Non-polio enteroviruses are ubiquitous viruses responsible for a wide spectrum of disease in people of all ages, although infection and illness disproportionately affect infants and young children. Hand-foot-mouth disease (HFMD) is an enteroviral clinical syndrome most frequently caused by coxsackievirus-A16 and enterovirus-A71. Since 2008, a novel coxsackievirus-A6 genotype has been associated with more severe HFMD in both children and adults, presenting with a unique constellation of findings, and whose prevalence has been increasing over the last few years. In this case report, an atypical clinical picture of confirmed enterovirus HFMD is described in an immunocompetent adult, with exuberant clinical findings, clinically consistent with coxsackievirus-A6 infection. This case report highlights the importance of awareness of the clinical presentation of this increasingly common infection in adults.
A 54-year-old woman with a history of excess weight and active smoking presented to the emergency department (ED) due to syncope after a long flight. She reported a similar episode in the previous month, which had also occurred after a long air voyage. She presented with hypotension, dehydration, and hyperlactacidemia. The clinical team ruled out acute coronary syndrome, pulmonary embolism, and cerebrovascular accident. After clinician insistence, she reported having ingested anhydrous caffeine, an over-the-counter diuretic usually used by individuals seeking to lose weight, and a diagnosis of caffeine intoxication was made. The overthe-counter sale of this apparently innocuous substances is a rising phenomenon, and physicians should be aware of the signs of its ingestion.
Streptococcus pneumoniae is a rare cause of infectious endocarditis. Most cases have an acute and aggressive evolution, with a high mortality rate. We report the case of a 36-year-old man, with a history of unrepaired ventricular septal defect, who came to the emergency department with fever, cough and asthenia with 3 months of evolution. Blood cultures were positive for Streptococcus pneumoniae. Echocardiogram showed large vegetation on septum, free wall and outflow tract of the right ventricle. Thoracic CT revealed septic pulmonary embolism. Antimicrobial therapy and surgical treatment was performed and the patient presented a favourable evolution.
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