Community acquired methicillin-resistant
Staphylococcus aureus
(MRSA) is an organism that can cause life threatening injuries with 6 cases of purulent pericarditis secondary to MRSA being reported so far. We report a 66 year-old -female who presented to our hospital with a two-week history of worsening shortness of breath, associated with pleuritic chest pain and chills. Patient was found to be positive for influenza type A virus two weeks prior to this presentation, but was never treated. Physical exam upon arrival showed muffled heart sounds and jugular venous distention. Electrocardiogram showed diffuse ST segment elevations along with PR segment depressions in anterolateral leads. She underwent emergent transthoracic echocardiogram that demonstrated a large pericardial effusion most noticeable around the right ventricle with impedance of right ventricle filling. Patient had a pericardial window performed and purulent fluid was drained. Pericardial fluid cultures grew MRSA. Patient was started on vancomycin along with colchicine for MRSA pericarditis and became hemodynamically stable. Pericarditis due to MRSA is extremely rare, especially in the antimicrobial era and in the absence of prior surgical interventions.
We present a 52-year-old man admitted to the hospital with diarrhoea and lower extremity weakness ongoing for the past 3 months. The patient was found to have malabsorptive diarrhoea, hypoproliferative anaemia and renal insufficiency with proteinuria. Extensive workup was performed including a bone marrow biopsy with 20% plasma cells, renal and duodenal biopsies with Congo-red staining revealed amyloid deposition. The patient was diagnosed with multiple myeloma and amyloidosis with gastrointestinal, kidney and nerve involvement explaining his presentation with diarrhoea, renal insufficiency and weakness. Throughout his admission, there were incidental findings of asymptomatic hypoglycaemia (serum blood glucose <40 mg/dL), which was later found to be caused by anti-insulin monoclonal antibodies produced by the neoplastic plasma cells. This is an extremely rare manifestation of multiple myeloma with only a few cases reported in the literature.
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