Rationale:Acute eosinophilic pneumonia(AEP)is an acute pulmonary illness caused by eosinophilic infiltration of the lung parenchyma.It can happen after using drugs such as daptomycin and minocycline.AEP induced by imi...Rationale:Acute eosinophilic pneumonia(AEP)is an acute pulmonary illness caused by eosinophilic infiltration of the lung parenchyma.It can happen after using drugs such as daptomycin and minocycline.AEP induced by imipenem/cilastatin is a rare condition.Patient’s Concern:A 45-year-old male patient,who previously suffered from a urinary tract infection and treated with imipenem/cilastatin antibiotic,was presented to us with acute respiratory distress,soon after the initiation of the antibiotic.Computed tomography identified pulmonary infiltrates in the upper and middle lung fields and eosinophils were found to account for 36%of differential count of the broncho-alveolar lavage fluid.He also developed peripheral eosinophilia as the disease progressed.Diagnosis:AEP,secondary to imipenem/cilastatin therapy.Interventions:Steroid therapy was administered and imipenem/cilastatin antibiotic was discontinued.Outcomes:The patient improved completely following the therapy and had clear lung fields on follow-up.Lessons:Imipenem/cilastatin is an uncommon cause of AEP and requires close monitoring during therapy.展开更多
Cardiovascular manifestations and electrocardiographic abnormalities have been reported among some prevalent infections in tropical regions,which lead to a great amount of morbidity and mortality.The major infectious ...Cardiovascular manifestations and electrocardiographic abnormalities have been reported among some prevalent infections in tropical regions,which lead to a great amount of morbidity and mortality.The major infectious diseases include chikungunya,dengue fever,H1N1 influenza,and coronavirus disease-19(COVID-19)in the viral category,leptospirosis,salmonellosis,scrub typhus and tuberculosis in the bacterial category,and malaria in the protozoan parasite category.All these infirmities constitute a foremost infection burden worldwide and have been linked to the various cardiac rhythm aberrancies.So we aimed to identify and compile different studies on these infections and associated acute electrocardiographic(ECG)changes.The search was made in online international libraries like PubMed,Google Scholar,and EMBASE,and 38 most relevant articles,including original research,systematic reviews,and unique case reports were selected.All of them were evaluated thoroughly and information regarding ECG was collected.Myocarditis is the predominant underlying pathology for rhythm disturbance and can be affected either due to the direct pathogenic effect or the abnormal immune system activation.ECG variabilities in some infections like chikungunya,scrub typhus,and leptospirosis are associated with longer hospital stay and poor outcome.Tropical infective diseases are associated with prominent acute cardiac rhythm abnormalities due to myocarditis,which can be identified preliminarily by ECG changes.展开更多
Rationale:Delayed post-hypoxic leukoencephalopathy(DPHL)is usually an overlooked condition,which arises as a result of a multitude of reversible and irreversible conditions.Patient’s Concern:A 50-year-old female with...Rationale:Delayed post-hypoxic leukoencephalopathy(DPHL)is usually an overlooked condition,which arises as a result of a multitude of reversible and irreversible conditions.Patient’s Concern:A 50-year-old female with a history of epilepsy,who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity.Diagnosis:DPHL on magnetic resonance imaging of the brain.Interventions:Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity.Outcomes:The patient developed akinetic mutism due to infirmity and had a residual disability,which led to permanent dependency.Lessons:The diagnosis of DPHL is often delayed or missed,given the rarity of this condition and its inconsistent clinical symptomatology.Diagnostic delay can be avoided by early recognition of the classical“delayed onset”symptoms.展开更多
Rationale:COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations.Among them,patients with cardiovascular involveme...Rationale:COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations.Among them,patients with cardiovascular involvement have a high mortality.Patient’s concerns:A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes,myalgia,and mild respiratory symptoms.Diagnosis:Mild COVID-19 infection with complete heart block.Interventions:Temporary pacing followed by permanent pacemaker insertion 10 days after the onset.Outcomes:The patient was managed as per COVID-19 protocol in an isolation ward,and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative,after which he was shifted back to the cardiac care unit for permanent pacemaker insertion.The patient was discharged after inflammatory markers were normal and clinical condition was completely stable.Lessons:COVID-19 has a wide range of clinical presentations,and extrapulmonary manifestations,especially,cardiovascular involvement can not be ignored.展开更多
Rationale:Clinicians encounter multiple alcohol-related illnesses in practice,and Marchiafava-Bignami disease is a rare and devastating entity among them.It is a toxic-demyelinating disease and seen in chronic alcohol...Rationale:Clinicians encounter multiple alcohol-related illnesses in practice,and Marchiafava-Bignami disease is a rare and devastating entity among them.It is a toxic-demyelinating disease and seen in chronic alcoholics,although it may be occasionally observed in chronically malnourished teetotalers.The clinical presentations are diverse.The symptoms and signs are non-specific,and the onset can be acute or chronic.Patient’s concerns:A 45-year-old right-handed patient suffered from alcohol use disorder with multiple non-specific neuropsychiatric manifestations.Diagnosis:Marchiafava-Bignami disease.Interventions:Thiamine,folate,vitamin B12,and steroid therapy.Outcome:The patient’s behaviour was significantly improved but dysarthria and pyramidal signs persisted.He was left with permanent cognitive impairment.Lessons:Though prompt therapy may halt the demyelinating process in this disease,the treatment remains a challenge in clinical practice.The recognition of the neuro-radiologic features is crucial to establish an early diagnosis.展开更多
文摘Rationale:Acute eosinophilic pneumonia(AEP)is an acute pulmonary illness caused by eosinophilic infiltration of the lung parenchyma.It can happen after using drugs such as daptomycin and minocycline.AEP induced by imipenem/cilastatin is a rare condition.Patient’s Concern:A 45-year-old male patient,who previously suffered from a urinary tract infection and treated with imipenem/cilastatin antibiotic,was presented to us with acute respiratory distress,soon after the initiation of the antibiotic.Computed tomography identified pulmonary infiltrates in the upper and middle lung fields and eosinophils were found to account for 36%of differential count of the broncho-alveolar lavage fluid.He also developed peripheral eosinophilia as the disease progressed.Diagnosis:AEP,secondary to imipenem/cilastatin therapy.Interventions:Steroid therapy was administered and imipenem/cilastatin antibiotic was discontinued.Outcomes:The patient improved completely following the therapy and had clear lung fields on follow-up.Lessons:Imipenem/cilastatin is an uncommon cause of AEP and requires close monitoring during therapy.
文摘Cardiovascular manifestations and electrocardiographic abnormalities have been reported among some prevalent infections in tropical regions,which lead to a great amount of morbidity and mortality.The major infectious diseases include chikungunya,dengue fever,H1N1 influenza,and coronavirus disease-19(COVID-19)in the viral category,leptospirosis,salmonellosis,scrub typhus and tuberculosis in the bacterial category,and malaria in the protozoan parasite category.All these infirmities constitute a foremost infection burden worldwide and have been linked to the various cardiac rhythm aberrancies.So we aimed to identify and compile different studies on these infections and associated acute electrocardiographic(ECG)changes.The search was made in online international libraries like PubMed,Google Scholar,and EMBASE,and 38 most relevant articles,including original research,systematic reviews,and unique case reports were selected.All of them were evaluated thoroughly and information regarding ECG was collected.Myocarditis is the predominant underlying pathology for rhythm disturbance and can be affected either due to the direct pathogenic effect or the abnormal immune system activation.ECG variabilities in some infections like chikungunya,scrub typhus,and leptospirosis are associated with longer hospital stay and poor outcome.Tropical infective diseases are associated with prominent acute cardiac rhythm abnormalities due to myocarditis,which can be identified preliminarily by ECG changes.
文摘Rationale:Delayed post-hypoxic leukoencephalopathy(DPHL)is usually an overlooked condition,which arises as a result of a multitude of reversible and irreversible conditions.Patient’s Concern:A 50-year-old female with a history of epilepsy,who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity.Diagnosis:DPHL on magnetic resonance imaging of the brain.Interventions:Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity.Outcomes:The patient developed akinetic mutism due to infirmity and had a residual disability,which led to permanent dependency.Lessons:The diagnosis of DPHL is often delayed or missed,given the rarity of this condition and its inconsistent clinical symptomatology.Diagnostic delay can be avoided by early recognition of the classical“delayed onset”symptoms.
文摘Rationale:COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations.Among them,patients with cardiovascular involvement have a high mortality.Patient’s concerns:A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes,myalgia,and mild respiratory symptoms.Diagnosis:Mild COVID-19 infection with complete heart block.Interventions:Temporary pacing followed by permanent pacemaker insertion 10 days after the onset.Outcomes:The patient was managed as per COVID-19 protocol in an isolation ward,and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative,after which he was shifted back to the cardiac care unit for permanent pacemaker insertion.The patient was discharged after inflammatory markers were normal and clinical condition was completely stable.Lessons:COVID-19 has a wide range of clinical presentations,and extrapulmonary manifestations,especially,cardiovascular involvement can not be ignored.
文摘Rationale:Clinicians encounter multiple alcohol-related illnesses in practice,and Marchiafava-Bignami disease is a rare and devastating entity among them.It is a toxic-demyelinating disease and seen in chronic alcoholics,although it may be occasionally observed in chronically malnourished teetotalers.The clinical presentations are diverse.The symptoms and signs are non-specific,and the onset can be acute or chronic.Patient’s concerns:A 45-year-old right-handed patient suffered from alcohol use disorder with multiple non-specific neuropsychiatric manifestations.Diagnosis:Marchiafava-Bignami disease.Interventions:Thiamine,folate,vitamin B12,and steroid therapy.Outcome:The patient’s behaviour was significantly improved but dysarthria and pyramidal signs persisted.He was left with permanent cognitive impairment.Lessons:Though prompt therapy may halt the demyelinating process in this disease,the treatment remains a challenge in clinical practice.The recognition of the neuro-radiologic features is crucial to establish an early diagnosis.
