Organizing Pneumonia Following Recombinant Zoster Vaccination: A Rare Adverse Reaction.

We describe a case of a severe but rare adverse reaction to recombinant varicella-zoster virus (VZV) vaccination: a 67-year-old female admitted with gradual onset of shortness of breath, hypoxia, and fever following VZV vaccination. The clinical picture and radiologic presentation mimicked COVID-19 pneumonia. However, repeated testing for COVID-19 by PCR was negative. A diagnosis of organizing pneumonia was made on transbronchial biopsies. The patient responded well to steroids and improved both clinically and radiographically. This case illustrates not only a rare and unreported complication from vaccination but also raises the awareness during the COVID-19 pandemic that other etiologies can mimic COVID-19 pneumonia. Physicians should be aware of other diagnoses that can mimic COVID-19 infection.

Acute Pancreatitis Induced by Polatuzumab-Vedotin-Piiq in Combination With Bendamustine and Rituximab for Diffuse Large B-Cell Lymphoma.

While alcohol and gallstones have been considered the most common causes of pancreatitis, we investigate two uncommon etiologies such as drug-induced and viral-induced. Pancreatitis, an inflammatory process, can lead to many complicated outcomes such as acute respiratory failure, sepsis, and death. Examining drug-induced pancreatitis poses a large challenge for physicians as majority of the data is extrapolated from case reports. This is made even more difficult for patients who are on large chemotherapeutic regimens which include multitude of drugs and various side effects. Besides patient medication regimens, other etiologies of pancreatitis must be ruled out such as viruses. We examine a case of a 48-year-old female undergoing treatment for diffuse large B-cell lymphoma with various chemotherapeutic agents and positive cultures for varicella zoster virus (VZV) presenting with diffuse epigastric abdominal pain.

Nasal myiasis in myasthenic crisis, a case report and literature review.

We are reporting a unique case of drosophila larva nasal myiasis (NM) in a 72-year-old male patient admitted to the ICU with diffuse muscle weakness and respiratory failure due to myasthenia gravis crisis and septic shock due to pseudomonas pneumonia. The myiasis was noticed on the third day of admission two days following traumatic insertion of a nasogastric tube. The patient underwent nasal endoscopic mechanical extraction and lidocaine nasal spray with saline nasal flushes. To our knowledge, this is the first case report of NM in a myasthenia gravis (MG) patient. Chronic muscle weakness in MG patients might play a role in having NM as these patients are less likely to be able to protect themselves from flies. Managing NM in our patient was challenging due to the potential neurologic side effects of most of treatment options mentioned in the literature.

A Case of Congenital Lymphedema Complicated by Chronic Chylous Effusions and Recurrent Pericardial Effusion Requiring Pericardial Window.

We are presenting a case of primary lymphedema (PL) complicated with a repeated need for thoracentesis and pericardiocentesis. Our patient is a 24-year-old male with primary lymphedema that is manifested in the left hand and right lower limb. The patient presented to the emergency department (ED) for recurrent right lower lobe cellulitis that had failed repeated attempts with outpatient antibiotic therapy. The patient was admitted to the intensive care unit due to signs of cardiac tamponade that were discovered on the physical examination. Pericardial tamponade was confirmed by echocardiography. The patient underwent thoracentesis and multiple pericardiocenteses and required a pericardial window. Pericardial and pleural fluids appeared milky and biochemical analysis was consistent with chylopericardium and chylothorax.

Pneumocystis Jirovecii (carinii) pneumonia causing lung cystic lesions and pneumomediastinum in non-HIV infected patient.

Pneumomediastinum is a rare, potentially life-threatening complication of PCP that occurs in HIV-positive and HIV-negative patients. We are presenting a rare case pneumomediastinum caused by pneumocystis Jirovecii pneumonia in a HIV-negative patient with history of diffuse B-cell lymphoma on R CHOP chemotherapy. What is unique about our case is that the patient developed pneumomediastinum while in the hospital, on atovaquone that improved when switched to clindamycin and primaquine with improvement in her respiratory status. Another interesting point is that diagnosis was entertained due to the characteristic CT scan finding of ground glass opacities with cystic lung lesions and pneumomediastinum in an immunocompromised patient who was started on empirical treatment for PCP. The diagnosis was eventually confirmed with PCP PCR.

Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion.

Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal.