The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. The manifestations of COVID-19 infection can range from being asymptomatic to developing severe acute respiratory distress syndrome (ARDS). Here, we present a case series of five patients who were either asymptomatic or had very mild symptoms of COVID-19 infection upon diagnosis. These patients neither required a visit to the emergency department (ED) nor did they need to be hospitalized but became symptomatic and were found to have interstitial lung disease four to eight weeks after a COVID-19 diagnosis. Thus, it is imperative that we routinely follow up patients with a subclinical COVID 19 infection besides those who were symptomatic. We may be witnessing a silent surge and new-onset interstitial lung disease (ILD) as sequelae of COVID 19 infection.
Amniotic fluid embolism (AFE) is a rare and life-threatening complication related to pregnancy. Early diagnosis and prompt intervention are important tools for the survival of the patient. Despite early intervention, mortality rate remains high. We present a case of a 19-year-old female who was admitted for labor induction and delivery. Her delivery course was complicated by meconium-stained amniotic fluid. The patient went into acute hypoxic respiratory failure (AHRF) and hemodynamic compromise within half an hour following delivery secondary to AFE. We hereby discuss the role of timely initiation of extra corporeal membrane oxygenation (ECMO) in a case of AFE which could have otherwise turned out to be fatal.
Bulathsinghala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Idiopathic pulmonary fibrosis is a chronic and progressive disease with a significant mortality rate. Pirfenidone is one of two oral antifibrotic therapies approved to treat idiopathic pulmonary fibrosis (IPF). Pirfenidone helps decrease disease progression in patients with IPF and reduces vital capacity. This has led to widespread use of this medication in recent years. In this case report, we present a 60-year-old male who started treatment with pirfenidone for IPF and had severe skin reactions after initiation of therapy.
INTRODUCTION: Pyometra is a very rare but serious and potentially life threatening condition. It is defined as an accumulation of purulent material within the uterine cavity. It is a common presentation in the veterinary world however exceedingly rare in humans.CASE PRESENTATION: This is a 72-year-old female who presented to the emergency room with complaint of suprapubic abdominal pain and fullness. She reports having mild abdominal pain and fullness for 3 months however it progressively became worse over 2 weeks prior to presentation. She reported the pain to be very severe and sharp in nature. She denied any fever, chills, weight loss, dysuria, or vaginal discharge. In the ER CT of the abdomen and pelvis was obtained which revealed an intrauterine mass measuring 9.7x9.8x10.5 cm. Laboratory workup revealed leukocytosis with white blood cell count of 17.05x10^3. All other pertinent labs were within normal limits. She was transferred to our hospital and admitted to the medical floor. A pelvic ultrasound was then obtained which again revealed an enlarged uterus with a complex cystic appearing lesion. Ob/Gyn was consulted and she underwent a Pap smear and endometrial biopsy with culture. Pathology was negative for any malignancy however culture did grow streptococcus viridans. Patient was started on clindamycin and levofloxacin per infectious disease recommendations. She was then transferred to the intensive care unit as she became hypotensive and was then started on norepinephrine drip. Patient then underwent a dilatation and curettage which revealed copious amounts of purulent drainage in the uterus. Cultures again grew streptococcus viridans and she was continued on antibiotics. A repeat CT abdomen and pelvis was obtained which showed resolution of lesion. Patient remained in the ICU for monitoring and on postoperative day 4 went into cardiac arrest and subsequently deceased.DISCUSSION: Pyometra is reported to occur in 0.1-0.2% of all gynecologic patients [1]. The condition is commonly caused by malignant or benign tumors, radiation cervicitis, atrophic cervicitis or with the use of an intrauterine device. The classic triad of symptoms are vaginal discharge, postmenopausal bleeding and lower abdominal pain, however >50% of patients can be asymptomatic [2]. Pubmed literature review will reveal only a handful of such cases that have been reported. Most common microorganisms causing pyometra are E.coli and bactericides fragilis. A recent case report with literature review revealed a mortality rate of 22.2% [3]. Most suggest a CT scan and a pelvic ultrasound to obtain an accurate diagnosis and prompt initiation of antibiotics along with drainage of the pyometra. CONCLUSIONS: Pyometra is exceedingly rare however life threatening. This case illustrates the severity of the condition requiring prompt recognition and treatment.
Renal biopsy is an important diagnostic test which is used to extract kidney tissue with the help of a biopsy needle. It is frequently performed under ultrasonography or CT guidance. As with every other procedure, renal biopsy also carries some risks. Common complications of renal biopsy are damage to adjacent organs. Hemothorax is an exceedingly rare complication of renal biopsy. We report a case of a middle-aged female who developed a left-sided hemothorax after undergoing percutaneous renal biopsy with ablation and conducted a literature review of this rare complication.
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