ABSTRACT
Clot-in-transit is associated with severe pulmonary embolism and higher mortality than acute pulmonary embolism without clot-in-transit. The optimal treatment of clot-in-transit is not established. Multiple treatment options have been described, including anticoagulation alone, systemic thrombolysis, surgical embolectomy and endovascular catheter-based therapies. Clot-in-transit can embolize to the pulmonary circulation in a matter of seconds and be immediately fatal. We describe two cases of clot-in-transit which embolized quickly upon Intensivist's evaluation and were associated with serious consequences. Management decisions for clot-in-transit should be emergent and based on multidisciplinary discussion of the pulmonary embolism response team.
ABSTRACT
A 61-year-old woman with severe gout, chronic kidney disease, type II diabetes, and heart failure with reduced ejection fraction was admitted with acute onset bilateral hand swelling and pain following a trauma. She was managed for a severe gout flare, but her symptoms, leukocytosis, and inflammatory markers did not improve. Six days into the hospital course, she developed fevers. Blood cultures grew Streptococcus pneumoniae. Intravenous antibiotics were started, and the patient underwent multiple incision and debridements of the bilateral hands with improvement in symptoms and clinical status. Septic arthritis secondary to S. pneumoniae is uncommon. We highlight this case to recognize that septic arthritis should always be considered when a patient presents with a painful, erythematous joint. Pneumococcal vaccination reduces the incidence of invasive pneumococcal disease, and should be prioritized for those at high risk for invasive disease and who are immunocompromised.
ABSTRACT
Although myiasis infestation of wounds presents with significant psychological discomfort to patients, studies have shown that it can be beneficial in the management of recalcitrant ulcers resistant to standard management. Here we report a patient with persistent ulcers unresponsive to standard management who was lost to follow-up for five months and presented with ''maggots in his wound''. This however proved beneficial to the patient as the ulcer showed healthy granulation tissue on presentation and improved healing on follow-up. Our case presents the beneficial effect of myiasis infestation in the 21st century and helps to highlight a time-tested therapy with further encouragement of the use of biotherapy (sterile maggots) for the management of recalcitrant ulcers.
ABSTRACT
A 62-year-old woman with hypertension presented with progressively worsening shortness of breath due to acute decompensated heart failure with atrial fibrillation in rapid ventricular response. During admission, she was managed with diuretics, goal-directed medical therapy for heart failure with successful DCCV (Direct current cardioversion) for first episode atrial fibrillation. However, one day after discharge, the patient presented with a recurrence of dyspnea with atrial fibrillation in rapid ventricular response and a reduction in urine output with elevated serum creatinine. In this case report, we describe the syndrome of acute kidney injury following cardioversion for atrial fibrillation known as AFCARD (Atrial Fibrillation Cardioversion Associated with Renal Dysfunction), highlight its incidence and reflect on renal dysfunction subserving the recurrence of atrial fibrillation after successful DCCV.
ABSTRACT
A 71-year-old Indian female presented with a 3-month history of weight loss and fatigue. Further review confirmed a histological diagnosis of diffuse large B-cell lymphoma. Although bone marrow analysis did not reveal hemophagocytosis, she had some clinical and laboratory pointers to hemophagocytic lymphohistiocytosis (HLH). Her clinical state deteriorated rapidly with development of acute respiratory distress syndrome, diffuse alveolar hemorrhage, and subsequently death.
