Recurrent arteriovenous graft thrombosis in COVID-19 positive patient.

Hypercoagulability is one of the common complications seen in COVID-19. It can lead to multiple thromboembolic complications. Recurrent arteriovenous graft thrombosis can be one of complications from this pathophysiology.

Histoplasma stomatitis unveiled: Not all opportunistic infections get better after initiation of antiretroviral therapy.

Immune reconstitution inflammatory syndrome in AIDS patients can lead to an initial worsening of underlying diseases due to body's ability to mount a strong immune response after recovery of CD4 counts.

Severe nonbacterial preseptal cellulitis from adenovirus detected via pooled meta-genomic testing.

Preseptal cellulitis is a serious diagnosis that can progress to postseptal cellulitis leading to grave consequences. Clinically, viral and bacterial cellulitis can be indistinguishable from each other. Using rapid DNA/RNA sequencing can be helpful.

Role of renin-angiotensin-aldosterone system inhibitors in heart failure and chronic kidney disease.

Renin-angiotensin-aldosterone system (RAAS) inhibitors are the key medications for patients with heart failure and chronic kidney disease. Multiple randomized controlled trials have demonstrated their benefits in an outpatient setting for the treatment of chronic heart failure. Additional advantages in acute heart failure treatment during inpatient hospitalization are less clear but a small number of non-randomized studies have favored their use. Conditions that result in stoppage of RAAS inhibitors during inpatient stay are an increase in serum creatinine, hyperkalemia, and hemodynamic instability such as hypotension. The role of RAAS inhibitors in chronic kidney disease has also been documented in multiple randomized controlled trials, with their use in hypertension and proteinuria being unambiguous. This narrative review summarizes the role of RAAS inhibitors in acute and chronic heart failure and chronic kidney disease.

Acute interstitial nephritis with only three doses of pantoprazole.

Several antibiotics, proton pump inhibitors, and nonsteroidal anti-inflammatory drugs can cause acute interstitial nephritis. This is not dose-dependent, and recurrence can occur with a second exposure of the same drug. Stopping the culprit is critical for successful management.

If You Go Up, You May Fall: A Rare Case of Rapidly Progressing Multifocal High-Altitude Vascular Thrombosis.

A high-altitude (HA) exposure can lead to hypercoagulability, increasing the risk for major thromboembolic events. The spontaneous vascular thrombosis can be arterial or venous, and may occur after a short or extended stay at higher elevations. Diagnosis is often challenging, and delays in treatment can lead to inevitable and disabling sequelae. With a limited scope of experimental studies and trials to prove HA thrombogenicity, a greater awareness of the diversity of presentations and management is imperative to those engaged in treating such patients. We report a case of rapidly progressing HA vascular thrombosis.

Current Overview on Hypercoagulability in COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC.

New-onset atrial fibrillation in a young patient detected by smartwatch.

Atrial fibrillation (Afib) is associated with 15%-25% of strokes. Wearable devices like Apple watch can generate an electrocardiogram and can increase detection of Afib in general population. Early diagnosis and treatment can decrease the risk of strokes.

Ceftriaxone-Induced Immune Hemolytic Anemia.

Ceftriaxone is a commonly used antibiotic in hospitals for the treatment of pneumonia, urinary tract infection, bacteremia, meningitis, skin, and soft tissue infection. It can be associated with common allergic reactions like skin rash, itching, and, rarely, angioedema. Ceftriaxone-induced immune hemolytic anemia (IHA) is a rare and potentially fatal complication if not identified and managed in time. We report a case of ceftriaxone-induced IHA in a young woman.

Acute Pulmonary Embolism in a Healthy Male With Elevated Lipoprotein(a).

Elevated lipoprotein(a) [Lp(a)] is a well-known risk factor for cardiovascular disease. Its role in venous thromboembolism (VTE) is unclear. We present a case of a healthy man presenting with bilateral pulmonary embolism and investigations suggested elevated Lp(a) being the only risk factor. In this case report, we would like to emphasize the role of Lp(a) in VTE without any other clear predisposing factors.

Old Era Continues in Modern World: A Case Report of Scurvy Induced Myopathy in Patient with Chronic Alcoholism.

We report a case of myopathy in a chronic alcoholic patient with scurvy who presented with generalized weakness, myalgias, and arthralgia. Our case raises awareness regarding rare interaction between vitamin C deficiency and myopathy which is seen more commonly in patients with history of chronic alcoholism and low socioeconomic status. Early treatment with vitamin C replacement is helpful in treatment of the disease and its complications.

Intestinal necrosis after co-administration of sodium polystyrene sulfonate and activated charcoal.

Development of acute abdominal pain after Kayexalate and activated charcoal administration should prompt clinician to consider intestinal necrosis. Concomitant use should be avoided to minimize the risk of this devastating but preventable condition.