Non Hodgkin's lymphoma presenting with chest pain.

BACKGROUND: Non-Hodgkin's Lymphoma is a heterogeneous group of lymphoproliferative malignancies which can have differing patterns of behavior and clinical presentation. Unlike Hodgkin's disease, Non-Hodgkin's Lymphoma is much less predictable and has a far greater predilection for disseminating to extranodal sites. CASE REPORT: We offer a case of a 50 year old Caucasian male who presented with chest pain, and was ultimately diagnosed with follicular lymphoma by means of liver biopsy, in conjunction with immunohistochemistry. This malignancy grew at a rapid rate and over came our patient in a short period of time. The combination of a large tumor burden and cardiac infiltration made resuscitation extremely difficult when it became necessary, and this also made a positive outcome unlikely. CONCLUSIONS: It is rare for an immunocompetent patient to present with cardiac lymphoma without any previous signs and symptoms. Due to the rarity and the vague clinical presentation there must be a high degree of suspicion in order to diagnose cardiac lymphoma. As evidenced by this case time is of the essence to increase the likelyhood of survival in these patients.

Infective endocarditis of native valve after anterior nasal packing.

We present a case report of a patient who was previously treated for spontaneous epistaxis with a petroleum jelly gauze (0.5 in x 72 in) anterior nasal packing filled with an antibiotic ointment, along with prophylactic oral clindamycin. The patient presented with fever and hypotension 3 days after the nasal packing. Her blood cultures grew methicillin-resistant Staphylococcus aureus and the transesophageal echocardiography showed vegetation on the atrial surface of the posterior mitral valve leaflet, confirming the diagnosis of bacterial endocarditis attributable to nasal packing. Several case reports discuss toxic shock syndrome after nasal packing, but none describe endocarditis of the native heart valves subsequent to anterior nasal packing. Current guidelines on endocarditis prophylaxis produced by the American Heart Association, European Cardiac Society, and British Cardiac Society together with published evidence do not recommend endocarditis prophylaxis for patients with native heart valves undergoing anterior nasal packing.