A Large Lung Abscess in an Electronic Cigarette User: To Drain or Not to Drain.

A lung abscess is a walled necrotizing infection involving the lung parenchyma, characterized by a cavitary lesion filled with fluid. It is usually caused by microbial infection with aspiration of oropharyngeal contents being the most common mechanism for primary lung abscesses. Secondary lung abscesses occur in the presence of predisposing lung conditions like bronchial obstruction, vascular or septic emboli or impaired host defenses. Lung abscesses caused by electronic cigarette use have gained relevance in the recent years since the outbreak of EVALI, that is, e-cigarette or vaping product use-associated lung injury, in 2019. First-line therapy involves prompt initiation of antibiotics given their success rate in the treatment of lung abscess in the current potent antibiotic era. Percutaneous aspiration and catheter drainage is considered a second line approach due to concerns for potential complications including catheter blockage necessitating repeat procedures, pneumothorax, hemothorax, hemoptysis, need for surgical intervention, infection of pleural space and bronchopleural fistula. We describe a case of a 21-year-old female with a history of electronic cigarette use presenting with a large left upper lobe lung abscess (14.5 x 8.5 x 13.3 cm) treated successfully with broad-spectrum antibiotics alone resulting in clinical and radiologic improvement.

Transient Cardiomyopathy in a Patient With Coronavirus Disease-2019.

A 66-year-old male patient with coronavirus disease-19 (COVID-19) developed cardiogenic shock with echocardiographic evidence of decreased left ventricular ejection fraction and global hypokinesia concomitant with a robust systemic inflammatory response. Following the administration of convalescent plasma therapy and inotropic support, left ventricular function recovered fully in accordance with the decrease in the concentration of the inflammatory markers. Thus, we demonstrate the presence of transient reversible cardiomyopathy in a patient with severe COVID-19 and illustrate the association of acute cardiac dysfunction with profound systemic inflammation among COVID-19 patients.

Peripheral T-cell Lymphoma, Not Otherwise Specified: An Unusual Presentation of a Rare Lymphoma.

We present a case of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) masquerading as a skin rash which progressively worsened over a year. After being treated for various dermatologic and infectious etiologies, he did not feel any relief and presented to our hospital. Imaging showed generalized lymphadenopathy. Later, lymph node biopsy and skin biopsy confirmed the diagnosis of CD30 + peripheral T-cell lymphoma. He was soon started on chemotherapy with cyclophosphamide, doxorubicin, etoposide, vincristine, and prednisone (CHOEP). However, because of the aggressive nature of his disease and advanced stage at presentation, he succumbed to complications and died of sepsis.  This case highlights the importance of considering a rash as one of the early symptoms of an underlying life-threatening disease.