A 22-year-old man presented to the hospital with progressive shortness of breath, chest discomfort, sinus tachycardia, and emesis. The echocardiogram demonstrated global hypokinesis with a left ventricle ejection fraction of 15–20%. The patient was treated for acute systolic heart failure decompensation with diuresis and afterload reduction. Unexpectedly, an abdominal computed tomography showed a left adrenal mass and subsequent serum/urine metanephrine tests suggested pheochromocytoma. Once the patient had stabilized, he underwent an uneventful adrenalectomy with histology results confirming the diagnosis of pheochromocytoma. After six months follow-up, he is currently doing well with close outpatient follow-up by cardiology.
SUMMARYCandida spp is a common pathogen of nosocomial infections that has increased in recent decades, with mortality rates close to 40% in cases of systemic candidiasis. One type of presentation is infective endocarditis, which, by its prolonged need for treatment, represents a constant challenge for clinicians. We describe a 36-year-old woman, recently diagnosed with ovarian cancer, who developed aortic valve infective endocarditis caused by Candida parapsilosis and who was treated with oral antifungal medication, with no surgical intervention required.
BACKGROUND
Patient: Female, 41Final Diagnosis: Hemophagocytic LymphohistiocytosisSymptoms: High grade fever • diarrhea • vomiting • altered mental statusMedication: —Clinical Procedure: —Specialty: Critical Care MedicineObjective:Rare diseaseBackground:Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening condition that has a poor prognosis due to the ensuing cytokine storm leading to severe organ damage. Current treatment guidelines suggest using a combination of steroid- and etoposide-based chemotherapy.Case Report:The authors present a case of a 41-year-old African-American female who presented with symptoms of food-borne illness and who developed multi-organ dysfunction. HLH was suspected because of poor response to broad-spectrum antibiotics with a constellation of findings, including cytopenia, hypofibrinogenemia, hypertriglyceridemia, and hyperferritinemia. Clinical improvement was noted after administration of intravenous immunoglobulin and dexamethasone while waiting for the soluble interleukin-2 receptor levels; therefore, chemotherapy was not administered.Conclusions:Despite the variable and poor prognosis of HLH, early treatment with steroids and immunosuppressive therapy is crucial to improving the survival rate. The inclusion of immunoglobulin therapy should be considered a treatment option for HLH.
Hepatitis C infection and its treatment have been associated with extrahepatic manifestations, including different skin conditions. Over the past decades, a greater number of drugs have been implicated as triggers for drug-induced subacute cutaneous lupus erythematosus. We report a case of a 42-year-old Hispanic man who developed a forehead violaceous rash during treatment with pegylated interferon alpha-2a as part of his therapy against hepatitis C infection that subsequently resulted to be subacute cutaneous lupus erythematosus. The skin lesion improved with discontinuation of medication and some topic therapy.
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