ABSTRACT
Fever is one of the most commonly seen presentations in intravenous drug abusers. "Cotton Fever" is a benign condition, unrecognized among the medical community. It is characterized by a systemic inflammatory response syndrome occurring within minutes of intravenous (IV) drug use. Patients present to tertiary-level care settings with fever, chills, gastrointestinal symptoms, shortness of breath, and chest pain. We present the case of a 46-year-old Caucasian male who presented with lightheadedness, chest pain, and gastrointestinal symptoms after using IV methamphetamine. On physical examination, he was disoriented, tachycardic, and had a fever of 102.8°F. He did not have any Osler nodes, Janeway lesions, or splinter hemorrhages. Diagnostics showed leukopenia with neutropenia, lactic acidosis, and elevated creatine kinase. Blood cultures did not grow any organisms. The patient was admitted to the intensive care unit and treated with IV fluids and broad-spectrum antibiotics. His condition improved rapidly and the patient left against medical advice (AMA). The toxic appearance of patients presenting with cotton fever often causes panic among clinicians, resulting in an extensive diagnostic workup, exhaustion of hospital resources, and overprescription of antibiotics. Due to the lack of knowledge about this condition among healthcare practitioners and the tendency of these patients to leave AMA, an appropriate management strategy remains unrecognized. Our case aims to bring awareness about this condition to help guide patient-directed care, reduce the use of healthcare resources, and establish prevention strategies in the community.
ABSTRACT
This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I² = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I² = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I² = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I² = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.
ABSTRACT
BACKGROUND Convexal subarachnoid hemorrhage (cSAH), a rare form of non-aneurysmal subarachnoid hemorrhage, is confined to cerebral convexities without extension into basal cisterns or ventricles. Typical presentation includes thunderclap/progressive headache or transient focal neurological symptoms; rare manifestations include seizures, intractable vomiting, or altered mental status. Here, we report the first case of convexal subarachnoid hemorrhage and multifocal ischemic lesions caused by infective endocarditis (IE) in a treatment-naïve advanced HIV patient. CASE REPORT A 52-year-old HAART-naïve, HIV-positive, African American man presented with altered mental status, shortness of breath, nonproductive cough, and generalized weakness. His past medical history was significant for congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (noncompliant with hemodialysis). Head computed tomography (CT) showed an isolated sulcal hemorrhage in the mid-left frontal lobe. Fluid-attenuated inversion recovery/gradient recalled echo sequences confirmed a hemorrhage in the left-mid-frontal sulcus, and diffusion-weighted imaging revealed multifocal bilateral ischemic lesions. Transesophageal echocardiography exhibited mitral valve vegetations. Multifocal ischemic lesions and cSAH caused by infectious endocarditis were confirmed. Initiation of intravenous vancomycin and piperacillin-tazobactam allowed the patient to have resolution of his altered mental status. A head CT 5 days later revealed the resolution of cSAH. CONCLUSIONS Infective endocarditis should be considered as an underlying etiology of cSAH, especially when present with multifocal ischemic lesions. Risk factors contributing to the development of cSAH in the IE patient population should be explored in future studies. HIV has not been previously reported in this subgroup and its prevalence should be considered. The prognosis for cSAH in relation to IE is generally favorable.
