Systemic loxoscelism leading to autoimmune haemolytic anaemia in a healthy young adult.

The brown recluse spider (Loxosceles reclusa) is endemic to the southcentral Midwest and the Southern United States. A bite from a brown recluse spider may result in symptoms that range from local skin necrosis to systemic complications such as acute haemolytic anaemia, disseminated intravascular coagulopathy, rhabdomyolysis and death. Although rare, systemic loxoscelism is a clinical diagnosis of exclusion that should be considered in a patient with acute autoimmune haemolytic anaemia. We describe a case of a young man with autoimmune haemolytic anaemia secondary to systemic loxoscelism successfully treated with intravenous immunoglobulin and steroids.

Eighteen-year-old man with syncope with Helicobacter pylori as the culprit: a case report.

Helicobacter pylori (H. pylori) is amongst the most common chronic bacterial infection in humans. Pediatric patients appear to differ from their adult counterparts in terms of the prevalence, the complication rate, and the rate of antibiotic resistance. In this report, we present an 18-year-old man without any past medical history who was evaluated after an episode of syncope. Evaluation revealed a case of chronic H. pylori gastritis leading to gastrointestinal (GI) bleeding and weight loss, and his syncope was the byproduct of symptomatic anemia and physical exertion. Pediatricians should think of peptic ulcer disease (PUD) in evaluating poor weight gain/feeding in younger patients, and abdominal pain in older patients. Early diagnosis can prevent complications such as perforation, bleeding and obstruction. Endoscopy is the gold standard of diagnosis for H. pylori infection. Noninvasive testing with urease breath test and stool antigen test is reserved for post-treatment testing only. Treatment consists of a 14-day course of a proton-pump inhibitor (PPI) and amoxicillin. A third agent, either clarithromycin or metronidazole, is added depending on regional resistance patterns. Testing for eradication at least 4 weeks later is recommended. This case serves as a reminder to primary care providers to be aware of H. pylori infection, diagnosis, treatment and complications.

Bartonella endocarditis in patients with right ventricle-to-pulmonary artery conduit: 2 case reports and literature review.

Bartonella species are Gram-negative bacilli and fastidious bacteria that can cause a number of clinical syndromes, including blood culture-negative infective endocarditis (IE). The two most commonly isolated species in humans are Bartonella quintana, the agent of trench fever, and Bartonella henselae, mostly known for causing cat scratch disease (Edouard et al., 2015 [1]; Edouard and Raoult, 2010 [2]). Both species also cause bacillary angiomatosis, primarily in immunocompromised patients (Edouard et al., 2015 [1]; Fournier et al., 2001 [3]). The risk of B. henselae IE is increased in patients with cardiac valvular disease and congenital heart disease (CHD) (Edouard and Raoult, 2010 [2]; Das et al., 2009 [4]; Abandeh et al., 2012 [5]; Ouellette et al., 2016 [6]; Hoffman et al., 2007 [7]; Georgievskaya et al., 2014 [8]). In this article, we detail two cases of Bartonella IE in patients with right ventricle-to-pulmonary artery (RV-PA) conduits who presented to our institution. We also perform a literature review on Bartonella IE in patients with a history of RV-PA conduit or pulmonary valve replacement.

Altered mental status and pronounced febrile response after second mRNA-1273 (Moderna) COVID-19 vaccine administration in a patient with previously documented COVID-19 infection.

A 54-year-old man who was previously found to be COVID-19 positive received two doses of mRNA-1273 (Moderna) vaccine 4 weeks apart, as recommended by the manufacturer. He was brought to the emergency department 1 day after second dose of the vaccine with altered mental status, headache and high fever. The patient was hospitalised for 2 days and managed with supportive care. He completely recovered with return of mental status to baseline and resolution of fever.

Meningitis secondary to disseminated gonococcal infection.

We report one of the unusual presentations of disseminated gonococcal infection. This case report describes a 24-year-old woman who presented with disseminated gonococcal infection manifesting as meningitis. Cerebrospinal fluid (CSF) and throat swab PCR were positive for Neisseria gonorrhoeae Blood and CSF cultures were negative for bacterial growth. The patient was treated with a total of 14 days of intravenous ceftriaxone. She was discharged with no neurological sequelae.