Alcaligenes faecalis is a gram-negative bacterium that is commonly found in the environment. This pathogen is usually transmitted in the form of droplets through ventilation equipment and nebulizers, but transmission through direct contact has also been documented in few case reports. This pathogen can cause rare but fatal infections including appendicitis, abscesses, meningitis, bloodstream infection, endocarditis, and post-operative endophthalmitis. Pan drug resistance to all commercially available antibiotics has been emerging globally. We present the case of a 66-year-old male who had respiratory failure along with multiple comorbidities. A large cavitary lesion caused by pan drug-resistant Alcaligenes faecalis was found on chest imaging. Despite the treatment with broad-spectrum antibiotics, the clinical outcome was very poor.
Drug-induced pancreatitis is uncommon among all cases of acute pancreatitis in the general population. The majority of reported cases are mild, but severe and even fatal cases have been also reported. Management of corticosteroid-induced acute pancreatitis requires withdrawal of the offending agent and supportive care. Our case describes a young patient, who was recently diagnosed with idiopathic immune purpura and was treated with steroids. Few days later, he returned to the hospital complaining of epigastric pain with nausea and vomiting and was diagnosed with steroid-induced pancreatitis after exclusion of other causes of pancreatitis.
Hyperthyroidism can present with cardiac issues, such as tachycardia, atrial fibrillation, and high output congestive heart failure. Rare case reports of coronary vasospasm leading to myocardial infarction (MI) are published. Of these cases, many are known to be hyperthyroid prior to cardiac presentation. We report a female patient with unrecognized thyrotoxicosis who presents with acute MI secondary to coronary vasospasm.
Lithium is a well-known medication that has been used for many years to treat mood disorders. One of its side effects is cardiotoxicity, which usually occurs at serum lithium levels > 1.5 mEq/L but rarely occurs when therapeutic levels of lithium are used. Other causes of bradycardia should be eliminated by performing a detailed workup that includes calcium level, thyroid function, and cardiac workup, with consideration of any medication interactions. Lithiuminduced bradycardia is reversible upon discontinuation of lithium, but irreversible sinus node can occur and may warrant permanent insertion of a pacemaker to maintain sinus rhythm when long-term lithium therapy is required. Herein, we describe the case of a 42-year-old woman who presented with symptomatic bradycardia. Bipolar disorder was described in her past medical history, and she was receiving lithium therapy. A detailed workup indicated bradycardia secondary to lithium use. Her condition improved after discontinuation of the lithium, and normal sinus rhythm was restored over the next three days.
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