A Rare Case of Anemia Secondary to Lice Infestation.

Lice are parasitic infections that can infect humans and survive by consuming host blood. They are most commonly associated with a lack of hygiene and occur most commonly in school-age children, homeless populations, and densely populated areas. Lice infections can potentially lead to vector-containing illness and are rarely complicated by acute blood loss anemia. These side effects, while exceedingly rare, are often very significant and potentially life-threatening. Here we present a rare case of severe anemia found in a patient with chronic lice colonization. We hope our findings will broaden the differential for acute anemias and raise awareness of lice infection as a possible cause of acute anemia.

A Rare Case of Junctional Bradycardia Secondary to Oral Phenytoin.

Phenytoin is a commonly used anti-seizure agent, which stabilizes neuronal membranes by blocking voltage-gated sodium channels to inhibit the propagation of action potentials during convulsions. However, phenytoin has also been shown to have antiarrhythmic effects as it can prolong the effective refractory period of ventricular pacemaker cells. Adverse cardiac effects such as junctional bradycardia are usually seen with intravenous use. Cardiovascular dysfunction is not well recognized in oral phenytoin toxicity. Here we present a case of junctional bradycardia due to oral phenytoin toxicity, which resolved spontaneously with the discontinuation of phenytoin. This case report will serve to increase awareness of the adverse cardiovascular effects of oral phenytoin toxicity to improve the recognition and treatment of these adverse effects.

A Rare Case of Dose-Dependent Losartan-Induced Angioedema.

Angiotensin converting enzyme inhibitors (ACE-Is) have long been associated with angioedema and cough. These complications are thought to be related to an increase in bradykinin levels. Angiotensin receptor blockers (ARBs) such as losartan, however, are not known to increase bradykinin levels and, therefore, this complication is not as widely recognized. However, there is a significant proportion of patients who develop angioedema on ARB medications after previous episodes of angioedema on ACE-I. Though there is increasing literature to support that the patients may develop angioedema while taking ARBs such as losartan, a dose-dependent nature has not been well documented. We present a patient with a 20-year history of losartan use who developed angioedema suddenly after an increase in dosage. A dose-dependent relationship between ARBs and angioedema has not been well documented and this is the first documented case of angioedema presenting in a dose-dependent manner with losartan use. We hope that our case will bring awareness to the potential dose-dependent relationship between losartan and angioedema in order to aid clinicians when titrating ARB medications in order to expediently diagnose the fatal side-effect of angioedema and to encourage further research.