RESUMEN
Methemoglobinemia is a condition characterized by the presence of abnormal hemoglobin, known as methemoglobin, in the blood, which impairs the ability of red blood cells to carry oxygen effectively. Symptoms include cyanosis, shortness of breath, fatigue, and in severe cases, organ damage or death. We presented a case of a 49-year-old female with multiple myeloma who developed drug-induced methemoglobinemia while on dapsone prophylaxis for Pneumocystis carinii pneumonia (PCP). Despite normal glucose-6-phosphate dehydrogenase (G6PD) levels, the patient exhibited cyanosis and shortness of breath. The case underscores the importance of considering methemoglobinemia in patients with unexplained hypoxemia, especially when associated with medication use. Diagnosis relies on clinical assessment, arterial or venous blood gas analysis with co-oximetry, and a thorough medication history. Methemoglobinemia poses a diagnostic challenge due to its varied presentations and requires a high index of suspicion, particularly in patients with multiple myeloma receiving potentially causative medications such as dapsone. Thorough evaluation, interdisciplinary collaboration, and prompt treatment are essential for favorable outcomes in these complex cases.
RESUMEN
Basal cell carcinoma (BCC) ranks as the most common form of skin cancer in the United States, and its prevalence continues to increase. Regular self-examinations of the skin can significantly enhance treatment outcomes. This report investigates a rare instance of BCC initially misdiagnosed as osteomyelitis, stemming from a longstanding wound on the patient's left shoulder. A 66-year-old male with a history of working in construction presented with a non-healing wound on his left shoulder, which he initially sustained from a metallic rod injury. Despite self-treatment, the wound deteriorated, revealing subcutaneous fat and producing foul-smelling drainage. Imaging suggested osteomyelitis, but the persistent and worsening nature of the wound over two years, previously concealed from his family and healthcare providers, prompted further investigation. A biopsy confirmed infiltrative BCC. The patient was referred to a tertiary care facility for comprehensive treatment, including long-term antibiotics for osteomyelitis and systemic therapy with vismodegib for BCC. Basal cell carcinoma commonly appears as a pink or flesh-colored papule or nodule, often with surface features that aid in early identification and treatment. Yet, infiltrative BCC, like the case described here, can pose diagnostic challenges because of its subtle yet aggressive characteristics. The complex causes of BCC highlight the necessity of preventive actions, particularly for those with prolonged exposure to ultraviolet (UV) radiation. Treatment approaches primarily aim at removing the tumor and may incorporate targeted therapies for more advanced instances. This case underscores the importance of regular skin self-examinations and prompt medical attention for lingering wounds, particularly among those at higher risk. Successfully addressing BCC demands a comprehensive strategy involving surgery, targeted chemotherapy, and preventive actions against potential future skin malignancies. Maintaining long-term surveillance is crucial for individuals with prior BCC diagnoses to detect any potential recurrence and address any enduring consequences of treatment.
RESUMEN
Ventricular septal rupture, a formidable complication of acute myocardial infarction (AMI), is linked to significant morbidity and mortality. The clinical manifestation typically involves pronounced hemodynamic compromise necessitating prompt surgical intervention. This report outlines the case of a 60-year-old male presenting with acute heart failure 3 weeks post a presumed AMI. On evaluation, a substantial ventricular septal defect with left-to-right shunt was observed. The patient, although hemodynamically stable with mild symptoms, underwent surgical closure of the defect and coronary artery bypass graft for multivessel coronary artery disease. This case contributes to the literature on the delayed presentation of post-myocardial infarction (MI) ventricular septal rupture, a scenario deviating from the anticipated severe hemodynamic instability given the timing of the MI and the extent of the septal defect.