The development of vaccines ushered in the most profound advancement in 20th century medicine, and have widely been regarded as the one of the most important scientific discovery in the history of mankind. However, vaccines are not without risk; reactions can range from injection site reactions to life-threatening anaphylaxis. Among the more serious vaccine-related sequela is myocarditis. Although myocarditis has been reported following many different vaccines, the smallpox vaccine has the strongest association. We report a case of a 36-year-old active duty service member presenting with progressive dyspnoea, substernal chest pain and lower extremity swelling 5 weeks after receiving the vaccinia vaccination. The aetiology of his acute decompensated heart failure was determined to be from myocarditis. Although the majority of cases of myocarditis resolve completely, some patients develop chronic heart failure and even death. Vaccine-associated myocarditis should always be on the differential for patients that exhibit cardiopulmonary symptoms after recent vaccinations.
ii I am fortunate to have so many people to thank. I truly would not be here, having written all of the pages before you if it weren't for the huge amounts of love and support that I have received from so many along the way. Most of the people listed in this section know that I have a difficult time expressing my feelings. I will attempt to overcome that difficulty here and hopefully give a small amount of something back to all those who have contributed so much to me. I know that I will not do justice to the feelings that I have, but will try my best to express them here. With that in mind, know that as you read on that this was the most difficult, and time consuming part of my thesis to write. It is because I have been fortunate enough to come into contact with a great many wonderful people that any of the subsequent chapters exist; so to say that these acknowledgements are the foundation of my thesis would be an understatement. So here we go. I will start with those who have supported me from the start, my parents. My parents have always encouraged, nurtured, loved and supported me in any venture that I have undertaken. As teachers, they have shown me the importance of education in so many ways. As their way of life, in their professional lives, and also at home. They always stressed the importance of reading, but also looked to establish education in other less traditional ways. These have included travel, and along the way sparked my love of both history and the outdoors, which have continued to be passions of mine to this day. Through my parents I also learned a great deal about the world around me that was not covered in the classroom curriculum. Learning how to build and fix things from my Dad has been a skill that has helped me countless times throughout life, although it also came with the unfortunate side effect of having to constantly fix the rotovap. My Dad also instilled in me the time and money sinks of boating and woodworking, both of which have given me countless hours of joy, and a means of finding peace at stressful times in my life as an adult. In the classroom my parents taught me to iii appreciate all subjects, which I did (except for English class, I hate grammar as anyone at Dean's writing workshop could tell you). This eventually led me to chemistry, which astonished my parents. I went off to college and pursued chemistry, becoming more interested as classes progressed, although I still could not shake my humanities leaning, and ended up with degrees in both chemistry and history. My parents continued to give me support when I set off for Charlottesville. They helped in my apartment search and moving the large amount of stuff that I had accumulated. They then made several house hunting trips, and we drove circles around Charlottesville and the surrounding counties. When I finally bought my first home in the spring of my first year, they both used nearly all of their vacation time to come down and help me with the seemingly endless remodels. I never could have finished it without them. Al...
Renal infarction is a rare occurrence accounting for 0.007% of patients seen in the emergency department for renal insufficiency or hypertension. Dysfibrinogenemia is also rare, and the combination of renal artery infarct in the setting of congenital dysfibrinogenemia has not been described in the literature. Our patient, with a remote history of congenital dysfibrinogenemia with no known haemorrhagic or thrombotic complications, presented with acute flank pain and was subsequently diagnosed with an acute renal arterial infarction. He was treated with subcutaneous enoxaparin and then transitioned to lifelong anticoagulation with rivaroxaban therapy.
Pulmonary arteriovenous malformations (PAVMs) are a rare cause of pulmonary symptoms, including dyspnoea on exertion, hypoxemia and haemoptysis. PAVMs are an aetiology that is often overlooked by physicians when developing a differential diagnosis for pulmonary symptoms and unidentified lung masses. However, it is an important differential diagnosis to have as PAVMs can have serious sequelae including strokes, brain abscess and life-threatening bleeding. We present a case of an impressive PAVM presenting with chest pain, chronic cough, feelings of anxiety, mild resting hypoxemia and exertional hypoxemia. Of note, on previous chest X-ray, 8 years prior to presentation, an incidental mass was found during a shoulder repair presurgical workup but not further evaluated.
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