by Fatai Oluyadi, Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Ezra Schrem, Ayesha Anwar, Moro o. Salifu and Samy I. McFarlane
Case Report
Background: Healthcare related bacterial endocarditis represents a significant portion of endocarditis seen today. Suspicion for these infections should be particularly high in patients with chronic indwelling central venous catheters, and most notably, in patients with hemodialysis catheters. These infections may have a predilection for the superior vena cava due to proximity of the catheters to the great veins of the neck. Transthoracic echocardiography and/or trans-esophageal echocardiography should be done promptly in patients in which there a high suspicion for such infections, in order to identify these lesions, and guide appropriate management with either antibiotics or surgical intervention. Case presentation: We present a 59-year-old female with multiple comorbidities including diabetes mellitus and end-stage renal disease requiring dialysis via an anterior chest wall catheter, who presented with fever, chills, and abdominal pain. She was found to have pus in and around her catheter. Further evaluation with trans-esophageal echocardiography revealed the presence of a superior vena cava vegetation extending into the right atrium. She received a 6 week course of appropriate antibiotics with repeat trans-esophageal echocardiography showing a significant reduction in the size of the vegetation. Patient remained afebrile, and without leukocytosis and negative blood cultures for the remainder of her hospital stay.
American Journal of Medical Case Reports. 2020, 8(9), 321-324. DOI: 10.12691/ajmcr-8-9-16
Pub. Date: June 11, 2020
4307 Views887 Downloads
by Pramod Theetha Kariyanna, Ashkan Tadayoni, Apoorva Jayarangaiah, Vivek Yadav, Volodymyr Vulkanov, Adam Budzikowski, Moro O. Salifu and Samy I. McFarlane
Case Report
Infective endocarditis (IE) is a serious medical condition with a high morbidity and mortality rate. Staphylococcus aureus is the most common etiologic organism in IE. While echocardiography plays an important role in diagnosis and management of IE, the electrocardiogram (ECG) is helpful in determination of disease progression as well as in prognostication. We present a case of a 72-year-old man who was diagnosed with IE following methicillin resistant Staphylococcus aureus (MRSA) bacteremia. The course of hospitalization was complicated with multiple septic-embolic strokes and aortic root abscess. Serial ECG revealed PR prolongation and new onset left bundle branch block (LBBB) before the patient became terminal. Our case highlights the utility of serial ECGs monitoring in the patients with IE that may reveal subtle ECG findings, such as PR prolongation and LBBB. These findings which might serve as a clue of the presence of peri-annular extension of IE, help in prognostication and aid in the therapeutic decision-making such as early surgical intervention in these high-risk patients with poor prognosis. In this report, we also present the pathophysiologic mechanisms underlining the ECG changes in patients with aortic valve endocarditis.
American Journal of Medical Case Reports. 2020, 8(9), 315-320. DOI: 10.12691/ajmcr-8-9-15
Pub. Date: June 11, 2020
5879 Views499 Downloads
by Jonathan Francois, Eric Kupferstein, Rishard Abdul, Joseph Casillas, Ishmam Ibtida, Moro Salifu and Samy I. McFarlane
Original Research
Cardiac tumors are rare disorders with an incidence of <0.33%. Primary cardiac tumors are extremely rare with an incidence between 0.0017% and 0.19%. Nearly 75% of cardiac tumors are benign with atrial myxomas representing nearly 50%. The majority of cardiac myxomas (75%) are located in the left atrium, 23% in right atrium and 2% in the ventricular cavity. This report presents a rare case of an asymptomatic patient with a left ventricular myxoma attached to the chordae tendinae of the mitral valve.
American Journal of Medical Case Reports. 2020, 8(9), 313-314. DOI: 10.12691/ajmcr-8-9-14
Pub. Date: June 11, 2020
4562 Views884 Downloads
by Hani Ashamalla, Mark Ashamalla and Samy I. McFarlane
American Journal of Medical Case Reports. 2020, 8(9), 311-312. DOI: 10.12691/ajmcr-8-9-13
Pub. Date: June 08, 2020
3173 Views434 Downloads
by Michael Trevisonno, Daniel E. Diaz, Steven S. Chin, FCAP Jenny Libien and Yamen Homsi
Case Report
Antisynthetase Syndrome is a rare type of idiopathic inflammatory myopathy. It is characterized by interstitial lung disease, non-erosive arthritis, Raynaud’s phenomenon, and mechanic’s hands. Diagnosis is confirmed with the detection of an antibody directed against amino-acyl transferase RNA. Opportunistic infections are common causes of mortality in patients with autoimmune diseases. Immunosuppressive treatment further contributes to the risk of infection. We report, for the first time in the literature, a 62-year-old woman diagnosed with Anti-EJ antisynthestase syndrome who died from disseminated mycobacterial tuberculosis infection. This case emphasizes the importance of early recognition and prompt treatment of opportunistic infections in order to decrease mortality.
American Journal of Medical Case Reports. 2020, 8(9), 306-310. DOI: 10.12691/ajmcr-8-9-12
Pub. Date: June 08, 2020
811 Views302 Downloads
by Pramod Theetha Kariyanna, Bayu Sutarjono, Ekjot Grewal, Kamal Preet Singh, Lyudmila Aurora, Leanna Smith, Harshith Priyan Chandrakumar, Apoorva Jayarangaiah, Sarah A. Goldman, Moro O. Salifu and Isabel M. McFarlane
Literature Review
Background. The COVID-19 infection which emerged in December 2019, is caused by the virus SARS-CoV-2. Infection with this virus can lead to severe respiratory illness, however, myocarditis has also been reported. The purpose of this study is to identify the clinical features of myocarditis in COVID-19 patients. Methods. A systematic review was conducted to investigate characteristics of myocarditis in patients infected with COVID-19 using the search term “Coronavirus” or “COVID” and “myocarditis,” “heart,” or “retrospective.” Case reports and retrospective studies were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 11 articles were selected for review. Results. COVID-19 myocarditis affected patients over the age of 50 and incidences among both genders were equally reported. Patients presented with dyspnea, cough, fever with hypotension and chest pain. Laboratory tests revealed leukocytosis with increased C-reactive protein, while arterial blood gas analysis demonstrated respiratory acidosis. All cardiac markers were elevated. Radiographic imaging of the chest showed bilateral ground glass opacities or bilateral infiltrates, while cardiac magnetic resonance imaging produced late gadolinium enhancements. Electrocardiography demonstrated ST-segment elevation or inverted T waves, while echocardiography revealed reduced left ventricular ejection fraction with cardiomegaly or increased wall thickness. Management with corticosteroids was favored in most cases, followed by antiviral medication. The majority of studies reported either recovery or no further clinical deterioration. Conclusion. Current available data on COVID-19 myocarditis is limited. Further research is needed to advance our understanding of COVID-19 myocarditis.
American Journal of Medical Case Reports. 2020, 8(9), 299-305. DOI: 10.12691/ajmcr-8-9-11
Pub. Date: June 05, 2020
4032 Views550 Downloads
by Irsa Munir, Talha Mehmood, Amena Fatima Mohiuddin, Moro O. Salifu and Isabel M. McFarlane
Case Report
Acute viral myositis is a rare condition that is commonly defined with influenza A, B, and enterovirus in the United States of America. Viral myositis complicated by rhabdomyolysis is even less common but requires prompt attention and diagnosis to prevent complications. We describe the occurrence of acute viral myositis complicated by rhabdomyolysis in a young 43-year-old man that lead to acute renal failure. It also highlights that clinicians should keep in mind that viral upper respiratory infections can be complicated with various clinical manifestations that could extend beyond respiratory symptoms.
American Journal of Medical Case Reports. 2020, 8(9), 293-298. DOI: 10.12691/ajmcr-8-9-10
Pub. Date: June 05, 2020
3799 Views441 Downloads
by Victoria Zaccone, Mary Lockwood, Javier Ticona, Pedram Jouharian, Michelle Zamora, Christopher Hampton, Baho Sidiqi, Samir Kumar and Isabel M. McFarlane
Case Report
Neutropenia is a serious complication found in immunocompromised patients, particularly those with cancer and human immunodeficiency virus (HIV). The etiology of neutropenia is multifactorial and can be caused by the direct effects of HIV infection, cytotoxic antineoplastic therapy, and malignancy. The main complication of neutropenia is a bloodstream infection caused by gram-positive bacteria (GPB) and gram-negative bacteria (GNB). GPB, specifically S. epidermidis, tend to affect cancer patients more often than GNB. However, GNB such as Pseudomonas aeruginosa have been associated with more serious infections. We report a case of neutropenic fever caused by a GNB, Pantoea agglomerans, in a 47-year-old Afro-Caribbean man with HIV and metastatic salivary adenocarcinoma. Pantoea agglomerans is a non-spore forming rod typically isolated from plants, fruits, and fecal matter, and is rarely pathogenic in humans. In the current literature, cases of P. agglomerans have been documented primarily in the pediatric population secondary to penetrating wound trauma. To our knowledge, this is the first case of spontaneous neutropenic fever secondary to P. agglomerans bacteremia in an Afro-Caribbean adult male.
American Journal of Medical Case Reports. 2020, 8(9), 289-292. DOI: 10.12691/ajmcr-8-9-9
Pub. Date: June 05, 2020
3349 Views395 Downloads
by Pramod Theetha Kariyanna, Leanna R. Smith, Karishma Patwa, Moro O. Salifu and Isabel M. McFarlane
Review Article
Marijuana is the most widely used recreational drug across the United States. Ongoing efforts to legalize marijuana, as well as the drug’s increasing popularity contribute to the marijuana’s reputation as having a low risk profile. Marijuana’s association with adverse cardiovascular events, such as arrhythmia and vasospasm is well-documented. We synthesized what is known about how marijuana use pertains to and is implicated endothelial cell damage and its effects on microcirculation. THC exerts effects through the cannabinoid receptors, CB1 and CB2. The downstream effects of CB1 activation point to a role for this receptor in atherogenesis and vasospasm, likely by precipitating oxidative stress. Endothelial cells, when exposed to reactive oxygen species, provide a stimulus for vasoconstriction with a diminished ability for vasodilation. This phenomenon has manifested itself in cases of coronary vasospastic angina, and coronary slow and no flow that have resulted from marijuana use, as confirmed by cardiac catheterization reports that showed no evidence of obstructive lesions that could otherwise be responsible for the patients’ symptoms. Marijuana users suffer from acute ischemic stroke at higher rates than non-users. Several theories have been proposed to support this observation, namely marijuana induced reversible cerebral vasoconstriction syndrome, and mitochondrial damage caused by oxidative stress that disproportionately affects cerebral vasculature. As marijuana use continues to grow, so does the important of elucidating the drug’s effect on endothelial cells and microcirculation. Further studies should investigate the temporal association between marijuana and endothelial damage, as well as the possibility of recovery from such injury, and whether there is therapeutic potential in cannabinoid receptors.
American Journal of Medical Case Reports. 2020, 8(9), 284-288. DOI: 10.12691/ajmcr-8-9-8
Pub. Date: June 05, 2020
3452 Views417 Downloads
by Tian Li, Leonel Mendoza, Wesley Chan and Isabel M. McFarlane
Case Report
Background: Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy characterized by increased trabeculation in one or more segments of the ventricle. LVNC presented with non-specific symptoms and highly variable clinical presentation ranging from asymptomatic to progressive heart failure and recurrent or life-threatening arrhythmias. Case presentation: 54-year-old Black man with a history of hypertension, diabetes and end-stage renal disease presented with one day palpitations and lightheadedness following a dialysis session. He denied any dyspnea or syncope. On examination, blood pressure was 175/91 mmHg with irregular pulse. No murmur, rubs or gallops were appreciated. Laboratory were unremarkable except increased creatinine and mild anemia with normal thyroid function test. Electrocardiogram (ECG) revealed atrial fibrillation with normal ventricular rate. Transthoracic echocardiogram revealed mildly increased left ventricular (LV) wall thickness with prominent trabeculation and ejection fraction of 55-60 percent, a pseudo-normal LV filling pattern, with concomitant abnormal relaxation and increased filling pressure, suggestive of LVNC. The patient was switched to apixaban. Genetic testing was recommended for family members. Conclusions: LVNC is rare congenital cardiomyopathy with non-specific symptoms and should be considered among the possible diagnosis in patients presenting with arrythmia patients. Echocardiographic and cardiac magnetic resonance imaging can be utilized to establish diagnosis.
American Journal of Medical Case Reports. 2020, 8(9), 281-283. DOI: 10.12691/ajmcr-8-9-7
Pub. Date: May 29, 2020
3898 Views620 Downloads
by Yuvraj Singh Chowdhury, Rishard Abdul, Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Mrinali Shetty, Clara Wilson, Naureen Kabani, Jonathan D. Marmur, Alan Feit, Moro O. Salifu and Isabel M. McFarlane
Original Research
Coronary artery ectasia (CAE) is defined by the Coronary Artery Surgery Study (CASS) registry as the aneurysmal dilatation 1.5 times the diameter of a coronary artery compared to the adjacent normal coronary artery. CAE is reported with a prevalence of 1.2% - 4.9%. Most CAEs are attributed to atherosclerosis or post-percutaneous coronary intervention (PCI) vessel injury. Vasculitides and infection are uncommon etiologies. A review of 59,423 patients from the Danish registry demonstrated a 3-fold increase in the prevalence of abdominal aortic aneurysms in patients with concomitant severe psoriasis. We present a case of a 64-year-old male with severe plaque psoriasis complaining of substernal chest pain whose coronary angiography demonstrated CAE of the left anterior descending and circumflex arteries. Due to its pro-inflammatory state, psoriasis is associated with various systemic manifestations including cardiac and vascular complications. With possibly a similar underlying pathophysiological mechanism, we describe to the best of our knowledge the first case of CAE in a patient with severe psoriasis.
American Journal of Medical Case Reports. 2020, 8(9), 277-280. DOI: 10.12691/ajmcr-8-9-6
Pub. Date: May 29, 2020
4292 Views749 Downloads
by Jonathan Francois, Sostanie Takota Enoru, Joseph Casillas, Dommalur Jayaranagaiah, Pramod Theetha Kariyanna, Ishmam Ibtida, Moro O. Salifu and Samy I. McFarlane
Case Report
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (MI) and it is greatly misdiagnosed. If not recognized, SCAD carries a high in-hospital mortality rate. It is most commonly seen in females during the peripartum period, individuals with atherosclerotic disease and/or connective tissue disorders. In this report we present a case of 55 years old non-pregnant female without history coronary artery disease (CAD), who presented with squeezing chest pain, ST segment elevation on electrocardiogram (ECG) and negative cardiac markers. Subsequently coronary angiogram (CAG) revealed dissection of the left anterior descending artery (LAD) with 100% stenosis. Due to high risk of perforation it was decided to treat the patient conservatively and subsequently she was discharged home with no complications. In this report, we demonstrated that early recognition of SCAD and conservative management, in a non-pregnant patient, can lead to decreases in-hospital complications and favorable outcomes.
American Journal of Medical Case Reports. 2020, 8(9), 274-276. DOI: 10.12691/ajmcr-8-9-5
Pub. Date: May 29, 2020
4074 Views518 Downloads
by Yuvraj Chowdhury, Shakil A. Shaikh, Ali Salman, Jonathan D. Marmur, Osagie Igiebor, Moro O. Salifu and Samy I. McFarlane
Case Report
An Aberrant Right Subclavian Artery (ARSA) is a rare congenita; anomaly (0.4-1.8%) of the aorta in which the right subclavian artery arises from the aortic arch distal to the origin of the left subclavian artery often coursing behind the esophagus to reach the right arm. It courses behind the esophagus in about 80% of cases, between the esophagus and the trachea in 15%, and anterior to the trachea or mainstem bronchus in 5%. Patient with this anomaly rarely have symptoms (90-95%) but when symptomatic the ARSA give rise to symptoms of dysphagia lusoria, dyspnea and chronic cough. In a vast majority of patients ARSA is clinically silent till right radial angiography is performed. We are reporting a case of dissection of the retroesophageal right subclavian artery traveling into the descending thoracic aorta (Stanford Type B) during right radial cardiac catherization performed on a patient presenting with non-ST elevation myocardial infarction.
American Journal of Medical Case Reports. 2020, 8(9), 271-273. DOI: 10.12691/ajmcr-8-9-4
Pub. Date: May 29, 2020
3497 Views423 Downloads
by Mohammad Alrehaili, Eid Al-Qurashi, Ahmed Sayeed and Hanan Muabbar
Case Report
Pulmonary tuberculosis (TB) is a common infectious disease that is considered one of the leading causes of morbidity and mortality worldwide. Special diagnostic studies for TB can be used including smear microscopy and cultures for acid fast bacilli (AFB) and Mycobacterium tuberculosis (MTB) nucleic acid amplification test (NAAT). The specimen is usually taken from the sputum but might also include pleural and bronchoalveolar lavage (BAL) fluids. In addition, BAL cytology and lung biopsy are commonly done if bronchoscopy is performed. Here, we present a case of suspected pulmonary TB in a patient who was complaining of cough and hemoptysis for several months. Chest x-ray showed right upper lung opacity with cystic changes that was confirmed by CT chest. Work up done for this case included three samples of sputum and one BAL fluid specimen for AFB smear microscopy, culture and NAAT in addition to transbronchial lung biopsies and they were all negative. However, Cytologic examination of BAL fluid using Papanicolaou stain surprisingly showed evidence of intact caseating granulomas characteristic for tuberculous infection. Ultimately, the patient was started on the standard anti-TB regimen for 6 months with significant clinical improvement confirming TB diagnosis. To the best of our knowledge, this unusual cytologic finding in culture-negative BAL fluid coupled with unremarkable lung biopsy and persistently negative sputum samples for TB was never reported in the English literature.
American Journal of Medical Case Reports. 2020, 8(9), 268-270. DOI: 10.12691/ajmcr-8-9-3
Pub. Date: May 28, 2020
3839 Views597 Downloads
by Mohammed Al-Sadawi, Amena Mohiuddin, Naseem Hossain, Shakil Shaikh, Alan Feit, Benjamin Ramalanjaona, Moro O. Salifu and Samy I. McFarlane
Original Research
Cardiac manifestations of COVID-19 include myocarditis, demand ischemia, myocardial infarction and arrhythmias with prothrombotic state being a major underlying pathogenetic mechanism. In this report we present a case of a 57-year-old, otherwise healthy, woman who presented with chest pain and nausea and was found to have an inferior wall ST-elevation myocardial infarction (STEMI) in the setting of an active COVID-19 infection. Angiography revealed tortuous coronary arteries with a 100% right coronary artery occlusion with high thrombus burden and normal left coronary system. In light of the available literature regarding the pro-thrombotic effects of this novel corona virus, we continued full dose anticoagulation with Enoxaparin after the cardiac catheterization and transitioned to rivaroxaban and we also continued the patient on dual antiplatelet therapy prior to discharge.
American Journal of Medical Case Reports. 2020, 8(9), 262-267. DOI: 10.12691/ajmcr-8-9-2
Pub. Date: May 22, 2020
5383 Views810 Downloads
by Pramod Theetha Kariyanna, Ashkan Tadayoni, Amog Jayarangaiah, Sudhanva Hegde, Apoorva Jayaranagaiah, Moro O. Salifu and Isabel M. McFarlane
Case Study
Cardiac free wall rupture (CFWR) is an uncommon complication of myocardial infarction, cardiac-based procedures, and blunt chest trauma. Cardiac tamponade and shock which occurs as a result of CFWR results in a high mortality rate. Despite the high mortality rate, there is a window of opportunity for intervention in selected patients with acute or subacute free wall rupture. Hence, prompt diagnosis and intervention are key to prevent cardiac tamponade and death. Even though emergency surgical repair is the standard treatment for the CWFR, the catheter-based procedure has provided an alternative treatment option, especially, in the high-risk surgical patients. For instance, Amplatzer occluder® (AO), a device which is used in repairing congenital septal wall defect, is being used as an alternative method of treatment in CFWR. In this systemic review, we assessed the 19 cases of CFWR occurring after invasive cardiac procedures who underwent repair with the utilization of AO®. The study shows that the successful rate of percutaneous closure of CFWR was 84.3% (16/19) with a mortality rate of 15.7% (3/19) in this cohort. Therefore, the in-hospital mortality rate of CFWR closure is comparable with the average in-house mortality rate of emergency surgical repair which is 14%. Furthermore, we found that AO® placement technique has a lower mortality rate compared to the other less-invasive methods such as percutaneous intrapericardial fibrin-glue injection which has a mortality rate of 25%. In conclusion, employing AO® in CFWR repair not only serves as the treatment of choice in the high-risk surgical candidates but could also be applied as an alternative method in the general population. However, further studies are required to assess the outcome and mortality rate of using AO® in CFWR to provide us with a more consistent and accurate data.
American Journal of Medical Case Reports. 2020, 8(9), 257-261. DOI: 10.12691/ajmcr-8-9-1
Pub. Date: May 22, 2020
3459 Views706 Downloads