ABSTRACT
A 29-year-old female with a history of bioprosthetic mitral valve replacement was admitted with fever, chills, and shortness of breath of two weeks duration. Transthoracic echocardiography revealed a thickened bioprosthetic mitral valve with a 26 mmHg mean gradient consistent with severe mitral stenosis and associated large vegetation. Blood cultures demonstrated no growth. The patient underwent repeat mitral valve replacement surgery. At the time of operation, diffuse mitral valve thickening was observed, causing decreased mobility in both cusps with vegetation covering both sides of the valve. PCR with 16s rRNA sequencing of the tissue specimen revealed Gemella species DNA. Her recovery period was uneventful. Infective endocarditis very rarely causes obstructive/functional stenosis. When present, fungal organisms are typically implicated. These patients often present acutely with distinctive clinical evidence of obstruction, and they usually demonstrate rapid deterioration. Prompt diagnoses and timely surgery are essential.
Subject(s)
Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis , Mitral Valve Stenosis , Adult , Constriction, Pathologic , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Female , Heart Valve Prosthesis/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Stenosis/diagnostic imaging , Mitral Valve Stenosis/surgery , RNA, Ribosomal, 16SABSTRACT
An 18-year-old female presented to a tertiary care center after sustaining blunt abdominal trauma. Work up, including computer tomography (CT) revealed a hypo-attenuated collection in the pancreatic body with concern for ductal injury on magnetic resonance cholangiopancreatography (MRCP). These findings were consistent with posttraumatic intrapancreatic hematoma. An exploratory laparotomy with distal pancreatectomy and splenectomy were performed with concern for a grade 3 pancreatic injury. Pathology of the excised pancreas showed presence of a solid pseudopapillary tumor in the body of the pancreas which had been obscured by the hematoma on imaging.
Subject(s)
Pancreatic Neoplasms , Wounds, Nonpenetrating , Adolescent , Cholangiography , Female , Humans , Pancreas/injuries , Pancreatectomy , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Splenectomy , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the causative virus of the COVID-19 (coronavirus disease 2019) pandemic. Hepatic involvement is widely reported, and there are many proposed causes of liver injury in this setting. We present a patient who developed autoimmune hepatitis in association with the COVID-19 infection, which created a diagnostic and therapeutic dilemma.
