Fatal Peripartum Cardiomyopathy after Bupivacaine Local Injection in Elective Cesarean Section: A Case Report

Bupivacaine is frequently used for pain control and local anesthesia. However, it is associated with certain acute and fatal side effects, although rare, including cardiac and central nervous system toxicities. In particular, bupivacaine-induced cardiac toxicity may be fatal. This condition can be diagnosed as bupivacaine-induced cardiotoxicity by excluding other causes and determining a history of bupivacaine administration. However, in emergency situations, recognizing bupivacaine toxicity can be difficult due to the physician's lack of awareness regarding the condition or in the absence of clear communication regarding the patient's medical history. In the current case report, we describe our experience with strong suspected bupivacaine-induced cardiotoxicity in a patient who underwent cesarean section along with a review of the literature.

Aspergillus Tracheobronchitis in a Mild Immunocompromised Host / 결핵및호흡기질환

Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.

Eosinophilic Pleuritis due to Sparganum: A Case Report

Sparganosis is a rare parasitic disease caused by migrating plerocercoid tapeworm larva of the genus Spirometra. Infection in humans is mainly caused by the ingestion of raw or inadequately cooked flesh of infected frogs, snakes, and chickens. Here, we report a rare case of a 45-year-old man who was admitted to our hospital with left lower chest pain. The chest radiograph and computed tomography (CT) scan revealed localized pleural effusion in the left lower lobe; further, peripheral blood eosinophilia and eosinophilic pleural effusion were present. Percutaneous catheter drainage was performed, which revealed long worm-shaped material that was identified as a sparganum by DNA sequencing. The patient showed clinical improvement after drainage of the sparganum. This study demonstrates the importance of considering parasitic diseases in the differential diagnosis of eosinophilic pleural effusion.

Pulmonary Sarcoidosis Diagnosed by Endobronchial Ultrasound Fine Needle Aspiration / 결핵및호흡기질환

BACKGROUND: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. METHODS: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. RESULTS: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. CONCLUSION: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

A case of infective endocarditis with endophthalmitis and septic arthritis caused by pneumococcal bacteremia / 대한내과학회지

Pneumococcal endocarditis accompanied by pneumococcal bacteremia is a rare condition. However, its clinical course is typically aggressive and associated with high morbidity and mortality rates. We report a case of a 67-year-old male who had small cell lung cancer and was undergoing concurrent chemoradiation therapy, and who presented with pneumococcal bacteremia complicated by infective endocarditis, endogenous endophthalmitis, and septic arthritis of the wrist. He presented with fever, sudden blindness, and a systolic cardiac murmur. Blood cultures were positive for penicillin susceptible Streptococcus pneumoniae. Despite appropriate treatment with intravenous and intravitreal antibiotics, destructive changes still appeared in his vitreous, mitral, and aortic valves. He underwent a vitrectomy and mitral and aortic valve replacement. We were able to prevent further embolic events with antibiotics and early surgical management.