The multisystem inflammatory syndrome in adults (MIS-A) came to attention back in June 2020, when the United States Center for Disease Control and Prevention (CDC) got initial reports regarding the patients who had delayed and multisystem involvement of the disease with clinical course resembling the multisystem inflammatory syndrome in children (MIS-C). We share a case of MIS-A, where the patient presented three weeks after the initial COVID19 exposure. His clinical course was consistent with the working definition of MIS-A as specified by CDC. Aggressive supportive care in the intensive care unit, utilization of advanced heart failure devices, and immunomodulatory therapeutics (high dose steroids, anakinra, intravenous immunoglobulin) led to clinical recovery. Management of MIS-A is a topic of ongoing research and needs more studies to elaborate on the treatment modalities and clinical predictors.
Sarcomas of the breast constitutes <1% of primary malignant breast tumors. Liposarcoma of the breast represents 3-24% of the primary breast sarcomas. Liposarcoma can arise from pre-existing benign lesions like fibroadenoma or from lipoid tissue in the breast. There are only few cases of liposarcoma of the breast in young females reported in the literature. Liposarcoma of the breast typically involves women with age after 50 years. In this article, we present a young woman with liposarcoma of the breast.
Background Cefazolin is a first-generation cephalosporin commonly used for skin and soft tissue infections, abdominal and orthopedic surgery prophylaxis, and methicillin-sensitive staph aureus. Cephalosporins as a whole are known potential inducers of hemolytic anemia; however, mechanism of action is primarily autoimmune, and compared to other drugs, cefazolin is the least common. Methods A rare case report of cefazolin-induced hemolytic anemia “CIHA” and a systematic review of CIHA articles in English literature. Two authors performed review of publications and articles were selected based on inclusion and exclusion criteria. A systematic search of the literature yielded 768 entries with five case reports on cefazolin-induced hemolytic anemia. Case presentation/results An 80-year-old female with methicillin-sensitive Staphylococcus aureus “MSSA” endocarditis. The patient was started on intravenous “IV” cefazolin that that resulted in hemolytic anemia and eosinophilia. Switching to vancomycin improved hemoglobin level and resolved eosinophilia. Four cefazolin-induced hemolytic anemia case reports and one population-based article with a case reported were analyzed with respect to direct antiglobulin test “DAT” (also known as the direct Coombs test) results, prior penicillin sensitivity, and acute anemia causes exclusion. Conclusions CIHA is a rare cause of clinically significant anemia. The diagnosis of drug-induced anemia is one of exclusion. It is important to consider DAT results and prior penicillin sensitivity when evaluating a patient for cefazolin-induced hemolytic anemia. However, the frequency of cefazolin use and resultant anemia necessitates early recognition of hemolytic anemia and prompt discontinuation of cefazolin, especially with long-term use.
Streptococcus gordonii (S. gordonii) is a pioneer oral bacteria that is recognized as an agent of bacterial endocarditis. However, an extensive review of the literature revealed no reported case of S. gordonii causing empyema. We present a case of a 65-year-old male who presented with respiratory distress. Physical examination revealed several dental caries with decreased breath sounds in the bibasilar regions. A computed tomography (CT) scan of the chest and abdomen demonstrated left-sided pleural effusion and a 4.3 cm x 2.8 cm splenic abscess. He received intravenous (IV) antibiotics, and his blood cultures remained negative. Drainage of the splenic abscess grew S. gordonii. A CT-guided thoracentesis yielded 450 ml of exudative fluid. Pleural fluid cultures grew S. gordonii. A CT scan of the head and neck ruled out an intra-oral abscess. He received six weeks of IV penicillin with a follow-up CT scan showing resolution of both the splenic abscess and the left parapneumonic effusion.
Purpose To provide an updated review of the diagnosis and pharmacotherapy of nontuberculous mycobacteria pulmonary disease (NTM-PD) and summarize guideline recommendations for an interdisciplinary treatment approach. Summary A systemic approach was taken in which all articles in English in MEDLINE and PubMed were reviewed. The US National Library of Medicine's DailyMed database was used to assess drug package inserts. Analysis of NTM treatment guidelines is summarized in the article with a focus on medications, dosing, interactions, and medication monitoring. Conclusion It is critical to manage patients with NTM with a multidisciplinary team approach. Treatment is prolonged and expensive, and the potential for drug toxicity, adverse effects, and drug interactions requires monitoring. Clinical pharmacists play a role in the management of NTM.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.