Dabbing" is the inhalation of concentrated marijuana, usually in butane solvent. This case report illustrates a previously healthy 25-year-old caucasian male with a 10-year history of cannabis butane hash oil (BHO) use. The patient presented with dyspnea and cough. The evaluation included a chest x-ray, basic laboratory investigations, computerized tomography angiogram of the chest and echocardiogram. Patient was diagnosed with acute lung injury mimicking atypical pneumonia. He was treated with steroids and had clinically improved and advised to stop dabbing. Further studies are needed to elucidate the full spectrum of the adverse effects of dabbing.
Pasteurella multocida
(P. multocida) is a zoonotic organism found in the normal flora of domestic and wild animals. In this case report, we present a 70-year-old Caucasian male who presented with fever, chills, and greenish sputum which began hours prior to presentation. His symptoms were initially thought to be due to refractory pneumonia because the patient had been discharged from our hospital three weeks prior to presentation. Blood cultures grew
P. multocida
, a rare pathogen to cause bacteremia. He was treated with cefepime and later amoxicillin/clavulanic acid and made an uneventful recovery. Later history of the patient’s cats scratching him was thought to be the mode of transmission.
P. multocida
infection is rare, and can also be dangerous and even fatal in immunocompromised individuals. Clinicians must therefore operate with a high degree of suspicion especially when treating immunocompromised patients with bacteremia.
<b><i>Background:</i></b> While the most common neurologic symptoms reported in patients affected by SARS-CoV-2 are headache, dizziness, myalgia, mental fog, and anosmia, there is a growing basis of published peer-reviewed cases reporting stroke in the setting of SARS-CoV-2 infection. The peer-reviewed literature suggests an increased risk of cerebrovascular accident (CVA) in the setting of COVID-19 infection. <b><i>Methods:</i></b> We searched 3 databases (PubMed, MEDLINE, and CINAHL) with search terms COVID-19, novel coronavirus, stroke, and cerebrovascular accident. Case series and case studies presenting patients positive for both COVID-19 and CVA published from January 1 through September 1, 2020, were included. Data collection and analysis was completed and risk of bias assessed. <b><i>Results:</i></b> The search identified 28 studies across 7 counties comprising 73 patients. Amongst patients hospitalized for COVID-19 infection and CVA, the average age was 60; the most common preexisting conditions were hypertension and diabetes mellitus, and those without preexisting conditions were significantly younger with an average age of 47. Amongst hospitalized patients with COVID-19 and CVA, there was a bimodal association with COVID-19 infection severity with majority of patients classified with mild or critical COVID-19 infection. <b><i>Discussion:</i></b> The data suggest SARS-CoV-2 is a risk factor for developing stroke, particularly in patients with hypertension and diabetes. Furthermore, the younger average age of stroke in patients with SARS-CoV-2, particularly those patients with zero identifiable preexisting conditions, creates high suspicion that SARS-CoV-2 is an independent risk factor for development of stroke; however, this cannot yet be proven without comparable control population. The data suggest the risk of developing CVA in the setting of COVID-19 infection is not dependent upon severity of illness. Continued studies must be done to understand the epidemiologic factors of COVID-19 infection and stroke and the pathophysiology of the COVID-associated hypercoagulable state.
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