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Cureus Apr 2023Hypodysfibrinogenemia-related thromboembolic disorder is a rarely encountered clinical entity. We present such a case of a 34-year-old lady with no known co-morbidities...
Hypodysfibrinogenemia-related thromboembolic disorder is a rarely encountered clinical entity. We present such a case of a 34-year-old lady with no known co-morbidities presenting to the accident and emergency unit with left-sided pleuritic chest pain associated with non-productive cough and breathlessness. Laboratory tests revealed fibrinogen level of 0.42 g/l (1.5-4g/l) with prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT) along with elevated d-dimer, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin. CT pulmonary angiogram (CTPA) found bilateral pulmonary embolism with right heart strain. Functional/antigenic fibrinogen ratio was 0.38. Genetic testing eventually revealed a heterozygous missense mutation in exon 8-p.1055G>C; p.Cys352Ser in the sequencing of the fibrinogen gene FGG (gamma chain) confirming the diagnosis of dyshypofibrinogenemia. She was treated with anticoagulants with fibrinogen replacement therapy and later discharged on apixaban.
PubMed: 37200649
DOI: 10.7759/cureus.37647 -
Cureus Apr 2023Pneumorrhachis (PR) is a rare phenomenon in which air is present in the spinal canal. PR can be stratified into different categories based on etiology, with spontaneous...
Pneumorrhachis (PR) is a rare phenomenon in which air is present in the spinal canal. PR can be stratified into different categories based on etiology, with spontaneous PR being the least common. In this report, we describe the case of a 33-year-old male with a four-year history of emesis secondary to chronic gastroparesis who presented with pleuritic chest pain radiating to the neck. A CT scan of the chest showed pneumomediastinum, with air extending into the soft tissues of the neck and the spinal canal. A literature review found a trend between maneuvers that increase intrathoracic pressure, such as emesis or coughing, and the incidence of spontaneous pneumomediastinum, in which air may freely communicate with the epidural space of the spinal canal. Currently, there are no guidelines for the management of patients with PR. From our experience, conservative management of asymptomatic PR is an appropriate approach for these patients.
PubMed: 37187634
DOI: 10.7759/cureus.37501 -
Cureus Apr 2023A 55-year-old female with hypertension presented to our facility with complicated pneumonia. She complained of progressively worsening shortness of breath and pleuritic...
A 55-year-old female with hypertension presented to our facility with complicated pneumonia. She complained of progressively worsening shortness of breath and pleuritic chest pain. She was in her usual state of health except for an upper respiratory infection treated with oral antibiotics a month prior. At the presentation, she was febrile, tachycardic, and hypoxic on room air. A chest computed tomography (CT) showed near-complete opacification of the right lung, a cavitation with the fluid level in the right middle lobe, and moderate-to-large effusion. Broad-spectrum antibiotics were started. Sputum culture was later positive for methicillin-resistant , which prompted antibiotic de-escalation to vancomycin. A chest tube was placed into the right pleural space draining 700 mL of exudative fluid, which cultures grew group (SAG) bacteria. Due to persistent respiratory distress and residual effusion, right thoracotomy and decortication were performed. A right upper lobe abscess ruptured into the pleural space was noted during the procedure. Pathology revealed necrotic tissue, and the microbiological workup was negative. The patient clinically improved postoperatively and was discharged home with oral Linezolid.
PubMed: 37187631
DOI: 10.7759/cureus.37506 -
Journal of the American College of... Jun 2023
PubMed: 37180954
DOI: 10.1002/emp2.12960 -
IDCases 2023spp. is an emerging pathogen that is increasingly recognized as a cause of human infections. Gastrointestinal manifestations are most described in the case report...
spp. is an emerging pathogen that is increasingly recognized as a cause of human infections. Gastrointestinal manifestations are most described in the case report literature. We present a case of the first documented case of spp. isolated in pericardial fluid in an immunocompromised patient with worsening cardiac tamponade that was successfully managed with an urgent pericardiocentesis and ensuing steroids, antibiotics, and a pericardial drain. The patient had a past medical history of HIV, latent syphilis, PCP pneumonia, ESRD, and hypertension, and presented with worsening dyspnea, subjective fever, myalgias, cough, pleuritic chest pain, and pericardial rub. Diagnostic workup revealed a positive COVID-19 PCR test, elevated high-sensitive cardiac troponins, elevated CRP, elevated D-dimer, and elevated creatinine. An ECG revealed diffuse ST-segment elevation, and imaging showed cardiomegaly with pulmonary vascular congestion and diffuse interstitial edema. Urgent TTE showed a large circumferential pericardial effusion with tamponade physiology present. Culture on aerobic blood agar grew spp. of unknown specific species, and blood cultures were also positive for spp. Treatment involved intravenous meropenem for five days, followed by oral ciprofloxacin, low-dose colchicine, and a tapered dose of ibuprofen. Repeat laboratory data and TTE showed complete resolution of the pericardial effusion and improved left ventricular function. This case highlights the potential for spp. to cause severe infections and the importance of considering it as a possible pathogen in patients with atypical presentations.
PubMed: 37151209
DOI: 10.1016/j.idcr.2023.e01771 -
Cureus Mar 2023Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from hematogenous dissemination into the eye from a remote focus...
Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from hematogenous dissemination into the eye from a remote focus of infection. We present a case of a 49-year-old Vietnamese gentleman with underlying hypertension and ischemic heart disease who presented with sudden onset bilateral eye blurring of vision for five days associated with fever, chills, and rigors. He started to have a chesty cough with right-sided pleuritic chest pain for three days as well as shortness of breath, which developed one day prior to admission. Bilateral ocular examinations and B-scan ultrasonography were consistent with endophthalmitis. A systemic workup was performed and showed multiloculated liver abscess and right lung empyema seen radiologically. Bilateral eye vitreous tap and intravitreal antibiotic injection were performed. He underwent ultrasound-guided pigtail catheter insertion and drainage of the subcapsular and pelvic collection. Microbiological findings revealed infection obtained from vitreous and endotracheal aspirate samples. There were no cultures yielded from the intraabdominal collection and peripheral blood. The right eye infection rapidly progressed to panophthalmitis, which subsequently led to globe perforation despite prompt treatment and eventually required evisceration. Thus, despite culture-negative pyogenic liver abscess in a non-diabetic patient, a high index of suspicion, emergent radiographic evaluation, and prompt intervention and treatment are crucial in salvaging the globes.
PubMed: 37131551
DOI: 10.7759/cureus.36965 -
ARYA Atherosclerosis May 2023Tuberculous (TB) pericarditis is a well-known manifestation of tuberculosis, particularly in endemic regions. The progression to constrictive pericarditis, while under...
Tuberculous (TB) pericarditis is a well-known manifestation of tuberculosis, particularly in endemic regions. The progression to constrictive pericarditis, while under anti-tuberculosis treatment, is reported to be as high as 30%. This report presents a case of a 56-year-old female patient who complained of cough, pleuritic chest pain, night sweats, and fever, followed by orthopnea, dyspnea, and peripheral edema. Transthoracic echocardiography revealed the early stages of constrictive pericarditis and a small pericardial effusion. Chest computed tomography (CT) showed a thickened pericardium, small pericardial and pleural effusions, and multiple mediastinal lymphadenopathies. Due to a high suspicion of tuberculous pericarditis, the patient was administered empirical anti-TB treatment. A follow-up after two months showed complete resolution of symptoms and echocardiographic findings. Empirical antimicrobial treatment in endemic areas is a well-established strategy for managing tuberculous infection and proved successful in this patient. The early presentation and the significant improvement in signs and symptoms following the medical anti-TB regimen, without the need for pericardiectomy, were unique aspects of this case.
PubMed: 38881588
DOI: 10.48305/arya.2022.11793.2445 -
Annals of Medicine and Surgery (2012) Apr 2023Pulmonary mucormycosis is an uncommon, difficult-to-diagnose disease with currently no suitable treatments. It is associated with hematological malignancies, diabetes,...
UNLABELLED
Pulmonary mucormycosis is an uncommon, difficult-to-diagnose disease with currently no suitable treatments. It is associated with hematological malignancies, diabetes, and immunosuppression.
CASE PRESENTATION
We report a 16-year-old boy who developed pleural mucormycosis for unknown reasons. The patient presented to our hospital because of fever, chills, weakness, lethargy, loss of appetite, pleuritic chest pain, and shortness of breath. Histopathological testing ultimately diagnosed mucormycosis.
DISCUSSION
Pulmonary mucormycosis is a potentially fatal infection with a challenging clinical presentation that requires prompt diagnosis. Diagnosis of pleural mucormycosis was verified by histopathological analysis of pleural fluid and pleural tissue biopsy.
CONCLUSION
This study emphasizes the relevance of histological examination in detecting mucormycosis, which will aid in early management by highlighting the difficulty of diagnosis.
PubMed: 37113846
DOI: 10.1097/MS9.0000000000000299 -
Cureus Mar 2023Smokeless tobacco is widely used in the United States. Many commonly used forms of smokeless tobacco may contain microorganisms that can change the oral flora of tobacco...
Smokeless tobacco is widely used in the United States. Many commonly used forms of smokeless tobacco may contain microorganisms that can change the oral flora of tobacco users. Here we present a case of a previously healthy 21-year-old male who presented with six weeks of worsening cough productive of yellow sputum as well as pleuritic left-sided chest and back pain. Computed tomography (CT) of the chest showed a large 3.9 x 5.5 x 6.3 cm mass-like lesion. He was extensively worked up for potential causes of this mass, including autoimmune, HIV testing, sputum staining for acid-fast bacilli, and fungal serologies. He was empirically treated with antibiotics and antifungals. He ultimately underwent a CT-guided biopsy which was negative for malignancy and tuberculosis. The culture from the biopsy revealed 5,000 colony forming units of Streptococcus intermedius. Based on the sensitivities of the culture, he was switched to intravenous ceftriaxone and discharged to complete a course of intravenous antibiotics. This case showcases a healthy 21-year-old male with no prior history who had an extensive workup for the possible causes and risk factors predisposing to a lung abscess. This workup was negative, and his only risk factor was the use of smokeless chewing tobacco. Smokeless tobacco may be associated with increased risk of lower respiratory tract infections and can increase the risk of lung abscess in an immunocompetent adult. More research is required to understand this association.
PubMed: 37090323
DOI: 10.7759/cureus.36467 -
Cureus Mar 2023A 42-year-old female with a past medical history significant for scleroderma and extensive tobacco use presented with a dry cough and pleuritic chest pain. Further...
A 42-year-old female with a past medical history significant for scleroderma and extensive tobacco use presented with a dry cough and pleuritic chest pain. Further workup was significant for leukocytosis, macrocytic anemia, left lower lung mass, bilateral supraclavicular, hilar, and mediastinal lymphadenopathy. After a comprehensive rheumatologic workup was completed, the patient was found to have strongly positive antinuclear antibody (ANA) and negative scleroderma-specific antibodies with fluorescent ANA indicating a nucleolar pattern. We present a case of paraneoplastic scleroderma in the setting of lung adenocarcinoma which emphasizes the bidirectional relationship that exists between malignancy and rheumatic diseases.
PubMed: 37082498
DOI: 10.7759/cureus.36366