Severe, uncorrected hypothyroidism can result in a dangerous hypometabolic state leading to myxedema crisis, a rare but life-threatening illness. Myxedema crisis is a clinical diagnosis. The treatment for severe hypothyroidism and myxedema crisis is multifaceted, centered around thyroid hormone replacement, identification and treatment of precipitating factors, and intricate supportive care. Even with early and aggressive treatment, the myxedema crisis carries a high mortality rate. We present a case of iatrogenic hypothyroidism with severe features in a patient concurrently taking methimazole and amiodarone. This case illustrates the need for a high index of suspicion for patients on treatment for hyperthyroidism with any inciting event. The complexity of this case was rooted in polypharmacy, specialized care for numerous comorbidities complicated by significant strain on ED resources and personnel due to a global pandemic, resulting in severe complications. This case brings to light the need for immediate and appropriate treatment and critical care consultation for admission to a unit with an advanced level of care, as is the case for all patients with concern for severe hypothyroidism or myxedema crisis.
Thyrotoxic crisis better known as thyroid storm is a rare life-threatening endocrine emergency that is the result of dysregulated hypermetabolic state caused by excessive production and release of thyroid hormones compromising multiple organ systems. Unfortunately, this condition carries significant mortality depending on whether the thyroid storm was associated with thyrotoxicosis. Early recognition and treatment are paramount to survival. Here we describe a case of thyroid storm complicated by pneumonia and gastrointestinal bleed in which the patient's baseline mental status was restored with prompt identification and treatment and led to a successful recovery.
Recognizing life-threatening infections is crucial for an emergency physician. In this case report, we describe an atypical presentation of a severe, infiltrating kidney infection, which, if not recognized early, could have led to a detrimental outcome. Emphysematous pyelitis, which is class I of emphysematous pyelonephritis, is a rare entity, and patients may present with a urinary tract infection or pyelonephritis. To add to this, underrecognition of gram-positive organisms, in this case
Corynebacterium
, can delay treatment and worsen outcomes, as described in this case. Through this case, we wish to create awareness of this disease and to reinforce emergency physicians to keep this entity on their differential diagnosis when evaluating an immunocompromised patient.
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