Vanessa Goyes Ruiz

Case report: Cocaine-induced takotsubo cardiomyopathy

lease cite this article in press as: Gi 2017), http://dx.doi.org/10.1016/j. tp://dx.doi.org/10.1016/j.hjc.2017 09-9666/a 2017 Hellenic Society of ense (http://creativecommons.org/ Cocaine is the second most common illicit drug used, and it is the most common cause of drug-related death. Cocaine is a sympathomimetic agent, and it acts by blocking the presynaptic reuptake of norepinephrine and dopamine, leading to an accumulation of these neurotransmitters at the postsynaptic terminal. This results in overstimulation of alphaand beta-adrenergic receptors. The peak effects of cocaine occur within 1-90 min after exposure and can last anywhere from 15 min to 2-3 h depending on the route of administration. Exposure to cocaine can result in hypertensive crisis, vascular complications including cerebral vascular accidents of either thrombotic or hemorrhagic origin, aortic dissection or rupture, and vasculitis. It most commonly affects the cardiovascular system, increasing the risk for myocardial ischemia, coronary artery spasm, myocardial infarction, atherosclerosis, myocarditis, cardiomyopathy, and arrhythmias. The association of cocaine use with Takotsubo cardiomyopathy is a rare occurrence. In this report, we present the case of a 41-year-old male who developed Takotsubo cardiomyopathy with cocaine use Figure 1.

Takotsubo Cardiomyopathy with Guillain-Barré Syndrome

A 70-year-old woman presented with progressive lower extremity weakness and heaviness accompanied with chest pain. Troponin T was elevated, and an echocardiogram showed a left ventricular ejection fraction of 30% and a hypokinetic left ventricular apex. Neurophysiologic testing was consistent with Guillain-Barré syndrome, which was treated with intravenous immunoglobulin therapy. Repeat echocardiogram showed an improved left ventricular ejection fraction and no left ventricular wall motion abnormalities. Takotsubo cardiomyopathy is a rare complication of Guillain-Barré syndrome; less than 10 cases have been reported.

Screening of Celiac Disease in Patients With Sarcoidosis

Sarcoidosis and celiac disease (CD) are both autoimmune disorders, which have been associated with class II haplotype HLA-DR3, DQ2. Literature demonstrates this combination is more prevalent in the Irish population. Celiac disease is caused by the ingestion of gluten, where the predisposed population (HLA BQ2 or BQ8 carriers) develop antibodies against gluten peptides. The prevalence of celiac disease ranges from 1:70 to 1:300 in most countries. More importantly, however, is the association between celiac disease and cancers, mainly B cell lymphoma and gastrointestinal cancers. Sarcoidosis is a multisystem granulomatous disorder most often found in lung parenchyma and related lymph nodes. Diagnosis of celiac disease in a patient with sarcoidosis has special importance, including implication for the treatment of both diseases. A 35-year-old woman who was diagnosed with biopsyproven sarcoidosis developed a complex clinical course over time. Her sarcoidosis was complicated by diffuse inflammatory arthritis, which involved her shoulders, knees, ankles, hands, and wrist. She also complained of significant and prolonged morning stiffness, but work-up for systemic lupus and rheumatoid arthritis was negative. Her sarcoidosis was otherwise stable, except for occasional flares treated with short courses of Medrol (Pfizer, New York, NY). Although her chest x-ray, computed tomography scan of the thorax, and pulmonary function tests remained stable over the course of 6 years, she started experiencing recurrent nonbloody watery diarrhea. These episodes occurred up to 7-8 times per day or night and were accompanied by abdominal cramping and generalized weakness. Over time, the patient developed other symptoms such as nonspecific dermatitis, hair loss, and oral ulcers.

Alcohol withdrawal induced posterior reversible encephalopathy syndrome

Received: January 13, 2017; Accepted: February 08, 2017; Published: February 11, 2017 Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition characterized by various clinical findings and imaging abnormalities. Patients can present with a myriad of symptoms ranging from headaches and confusion to seizures and focal neurologic deficits (hemiparesis, aphasia) [1-3]. We report a rare case of PRES induced by acute, malignant hypertension associated with alcohol withdrawal.

Sjogrenâs Syndrome in a Patient with Maculopapular Cutaneous Mastocytosis

We report a case of a 42-year-old female with past medical history significant for cutaneous mastocytosis who presented with complains of progressive dry eyes, and dry mouth for the past few weeks. Her vital signs were remarkable for blood pressure of 106/71 mmHg, pulse of 86 beats per minute, temperature of 36.7°C (98.1°F) (oral), and respiratory rate of 16 breaths per minute. Physical exam was significant for bilateral dryness in eyes, cracks at the corners of the mouth, dry and smooth tongue. Lab work revealed a benign blood count and chemistry. Sedimentation rate was elevated at 25 mm/hr, CRP was also elevated at 11.1 mg/L, and ANA with speckled pattern was elevated at 1250 1/dil. Speckled pattern was elevated at 1250 1/dil. Hence patient was managed with muscarinic agonists such as cevimeline and pilocarpine, which improved her symptoms. We report a rare case of a patient with maculopapular cutaneous mastocytosis who develops Sjogren’s syndrome. Literature review revealed that in the past there have been case reports which linked systemic mastocytosis to Sjogren’s syndrome, however there are no case reports of maculopapular cutaneous mastocytosis linking to Sjogren’s syndrome. Clinicians need to be aware that even the milder form of mastocytosis, cutaneous type, can also be associated with Sjogren’s syndrome. Absence of well defined histopathological features and lack of clinical awareness can delay its diagnosis and treatment.

Successful Treatment of Lung Abscess with Pigtailed Catheter after Failure with Antibiotics and Surgical Debridement

Necrotizing pneumonia is a rare complication of pneumonia as it could lead to lung abscess, septic shock and respiratory failure. 80%-90% of lung abscess are successfully treated with antibiotics, however surgical intervention is required in refractory cases1. Mortality rates are high despite thoracotomy and lobectomy, ranging from 15%-20% [1]. An alternative therapy is percutaneous tube drainage.

Complex Case of Methicillin Resistant Staphylococcus aureus Occipital Osteomyelitis and Subdural Empyema: Vancomycin or Linezolid?

Methicillin-resistant Staphylococcus aureus (MRSA) is typically considered a nosocomial pathogen, however it has now emerged to cause infections in the community. We report a case of MRSA bacteremia with subdural empyema and occipital osteomyelitis in a female with a history of significant intravenous drug use (IVDU). There are very few reports on MRSA bacteremia leading to problems with central nervous system (CNS) involvement.

A Case of Diffuse Ischemic Limb Gangrene with Palpable Pulses in a Patient withSeptic Shock

It is widely believed that ischemic limb gangrene is sequelae of arterial thrombosis or thromboembolism. In patients with severe sepsis, there is widespread activation of acute systemic inflammatory response. This can activate the coagulation cascade in the smaller vessels, therefore the pulse may still be palpable but patients may have ischemic injury due to vasoconstriction. Sepsis is also known to be associated with disseminated intravascular coagulation (DIC) because of hypercoagulable state and subsequent consumption of platelets and coagulation proteins.

Rare Cause of Cardiotoxicity

Etoposide based combination chemotherapy is used with curative intent in patients with advanced testicular germ cell tumors. Common side effects involve nausea and vomiting (up to 43%), alopecia (up to 66%), leukopenia (up to 91%). Cardiovascular side effects are rare, and hypotension only occurs in 1%-2% of patients. Etoposide is not known to cause thyroid dysfunction. We observed a case of bradycardia and QTc interval shortening after introduction of etoposide based chemotherapy.

Palisaded Neutrophilic Granulomatous Dermatitis Associated with Adult OnsetStill's Disease

A 66-year-old male presented with a new onset of rash. The rash was erythematous, macular and localized to the shoulders and neck. Biopsy showed palisading neutrophilic granulomatous dermatitis with features of atypical granuloma annulare tissue. Improvement was noted with steriods. To our knowledge, there has only been one reported case of PNGD in a patient with AOSD. It is diagnosed with skin biopsy and historically glucocorticoids have been the mainstay of treatment. However, clinicians should have a high suspicion of PNGD in patients with AOSD who present with features of atypical rash, as treatment may be required. This association is extremely rare, since this is only the second reported case. We strongly believe that to further delineate different forms of PNGD and rare instances such as in patients with AOSD, further case reports are needed. Additional research into the pathophysiology of PNGD is also warranted, as this would optimize medical management.