An Unusual and Rare Presentation of Pulmonary Aspergillosis: Endobronchial Aspergilloma.

Aspergillosis is a wide spectrum of the disease process that is caused by the fungus Aspergillus. Endobronchial aspergilloma is a very rare type of aspergillosis which is not yet included in the classification of aspergillosis. Due to its rare nature and a limited number of cases, there are no current treatment guidelines. Here we present the case of a 57-year-old female with an endobronchial aspergilloma. The patient was started on intravenous voriconazole and subsequently discharged on oral voriconazole.

ST-Elevation Myocardial Infarction in a 27-Year-Old Male With COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that led to a global public health emergency causing coronavirus disease 2019 (COVID-19). It was initially identified in Wuhan, China after causing significant respiratory illness. Although respiratory symptoms are the most common presenting symptoms, it is now recognized that COVID-19 encompasses multiple organ systems including the cardiovascular system. Acute myocardial injury and ST-elevation myocardial infarction (STEMI) have now been associated with COVID-19. COVID-19 patients with cardiovascular manifestations are at risk for increased severity of illness. Here we present a case of a very young 27-year-old patient without any past history of hypertension, coronary artery disease, or any risk factors for coronary artery disease except obesity, who developed STEMI while in the hospital.

Cardiac Arrhythmia Secondary to Loperamide Abuse and Toxicity.

Loperamide is a synthetic, over-the-counter, antidiarrheal medication that is widely available and used for the treatment of diarrhea. It is a peripherally acting opioid agonist acting mostly on the µ-opioid receptors in the gut. It was thought to be a very safe medication up until very recently, as the bioavailability of the drug is very low. At significantly higher doses, it is able to cross the blood-brain barrier and mimic the effects of centrally acting opioids. However, at these significantly high doses it also leads to significant cardiotoxic consequences. Here we present a case of a 31-year-old male with significant cardiotoxicity secondary to misuse and abuse of loperamide.