by Pramod Theetha Kariyanna, Amog Jayarangaiah, Jeewendra Dulal, Apoorva Jayarangaiah, Sushruth Das, George Jojo Punnakudiyil, Ashkan Tadayoni, Michael Freilich and Isabel M. McFarlane
Literature Review
Coronavirus Disease-19 (COVID-19) is a pandemic caused by severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 is known to cause a wide variety of cardiovascular manifestations, including myocarditis, pericarditis, myocardial infarction, stroke, thrombus, pulmonary embolism and acute ventricular failure In this paper, we explore cases of infective endocarditis (IE) that occurred in patients who were concurrently (not sure if they were concurrently infected but if so, makes the sentence smoother and easier to understand) infected with COVID-19 and discuss its association in contributing to factors that can ultimately lead to the development of infective endocarditis. Some of these factors that contribute to IE in COVID-19 include severe inflammatory response, endothelial damage and dysfunction and immunosuppression caused by medications that are used to treat COVID-19. In this systematic review, 12 papers detailing 15 pertinent cases of IE following an infection with COVID-19 were identified. Data from these cases were tabulated and analyzed. The ages of the patients ranged from 20-70 years, with 73% of the patients developing IE of native heart valves and the remaining 27% developing IE of mechanical and bioprosthetic valves. The three most common organism implicated were Enterococcus faecalis (28.57%), Methicillin Resistant Staphylococcus aureus (MRSA) (14.28%), and Methicillin Sensitive Staphylococcus aureus (MSSA) (14.28%). Medical management of these cases involved antibiotic therapy and was reported in 80% of the cases, while only one patient (6.67%) underwent surgical valve replacement. The mortality rate of the patients in this review was quite high at 38%, and other major complications included cardioembolic stroke (20%) and septic embolization to the extremities (6.67%). COVID-19 infection results in a severe inflammatory response caused by a variety of mechanisms. This severe degree of widespread inflammation may result in damage to the endocardium, thus creating an environment to which microorganisms can adhere to and colonize. Additionally, the immunosuppressive medications used in a COVID-19 infection can result in an increased risk of developing infections that have the potential to spread to the endocardium via a hematogenous route. Physicians should be aware of occurrences of IE in COVID-19, as delay in diagnosis and management may cause significant morbidity and mortality.
American Journal of Medical Case Reports. 2021, 9(7), 380-385. DOI: 10.12691/ajmcr-9-7-11
Pub. Date: April 20, 2021
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by Omar Rafa, Aaron Campeas and Eric J. Basile
Original Research
Colonoscopies are performed in order to screen for and identify gastrointestinal malignancies, underlying colonic bleeds, and structural anomalies or defects. Though the procedure largely has few complications, some of the potential adverse outcomes include splenic laceration, colonic perforation, hemorrhage due to prolonged bleeding from biopsy sites, generalized abdominal bloating and pain, and anesthesia-related adverse reactions. In this paper, we present a case of grade 3 splenic laceration post routine colonoscopy. Splenic lacerations range in presentation from completely asymptomatic, non-life-threatening to immediate hemodynamic instability. It is vitally important to recognize this potential complication clinically because proper management and timely recognition has the potential to improve survival outcomes.
American Journal of Medical Case Reports. 2021, 9(7), 378-379. DOI: 10.12691/ajmcr-9-7-10
Pub. Date: April 19, 2021
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by Nicola Jackson, Alain Morel, Alicia Pollard, Shion Betty and James Appiah-Pippim
Case Report
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an idiosyncratic, potentially life-threatening hypersensitivity reaction to therapeutic medication. [1] The most common culprits historically being anticonvulsants followed by antibiotics, but most recent publications are beginning to show the opposite trend. [1] This case describes a 58-year-old-woman who presented for evaluation of a generalized skin rash associated with facial edema 4 weeks after treatment for Methicillin-resistant Staphylococcus aureus pneumonia with empyema.
American Journal of Medical Case Reports. 2021, 9(7), 375-377. DOI: 10.12691/ajmcr-9-7-9
Pub. Date: April 16, 2021
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by Sufyan AbdulMujeeb, Faisal Masood, Syed Hussain and Adib Chaus
Case Report
Gerbode defect refers to an abnormal communication of the left ventricle (LV) with the right atrium (RA), causing a severe left-to-right shunt. Symptoms of gerbode defect depend on the degree of communication between LV and RA. This defect can be congenital or acquired. Some etiologies of acquired gerbode defect include cardiac trauma, myocardial ischemia, a complication of prior cardiac surgery, or bacterial endocarditis. Regardless of the etiology, surgical intervention involving the closure of the defect is the definitive treatment of this rare anatomical anomaly. We present the case of a young man with an acquired gerbode defect as a complication of bacterial endocarditis for which he underwent surgical correction. He later had a recurrence and worsening of left-to-right shunt via the gerbode defect a few days after the first surgery, requiring another surgical intervention. To our knowledge, recurrence of this defect after a surgical repair has so far not been reported in the literature. Therefore, we conclude that patients presenting with symptoms of severe right heart failure in whom prior surgical repair of the gerbode defect is performed should prompt clinicians to rule out recurrence of this defect.
American Journal of Medical Case Reports. 2021, 9(7), 372-374. DOI: 10.12691/ajmcr-9-7-8
Pub. Date: April 16, 2021
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by Rachel L. Axman, Brian Wolf, Susan Lin, Benjamin Schwartz, Urmi Khanna, Fahad Zafar, Melvyn Hecht and Isabel M. McFarlane
Case Report
Background: Subcutaneous Panniculitis-Like T-Cell Lymphoma is a cytotoxic T-cell lymphoma that infiltrates subcutaneous adipose tissue and rarely involves the lymph nodes. SPTCL accounts for less than 1% of non-Hodgkin’s lymphomas. Lesions are commonly localized to the trunk and lower extremities and may be relapsing and remitting in nature. Systemic symptoms such as fever and night sweats are common. SPTCL may closely mimic cellulitis, and other causes of skin and soft tissue infections. Definitive diagnosis is made with tissue biopsy showing atypical lymphocytes rimming adipocytes. There is no current standard of treatment. Prognosis is favorable with a 5-year survival rate as high as 91%. Case Report: A 40-year-old Chinese female presented with a two-week history of recurrent fevers and painful subcutaneous nodules and plaques, initially thought to be infectious in nature. Tissue sampling demonstrated CD4+ and CD8+ T-cells rimming adipocytes with a high Ki-67 proliferation index and an alpha beta T-cell receptor subtype. A diagnosis of SPTCL was established and the patient was treated with multiagent chemotherapy regimen consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP therapy), which resulted in resolution of her constitutional symptoms and cutaneous. Conclusion: SPTCL is a challenging diagnosis due to the wide array of etiologies of panniculitides and its close clinical resemblance to soft tissue infection. Early tissue biopsy should be employed to expedite management.
American Journal of Medical Case Reports. 2021, 9(7), 367-371. DOI: 10.12691/ajmcr-9-7-7
Pub. Date: April 16, 2021
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by Muna Kilani, Marwan Shalabi and Ahmad Amer
Case Report
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has caused a pandemic in the year 2020. Infection rates and severity of infection in the pediatric population were milder than in adults. This is a case of a 10-year-old male, who was previously healthy, except for being overweight. The patient presented with cough, fever and shortness of breath of two days duration prior to admission. Several of his family members were infected with the SARS-CoV2 virus. The patient developed significant hypoxia and was admitted to the hospital. CXR showed bilateral pulmonary infiltrates consistent with a viral infection. CT scan of his lungs showed areas of significant consolidation scattered over both lung fields, with minimal ground glass opacification. The patient had an elevated CRP, in addition to elevated liver enzymes. His RT-PCR test was positive for the SARA-CoV2 virus. The patient was treated with dexamethasone and IV antibiotics and had a good recovery. This is a case of significant lung disease with consolidation and air bronchograms, in a previously healthy, overweight 10-year-old male from Jordan. The degree of consolidation observed and clinical course of fast recovery and good outcome have not been described in the literature before up to our knowledge.
American Journal of Medical Case Reports. 2021, 9(7), 363-366. DOI: 10.12691/ajmcr-9-7-6
Pub. Date: April 12, 2021
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by Chukwuemeka A. Umeh, Sabina Kumar, John Carvalho, Christina Arcuri, Hycienth Ahaneku, Krishna Pulumati, Shivang Shah, Austin Ma and Rakesh Gupta
Case Report
Introduction: Vancomycin is widely used in patients with methicillin resistant staphylococcus aureus (MRSA) infections or with other infections unresponsive to other antibiotics. Vancomycin-related adverse effects, including nephrotoxicity, ototoxicity, red-man syndrome, and neutropenia have been reported. Vancomycin induced thrombocytopenia is a rare complication of vancomycin that many physicians are unaware of. When an acute decline in platelet count or bleeding occur in patients on vancomycin, vancomycin- induced thrombocytopenia should be considered. Case: We present a case of acute severe thrombocytopenia that occurred within 12 hours after vancomycin infusion in a patient that received permanent pacemaker placement. Vancomycin was discontinued and patient’s platelets returned to baseline five days after vancomycin was discontinued. Conclusion: This case report highlights the importance of physicians being aware of vancomycin induced thrombocytopenia, a rare but reversible complication of vancomycin, which if diagnosed early will lead to early discontinuation of vancomycin, early resolution of thrombocytopenia and reduced hospital stay.
American Journal of Medical Case Reports. 2021, 9(7), 360-362. DOI: 10.12691/ajmcr-9-7-5
Pub. Date: April 09, 2021
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by Mohamed Khaled Shamasneh, Anas Ghousheh and Ibrahim Taha
Case Report
Polyorchidism is an uncommon pediatric urological condition, having it in a down syndrome patient with bilateral cryptorchidism is tremendously rare. In this case report, a five-year old child with down syndrome was examined and admitted for further evaluation of bilateral undescended testicles. At the time of surgery, a third testicle was excised and sent to pathology department to exclude any type of cancer. The pathologist ruled out malignancy and confirmed the presence of atrophied testicular tissue. This is a rare case of undescended atrophied third testicle in a down syndrome child.
American Journal of Medical Case Reports. 2021, 9(7), 358-359. DOI: 10.12691/ajmcr-9-7-4
Pub. Date: April 06, 2021
2549 Views6 Downloads
by Eiad Habib, Jay Patel, Connor Kerndt, Dan Summers and TaLawnda Bragg
Case Report
Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a syndrome of psychiatric symptoms and neurologic sequelae that is commonly associated with an ovarian teratoma. The antagonism of cerebral NMDA receptors disrupts normal brain activity causing acute onset psychological disturbances including mania, psychosis, or anxiety. Due to the rarity of the condition, diagnosis may be delayed as other common disorders such as primary psychiatric disorders or infectious encephalitis are ruled out. With rapid diagnosis and management, including resection of the tumor and immunotherapy, positive outcomes may be achieved. We present the case of a 25-year-old female with neuropsychiatric manifestations and an ovarian teratoma who was subsequently diagnosed with anti-NMDA-receptor encephalitis.
American Journal of Medical Case Reports. 2021, 9(7), 354-357. DOI: 10.12691/ajmcr-9-7-3
Pub. Date: April 06, 2021
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by Syed Hamza Bin Waqar, John Diks, Unaiza Zaman, Sarah Sharif, Taha Sheikh, Srinivas Kolla and Isabel M. McFarlane
Original Research
Whipple’s disease is a bacterial infection caused by Tropheryma whipplei and is known to cause perplexing clinical presentations, making its diagnosis challenging. The beginning by the involvement of the gastrointestinal tract, Whipple's disease can slowly progress to affect almost any organ system and lead to chronic multi-system inflammatory disease. Hereby, we present a middle age man who initially manifested with shortness of breath and chronic weight loss. He subsequently developed pleuro-pericardial effusion, ascites, mesenteric lymphadenopathy, possible myocarditis, and severe osteopenia with multiple vertebral fractures during his illness. Esophagogastroduodenoscopy with the biopsy and subsequent molecular confirmation of disease led to the confirmation of WD. Therapeutic management included two separate antibiotic regimens in an attempt to address the refractory course of WD in this patient.
American Journal of Medical Case Reports. 2021, 9(7), 348-353. DOI: 10.12691/ajmcr-9-7-2
Pub. Date: April 01, 2021
4182 Views25 Downloads
by Eman EL-Sawalhy, Muna Shaaeli, Wehbi Hnayni, Lubna Alattia and Shahina Patel
Case Report
Epithelioid Angiosarcoma (EA) is an extremely rare and highly aggressive malignant tumor. It comprises <1 % of all soft tissue sarcomas and is associated with a poor prognosis. In this case report, we are reporting an 85-years-old male who presented with lower back and left hip pain. A computerized tomography (CT) of the lumbar spine and left hip showed a significant fracture of lumbar spine L3 and osteolytic lesions involving the left hip and femur. The patient underwent L1-L5 fusion with cement augmentation and biopsy of L3. Surgical pathology showed a metastatic undifferentiated tumor of unknown primary origin. Histologic analysis of the specimen and immunohistochemistry confirmed EA. Given extensive diffuse bone involvement, our patient was not a candidate for definitive surgical treatment.
American Journal of Medical Case Reports. 2021, 9(7), 345-347. DOI: 10.12691/ajmcr-9-7-1
Pub. Date: March 31, 2021
2561 Views3 Downloads