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Cureus Sep 2023Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent hypereosinophilia that is associated with multi-organ damage. Eosinophilic...
Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent hypereosinophilia that is associated with multi-organ damage. Eosinophilic endocarditis is a serious complication of HES. The exact prevalence of the disease is unknown, and it is characterized by a persistently elevated eosinophil count, resulting in multi-organ involvement due to eosinophilic infiltration. We present a case of a 65-year-old Caucasian male patient who presented with one-week symptoms of feeling unwell and intermittent pleuritic chest pain. His medical history was significant for the idiopathic hypereosinophilic syndrome, eosinophilic myocarditis, hypertension (HTN), type 2 diabetes mellitus (T2DM), and chronic obstructive pulmonary disease (COPD). Inflammatory markers were raised, including eosinophil count, and a transthoracic echocardiogram (TTE) showed a mass attached to the mitral valve (MV) leaflets, suggesting vegetation or thrombus. The patient was commenced on intravenous antibiotics, inotropes for septic shock, and low molecular weight heparin (LMWH) for a possible thrombus. He showed mild biochemical improvement initially without any clinical improvement before further deterioration secondary to aspiration pneumonia. He was seen by the palliative care team and mental health team for confusion and agitation and was put on the palliative care pathway. All active medical treatment was stopped, and the patient succumbed to his illness three weeks into his admission.
PubMed: 37822441
DOI: 10.7759/cureus.44963 -
Cureus Jul 2023Pyogenic liver abscesses (PLAs) represent a rare yet life-threatening condition, and species are an atypical etiology typically associated with immunocompromised...
Pyogenic liver abscesses (PLAs) represent a rare yet life-threatening condition, and species are an atypical etiology typically associated with immunocompromised patients or those with recent dental procedures or oro-gingival disease. Nonetheless, it is crucial to maintain a high level of suspicion for infection in all cases, including immunocompetent individuals without known risk factors. In this case report, we present the clinical scenario of a young male with a history of COVID-19 pneumonia who exhibited subacute fever, abdominal pain, and pleuritic chest pain, leading to sepsis attributed to intraabdominal pathology. Subsequent imaging confirmed the presence of possible liver abscesses, prompting interventional radiology-guided drainage. Cultures obtained from the drained abscesses yielded species, and significant clinical improvement was observed following the initiation of appropriate antibiotic therapy. This case report underscores the potential for disseminated infections to occur in immunocompetent individuals without a history of oropharyngeal disease, highlighting the importance of early diagnosis and management to mitigate mortality risk.
PubMed: 37489179
DOI: 10.7759/cureus.42263 -
BMJ Case Reports Jul 2023A young woman in her mid-40s was referred by her primary care physician for fever, worsening shortness of breath, pleuritic chest pain and tachycardia. CT angiogram of...
A young woman in her mid-40s was referred by her primary care physician for fever, worsening shortness of breath, pleuritic chest pain and tachycardia. CT angiogram of the chest revealed a large pericardial effusion. Echocardiogram confirmed tamponade physiology despite her being haemodynamically stable. She had an emergency pericardiocentesis which revealed evidence of a haemorrhagic pericardial effusion. However, the patient was still symptomatic after treatment and had to undergo video-assisted thoracoscopic surgery with a pericardial window and chest tube. Postoperatively, her fevers resolved. Pan-culture was initially negative, and all antibiotics were discontinued. Acid-fast bacilli cultures later grew complex. She continued to have chest discomfort postoperatively, but follow-up CT of the chest 3 months postoperatively showed continued resolution of her pericardial effusion. The patient's symptoms improved, and she has had no recurrence of effusion without the need for anti-tuberculosis drugs.
Topics: Female; Humans; Cardiac Tamponade; Pericardial Effusion; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pericarditis; Fever
PubMed: 37407234
DOI: 10.1136/bcr-2023-255237 -
SAGE Open Medical Case Reports 2024Tuberculosis, being an airborne disease with a broad spectrum of symptoms and signs, is a rare cause of chylothorax. Mortality due to tuberculous chylothorax is 6%, and...
Tuberculosis, being an airborne disease with a broad spectrum of symptoms and signs, is a rare cause of chylothorax. Mortality due to tuberculous chylothorax is 6%, and bilateral chylothorax has a higher mortality with a poor prognosis. A previously well 28-year-old male with a household contact history of tuberculosis exposure presented with a 1-month history of shortness of breath, fever, pleuritic chest pain, and constitutional symptoms. He was found to have bilateral chylothorax, generalized lymphadenopathy, hepatosplenomegaly, and miliary nodules in chest x-ray. Sputum acid-fast bacilli, pleural fluid TB PCR (Tuberculosis polymerase chain reaction) and culture became negative. Sputum culture became positive for at 6 weeks. He had marked clinical and radiological improvement within 2 months of starting anti-tuberculosis treatment. Diagnosis of pleural tuberculosis is difficult as pleural fluid acid-fast bacilli detection has poor sensitivity. It is important to consider tuberculosis in patients with chylothorax and initiate prompt treatment.
PubMed: 38638875
DOI: 10.1177/2050313X241247410 -
Cureus Oct 2023Pericarditis is the inflammation of the pericardial layers. Myopericarditis is diagnosed when this inflammation involves the myocardium, which is marked by elevated...
Pericarditis is the inflammation of the pericardial layers. Myopericarditis is diagnosed when this inflammation involves the myocardium, which is marked by elevated serum cardiac enzymes. With these two pathologies sharing overlaps in etiology, we present a case of a young patient with a recent history of COVID-19 infection who presented with pleuritic and positional chest pain with troponin I elevation and serial ECG changes attributed to myopericarditis as a post-viral sequela of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. This case demonstrates the importance of identifying and managing the potential cardiac complications in coronavirus disease 2019 (COVID-19) patients, regardless of age or symptom onset.
PubMed: 37942379
DOI: 10.7759/cureus.46655 -
Cureus Jul 2023In this case report, we review a case of pneumatocele in a 54-year-old Caucasian male patient diagnosed with infection of COVID-19 29 days prior, presenting with...
In this case report, we review a case of pneumatocele in a 54-year-old Caucasian male patient diagnosed with infection of COVID-19 29 days prior, presenting with complaints of dyspnea and sharp pleuritic chest pain located in the left mid-axillary region exacerbated by deep inspiration with an episode of significant forceful cough a day prior. Preliminary labs were unrevealing for leukocytosis or neutrophilia, with normal troponins, and COVID-19 negative upon presentation. Radiographic imaging was significant for bilateral infiltrates in the left upper lobe, air fluid levels with initial concern for abscess but with subsequent inference of pneumatocele. Imaging was negative for pneumothorax. The patient was monitored, remained stable throughout admission, and discharged after work-up for fungal and bacterial infection were found to be negative with expectation of self-resolution of the pneumatocele. In this study, we overview the pulmonary impact of COVID-19 in the scope of pneumatocele occurrence in the early recovery phase of the viral illness.
PubMed: 37529801
DOI: 10.7759/cureus.41259 -
BMJ Case Reports Dec 2023Congenital pulmonary airway malformation (CPAM) is the most common among a rare group of congenital anomalies of the lower respiratory tract. It has variable...
Congenital pulmonary airway malformation (CPAM) is the most common among a rare group of congenital anomalies of the lower respiratory tract. It has variable presentation depending on its subtype and the patient's age. It may lead to respiratory distress in neonates. It can be a particularly challenging diagnosis in children born asymptomatic but present with complications later in life such as haemoptysis, recurrent chest infections, breathlessness and pneumothorax. Prenatal ultrasound, chest X-ray, CT scan and MRI are helpful in making a radiological diagnosis.A woman in her late teens presented with shortness of breath and right pleuritic chest pain. CT's chest showed a number of bullae of varying sizes on the right, including one huge bulla compressing all three lobes. She underwent lung volume reduction surgery via video-assisted thoracoscopy, and the histology specimen confirmed the diagnosis of CPAM type 1.
Topics: Infant, Newborn; Child; Pregnancy; Female; Adolescent; Humans; Pneumothorax; Cystic Adenomatoid Malformation of Lung, Congenital; Tomography, X-Ray Computed; Radiography; Pneumonectomy; Dyspnea
PubMed: 38050398
DOI: 10.1136/bcr-2022-254294 -
JPMA. the Journal of the Pakistan... Oct 2023Post-Cardiac Injury Syndrome (PCIS) akin to Dressler's syndrome is late-onset pericarditis that is triggered by the body's immune system and presents commonly as pleuro-...
Post-Cardiac Injury Syndrome (PCIS) akin to Dressler's syndrome is late-onset pericarditis that is triggered by the body's immune system and presents commonly as pleuro- pericardial symptoms and raised inflammatory markers. Its occurrence following the insertion of a pacemaker has been reported infrequently and varies in different studies with an estimated prevalence of 1-2%. Our case reports a unique incidence of isolated pleural effusion following the implantation of a pacemaker in a 62-year-old female with complete heart block with no evidence of pericardial effusion on imaging. She developed dyspnoea, pleuritic chest pain, and lethargy. She successfully responded to treatment with NSAIDs and colchicine with no recurrence. This report demonstrates the uncommon course of the disease and highlights the need to consider PCIS as a possible diagnosis in patients presenting with predominant pulmonary findings and suspect it early so that timely treatment can be started, thereby preventing complications.
Topics: Female; Humans; Middle Aged; Pacemaker, Artificial; Pericardial Effusion; Pleural Effusion; Anti-Inflammatory Agents, Non-Steroidal; Syndrome; Heart Injuries
PubMed: 37876079
DOI: 10.47391/JPMA.8237 -
Clinical Case Reports Jul 2023Anti-TNFα inhibitor-induced Lupus (ATIL) is a rare syndrome characterized by a wide array of symptoms ranging from skin manifestations to organ-specific symptoms such...
Anti-TNFα inhibitor-induced Lupus (ATIL) is a rare syndrome characterized by a wide array of symptoms ranging from skin manifestations to organ-specific symptoms such as pleural effusions, pericardial effusions, hepatotoxicity, etc. Infliximab is implicated in most cases, and ATIL usually develops between the first month and 4 years of infliximab application. In this report, we present an interesting case of ATIL that developed rather gradually upon anti-TNFa used to treat Crohn's disease. The patient presented with oral ulcers, photosensitive rash, diffuse alopecia, inflammation of the hands, and pleuritic chest pain. Comprehensive serological testing revealed the presence of antinuclear antibodies and anti-DNA antibodies. During the evaluation, the patient developed headaches, followed by a brain MRI that suggested nonspecific white matter lesions. Given the chronic development of symptoms, invasive examinations such as an arteriogram were performed to exclude CNS vasculitis, which showed no evidence of the vasculitis. Therefore, in the absence of any clear radiographical signs of vasculitis, patients should not undergo invasive studies, including an angiogram. The CNS angiogram can be associated with several side effects, including damage to the blood vessel, bruising or bleeding at the puncture site, and infection, which can further aggravate ATIL. Although rare, ATIL should always be considered while evaluating a patient with suggestive symptoms on infliximab therapy. Further research on identifying the variety of clinical presentations of ATIL and the underlying pathophysiology can help improve health policy and clinical practice by reducing unnecessary examination and allowing early management and better-quality care.
PubMed: 37476595
DOI: 10.1002/ccr3.7673 -
International Journal of Surgery Case... Jun 2024Pulmonary sarcomatoid carcinoma is a very rare primary tumor of the lung. Although usually aggressive, these tumors have not been described previously to invade through...
INTRODUCTION
Pulmonary sarcomatoid carcinoma is a very rare primary tumor of the lung. Although usually aggressive, these tumors have not been described previously to invade through the diaphragm into the liver. We present a patient with a pulmonary sarcomatoid carcinoma with transdiaphragmatic spread into the dome of the liver.
PRESENTATION OF CASE
An 82-year-old female with a lifetime non-smoking history presented with generalized fatigue, fever, night sweats, cough, and pleuritic chest pain. She had recently traveled to the western United States. Additionally, she had recently undergone periodontal deep cleaning with no peri-procedural antibiotics. Laboratory testing was significant for a leukocytosis of 13.5 white blood cells per microliter and a negative viral panel. Computed tomography and magnetic resonance imaging revealed a large heterogeneous mass extending from the right pulmonary hilum through the diaphragm. Although initial radiology reports suggested hepatic abscess, percutaneous fine needle aspiration was performed. Biopsy revealed pulmonary sarcomatoid carcinoma. She was begun on systemic treatment.
DISCUSSION
Pulmonary sarcomatoid carcinoma can exhibit transdiaphragmatic invasion into the liver. This clinical situation can easily be confused with a hepatic abscess, but suspicion should remain for abscess. Clinical suspicion for neoplasm should warrant biopsy when technically possible.
CONCLUSION
Although hepatic abscesses can exhibit transdiaphragmatic spread into the chest, pulmonary sarcomatoid carcinoma can also invade the abdomen. Biopsy should be performed during the evaluation and workup of the patient.
PubMed: 38718493
DOI: 10.1016/j.ijscr.2024.109675