Anagrelide-induced pericardial effusion in a patient with essential thrombocythemia.

Pericardial effusion leading to cardiac tamponade can occur due to a multitude of etiologies, one of which is medication adverse effects. In patients with comorbid conditions, this can prove to be a challenge in its co-management along with the primary disease. We present a rare case of anagrelide-induced pericardial effusion that is presented with tamponade physiology in a patient with essential thrombocythemia. After cautiously weighing the risks and benefits of further invasive interventions following an unsuccessful pericardiocentesis, the decision was to stop anagrelide while managing the pericardial effusion medically. Therefore, managing pericardial effusion should be tailored to each patient individually through shared decision-making.

Chronic skin ulcers in hemodialysis patient: A fatal case of calciphylaxis.

Calciphylaxis is a rare and deadly vascular disease with poorly understood pathophysiology and without definitive treatment. Early presentations include skin ulcers with risk factors including end stage renal disease on hemodialysis, hypertension, hyperlipidemia, and diabetes mellitus. In our case, we present an 80-year-old female with multiple risk factors including hemodialysis and clinical features of necrotic and gangrenous skin lesions diagnostic of calciphylaxis who became hemodynamically unstable and ultimately expired secondary to toxic sequelae. We illustrate this case to explore early clinical presentation, limitations of current disease management and treatments, and the role for further studies to improve diagnosis and reduce mortality.

Delayed doxorubicin induced cardiomyopathy in a breast cancer patient: A case report.

Heart failure (HF) is a clinical syndrome with a wide spectrum of presentations and an even wider array of etiologies. Anthracyclines such as Doxorubicin, Daunorubicin, Idarubicin, and Epirubicin have demonstrated increased risk of HF with significant morbidity and mortality. We present an interesting case report of a patient with a history of breast cancer treated with Doxorubicin who presented with symptoms of HF who had a comprehensive evaluation that excluded the most common etiologies, narrowing our diagnosis to late onset doxorubicin induced HF with on-going recovery after initiation of guideline-directed medical therapy.

A Fatal Case of Massive Verapamil Overdose: An Overview of the Treatment Options.

Calcium channel blocker overdose is usually very fatal and challenging to manage. The patients are usually asymptomatic on admission, but deteriorate very rapidly. Currently, there is no specific antidote, and the treatment is supportive requiring high level of critical care, and may necessitate extracorporeal membrane oxygenation. The use of high-dose insulin is reported to help stabilize the blood pressure and wean off inotropes. The recommendations for supportive treatment in patients with calcium channel blocker overdose are based upon low-quality evidence reports including case series and animal studies. We present the case of a 55-year-old male with a history of atrial fibrillation who was admitted to the hospital 30 min after intentionally ingesting 80 tablets of 180 mg extended release verapamil. On admission, the patient was asymptomatic, but electrocardiogram (ECG) showed a complete heart block which necessitated a transcutaneous pacing, followed by transvenous pacemaker placement. Rapid deterioration of the patient's hemodynamic status led to the patient getting intubated and was started on pressors as well as high-dose insulin. Despite all the aggressive measures, the patient died in less than 24 h after being admitted. We report this case to provide a brief review of the treatment options available at this time, because to date, there is no specific antidote for such overdose, and it remains very fatal despite the amount of supportive care provided.