Stevens-Johnson Syndrome and Stroke Related to Mycoplasma.

Mycoplasma pneumonia usually causes asymptomatic to mild respiratory tract infection. However, nonrespiratory manifestations are not rare with involvement of various organ including skin, cardiovascular, central nervous system. We are presenting a 43-year-old male who presented with diffuse rash, sever mucositis, confusion, and complicated by ischemic stroke; also, review of mycoplasma related stroke and Stevens-Johnson syndrome.

Takayasu's Disease With Bilateral Carotid Arteritis in a Caucasian Female: A Rare Presentation and Diagnostic Dilemma.

Takayasu arteritis (TAK) is not an uncommon cause of vasculitis in Caucasian females, however, involvement of bilateral carotid artery is a very rare presentation. We are presenting a 31-year-old young Caucasian female who presented with left-sided neck pain, headache and was subsequently found to have vasculitis of bilateral carotid arteries.

Atypical Cystic Fibrosis: Diagnosis at the Age of 57 Years.

Cystic fibrosis (CF) is an autosomal recessive, multi-organ disorder found predominantly among Caucasians. It classically presents in childhood with chronic productive cough, malabsorption causing steatorrhea, and failure to thrive. We present a 75-year-old female diagnosed with CF at the age of 57 years, which highlights the natural history and challenges in the diagnosis of atypical CF, including broadening physicians' respiratory differential diagnosis, limited patient symptoms, and late age of symptom onset.

Bilateral pulmonary artery thrombectomy with saddle embolism and COVID-19 infection.

Thrombotic complications such as venous thromboembolism, ischemic stroke, and myocardial infarction have emerged as causes of significant morbidity and mortality in patients infected with COVID-19. We present a 32-year-old man who developed a large saddle pulmonary embolus secondary to COVID-19 infection and underwent successful bilateral percutaneous pulmonary artery mechanical thrombectomy.

A Rare Case of Ventilator-Associated Pneumonia Caused by Cupriavidus Pauculus.

Ventilator-associated pneumonia is a hospital-acquired infection that is commonly encountered in intubated patients in the intensive care unit (ICU). It is associated with significant morbidity and mortality. The causative organisms include gram-negative rods (Escherichia coli, Klebsiella pneumoniae, or Acinetobacter species) or gram-positive cocci (Staphylococcus aureus). Described here is a case of ventilator-associated pneumonia caused by a relatively unknown gram-negative bacterium, Cupriavidus (C.) pauculus that was successfully treated with intravenous cefepime.

Determining the Impact of the Opioid Crisis on a Tertiary-Care Hospital in Central New York to Identify Critical Areas of Intervention in the Local Community.

BACKGROUND: Central New York has been afflicted by the heroin epidemic with an increase in overdose deaths involving opioids. OBJECTIVE: The objective of the study was to understand the epidemiology of hospitalizations related to a diagnosis of opioid use (OU). DESIGN: The study was designed as a retrospective analysis of hospitalized patients admitted from January 1, 2008, to December 30, 2018, using ICD-9 and 10 codes for heroin or opiate use, overdose, or poisoning. Setting. The study was conducted in a tertiary-care and teaching hospital located in Central New York. Patients. Hospitalized patients were included as study participants. RESULTS: Opioid use-related admissions increased from .05/100 hospital admissions in 2008 to a peak of 2.9/100 in 2018, a 58-fold increase. There were 49 deaths over the 11-year period for an overall case fatality of 1.2 per 100 OU admissions. The median age for all years was 40 years (SD of 13.7 years), and admissions were largely white caucasians (67.0% of all admissions). The mean length of stay was 8.55 days (SD 12 days), with a range of 1 to 153 days. The most frequent discharge diagnosis was due to infections (15.0% of discharge diagnoses) followed by trauma (5.8% of discharge diagnoses). Methicillin-resistant Staphylococcus aureus was more common in patients with OU (58.1%) than in patients with non-OU (43%) (p < 0.0001 by chi-square with Yates' correction). Spatial analysis was performed by zip code and demonstrated regional hotspots for OU-related admissions. Limitations. The limitations of this study are its retrospective nature and largely numerator-based analysis. The use of ICD codes underrepresents the true burden due to underreporting and failure to code appropriately. This study focuses on patients who are hospitalized for a medical reason with a secondary diagnosis of opioid use and does not include patients who present to the emergency room with an overdose underrepresenting the true burden of the problem. CONCLUSIONS: Our results demonstrate the impact of the opioid epidemic in one tertiary-care center and the need to prepare for the costs and resources to address addiction care for this population.

Statin-induced necrotizing autoimmune myopathy.

Statins are the most widely used class of drug in the United States. They lower blood cholesterol levels by inhibiting 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase. Common side effects include myalgias and a mild increase in liver function tests. Statin-induced necrotizing autoimmune myopathy (SINAM) is a very rare side effect that is independent of the type and duration of statin use. Treatment involves high-dose steroids and immunosuppressants such as azathioprine, methotrexate, or mycophenolate mofetil. Nonresponders and patients with severe weakness can be treated with intravenous immunoglobulin or rituximab. We present a case of SINAM that was successfully treated with intravenous immunoglobulin.

Cardiovascular implantable electronic device infection with rapidly growing mycobacteria.

Cardiovascular implantable electronic devices, which are frequently utilized for many cardiovascular diseases, can become infected, leading to significant morbidity and mortality. This case highlights an unusual presentation of pacemaker generator pocket infection with Mycobacterium fortuitum.

Post-malaria neurological syndrome: a rare neurological complication of malaria.

BACKGROUND: Post-malaria neurological syndrome (PMNS) is a rare self-limiting neurological complication that can occur after recovery from malaria, usually severe falciparum malaria. It is characterized by a myriad of neuropsychiatric manifestations including mild neurological deficit to severe encephalopathy. PMNS was first described in 1996 and since then there have been 48 cases reported in the English literature. We report another case of PMNS in a 24-year-old healthy male and present a review of the disease entity. METHOD: We searched PMNS-related journal articles and case reports in the English literature, using PubMed and Google search engines. A total of forty-nine cases meeting the diagnostic criteria of PMNS were selected in this review. CONCLUSION: PMNS is a rare complication of severe malaria that might be underreported. It can develop up to 2 months after clearance of parasitemia. Clinical features can be variable. Most cases are self-limited, but more severe cases may benefit from steroid therapy.

Vertebral Osteomyelitis, Discitis, and Epidural Abscess: A Rare Complication of Cardiobacterium Endocarditis.

In this article, we report the case of a 75-year-old man who was presented with new low back pain for 2 weeks. His past history was significant for severe aortic stenosis necessitating bioprosthetic aortic valve placement 4 years ago, hypertension, and coronary artery disease. His physical examination was positive for point tenderness over the lower lumbar spine. He was found to be bacteremic with Cardiobacterium hominis. Magnetic resonance imaging of the spine showed lumbar (L4-L5) epidural abscess and vertebral osteomyelitis, discitis. He underwent a computed tomography-guided needle biopsy of L4-L5. The biopsy culture was also positive for Cardiobacterium hominis. A transesophageal echocardiogram showed small vegetation on the mitral valve with mild regurgitation. He was started on intravenous ceftriaxone 2 g once daily for a planned duration of 6 weeks and was discharged. However, he, unfortunately, expired at an outside facility secondary to an unknown illness 4 weeks into the treatment course.

Role of fine needle aspiration cytology in diagnosis of filarial infestation.

Filariasis is a tropical disease transmitted by the Culex mosquitoes. The diagnosis of it is conventionally made by demonstrating microfilariae in the peripheral blood smear. However; microfilariae and adult filarial worm have been incidentally detected in fine needle aspirates of various lesions in clinically unsuspected cases. The cases of filariasis diagnosed by fine needle aspiration cytology (FNAC) were retrieved from the archives of the Cytopathology laboratory between the periods of January 1998 to February 2009. Both Papanicolaou- and May-Grunwald-Giemsa-stained smears were available in all the cases. A total of 26 diagnosed cases of filariasis were found, of which 19 were related to funiculo-epididymitis, four presented with breast lump, and three cases with lymphadenopathy. Smears revealed fragments of adult worm in 12 cases including 10 gravid female worm containing eggs and microfilariae and two male adult worm; whereas in remaining 14 cases only microfilariae or eggs were seen. Unfertilized eggs were seen in three cases and fertilized eggs were seen in five cases. Tissue response in the form of eosinophils in 16 cases, acute inflammatory exudate in five cases, macrophages in 22 cases, epitheloid cell granulomas in five cases, giant cells in four cases, lymphocytes in 10 cases, and plasma cells in three cases were seen. Adherence of polymorphonuclear leukocytes, eosinophils, and epithelioid cells were observed in four cases. On conclusion, filaria may affect the epididymis, spermatic cord, breast, and lymph node, and the accurate diagnosis can be easily and conveniently achieved by FNAC without any requirement of biopsy.