ABSTRACT
Infective endocarditis (IE) is an infection of the heart valves or endocardium, usually due to the spread of infection through the blood. It can cause a varied range of symptoms, from being asymptomatic to reduced heart function, valvular abnormalities, embolization, or death. Enterococci are usually present as normal gut flora but can also cause bacteremia, urinary tract infections, or IE, especially in the elderly population. The source of enterococcal spread in most of the cases is unidentifiable and sometimes associated with the genitourinary tract or damage to the gut mucosa due to trauma, malignancy, and infection, among others. Very few cases have been reported so far on Enterococcus faecalis (E. faecalis) endocarditis and even rarer for such cases complicated by osteomyelitis. Here, we describe the case of a 63-year-old male patient with a recent history of cardiac arrest, a percutaneous endoscopic gastrostomy tube placement, and endotracheal tube placement. He presented with back pain and was found to have osteomyelitis on magnetic resonance imaging and aortic valve vegetations on transthoracic echocardiography (TTE). His blood cultures were positive for E. faecalis. Repeat TTE showed growth in the vegetation, and the patient underwent bioprosthetic aortic valve replacement.
ABSTRACT
Polyarteritis nodosa (PAN) is a type of vasculitis that mainly affects small and medium-sized blood vessels. The clinical presentation can be nonspecific as weight loss, abdominal pain, and hypertension, or fatal as myocardial infarction (MI) and bowel perforation depending upon the organ involved. Cardiac involvement of PAN usually manifests as congestive heart failure, aneurysms, or MIs and is mostly identified during postmortem studies of autopsied patients. Here, we report a case of anterior MI as a sequela of PAN in a 40-year-old female who was diagnosed with PAN two weeks before her MI. She presented with intermittent chest pain for one day. At the time of admission, an electrocardiogram revealed anterior MI, and she was subsequently found to have 95-99% stenosis of the proximal left anterior descending artery during cardiac catheterization. The patient was successfully treated with percutaneous coronary intervention and was started on dual antiplatelet therapy. Her treatment was continued with steroids and cyclophosphamide. The case illustrates the importance of recognizing MI as a sequela of PAN as timely treatment could be lifesaving.
ABSTRACT
Thrombus in transit (TIT) remains an uncommon diagnosis. However, it is often found in patients diagnosed with acute pulmonary embolism (PE). While thrombolytics are mainly used in life-threatening presentations, their role in stable patients with a known history of intracranial hemorrhage (ICH) is unclear.
