IntroductionInvasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis with extension to the pulmonary vasculature and concomitant Aspergillus endocarditis in an apparently immunocompetent patient without pre-existing lung disease.Case presentationOur patient was a previously healthy 47-year-old Asian woman, who presented to our emergency room with severe progressive shortness of breath of one month’s duration, associated with orthopnea and unstable vital signs.ConclusionInvasive aspergillosis has been described in the presence of pulmonary disease, such as chronic obstructive pulmonary disorder, and one case has been reported in a patient without preexistent disease, but none of these have been fatal. Our case is therefore the first reported case of its kind. Our case shows that fulminant aspergillosis can occur in an immunocompetent host and can be fatal. We conclude that invasive aspergillosis should not be excluded from the differential diagnosis on the basis of immunocompetency.
Patient: Female, 44Final Diagnosis: Serotonin syndromeSymptoms: Altered mental status • random spontaneous jerky movements in the extremities • generalized weakness • vomitingMedication: —Clinical Procedure: Holding SSRI and tramdolSpecialty: Critical Care MedicineObjective:Rare diseaseBackground:Serotonin syndrome is a potentially life-threatening adverse drug reaction that most commonly results from adverse interactions between drugs. Because serotonin syndrome can be fatal and is often difficult to diagnose, it is vital for health professionals to know about this reaction. We report a typical case of transient serotonin syndrome secondary to tramadol-Citalopram combination. This case report highlights the value of awareness of the early and subtle signs of serotonin syndrome.Case Report:A 44-year-old female with past medical history of chronic pancreatitis, back pain, and major depression was brought to the emergency room (ER) with altered mental status, jerky movements in extremities, generalized weakness, and vomiting.Conclusions:Most physicians are aware of serotonin syndrome secondary to antidepressants but do not think about other classes of medications such as analgesics. Clinicians should also be aware of the possibility of serotonin syndrome when encountering a patient taking serotonergic drugs who presents with characteristic symptoms of serotonin syndrome.
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