Cytomegalic infection of the immunocompetent adult is usually asymptomatic or expressed by a mononucleosic syndrome. We present a case of a young adult with rare and severe primary cytomegalic infection and multisystemic involvement, namely hematological, hepatic, gastrointestinal and respiratory, including pneumonia with severe pulmonary hypertension, to the best of our knowledge, not previously described. Also of note is the fact that these dysfunctions were treated successfully with ganciclovir, although a formal indication to antivirals on cytomegalic infection of the immunocompetent patients is not established yet.
Long-term nitrates use in patients with ischemic HF was associated with higher occurrence of ischemic events, defined as fatal or nonfatal myocardial infarction or stroke. Our results, although from a retrospective analysis, do not support a role for chronic nitrate use in HF.
Platypnea-orthodeoxia syndrome (POS) is a rare and underdiagnosed disease characterized by dyspnea in the upright position (platypnea) with simultaneous hypoxemia (orthodeoxia) that is relieved by recumbency. The physiopathological mechanisms involved are mediated by intracardiac shunts, pulmonary arteriovenous shunts or ventilation/perfusion mismatch. When POS is caused by a cardiac pathology, there is an anatomical (interatrial communication) and a functional component (as a dilated aorta or pneumectomy) working together to cause a right to left shunt without a constant right to left pressure gradient. Diagnosis is suspected through pulse oximetry verifying orthodeoxia. Confirmation usually is made by transesophageal echocardiography with bubble study to visualize the shunt. Percutaneous closure of the shunt is effective in most cases of cardiac POS. We report a case of an 87-year-old woman with POS related to a patent foramen ovale and an ectatic aorta followed by a review of the literature.
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