A Rare Case of Severe Hemolytic Anemia and Pulmonary Embolism Secondary to Mycoplasma pneumoniae Infection.

A 27-year-old woman was admitted with a history of dry cough, breathlessness, fever, lethargy, and nausea and vomiting. On examination, she was febrile, jaundiced, and hypoxic. Blood tests revealed severe leucocytosis and severe hemolytic anemia. The chest imaging demonstrated coexisting pneumonia and pulmonary embolism. An initial blood transfusion worsened the hemolytic anemia to the point that critical care review was required. Subsequent blood tests revealed cold agglutinin hemolytic anemia due to Mycoplasma pneumoniae infection. The patient's condition improved after receiving a warm-blood transfusion, antibiotics, and steroid therapy. The patient also received anticoagulant therapy for 6 months. Our case is unique in that the patient had very severe anemia and very severe leucocytosis, making us suspect a hematologic malignancy at initial presentation. This case emphasizes the importance of prompt evaluation of hemolytic anemia and the use of warm blood transfusion for cold agglutinin disease.

A Rare Case of Mesalazine-Induced Acute Myocarditis in a 19-Year-Old Female With Ulcerative Colitis.

Mesalazine is a commonly used first-line therapy to treat acute mild to moderate ulcerative colitis (UC). Myocarditis is a rare complication of inflammatory bowel disease. This is a case report of a 19-year-old female with myocarditis induced after commencing mesalazine for UC. She was admitted with pleuritic-type chest pain associated with severe dyspnoea and was hemodynamically unstable during admission. She had elevated troponin and N-terminal pro-B-type natriuretic peptide. Transthoracic echocardiogram (TTE) results suggested there was evidence of myocarditis with reduced ejection fraction, which was later confirmed by cardiac magnetic resonance imaging. There was a rapid improvement of cardiac status after stopping mesalazine within two weeks.

Severe Hypophosphatemia Following Ferric Carboxymaltose in a Patient With Inflammatory Bowel Disease.

Inflammatory bowel disease is a chronic inflammatory condition that affects the large and small bowel, which includes Crohn's disease (CD) and ulcerative colitis (UC). Iron deficiency anemia (IDA) is one of the most common complications in people with inflammatory bowel disease. The treatment of choice is intravenous iron infusion. There is a lack of awareness of side effects of intravenous iron (Ferinject) such as hypophosphatemia, which can prolong hospital admission. We present the case of a patient with iron deficiency anemia and vitamin D deficiency who developed severe hypophosphatemia after intravenous injection of ferric carboxymaltose (Ferinject). In this case presentation, our aim is to increase the awareness of prescribers about the risk of developing low phosphate levels after Ferinject and the need to monitor serum phosphate levels.