RESUMO
Elevated troponin levels have been observed in a wide spectrum of patients who do not have ischemic heart disease, including nonacute coronary syndrome and cardiovascular and noncardiovascular conditions. The cases of two patients with diabetic ketoacidosis who had elevated troponin levels in the absence of coronary artery disease are presented. This clinical scenario can pose a diagnostic dilemma for the physician. The objective of the present report is to highlight the mechanism of troponin elevation in patients with diabetic ketoacidosis, in addition to the clinical and prognostic significance of this finding.
RESUMO
Pyomyositis is an acute or sub-acute primary infection of the striated muscles. It is commonly misdiagnosed in its early stages due to its nonspecific presentation and lower suspicion among physicians when it comes to diagnosis. It has been historically associated with tropical climates but is being seen with increasing incidence in temperate regions. In both tropical and temperate areas, Staphylococcus aureus is the most common causative organism; gram-negative organisms are rare and traditionally only seen in immunocompromised patients. We report a case of Klebsiella pneumoniae pyomyositis in an immunocompetent patient with no risk factors. The awareness of the possibility of gram-negative pyomyositis in immunocompetent patients will broaden initial empiric antibiotic treatment, especially in those patients not responding to traditional empiric treatment.
RESUMO
Factor X deficiency is the most common coagulation factor deficiency amongst patients with AL amyloidosis. It presumably occurs due to adsorption of factor X to amyloid fibrils. The deficiency of this factor, in conjunction with other hemostatic defects, can cause bleeding complications. A case of acquired factor X deficiency due to AL amyloidosis is reported, where abnormal coagulation parameters were the only presenting feature.
