ABSTRACT
Immune checkpoint inhibitors (ICIs) are increasingly used to treat certain malignancies due to their higher efficacy compared with conventional chemotherapy. As familiarity with these agents increases, it is becoming apparent that a significant number of patients treated with ICIs experience adverse events. With time, more immune-related adverse events (IRAEs) are being recognised. It is important to be vigilant for IRAEs and recognise that a patient may have multiple IRAEs affecting multiple organ systems. Common cardiovascular adverse events associated with ICIs include myocarditis, arrhythmias and pericarditis. This case report identifies a patient presenting with takotsubo syndrome followed by ketoacidosis (associated with sodium-glucose transport protein 2 (SGLT2) inhibitor) in the setting of combination ipilimumab and nivolumab therapy for metastatic melanoma.
Subject(s)
Brain Neoplasms/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Diabetic Ketoacidosis/chemically induced , Immune Checkpoint Inhibitors/adverse effects , Melanoma/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Takotsubo Cardiomyopathy/chemically induced , Aged , Benzhydryl Compounds/adverse effects , Brain Neoplasms/complications , Brain Neoplasms/secondary , Coronary Angiography , Diabetes Mellitus, Type 2/complications , Diabetic Ketoacidosis/complications , Echocardiography , Glucosides/adverse effects , Humans , Ipilimumab/adverse effects , Magnetic Resonance Imaging , Male , Melanoma/complications , Melanoma/secondary , Nivolumab/adverse effects , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/diagnostic imagingABSTRACT
Scrotal haematoma is an extremely rare complication after cardiac catheterisation (CC) with only few cases reported in literature. We report a 56-year-old patient who developed large scrotal haematoma after CC via transfemoral approach requiring blood transfusion due to haemodynamic instability. After an uneventful elective procedure, he was discharged with a collagen plug-based vascular closure device (Angio-Seal). He developed sudden onset, excruciating groin pain with scrotal swelling and shock. Bleeding was stopped with manual compression over the femoral artery and 2 units of packed red blood cells were transfused. CT angiogram revealed scrotal haematoma without active bleeding. Testicular blood supply remained intact. Scrotal swelling improved with conservative management and patient got discharged 3 days later in a stable condition. The review of literature suggests that penoscrotal haematoma is unusual after CC but may result from arterial injury or bleeding into the fascial planes. Majority of patients require observation but surgery is indicated in selected cases for vascular complications.
Subject(s)
Cardiac Catheterization/adverse effects , Genital Diseases, Male/complications , Hematoma/complications , Scrotum/blood supply , Testis/diagnostic imaging , Hematoma/therapy , Humans , Male , Middle Aged , Scrotum/pathology , Testis/pathology , Treatment Outcome , Ultrasonography, Doppler/methods , Vascular Closure Devices/adverse effectsABSTRACT
Hyperbaric oxygen therapy (HBOT) has been shown to be effective in the treatment of diabetic ulcers, air embolism, carbon monoxide poisoning and gas gangrene with minimal adverse effects. Very few cases of HBOT causing acute pulmonary edema (PE) has been described; with a study on dogs suggesting that a complication of this therapy could be PE. We describe the case of an 80-year-old man with a history of stable systolic heart failure and diabetes mellitus presenting with acute PE following treatment with HBOT for diabetic foot.
ABSTRACT
Addison's disease (AD) is a metabolic disorder that affects the metabolism of potassium. The hyperkalemia that results from this condition can be reflected in the electrocardiogram, which could confound the diagnosis of other cardiac conditions. Such a challenging situation was encountered when a 73-year-old male with history of AD presented to the emergency department with chest pain.
ABSTRACT
Infective endocarditis (IE) is usually caused by Streptococcus, Staphylococcus or Enterococcus species or slow-growing HACEK organisms. We report an extremely rare case of IE caused by Gemella sanguinis.
Subject(s)
Endocarditis/diagnosis , Endocarditis/microbiology , Gemella , Gram-Positive Bacterial Infections/complications , Aged , Anti-Bacterial Agents/therapeutic use , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Echocardiography , Endocarditis/therapy , Gram-Positive Bacterial Infections/drug therapy , Heart Valve Prosthesis Implantation , Humans , Male , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Treatment OutcomeABSTRACT
Tako-tsubo cardiomyopathy was first described in Japan in 1990. The clinical presentation of Tako-tsubo cardiomyopathy (TCM) is similar to an acute myocardial infarction with patients having chest pain, ST segment elevations on EKG and elevated cardiac biomarkers. In TCM, however, the elevation in cardiac enzymes is usually mild. We report a case of TCM where the patient had Troponin I elevation up to 42.3 ng/ml. To the best of our knowledge, this is the first case in which such high troponins have been reported in a patient with Tako-tsubo cardiomyopathy.
Subject(s)
Takotsubo Cardiomyopathy/blood , Troponin I/blood , Biomarkers/blood , Female , Humans , Middle AgedABSTRACT
Tako-tsubo cardiomyopathy is a relatively recently recognized clinical entity, which presents similar to an acute myocardial infarction but there is no evidence of obstructive coronary artery disease on cardiac catheterization. It mostly affects postmenopausal women and an episode of acute illness or stress can often be identified preceding the presentation. Tako-tsubo cardiomyopathy (TCM) usually has a favorable outcome and an excellent prognosis but, in rare instances, it can be associated with life threatening complications. We report a unique case of TCM where the patient presented with a transient complete heart block.
