.Patient’s consent: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

Pemphigus Vulgaris Presenting with Epigastric PainAuthors: Marawan Elmassry MD1, Jerapas Thongpiya MD1, Pitchaporn Yingchoncharoen MD1, Jali Garza MS1, Matthew Soape MD2, Kanak Das MD11Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA2Department of Gastroenterology, Covenant Medical Center, Lubbock, TX, USA