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Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy (TTS), is characterized by transient regional systolic dysfunction. Furthermore, electrocardiogram (ECG) changes can vary as TTS evolves. We report a case of a 67-year-old woman who presented to the ER after cardiac arrest. She was found to have stress-induced cardiomyopathy with prolonged QTc interval. The patient developed torsades de pointes for which she required cardioversion, followed by improvement of QTc interval corresponding to resolution of echocardiographic evidence of apical ballooning.

Importance: COVID-19 has affected millions of people worldwide. Furthermore, with its increasing incidence, more has been learned about the risk factors that can make certain groups more at risk of contracting the disease or have worse outcomes. We aim to identify any discrepancy in the hospitalization rate by race/ethnicity of patients who tested positive for COVID-19, and through this, analyze the risks of these groups in an effort to call out for attention to the circumstances that make them more vulnerable and susceptible to disease. Observations: Analysis indicates that patients identified as non-Hispanic White and Asian/Pacific Islander in hospital admission data are underrepresented in COVID-19 admissions. Patients identified as non-Hispanic Black, Hispanic/Latino, and American Indian have a disproportionate burden of hospital admissions, suggesting an increased risk of more severe disease. Conclusions and Relevance: There is a disproportionate rate of COVID-19 hospitalizations found among non-Hispanic Blacks. Further investigation is imperative to identify and remediate the reason(s) for increased vulnerability to COVID-19 infections requiring hospital admission. These efforts would likely reduce the COVID-19 morbidity and mortality in the non-Hispanic Black population.

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Cryptogenic organizing pneumonia (COP) has rarely been associated with radiotherapy for breast cancer since the advent of planned irradiation field therapy. Here we present a case of a woman diagnosed with radiation-primed COP, diagnosed on lung biopsy. CASE PRESENTATION:A 78-year-old female with a medical history of asthma and three year old history of invasive ductal carcinoma of the right breast post lumpectomy, radiotherapy and adjuvant Taxol and Herceptin chemotherapy presented to the hospital with symptoms of progressive dyspnea. CT Chest at the time of admission revealed patchy areas of ground-glass and peripheral nodular consolidation with cavitation superimposed on postradiation fibrosis. She was diagnosed with pneumonia and discharged on a 5 day course of Amoxicillin-Clavulanic Acid.She continued to have persistent dyspnea, dry cough and was retreated with a 7 day course of Levofloxican. She symptoms persisted and a repeat CT Chest performed a month later demonstrated persistent pulmonary opacities concerning for cryptogenic organizing pneumonia and she underwent a CT-guided biopsy. Pathology revealed acute lung injury consistent with organizing pneumonia and cultures were negative for bacteria, fungi or acid-fast bacilli. She was treated with 1 mg/kg of prednisone daily, adjusted body weight, for a total of 3 months and experienced complete resolution of symptoms.DISCUSSION: Radiotherapy is the core treatment of breast cancer with planned field irradiation allows for minimal risk of side effects e.g. pneumonia and fibrosis. Pneumonia typically presents 4 to 12 weeks after radiotherapy; it's characterized by dyspnea, dry cough and alveolar opacities restricted to the treatment port [1]. In rare cases, bilateral lymphocytic alveolitis can develop, in spite of a limited radiation treatment area and it's radiological and histological pattern emulates cryptogenic organizing pneumonia (COP) [2]. Corticosteroid treatment in COP often results in rapid correction of both clinical symptoms and radiological signs; the precise dose and duration of treatment has not yet been defined [1].In our case, the patient presented with the typical signs of pneumonia and failed multiple rounds of treatment with antibiotics. The correct diagnosis was only established months later, after her symptoms persisted and a pathological tissue sample and negative cultures enabled a conclusive diagnosis of radiation-primed COP. Her clinical response to systemic corticosteroid provided further confirmation of her diagnosis. CONCLUSIONS:A high index of suspicion is required in order to diagnose radiation-primed cryptogenic organizing pneumonia. Clinicians must be aware of its chronic and persistent presentation if left untreated, as early diagnosis will prevent significant physical and psychological morbidity.

INTRODUCTION:Cryptococcal laurentii as a primary pathogen in infection is rare. The understanding of this non-neoformans species remains unclear as a rare virulent factor with high associated mortality or incidental finding in an at-risk immunocompromised populations. Here we present the case of a patient with chronic severe respiratory disease with acute pneumonia symptoms, found to have Cryptococcus laurentii pneumonia. CASE PRESENTATION:A 49-year-old woman with a 24 pack-year smoking history, COPD and uncontrolled severe persistent asthma, frequent hospitalizations for respiratory failure presented with acute dyspnea, wheezing and productive cough. She has previously responded to steroids, with several long tapers over the past year. A CT was performed revealing scattered ground-glass opacities, tree in bud pattern, hilar and mediastinal adenopathy, mucus plugging, and airway thickening. Initial labs were remarkable only for peripheral eosinophilia, a count of 640, with serum quantitative IgE of 33. Aspergillus testing, viral panel, COVID, and MRSA PCR were negative. Serum Quantiferon and autoimmune antibody panel were negative. The patient was started on broad-spectrum antibiotics but failed to improve. Bronchoscopy with BAL was performed, cytology showed growth of Cryptococcus Laurentii. Other respiratory samples were negative. The patient was started on a fluconazole regimen, with improvement in respiratory symptoms.DISCUSSION: Cryptococcal infection can be difficult to diagnose. Imaging and symptom presentation can be nonspecific. The most frequent symptoms are dyspnea, cough, and fever. Imaging findings can include pulmonary nodules, consolidations, nodular interstitial pattern, reticular interstitial pattern, ground glass opacities and pleural effusions. Severity can range from asymptomatic nodules to life-threatening illness. (3) There have been limited case reports of these species causing infection and pre-existing lung disease is a risk factor for pulmonary cryptococcal infection. There is a high associated risk of mortality (25-35%) (1). Due to an elevated risk of disseminated infection, diagnostic evaluation and workup should be broad and thorough. Standard cryptococcal antigen testing has worse sensitivity for non-neoformans species (3). The most appropriate treatment regimen remains contested as there has been poor correlation between in vitro antifungal susceptibility and treatment outcomes in patients (2).CONCLUSIONS: Cryptococcus laurentii remains a rare cause of infection. The symptoms may be non-specific; a high degree of suspicion is required for diagnosis. A better understanding of epidemiology and pathogenesis is crucial for improved recognition and treatment.