RESUMEN
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder that can affect all age groups. It appears to have a higher incidence in the female population. Some common risk factors include hypertension, electrolyte abnormalities, sepsis, and chemotherapeutic medications such as Obinutuzumab. Our patient, who had chronic lymphocytic leukemia (CLL), presented with altered mental status. She was recently started on Obinutuzumab less than a week before this presentation. MRI findings were consistent with PRES, including diffuse vasogenic cerebral edema predominately throughout the bilateral parietal and occipital lobes associated with some edematous extension into the posterior part of bilateral frontal lobes. This case aims to highlight the importance of early diagnosis by appropriately identifying the MRI features of PRES to improve patient quality of life and decrease morbidity and mortality.
RESUMEN
Transcatheter aortic valve replacement(TAVR)-related infective endocarditis is a rare but fatal complication that can lead to mitral valve perforation. The clinical presentation usually includes rapidly progressive heart failure and mitral regurgitation. Transesophageal echocardiogram (TEE) is considered superior to transthoracic echocardiogram (TTE) in delineating the diagnosis of mitral valve perforation. We present a case of a 75-year-old female who had a TAVR for severe aortic stenosis three years ago and presented with new-onset atrial fibrillation and developed rapidly progressive acute decompensated heart failure. A TTE showed echogenic vegetation of the mitral valve with a perforated mitral anterior leaflet and mitral regurgitation. The blood cultures grew Group B Streptococcus, and our patient lacked the risk factors for infective endocarditis, including alcoholism, chronic liver disease, pregnancy, immunosuppression, or malignancy. This article highlights infective endocarditis with an uncommon pathogen in a patient with a prior TAVR that leads to the fatal complication of mitral valve perforation.
RESUMEN
Leishmaniasis, a protozoan parasitic pathology, is caused by infection with a parasite known as Leishmania donovani, which is transmitted to humans through the bite of a sand fly. The disease has various manifestations, including cutaneous leishmaniasis, visceral leishmaniasis (VL), and disseminated cutaneous leishmaniasis. Visceral leishmaniasis (VL), also known as kala-azar, is mostly seen in the Asian and African regions and can be deadly if left untreated. We present the case of a 10-month-old male infant who was brought to the office with the chief complaints of recurrent fever for the past one month, along with generalized fatigue and poor feeding. A comprehensive history, detailed physical examination, and laboratory testing, including bone marrow aspiration, were performed, and visceral leishmaniasis was diagnosed.
RESUMEN
Niemann-Pick disease (NPD) type A is a fatal autosomal recessive lysosomal storage disorder. This rare condition impairs the metabolization of lipids, leading to their accumulation within the cells. Consequently, it causes growth retardation, pancytopenia, and cellular malfunctioning in various organ systems, including ocular, hepatic, pulmonary, brain, and neuronal tissues. Although rare, these patients present in both emergency and outpatient settings. Here, we report the case of a seven-month-old male infant who presented to the emergency department with continuous fever for one week, poor feeding, and failure to thrive. After a thorough history, examination, and laboratory workup, NPD type A was diagnosed. The patient received symptomatic therapy with the continuation of conservative management. In addition, the parents received detailed counseling regarding the genetics, progressive disease course, and prognosis of this condition.
RESUMEN
Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Initially, it was reported in December 2019 and became a global pandemic in March 2020, with many presentations and after-effects. We report the case of a 68-year-old female patient who presented to the emergency room with the chief complaint of a skin rash and itching all over her body, developing within a few minutes of insulin injection. The patient had tested positive for COVID-19 almost eight days ago and was self-quarantined. She was a known diabetic for the past 28 years. Her blood glucose levels were maintained within the normal range by a combination regimen of oral anti-diabetic drugs and subcutaneous humulin 70/30 (70% neutral protamine Hagedorn (NPH) insulin and 30% regular human insulin) injections. After careful examination and thorough history taking, a newly acquired insulin allergy was diagnosed in the patient, attributed to her disrupted immune system due to the recent COVID-19 infection.
RESUMEN
Supraventricular tachycardia (SVT) refers to the narrow complex tachycardia originating at or above the bundle of His. Several risk factors are associated with the development and recurrence of SVT, but its association with gastric problems, especially dyspepsia, is relatively rare. We report the case of a 54-year-old female who presented to the emergency room (ER) with palpitations, which were diagnosed as an episode of paroxysmal supraventricular tachycardia (PSVT). She had a history of PSVT in the past, along with hypertension and dyspepsia. After thorough history and examination, dyspepsia was identified as the common trigger of her PSVT episodes, pointing towards the likelihood of gastrocardiac symptoms. Therefore, an appropriate regimen of beta-blockers, proton pump inhibitors (PPIs), and anti-foaming agents (simethicone) was prescribed to manage her symptoms with the plan to perform a catheter ablation later.
RESUMEN
Isotretinoin is an analog of vitamin A, used to treat severe, recalcitrant nodular acne, psoriasis and disorders of keratinization. However, its benefits come with a broad range of serious side effects, including ocular adverse effects. We report and describe a rare case of bilateral myopia in a female patient treated with oral isotretinoin for acne vulgaris. A female patient, 29-year old, presented to the office for blurry vision. The patient was treated with oral isotretinoin for four weeks. She had a past medical history of myopia precisely corrected with laser-assisted in situ keratomileusis without any residual refractive error. After a thorough examination and laboratory workup, isotretinoin was thought to be the causative agent of her current complaint, so it was immediately stopped. The follow-up showed no further decrement of visual acuity in the patient. However, the vision loss acquired as an adverse effect of oral isotretinoin persisted.