Spontaneous haemorrhagic cholecystitis secondary to the use of novel anticoagulants (rivaroxaban).

Haemorrhagic cholecystitis is a rare complication of acute cholecystitis. It carries a high risk of morbidity and mortality. Risk factors for haemorrhagic cholecystitis include cholelithiasis, trauma, malignancy and the use of anticoagulants. There have only been a few reported cases of haemorrhagic cholecystitis secondary to the use of novel oral anticoagulants (NOACs). The demographic transition of an ageing population will potentially increase the utilisation of NOACs. Therefore, the incidence of haemorrhagic cholecystitis secondary to NOACs will likely increase. Awareness and prompt diagnosis is paramount to avoid morbidity and mortality associated with haemorrhagic cholecystitis.

A man with culture sterile cavitating lung lesions: molecular techniques can provide the key to diagnosis.

A 20-year-old male presented to the Emergency Department with pyrexia, dyspnoea, chest pain and haemoptysis. Cavitating lung lesions were noted on chest X-ray and the patient was admitted to the intensive care unit where he was intubated and ventilated. Routine investigations including serial cultures did not provide an aetiological diagnosis. As such, a CT-guided lung biopsy was carried out and 16S rDNA PCR was undertaken on the sample. This identified Fusobacterium necrophorum as the causative organism. The patient was treated for Lemierre's syndrome and successfully discharged from hospital. This case highlights how DNA tissue typing on a lung biopsy sample can be the key to successful diagnosis in an atypical pneumonia and raises the question as to whether this infrequently used approach should be added to forthcoming community acquired pneumonia guidelines.

Persevering With Prone Ventilation in Coronavirus Disease 2019 Pneumonia.

As well as placing unprecedented demands on resources and staff involved in the care of these patients, there has been significant uncertainty regarding the optimal management of patients with coronavirus disease 2019 pneumonia. Randomized controlled trials have shown clear benefits of both neuromuscular blockade and prone positioning in treating moderate to severe acute respiratory distress syndrome, as defined by the Berlin Criteria. CASE SUMMARY: We present a case of a 53-year-old patient with a severe coronavirus disease 2019 pneumonia who has made a remarkable recovery following a turbulent period on intensive care. During his stay, he was prone positioned on 16 consecutive occasions and is an exemplar of the many patients we treated who benefited considerably from this intervention. CONCLUSION: We believe that sustained administration of prone position ventilation was instrumental in saving his life. While there is associated morbidity, we encourage clinicians to continue with this strategy beyond their normal practice.