ABSTRACT
There are many microvascular and macrovascular complications regarding uncontrolled diabetes mellitus (DM). Among them, diabetes myonecrosis is one of the complications but rarely seen in the uncontrolled DM patient population. Here, we present a rare case of DM myonecrosis in a patient with elevated hemoglobin A1c (HbA1c) of 18.2% and discuss the literature review of diabetes myonecrosis. A 48-year-old male with hypertension and uncontrolled type 2 diabetes mellitus (T2DM) with hemoglobin A1c of 18.2% presented with progressive swelling and pain in the right thigh for two days. Physical examination demonstrated swollen and tense tender right thigh with a circumference five inches larger than the left. Computed tomography (CT) and magnetic resonance imaging (MRI) results revealed severe myositis of the right leg, likely myonecrosis, and associated fascial edema/fasciitis. The patient was also complicated with diffuse anasarca, which was corrected with albumin transfusion and furosemide. Aspirin and lisinopril were also started for antithrombotic and cardioprotective effects. The right thigh swelling improved, and the patient could ambulate with supportive measures and regular physical therapy (PT). He was discharged home after 45 days of hospitalization. Diabetic myonecrosis is a rare condition and hence is underdiagnosed. In patients with uncontrolled diabetes, especially with diabetic complications, physicians should have high clinical suspicion to diagnose diabetic myonecrosis when patients present with an acute unilateral painful swollen limb. Our case highlights the complicated course of diabetes myonecrosis with anasarca, improved with supportive measures.
ABSTRACT
Severe endocrinopathies can lead to pancytopenia. Hypothyroidism can affect any organ system including hematopoietic, resulting mainly in a normochromic normocytic anemia. Rarely, in severe hypothyroidism, all hematopoietic cell lines can be affected, resulting in pancytopenia. We, hereby, would like to discuss a case of hypothyroidism with worsening pancytopenia, which gradually improved after repletion with levothyroxine. Although pancytopenia is not a common feature of hypothyroidism, this case highlights the importance of hypothyroidism being considered as one of the differentials.
ABSTRACT
Background: The exercise stress test is widely used as a diagnostic test for evaluating coronary artery disease in symptomatic patients or those with underlying cardiovascular disorders. Although exercise stress test risk is minimal with a <1% chance of causing heart block, physician awareness of potential complications is paramount for prompt recognition and treatment. Case Report: A 65-year-old-female with angina-like chest pain underwent an exercise stress test for ischemic heart disease evaluation. She performed the exercise stress test up to stage 2 (exercise Bruce protocol) with an exercise duration of 5 minutes and maximum metabolic equivalents of 7. During her recovery phase, the patient developed atrioventricular dissociation with junctional rhythm followed by syncope. Immediate treatment was administered, including intravenous normal saline, and she recovered without any complications. Conclusion: This case reminds clinicians to be aware of the unpredictable effects of the exercise stress test even though atrioventricular dissociation after an exercise stress test is rare. Providing immediate treatment to prevent any untoward effects is essential.
ABSTRACT
Digoxin is rarely used in modern cardiovascular disease management. Therefore, digoxin toxicity has been infrequently encountered and it is paramount to diagnose in a timely fashion. Bidirectional ventricular tachycardia is an unusual arrhythmia wherein every other beat has a different QRS axis as it travels alternately down different conduction pathways. The arrhythmia can be a manifestation of myocarditis, myocardial infarct, Andersen-Tawil syndrome, arrhythmogenic right ventricular cardiomyopathy, catecholaminergic polymorphic ventricular tachycardia, herbal aconite poisoning, and digoxin toxicity. This case illustrates the importance of clinician awareness of rare electrocardiogram (EKG) patterns of digoxin toxicity and visual resolution of fatal arrhythmia with timely treatment.
ABSTRACT
The occurrence of diabetes is increasing globally and carries a variety of complications, such as thromboembolism, acute cerebrovascular accidents, and diabetic ketoacidosis (DKA). Although DKA is not commonly associated with type 2 diabetes (T2D), it can manifest in patients who have underlying comorbidities predisposed to DKA. Since the emergence of the coronavirus disease (COVID-19) pandemic, we have seen many cases and studies on the underlying pathophysiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia with or without respiratory failure. We have also learned that the angiotensin-converting enzyme receptor is one of the major entry sites of SARS-CoV-2 infection, and it might be one of the causes that predispose patients to DKA. However, few studies exist that explore the development of DKA in T2D with SARS-CoV-2 infection. We present two cases of patients with DKA and COVID-19 treated with an insulin regimen with no further complications.
ABSTRACT
Cocaine has been used increasingly nowadays because of its abundant availability and recreational effects. Along with that, we have been experiencing many cases presenting with cocaine intoxication and withdrawal effects, including hypertension and chest pain syndrome. In the modern era, many medical advances related to myocardial infarction treatment have been made, including not only medical therapy but also urgent or emergent reperfusion, and revascularization therapies. In percutaneous coronary revascularization therapy, a second-generation drug-eluting stent (DES) with dual antiplatelet therapy is the first-line treatment compared to bare-metal stent (BMS) with significant reduced risk of stent thrombosis and restenosis. However, there is limited clinical and research data on how to approach cocaine-induced myocardial infarction (CIMI) and it remains unclear what would be the optimal stent type we should use in CIMI. We, hereby, would like to describe a case of cocaine-related ST-segment elevation myocardial infarction (STEMI) requiring emergent percutaneous coronary intervention with a DES and clinical outcome. We also performed a literature review of cocaine-induced acute myocardial infarction management.
