RESUMEN
Coxsackie B virus is primarily associated with fever, pharyngitis, and gastrointestinal symptoms, while myocarditis is rarely reported. We present a rare case of a 47-year-old male with a history of hypertension and obesity, who developed Coxsackie B virus-induced myositis, myocarditis, and polyarthralgia. The patient presented with worsening back pain radiating to his chest, migratory arthralgia, exertional dyspnea, and bilateral shoulder pain with arm weakness. Initial investigations revealed elevated creatinine kinase (CK) levels and troponin I, alongside a high white blood cell (WBC) count and C-reactive protein (CRP) levels. Given the patient's symptoms and uptrending troponin without EKG changes, there was a high concern for non-ST-elevation myocardial infarction (NSTEMI), leading to initial treatment with aspirin and IV heparin. However, further questioning revealed a recent sore throat and contact with an ill family member, prompting investigations for an infectious etiology. A viral panel confirmed Coxsackie B virus infection. The patient made a full recovery with supportive care. This case highlights the importance of considering viral causes, particularly the Coxsackie B virus, in patients presenting with muscle pain, cardiac symptoms, and joint pain. Comprehensive viral testing is crucial for early identification and appropriate management to prevent long-term complications. Understanding the mechanisms of Coxsackie B virus infection is essential for developing effective treatment strategies addressing both the viral infection and the inflammatory response.
RESUMEN
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RESUMEN
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition that leads to free water retention and solute excretion, predisposing patients to hyponatremia. We present the case of a 79-year-old female with a history of SIADH well-controlled with fluid restriction and sodium chloride tablets who presented with hyponatremia after bowel preparation. Her medication regimen was not adjusted before she took the bowel preparation. Her SIADH diagnosis was unknown when she presented but was exemplified by her sodium levels dropping while on a normal saline drip on her third day in the hospital. She was able to successfully take the bowel preparation without hyponatremia after oral urea was added to her regimen. There are currently no clinical guidelines for SIADH patients receiving bowel preparation for colonoscopies and no case reports describing this situation. We discuss the pathophysiology behind the patient's fluctuating sodium levels when on various maintenance fluids and when on fluid restriction. This case concludes that it is imperative to either increase solute intake or increase free water excretion for SIADH patients receiving bowel preparation to prevent potentially deadly hyponatremia.