Saad Ullah

Klebsiella oxytoca Endocarditis With Complete Heart Block

Gram-negative bacterial endocarditis causes 5% of all bacterial endocarditis. Among gram-negative bacteria, Klebsiella species are rare causes of native valve endocarditis. Klebsiella oxytoca is an extremely rare subspecies that can infrequently cause endocarditis and is associated with poor outcome. We report a case of Klebsiella oxytoca endocarditis in an elderly man who initially presented with stroke but later developed sepsis and heart block secondary to endocarditis.

Absence of Left Circumflex Artery: A Rare Congenital Disorder of Coronary Arteries

Congenital absence of left circumflex artery is a rare occurrence and very few cases have been reported in literature. It is a benign incidental finding; however some patients present with sudden onset chest pain mimicking acute coronary syndrome often resulting in detection of this rare anatomy on coronary angiography. Coronary computed tomography angiography is a relatively new noninvasive imaging modality which can be used to confirm this suspicion and diagnose this unique morphology reliably.

Necrotizing Autoimmune Myopathy: A Rare Variant of Idiopathic Inflammatory Myopathies:

Idiopathic inflammatory myopathies are an unusual group of myopathies with annual incidence of 1 in 100 000 people in the United States. Necrotizing autoimmune myopathy comprises only 16% of this group. It usually presents with severe proximal weakness, lower extremity weakness, and severe fatigue while very rarely does it present with dysphagia and respiratory muscle weakness. Statin use, cancer, and connective tissue disorder are the usual associated risk factors. Anti-signal recognition particle and 3-hydroxy-3-methylglutaryl-coenzyme A reductase are the 2 most common autoantibodies associated with necrotizing autoimmune myopathy. In this article, we present a very rare case of a 66-year-old male who presented with shortness of breath and dysphagia requiring intubation and ventilator support. Creatine kinase was 23 000, myoglobin was 7000, and ANA was positive. All other autoimmune and infectious workup including Lyme disease was unremarkable. Muscle biopsy turned out remarkable for necrotizing myopathy. No evidence of statin use, active malignancy, or connective tissue disease was found. He was treated with high-dose corticosteroids and a short course of intravenous immunoglobulin with very mild improvement in symptoms. Anti-signal recognition particle and 3-hydroxy-3-methylglutaryl-coenzyme A reductase could not be performed as the patient refused to pursue further medical testing. This is a very rare case of idiopathic inflammatory myopathy presenting with bulbar and respiratory muscle weakness requiring ventilator support.

Complex Aortic Plaques; an Emerging Source of Life Threatening Cardioembolic Ischemic Infarction

Cardioembolic ischemic infarction, the most severe subtype of ischemic strokes account for approximately 15-30 % of all ischemic strokes. The most common associated disorders include atrial fibrillation, recent myocardial infarction, dilated cardiomyopathy, mechanical prosthetic valve, and mitral rheumatic stenosis. Complex calcified atheromatosis of the aorta, defined as calcified plaques measuring > 4mm in size, ulcerated or having a mobile component are potentially emerging sources of cardioembolic infarction. We present a case of severe cardioembolism with evidence of complicated calcified aortic plaques in an otherwise healthy78 year old female.