Erysipelas Complicated with Acute Exudative Pericarditis.

Erysipelas is a common skin infection of the upper dermis. Its most common complications are local; these include abscess formation, skin necrosis, etc. In the present article, we introduce a case of a 75-year-old patient with erysipelas of the face complicated with acute exudative pericarditis. The patient came to Kaunas Clinical Hospital complaining of extreme fatigue and fever, oedema of the left side of the face, and erythema typical for erysipelas. The patient also felt sternum and epigastric pain, especially during breathing, and dyspnoea. Heart work was rhythmic 100 bpm; blood pressure was 142/70 mmHg. Pericardial friction rub was heard over the left sternal border. There were no alterations in other systems. In the electrocardiogram, concave ST segment elevation in leads II, III, and aVF was identified. In addition, during hospitalisation, the patient experienced atrial fibrillation paroxysm, which was treated with amiodarone intravenously. The blood test showed C-reactive protein: 286 mg/L; white blood cells: 20 × 109/L; troponin I was within the normal range. During echocardiography, pericardial fluid in pericardial cavity was identified. As no changes in troponin I were observed, according to the ST segment elevation, the woman was diagnosed with erysipelas of the left side of the face complicated with acute exudative pericarditis. Antibacterial treatment of cephalosporins was administered. After the treatment, C-reactive protein decreased to 27.8 mg/L; whereas, in the electrocardiogram, the return of the ST segment to the isoline was observed, and pericardial fluid resorbed from the pericardial cavity. To the best of the authors' knowledge, this case is a rare combination of erysipelas complicated with acute exudative pericarditis.

Infective endocarditis in an HIV-infected intravenous drug user.

Infective endocarditis is a common complication among injecting drug users. Disease risk among these patients is increased by the spread of HIV infection. In the following article, we discuss the exceptional clinical presentation of a 28-year-old patient who used intravenous drugs (heroin) for 10 years, had been infected with HIV for seven years and as a complication had developed Staphylococcus aureus infective endocarditis. The patient came to the hospital in serious condition, complaining of bodily pain, swelling of the legs and general weakness. During hospitalization, besides infective endocarditis, she was also diagnosed with anemia, toxic hepatitis, renal failure, ascites, sepsis, and pneumonia. A completely disrupted tricuspid valve, damaged aortic valve, and fibrosis of the mitral valve were detected. Echocardiographic and radiologic data showed that the patient's condition continued to deteriorate day by day, with significant progression of heart failure, ejection fraction decreasing from 45% to 10%, and development of myocarditis, hydrothorax and pericarditis. However, this progressive worsening of the patient's condition ceased when vancomycin was administered. To the authors' knowledge, this is the first such case described in the literature in which significant improvement was observed despite the patient's complex condition with associated complications.

[JTc prolongation in hypertrophic cardiomyopathy amd arterial hypertension]. / JTc pailgejimas sergantiesiems hipertrofine kardiomiopatija ir arterine hipertenzija.

UNLABELLED: Pathological long duration of QTc and JTc intervals is non-questionable factor of sudden death. Information of the investigation of electrocardiogram increases during physical exercise test or transesophageal pacing of the left atrium. OBJECTIVE: The search of the factors of sudden death in hypertrophic cardiomyopathy and arterial hypertension patients and healthy persons from their electrocardiographic changes of JTc interval applying transesophageal pacing of the left atrium. MATERIAL AND METHODS: It was done transesophageal pacing to 12 healthy persons, 12 arterial hypertension and 13 hypertrophic cardiomyopathy patients. Pacing rates of 80, 100 and 130 bpm were applied for 3 min each. RESULTS: There was no prolongation of JTc in control group. JTc prolongation (more than 0.35 s) appeared in 3 arterial hypertension patients and 3 hypertrophic cardiomyopathy patients. Five hypertrophic cardiomyopathy patients and one arterial hypertension patient had prolonged JTc interval at the rest electrocardiogram. CONCLUSIONS: Transesophageal pacing of the left atrium helped to detect pathological long JTc interval in arterial hypertension and hypertrophic cardiomyopathy patients, when JTc interval was not prolonged at the rest electrocardiogram.