Case Report: Dilated cardiomyopathy with biventricular thrombus secondary to impaired coagulation in a patient with HIV.

Human immunodeficiency virus (HIV) infection is a known hypercoagulable state with venous thromboembolism with a high mortality rate compared to the general population. The homeostatic balance in HIV infected patients improves with treatment compared to those who are not.  A decreased hypercoagulable state noted by low levels of Von Willebrand factor, factor VIII and d-dimer levels along with higher protein C and S activity in patients on treatment suggests that hypercoagulable state is partially correctable with highly active antiretroviral therapy.  HIV with heart muscle involvement can present as myocarditis or as dilated cardiomyopathy with left or right ventricular dysfunction.  Here we present a case of a 57-year-old man with a known history of HIV infection, noncompliant with medical therapy presenting with dilated cardiomyopathy with biventricular thrombi with reduced protein C, protein S, and Antithrombin III levels.

Co-infection with Influenza A and COVID-19.

COVID-19, also called severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), originated in Wuhan, China. It has caused significant morbidity and mortality worldwide and has been declared a global pandemic by the WHO. Influenza occurs mainly during the winter, with the burden of disease determined by several factors, including the effectiveness of the vaccine that season, the characteristics of the circulating viruses, and how long the season lasts. We describe the case of a 66-year-old woman who was diagnosed with influenza A and COVID-19 co-infection. LEARNING POINTS: COVID-19 can co-occur with other viral infections.Some of these co-infections have active treatments, while supportive treatment is the mainstay of treatment for others.

Association of Autoimmune Hashimoto's Thyroiditis with Systemic Lupus Erythematosis.

SLE (systemic lupus erythematosus) can be associated with other autoimmune disorders with overlapping clinical symptoms. We present a case of a 22-year-old male with recurring exertional dyspnea, chest pain, dry cough and chills, which on further testing revealed large pericardial effusion and bilateral pleural effusions along with laboratory abnormalities consistent with a diagnosis of overlap of SLE with serositis and Hashimoto's thyroiditis. SLE patients with underlying hypothyroidism are slow to respond to standard therapy unless the underlying hypothyroidism is adequately treated.

Yield of computed tomography pulmonary angiogram in the emergency department in cancer patients suspected to have pulmonary embolism.

OBJECTIVE/BACKGROUND: The use of computed tomography pulmonary angiography (CTPA) in the emergency department (ED) for patients suspected to have pulmonary embolism (PE) has been steadily rising in the last 2decades. However, there are limited studies that specifically address the use of CTPA in the ED for cancer patients suspected to have PE. The objective of this study is to assess the rate of positive PE by CTPA in the ED in cancer patients and the variables that are associated with positive results. METHODS: A retrospective review of electronic medical records for 208 consecutive patients with cancer who presented to the ED and received a CTPA for suspected PE over a 12-month period. The review included demographics, type and status of cancer, presenting symptoms, CTPA results, calculation of Wells Score, management based on CT findings, and outcome of patients. RESULTS: Among the 208 patients who met the inclusion criteria during our study period (mean age 57±13.37years, 73% women, 59% African American, and 32% Caucasians), 5.7% were diagnosed with PE. One hundred and eighty-two (83.7%) had a Wells Score ⩽4, of which 2.2% were found to have to have PE, 22 (16.3%) patients had a Wells Score >4, of which 36.4% were found to have PE (p<.0001). Sensitivity and specificity of Wells >4 was 66.7% and 92.9%, respectively, with an odds ratio of 27 (95% CI 6.6-113.6). Receiver operator characteristics area under the curve for Wells Score was 0.868. Age, race, sex, malignancy type, stage, status, clinical presentation, D-dimer, and a previous history of venous thromboembolism were not found to have statistically significant predictive values. CONCLUSION: The yield of CTPA to rule out PE in patients with cancer presenting in the ED is low. Following a validated decision-making protocol such as Wells Criteria may significantly decrease the number of CTPA used in the ED.