Cardiac Tamponade Associated with Pembrolizumab Therapy in Patient with Pneumonectomy for Lung Cancer

A 57-year-old man with a history of right pneumonectomy for squamous cell lung cancer who presented with dyspnea and hypotension, was found to have pericardial effusion complicated by cardiac tamponade, associated with pembrolizumab therapy. Pericardiocentesis could not be safely attempted due to presence of right-sided mediastinal tissue shift in the setting of previous right pneumonectomy. The patient improved significantly with surgical placement of pericardial window. Analysis of the pericardial fluid was negative for malignancy and was consistent with acute inflammation. Pembrolizumab and other immune checkpoint inhibitors are associated with cardiovascular toxicity, including pericardial effusion and in rare cases, cardiac tamponade. Treatment of cardiac tamponade in post-pneumonectomy patients may be subject to anatomical limitations precluding percutaneous pericardiocentesis and requires early recognition as well as availability of surgical intervention.

A Case of Multiple Organ Disseminated Cryptococcosis

Cryptococcus neoformans is an encapsulated yeast found worldwide.1 Patients with immunosuppression, including individuals with HIV/AIDS, transplant recipients and/or individuals with other T-cell mediated immunosuppression are more susceptible to becoming infected with Ciyptococcus neoformans than immunocompetent individuals.2 This is a case report of a 66-year-old woman who presented to the emergency department with an unsteady gait and urinary incontinence. Magnetic resonance imaging (MRI) on presentation showed a large C5-C6 central disc protrusion. The patient underwent surgical repair and was treated with five days of IV steroids. Later in the course of her hospitalization, she had an unexplained increasing leukocytosis and tachycardia with witnessed episodes of unresponsiveness. she subsequently had a pulseless electrical activity cardiac arrest and succumbed despite resuscitative efforts. A post-mortem diagnosis revealed Ciyptococcus neoformans fungemia and disseminated cryptococcosis involving multiple organs. Disseminated cryptococcosis primarily affects the central nervous system3, and thus this report presents a rare case of disseminated cryptococcosis involving multiple organs.

Iatrogenic Pneumothorax and Pneumomediastinum in a Patient with COVID-19

Co-occurrence of pneumothorax and pneumomediastinum is rare in COVID-19 patients. Positive airway pressure therapy used to improve oxygenation may sometimes worsen clinical outcomes in some patients with severe COVID-19 pneumonia. In this case report, we describe an individual who was diagnosed with COVID-19 and developed bilateral pneumothorax and pneumomediastinum after initiating non-invasive positive airway pressure therapy.

Severe, Symptomatic Reinfection in a Patient with COVID-19

To date, there have only been a few reports of reinfections in COVID-19 patients. The possibility of being reinfected with COVID-19 is poorly understood. In this case report, we describe an individual who was initially diagnosed in April 2020 with COVID-19. Seven months later, he presented again to the hospital with shortness of breath and was found to have COVID-19 reinfection. We also summarize a list of all known cases of COVID-19 reinfection at this time.