Treating obesity is crucial as it will ultimately result in the prevention of many related chronic diseases and will decrease morbidity and mortality. Weight loss medications are a valuable part of the clinician's toolbox in the treatment of obesity and should be used when appropriate. Having a variety of medications would be a great asset to accommodate various patients' needs and pre-existing medical conditions.
A 78-year-old male presented for evaluation of a cold, painful left foot. He had undergone two recent hospital admissions for unexplained fever, fatigue, arthralgias, and an 8-to 10-lb. weight loss over a 4-month period. The patient had a past medical history of hypertension, hyperlipidemia, benign colon polyps, type II mixed cryoglobulinemia, and a bioprosthetic aortic valve that was placed 2 years earlier. Despite extensive evaluations during these two admissions, including three transesophageal echocardiograms that demonstrated a normally functioning aortic bioprosthesis, no diagnosis was established. Type II mixed cryoglobulinemia was documented and treated with oral steroids and brief plasmapheresis.During the present admission, an acute arterial embolus was diagnosed, and an emergent femoral-popliteal embolectomy was performed. A foul-smelling clot was extracted and sent to the microbiology laboratory for testing. An intraoperative transesophageal echocardiogram showed a mobile vegetation on the bioprosthetic valve and ϩ4 tricuspid regurgitation. Six days later, the patient underwent uneventful aortic valve replacement and tricuspid valve repair. Gram stains of the embolus and valve vegetation were both negative. Fungi-Fluor fungal smears of the same specimens showed many yeasts and hyphae. Routine blood cultures remained negative. No fungal blood cultures were performed.
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