Mehandi Haran

Celiac disease associated with dilated cardiomyopathy.

Celiac disease is an intestinal disorder caused by an immunologic response to gluten, which results in diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients. An association between celiac disease and nonischemic dilated cardiomyopathy has been noted. Cardiomyopathy has been shown to improve in some patients on a gluten-free diet. We report a case of progressively worsening dilated cardiomyopathy in a patient with documented celiac disease.

Blood Cyst of the Mitral Valve: A Rare Cause of Stroke

Intracardiac blood cysts are thin‐walled cysts, lined by flattened, cobblestone‐shaped epithelium, and filled with nonorganized blood. During autopsy, they are found on cardiac valves in approximately 50% of infants below the age of 2 months and are rarely found after the age of 2 years. We report a rare case of blood cyst attached to the mitral valve and a possible cause of an embolic stroke. (ECHOCARDIOGRAPHY, Volume 26, July 2009)

Thyrotoxicosis Causing Arterial and Venous Thrombosis

We present an interesting case of a patient with thyrotoxicosis who developed both arterial and venous thrombosis. Although there have been reports of thrombosis in such patients, there has been no case reporting arterial and venous thrombosis in the same patient. We describe the case and discuss the medical literature. We feel that any patient with unexplained hypercoagulability should be thoroughly evaluated for thyroid dysfunction.

Unusual Endocarditis: “Rare Bug, Rare Site”

A 27-year-old man was diagnosed with infective endocarditis due to Streptococcus agalactiae. Large vegetations were seen on the anterior mitral valve leaflet and also on the right ventricular side of a membranous ventricular septal defect. Streptococcus agalactiae is a rare cause of endocarditis, and it is very rare to find large vegetations around ventricular septal defect. The authors present this interesting case of unusual endocarditis with vegetations in both the right and left heart. This case is the first reported case of infective endocarditis involving the left and the right sides of the heart at the same time in a nonintravenous drug user.

Brucellosis presenting as septic shock

Brucellosis generally presents with fever, malaise, weight loss and bone pain with either an abrupt or insidious onset. A 76-year-old man presented in April 2010 with fever of 103°F, severe tachycardia, tachypnoea and a blood pressure of 80/50 mm Hg requiring fluids and vasopressor support with norepinephrine. The patient had brucellosis in 1956 which was treated for ‘many weeks’ with tetracycline and streptomycin. He has had no recurrences since that time. He denies recent travel outside the USA or consumption of raw dairy products. Blood cultures grew Brucella melitensis. He was treated with gentamycin, doxycycline and rifampin for 1 week and discharged home on doxycycline and rifampin. He relapsed after 2 days, requiring re-admission and a 4-week course of gentamycin. This case is most unusual in that the brucellosis presented with septic shock after a 50-year quiescence and required prolonged therapy with gentamycin to induce remission.

Bacterial pericarditis caused by infected trichilemmal cyst

Bacterial pericarditis is a well-known although rare complication of Staphylococcus aureus infection in modern practice. We present a rare case of Staphylococcus pericarditis caused by an infected trichilemmal cyst present on patient’s scalp. Our case emphasizes that all cases of bacterial pericarditis should be thoroughly investigated for a source of infection. Constrictive changes can be seen in the pericardium postinfection, as in our patient, and should be treated aggressively. To our knowledge, a case of an infected cyst causing bacterial pericarditis has never been reported previously in the literature.

Cor Triatriatum Dextro Iatrogenica: An Unusual Complication of Atrial Septal Defect Closure Device

We present a case of a rare complication of atrial septal defect (ASD) device closure causing cor triatriatum dextro iatrogenica. A 29‐year‐old female presented with sudden onset dysarthria and ataxia and was found to have basilar and thalamic infarcts. Further evaluation using transthoracic echocardiography revealed an ASD which was repaired using the Gore HELEX septal occluder. Transesophageal echocardiography done after 2 months of ASD closure revealed an interesting finding termed cor triatriatum dextro iatrogenica. We briefly describe the case and discuss the relevant literature. (Echocardiography 2012;29:E45‐E47)

Hypereosinophilic syndrome presenting with biventricular cardiac thrombi.

Hypereosinophilic syndrome is a rare condition characterized by idiopathic eosinophilia with organ system involvement. Cardiac involvement portends a less favorable prognosis as it can be complicated by development of heart failure, valvular dysfunction, and restrictive cardiomyopathy. We present a rare case of hypereosinophilic syndrome with FIP1L1/PDGFRA fusion in a 50‐year‐old male associated with thrombus in left and right ventricle. (Echocardiography 2010;27:E57‐E59)

Pulmonary Hypertension in Grave's Disease

Abstract: Pulmonary arterial hypertension (PAH) is characterized by pulmonary artery systolic pressure (PASP) >35 mm Hg or mean >30 mm Hg with exercise. Etiology is divided into primary or secondary causes. Common causes of secondary PAH are myocardial or valvular disease, obstructive or restrictive lung disease, sleep apnea, left ventricular dysfunction, pulmonary embolism, and connective tissue disorders. The association between PAH and hyperthyroidism was first reported in an autopsy case in 1980. We report here the case of a patient with reversible pulmonary hypertension associated with Graves disease managed only with medication. An association between Graves disease and pulmonary hypertension was established here when other causes of pulmonary hypertension were ruled out and the patient had significant hemodynamic and symptomatic improvement after normalization of thyroid function.

Rare Association of Immunoglobulin A Nephropathy and Lymphedema-Distichiasis Syndrome

Immunoglobulin A nephropathy is the most common primary glomerulonephritis worldwide. The pathogenesis is still unknown and newer treatments are being researched. Rarely, it can be associated with other disorders. Its association with hereditary lymphedema has been reported on one occasion but never with lymphedema-distichiasis syndrome. We report a patient with hereditary lymphedema-distichiasis syndrome and immunoglobulin A nephropathy occurring simultaneously.