Spontaneous facial hematoma induced by vitamin K antagonist therapy: a rare case report.

The benefits of anti-vitamin K drugs have been demonstrated in several indications; however, it is always counterbalanced by an increased risk of bleeding, that can occur in different areas. Facial hematoma is a rare bleeding complication to our knowledge, this is the first report of a rapidly expanding atraumatic facial hematoma secondary to vitamin K antagonist over coagulation. Case Presentation: The authors report the case of an 80-year-old woman with a medical history of hypertension, and pulmonary embolism after 15 days of immobilization following a hip fracture treated surgically 3 years earlier, who has been on vitamin K antagonist therapy since then, without any follow-up, came into our emergency department complaining of a sudden onset of progressive left facial swelling for one day, and vision loss in her left eye. Her blood investigations revealed a high international normalized ratio of prothrombin up to 10. A computed tomography scan exposing face, orbit, and oromaxillofacial area objectived spontaneously hyperdense collection in the left masticator space suggestive of an hematoma. An intraoral incision was done by oromaxillar surgeons, and drainage were performed with a favorable evolution. Clinical Discussion: In this mini review, the authors aim to describe this rare complication and to insist on the necessity of regular follow-up with international normalized ratio values and early warning signs of bleeding to prevent such fatal complications. Conclusion: Immediate recognition and management of such complication is very important to avoid complications.

Uncommon ascaris induced eosinophilic myocarditis simulating acute coronary syndrome without ST segment elevation: A case report.

Introduction: and importance: Ascaris lumbricoides is a nematode parasite that causes ascariasis. Cardiac involvement in ascariasis is uncommon and rarely reported in the literature. Case presentation: We present the case of 45 years-old man, with previous medical history of ascaris infection one week before his admission to the emergency department for acute chest pain. The electrocardiogram revealed ST-segment and T wave abnormalities in septo-apico-lateral and inferior leads, along with high levels of troponin T and eosinophil blood cells count, while transthoracic echocardiography showed lateral and inferior walls motion abnormalities. The diagnosis of myocardial infarction was made and an urgent coronary angiography was carried out revealing normal coronary arteries which redressed the diagnosis and supported ascaris induced eosinophilic myocarditis (EM). The patient was put under anthelmintic drugs with favorable clinical, biological and imaging evolution. Clinical discussion: Eosinophilic myocarditis may present with variable and misleading scenarios ranging from asymptomatic patients to cardiogenic choc and sudden death and in some cases with clinical presentation of acute coronary syndrome. Conclusion: The aim of this work was to increase recognition of EM in the light of this clinical case report of ascaris lumbricoides associated myocarditis simulating an acute coronary syndrome without ST segment elevation.

Peripartum cardiomyopathy: alluring challenge - case series and review of literature.

Peripartum cardiomyopathy (PPCM) is a rare disease responsible for heart failure that usually occurs in the last month of pregnancy or within five months postpartum, without any other known cause. A case series of five PPCM patients admitted at the Department of Cardiology of the University Hospital Mohammed VI of Oujda, Morocco, between 2017 and 2019. All cases were represented by young (case 1: 35-year-old; case 2: 28-year-old; case 3: 30-year-old; case 4: 36-year-old; case 5: 34-year-old). All patients were multiparous who were admitted to our department with a severely reduced left ventricular ejection fraction. Case 1 and 4 were admitted 3 days after delivery for heart failure. Case 2 was admitted for cardiogenic shock after 3 months of delivery. Case 3 was admitted twelve days after delivery for acute heart failure with pulmonary embolism and multiple venous thrombosis. Case 5 had a history of PPCM was admitted for cardiogenic shock with a course marked by recurrent thromboembolic events. Case 1 and 2 responded to treatment at an early stage, case 4 has evolved to chronicity, the third patient died from an unclear cause, and the fifth patient died from a contraindicated pregnancy leading to the recurrence of fatal thromboembolic events. Above reported cases confirming the great heterogeneity in clinical presentation and course of peripartum cardiomyopathy and seems to confirm that a delayed diagnosis, as well thromboembolic complications are bad prognosis factors of these patients. Early diagnosis, multidisciplinary collaboration, prompt treatment of heart failure and continued monitoring are the keys to improve maternal survival.

Spontaneous massive pectoral hematoma induced by vitamin K antagonist therapy: a case report.

Vitamin K antagonists (VKA) based oral anticoagulation, is widely used for the prevention and treatment of thromboembolic disease. The major complication of this therapy is bleeding, and sometimes it can occur in unsuspected areas. Spontaneous pectoral hematoma is one of the rare complications due to over anticoagulation by VKA therapy, with only a few cases reported in the literature. Concomitant use of this therapy with commonly used antibiotic, especially in the elderly with multiple comorbidities, can increase the risk of bleeding. Herein, we report a case of a 72-year-old woman under VKA for the treatment of atrial fibrillation, who presented with a spontaneous massive pectoral hematoma, while using antibiotic to treat a respiratory tract infection, who was successfully managed.