A Rare Case of Peritoneal Dialysis-Associated Peritonitis Caused by Neisseria sicca.

Peritonitis is a critical complication in peritoneal dialysis, often leading to peritoneal dialysis (PD) treatment failure. We present a rare case of Neisseria sicca (NS)-related peritonitis in a 47-year-old male with multiple comorbidities. Despite NS's infrequent association with infections, prompt diagnosis and antibiotic therapy based on International Society for Peritoneal Dialysis (ISPD) guidelines led to a favorable outcome. This case emphasizes identifying uncommon pathogens in immunocompromised individuals and highlights the importance of prompt treatment to prevent morbidity.

Large Coronary Cameral Fistula to the Left Ventricle Presenting as Congestive Heart Failure.

A 56-year-old African American female was under evaluation for coronary artery disease by a cardiologist due to her complaints of intermittent chest pain. She underwent an outpatient echocardiogram and was found to have an ejection fraction of 20-25% with global left ventricular hypokinesis. Due to this finding along with her ongoing chest pain, she was referred to the emergency department for further evaluation. Her electrocardiogram showed changes suggestive of ischaemia and her cardiac troponins were mildly elevated, so she underwent an urgent cardiac catheterisation. The angiography confirmed the reduced ejection fraction and global left ventricular hypokinesis, but also demonstrated a large coronary cameral fistula (CCF) extending from the first septal branch into the left ventricle. She was then diagnosed with non-ischaemic cardiomyopathy and heart failure with reduced ejection fraction secondary to the CCF. In this report, we illustrate a frequently encountered clinical scenario in which a patient presented with chest pain and EKG findings indicative of ischaemic cardiomyopathy. The patient also had several risk factors for coronary artery disease, however further investigation revealed an alternative diagnosis. LEARNING POINTS: A description of rare coronary anomalies adds to the fund of medical knowledge and can guide physicians to make evidence-based decisions regarding its management.Increasing description of coronary cameral fistula will alert clinicians to suspect it as a cause for worsening heart failure and as a treatable cause of non-ischaemic cardiomyopathy.

Painless Aortic Dissection with Catastrophic Consequences Presenting as Sudden Loss of Consciousness with no Prodromal Symptoms.

This case report presents a complex clinical scenario involving a 71-year-old female with aortic dissection accompanied by hypotension. The patient's initial presentation of sudden loss of consciousness unveiled a large pericardial effusion and cardiac tamponade, leading to emergency surgery. Subsequent diagnostic findings revealed an intramural haematoma with an intimal tear in the ascending aorta. Postoperatively, the patient experienced an ischaemic stroke, necessitating prompt neurology consultation and treatment. This report underscores the significance of early recognition and collaborative management in achieving positive patient outcomes. LEARNING POINTS: Early identification of aortic dissection symptoms, such as sudden loss of consciousness and hypotension, is crucial for effective management.Managing aortic dissection involves a multidisciplinary effort with emergency medicine, cardiology and surgical teams working together for optimal patient outcomes.After aortic dissection surgery, staying attentive to potential neurological complications such as ischaemic strokes is essential.