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1.
Cureus ; 16(7): e64821, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39156362

RESUMEN

Prosthetic joint infection (PJI) is defined as an infection involving the prosthesis and surrounding soft tissue and bone that is a difficult complication to treat and is a common cause of revision total joint arthroplasty (TJA). Bacteremia, sepsis, and infective endocarditis (IE) are rare complications in patients who have undergone TJA. We report a rare case where a patient presented with purulent discharge from the left knee joint post-TJA concerning PJI and was found to have methicillin-sensitive Staphylococcus aureus bacteremia, tricuspid valve endocarditis, and septic pulmonary emboli. The patient underwent irrigation, debridement, and a spacer device placement in the affected knee joint for PJI and was medically treated for IE with six weeks of antibiotic therapy. The patient successfully recovered and was discharged to a rehabilitation facility. We conclude that PJI and IE secondary to TJA are very rare, but given the high morbidity and mortality, if diagnosis and treatment are delayed, physicians should always remain vigilant for these complications in the appropriate clinical context.

2.
Cureus ; 15(7): e41468, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37546113

RESUMEN

Upper gastrointestinal bleeding (UGIB) is a medical emergency with substantial morbidity and mortality worldwide. It is defined as bleeding originating in the gastrointestinal (GI) tract proximal to the ligament of Treitz and can be caused by various conditions, including peptic ulcers, gastritis, esophageal varices, Mallory-Weiss tears, and malignancies. Common complications include anemia, hemodynamic instability, perforation, and rebleeding. It is associated with high mortality and a poor prognosis, especially in high-risk populations. Management includes medical treatment, endoscopic intervention, endovascular arterial embolization, and surgery. We present an interesting case of an 87-year-old male with a history of duodenal ulcers who presented with a bleeding duodenal ulcer complicated by recurrent bleeding despite multiple hemostatic endoscopic interventions and arterial embolization. This case highlights the complexities involved in managing recurrent upper GI bleeding and emphasizes the significance of multidisciplinary approaches, timely interventions, and close monitoring.

3.
Cureus ; 15(6): e40924, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37496539

RESUMEN

Takotsubo cardiomyopathy (TTC), also known as stress cardiomyopathy or broken heart syndrome, is a condition characterized by transient left ventricular dysfunction resembling myocardial infarction but without obstructive coronary artery disease. We present a rare case of a 59-year-old patient with cardiogenic shock (CS) caused by reverse TTC triggered by an undiagnosed right adrenal pheochromocytoma tumor. The patient initially presented with chronic headaches and difficulty breathing, and their condition rapidly deteriorated, necessitating intubation and inotropic support. Diagnostic tests confirmed the diagnosis of reverse TTC, and further investigation revealed an actively growing adrenal mass suggestive of a pheochromocytoma. The patient responded well to treatments, including the use of intra-aortic balloon pump support and subsequent weaning. A right adrenalectomy confirmed the presence of a pheochromocytoma. This case highlights the association between pheochromocytoma and reverse TTC, emphasizing the need to consider this rare etiology in patients presenting with CS. Long-term monitoring is crucial due to the risk of recurrence, even after tumor removal.

4.
Cureus ; 15(6): e40517, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37461774

RESUMEN

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced technique using a side-viewing upper endoscope to diagnose and treat pancreaticobiliary diseases. ERCP is generally considered a safe procedure; however, it is associated with risks of certain complications such as pancreatitis, bowel perforation, bleeding, and infections. Very rarely, ERCP can result in abscess formation in different organs, such as the pancreas, liver, and intestines. Physicians should be vigilant for rare post-ERCP complications such as clinically significant bacteremia and hepatic abscess, especially in high-risk populations, as if left untreated, they can result in significant morbidity and mortality. We present an interesting and rare case of an 80-year-old patient who presented with nausea, vomiting, and abdominal pain post-ERCP and was found to have a polymicrobial bloodstream infection and a hepatic abscess. The patient was treated with medical therapy alone, with an appropriate clinical response.

5.
Cureus ; 15(5): e39179, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37378172

RESUMEN

Stercoral colitis, although rare, remains a significant cause of acute colonic inflammation. It is characterized by the presence of fecaloma leading to fecal impaction and subsequent mucosal injury, ultimately resulting in colonic wall inflammation. This condition primarily affects elderly patients with chronic constipation and is associated with significant morbidity and mortality if not recognized and managed promptly. Given its rarity and varied presentation, stercoral colitis often poses a diagnostic challenge. The clinical manifestations can mimic other colonic pathologies, such as diverticulitis, ischemic colitis, and inflammatory bowel disease, further contributing to diagnostic dilemmas. However, an astute clinician, armed with a high index of suspicion and the aid of advanced imaging techniques, can establish the correct diagnosis and initiate timely management. In this case report, we present a challenging case of stercoral colitis in an elderly patient with a history of chronic constipation. The aim of this report is to enhance awareness and understanding of this underdiagnosed condition among healthcare providers. Additionally, we discuss the clinical presentation, diagnostic workup, and therapeutic interventions employed to manage this formidable gastrointestinal entity.

6.
Cureus ; 15(5): e39404, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37362542

RESUMEN

We present a case of a 68-year-old female with a history of hypertension and hypothyroidism who presented to the emergency department with right lower extremity pain and difficulty ambulating. An initial evaluation revealed an abnormal appearance of the right hip on MRI, concerning avascular necrosis versus acetabular compression fracture. Subsequent diagnostic procedures, including joint aspiration and radiologic bone biopsy, led to the surprising discovery of metastatic lung carcinoma on tissue pathology. Further work-up reveals lung primary adenocarcinoma with additional metastases to the brain as well. The patient underwent resection of acetabulum and complex surgical pelvis reconstruction, irradiation for brain metastases, and rehabilitation. This case highlights the importance of considering atypical presentations of metastatic malignancies and the need for a multidisciplinary approach to optimize patient management.

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