Estrogen-Eluting Ring for Contraception and Possible Issues of Severe Pulmonary Emboli.

BACKGROUND This case report demonstrates the relationship of an estrogen-eluting vaginal ring and thrombosis. There have been multiple reports in the literature demonstrating this scenario, but it is normally found that the patient is taking the medication orally. In this unique report we present the case of a patient with an acute severe pulmonary embolus while using an estrogen-eluting vaginal ring, with no other significant risk factors. CASE REPORT A 27-year-old African American woman who came to the Emergency Department due to new shortness of breath and tachycardia. She was discovered to have a pulmonary embolus found on CTA pulmonary. On further questioning, the patient noted using an estrogen-eluting ring for contraception. CONCLUSIONS We postulate that her use of this estrogen-eluting ring likely played a large part in her developing a pulmonary embolus, as this patient had little to no risk of developing a pulmonary embolism.

Bilateral Spontaneous Pneumothorax in a COVID-19 and HIV-Positive Patient: A Case Report.

This case report describes a 60 year-old Black-American male with a past medical history of human immunodeficiency virus (HIV) infection and hyperthyroidism, who suffered a bilateral spontaneous pneumothorax (SP) in the setting of coronavirus disease 2019 (COVID-19) pneumonia. SP is a well-established complication in HIV-positive patients and only recently has been associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. While HIV and COVID-19 infections have been independently linked with increased risk of SP development, it is unknown if both infections interact in a synergistic fashion to exacerbate SP risk. According to the Centers for Disease Control and Prevention (CDC), patients living with HIV have a higher risk of developing severe COVID-19 infection and the mechanism remains to be elucidated. To the best of our knowledge, this is the first report of a HIV-positive patient, who in the setting of SARS-CoV-2 infection, developed bilateral apical spontaneous pneumothorax and was later found to have a left lower lobe tension pneumothorax. This case highlights the importance of considering SP on the differential diagnosis when HIV-positive patients suddenly develop respiratory distress in the setting of SARS-CoV-2 infection.