Tuberculomas are an intracranial form of tuberculosis that account for a third of intracranial lesions in endemic areas. If symptomatic, they usually present as meningitis in an immunocompromised host; however, in patients without signs of meningitis, clinical features are essentially indistinguishable from any other space-occupying lesion. We present a case of central nervous system tuberculosis in an immunocompetent host who presented with new-onset seizures.

Purpose: The purpose of this study was to compare how treatment with convalescent plasma (CP) monotherapy, remdesivir (RDV) monotherapy, and combination therapy (CP + RDV) in patients with COVID-19 affected clinical outcomes. Methods: Patients with COVID-19 infection who were admitted to the hospital received CP, RDV, or combination of both. Mortality, discharge disposition, hospital length of stay (LOS), intensive care unit (ICU) LOS, and total ventilation days were compared between each treatment group and stratified by ABO blood group. An exploratory analysis identified risk factors for mortality. Adverse effects were also evaluated. Results: RDV monotherapy showed an increased chance of survival compared to combination therapy or CP monotherapy (p = 0.052). There were 15, 3, and 6 deaths in the CP, RDV, and combination therapy groups, respectively. The combination therapy group had the longest median ICU LOS (8, IQR 4.5-15.5, p = 0.220) and hospital LOS (11, IQR 7-15.5, p = 0.175). Age (p = 0.036), initial SOFA score (p = 0.013), and intubation (p = 0.005) were statistically significant predictors of mortality. Patients with type O blood had decreased ventilation days, ICU LOS, and total LOS. Thirteen treatment-related adverse events occurred. Conclusion: No significant differences in clinical outcomes were observed between patients treated with RDV, CP, or combination therapy. Elderly patients, those with a high initial SOFA score, and those who require intubation are at increased risk of mortality associated with COVID-19. Blood type did not affect clinical outcomes.

Infective endocarditis (IE) involving multiple cardiac valves is uncommon and has more risk of complications. We present an interesting case of infective endocarditis involving both aortic and tricuspid valves, suspected based on clinical presentation. He is a 54-year-old male with history of intravenous drug abuse (IVDA) who presented with exertional dyspnea, fevers/ chills, fatigue, and temporarily vision loss. On exam, he had a low-grade fever, systolic murmur, bilateral crackles in lungs, and left hemineglect. He had leukocytosis and elevated BNP. First EKG showed first-degree AV block. CT head showed a subacute stroke in the right posterior cerebral artery (PCA) distribution. Transthoracic echocardiogram revealed a large tricuspid valve vegetation. He developed a second-degree heart block and a transcutaneous pacemaker was placed. Due to high concern for aortic valve involvement, a transesophageal echocardiogram was done revealing a large mobile tricuspid valve vegetation and an aortic valve ring abscess. He underwent abscess debridement and replacement of the aortic and tricuspid valve. He was found to have a ventricular septal defect which was also repaired. He recently had antibiotics for presumed pneumonia that is likely the reason for negative cultures. He received an 8-week course of Ceftriaxone for culture negative infective endocarditis and subsequently recovered well. This case report highlights that, although rare, the presence of right and left sided IE is possible and suspicion of aortic valve involvement is crucial in the setting of AV nodal blocks and peripheral embolic events. In patients with progressive heart blocks, transvenous pacemaker placement and valve replacement should be considered immediately to prevent further morbidity and mortality.

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