Accidental Snapping of Right Ventricular Pacing Lead with MICRA.

Leadless Pacemaker implantation rates are increasing worldwide. These pacemakers have to be deployed, captured and redeployed in order to achieve optimal electric parameters. Various complications occur during this procedure. We herein report a unique case, where right ventricular (RV) pacing lead of the patient was accidently snapped with the tines during deployment of intracardiac pacemaker in an elderly male with pocket site infection.

Pneumocephalus Presenting as Sudden Thunderclap Headache.

Pneumocephalus is a rare condition characterized by the presence of gas within the cranial cavity. This gas arises either from a trauma, tumor, surgical procedure, or occasionally from infection. Pneumocephalus secondary to chronic otitis media is an extremely rare phenomenon. We describe here a 70-year-old male, a known case of chronic suppurative otitis media who presented with sudden onset severe thunderclap headache and was eventually diagnosed as pneumocephalus.

Oxcarbazepine induced toxic epidermal necrolysis - a rare case report.

Carbamazepine, is well known to cause Stevens-Johnson syndrome and toxic epidermal necrolysis(TEN). Oxcarbazepine, a 10-keto analog of carbamazepine, is an anticholinergic, anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy. Its efficacy is similar to carbamazepine but allergic reactions and enzyme induction is low. We describe a case of oxcarbazepine induced TEN, who presented with erythematous ulcerative maculopapular rash.

Shrinking lung syndrome in systemic lupus erythematosus-scleroderma overlap.

Shrinking lung syndrome (SLS) is a infrequently reported manifestation of systemic lupus erythematosus (SLE). Reported prevalence of SLS is about 0.5% in SLE patients. Pathogenesis is not fully understood and different therapeutic modalities have been employed with variable results, as only 77 cases of SLS have been documented in literature. SLS in SLE-Scleroderma overlap has not been reported yet. We report a patient of SLE - scleroderma overlap presenting with dyspnea, intermittent orthopnea and pleuritic chest pain. Evaluation revealed elevated hemidiaphragms and severe restrictive defect. She was eventually diagnosed as a case of SLS. This case report is a reminder to the medical fraternity that SLS although a rare complication must be thought of in the special subset of patients of SLE having respiratory symptoms.

Ceftriaxone induced drug rash with eosinophilia and systemic symptoms.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction commonly occurring in association with aromatic anticonvulsants and allopurinol. It is characterized by triad of fever, skin eruption, and systemic involvement. DRESS is rare with beta-lactam antibiotics and even rarer with ceftriaxone. We describe a case of pneumonia who developed ceftriaxone-induced rash, bicytopenia, eosinophilia, transaminitis and was eventually diagnosed and managed successfully as a case of DRESS.

All that seems sepsis is not sepsis.

Catastrophic antiphospholipid antibody syndrome (CAPS) resembles severe sepsis in its acute presentation, with features of systemic inflammatory response syndrome (SIRS) leading to multiple organ dysfunction. Infections are the best known triggers of CAPS. This emphasizes the need for early diagnosis and aggressive treatment as the mortality is as high as 50%. We present a 42-year-old woman who developed SIRS postoperatively and was eventually diagnosed as CAPS.

Ceftriaxone-induced hemolysis.

Immune hemolytic anemia is a rare adverse effect of ceftriaxone, a third-generation cephalosporin, which is a commonly used antibiotic. We describe a 60-years-old lady, a case of community-acquired pneumonia, who developed severe hemolysis after the first dose of ceftriaxone. Her hemoglobin dropped from 9.6 g /dl to 5.5 g /dl. However, she improved after discontinuation of the drug and blood transfusion. This report serves as a reminder to medical fraternity that life-threatening hemolysis can rarely follow administration of ceftriaxone.