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Han S, Pradhan J, Girishkumar H. Rare renal embolic manifestation of left atrial myxoma: A case report. Int J Surg Case Rep 2023; 105:108118. [PMID: 37028188 PMCID: PMC10106462 DOI: 10.1016/j.ijscr.2023.108118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A complete occlusion of the renal artery due to atrial myxoma is a rare occurrence. CASE PRESENTATION Here we present a case of a completely occluded left renal artery caused by atrial myxoma emboli that presented with a 14-hour history of sudden onset sharp left flank pain radiating to the left lower quadrant of the abdomen, nausea, with preserved kidney function. Revascularization is unlikely to benefit the patient because it has been more than 6 h since the onset of ischemia. Anticoagulation therapy was initiated, followed by myxoma resection. The patient was discharged with no evidence of nephropathy. CLINICAL DISCUSSION Anticoagulation with or without thrombolysis is the standard treatment strategy for renal artery embolism. Given the delayed presentation of renal artery occlusion and the nature of the embolism, revisualization is not beneficial for this case. CONCLUSION Emboli of atrial myxoma caused renal artery occlusion is rare. Thrombolysis or surgical revascularization can be used to restore perfusion for renal artery embolism. However, the likelihood of benefit from revascularization must be assessed.
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Affiliation(s)
- Shiwei Han
- Department of Surgery, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jigyasha Pradhan
- Department of Surgery, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hanasoge Girishkumar
- Department of Surgery, BronxCare Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Danyalian A, Padron I, Almeida P, Danckers M. Fulminant methicillin-sensitive Staphylococcus aureus infection: from pinprick to multiorgan failure. BMJ Case Rep 2021; 14:e239396. [PMID: 33975834 PMCID: PMC8117990 DOI: 10.1136/bcr-2020-239396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/03/2022] Open
Abstract
A woman in her 60s with diabetes presented to our institution with altered mental status. Preceding symptoms included headaches, nausea and vomiting. One month prior to presentation, she cut her left thumb and developed a pustule, which she occasionally manipulated with a non-sterile needle. On arrival, the patient was in shock, with a Glasgow Coma Scale of 3, requiring emergent intubation and intensive care unit admission. Her initial imaging studies revealed a large pericardial effusion and cerebral subcortical hypodensities. She suffered from a cardiopulmonary arrest with return of spontaneous circulation, with bedside echocardiogram revealing cardiac tamponade. She underwent emergent pericardiocentesis which revealed purulent drainage. Blood, pericardial fluid, cerebrospinal fluid, sputum and urine cultures returned positive for methicillin-sensitive Staphylococcus aureus The hospital course was further complicated by refractory septic shock and fulminant multiorgan failure, ultimately leading to her demise.
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Affiliation(s)
- Aunie Danyalian
- Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
| | - Ivett Padron
- Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
| | - Patricia Almeida
- Intensive Care Unit, Aventura Hospital and Medical Center, Aventura, Florida, USA
| | - Mauricio Danckers
- Intensive Care Unit, Aventura Hospital and Medical Center, Aventura, Florida, USA
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Amelie M, Magalie D, Liliane T, Merzaka B, Florin S, Maryvonne D, Jelena V, Henry D, Nadia S. Uncommon Association Between Diabetic Ketoacidosis, Thyrotoxicosis, Cutaneous Abscess and Acute Pericarditis in an Immunocompetent Patient: A Single Case Report and Literature Review. Curr Diabetes Rev 2020; 16:641-648. [PMID: 31654516 DOI: 10.2174/1573399815666191025141841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/28/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The typical factors precipitating diabetic ketoacidosis (DKA) include infections (30%), cessation of antidiabetic medication (20%), and a new diagnosis of diabetes (25%). The etiology remains unknown in 25% of cases. Less frequent causes cited in the literature include severe thyrotoxicosis and, infrequently, pericarditis. Few publications have described the role of human T lymphotropic virus type 1 (HTLV-1) in endocrine and metabolic disorders. Based on a clinical case associated with several endocrine and metabolic disorders, we suggest a potential role for HTLV-1, an endemic virus in the Amazonian area, and review the literature concerning the role of this virus in thyroiditis, pericarditis and diabetes mellitus. CASE REPORT A fifty-year-old Surinamese woman without any medical history was admitted for diabetic ketoacidosis. No specific anti-pancreatic autoimmunity was observed, and the C-peptide level was low, indicating atypical type-1 diabetes mellitus. DKA was associated with thyrotoxicosis in the context of thyroiditis and complicated by nonbacterial pericarditis and a Staphylococcus aureus subcutaneous abscess. The patient was infected with HTLV-1. CONCLUSION To our knowledge, this uncommon association is described for the first time. Few studies have analyzed the implications of HTLV-1 infection in thyroiditis and diabetes mellitus. We did not find any reports describing the association of pericarditis with HTLV-1 infection. Additional studies are necessary to understand the role of HTLV-1 in endocrine and cardiac disorders.
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Affiliation(s)
- Martinot Amelie
- Service d'Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Demar Magalie
- Laboratoire de Biologie, Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
- EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, French Guiana
| | - Thelusme Liliane
- Service d'Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Bounoua Merzaka
- Service d'Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Santa Florin
- Service de Medecine Interne, Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Dueymes Maryvonne
- Laboratoire de Biologie, Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Vujica Jelena
- Service d'Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Dequidt Henry
- Service d'Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - Sabbah Nadia
- Service d'Endocrinologie-Diabetologie Centre Hospitalier Andre Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana
- EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, French Guiana
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Ghazala S, Golden TR, Farran S, Zangeneh TT. A rare case of pyogenic pericarditis secondary to Streptococcus constellatus. BMJ Case Rep 2018; 2018:bcr-2017-223804. [PMID: 29592995 DOI: 10.1136/bcr-2017-223804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report an extremely rare case of purulent pericarditis caused by the normally commensal oral flora, Streptococcus constellatus, a viridans Streptococcal species and member of the S. anginosus group (previously also known by the eponymous 'S. milleri', for American Willoughby Dayton Miller). This case is a previously healthy 71-year-old immunocompetent woman from Arizona who presented with a 5-day history of progressive shortness of breath and chest tightness, and subjective fever and chills, but without history of nausea, vomiting, night sweats, recent travel, autoimmune disease or sick contacts. Early recognition and intervention of purulent pericarditis allow patients like the one outlined in this case to achieve full recovery.
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Affiliation(s)
- Sehem Ghazala
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Todd Rabkin Golden
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sumaya Farran
- Infectious Diseases, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Tirdad T Zangeneh
- Infectious Diseases, The University of Arizona College of Medicine, Tucson, Arizona, USA
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Lee HH, Chu CY, Su HM, Lin TH, Voon WC, Lai WT, Sheu SH, Hsu PC. Purulent pericarditis, multi-site abscesses and ketoacidosis in a patient with newly diagnosed diabetes: a rare case report. Diabet Med 2014; 31:e25-8. [PMID: 24698085 DOI: 10.1111/dme.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Purulent pericarditis is an acute and fulminant disease characterized by pus accumulation in the pericardial space. Its incidence has declined substantially and the common pathogen has changed since the beginning of the antibiotic era; however, it is still found in some patients with immunocompromised conditions. CASE REPORT We report a rare case in which the onset of diabetes mellitus presented as extremely high HbA1c concentration, ketoacidosis, multi-site abscesses and purulent pericarditis. After antibiotic therapy and pericardiocentesis, the purulent pericarditis still did not resolve and further intrapericardial thrombolytic therapy also failed. Finally, this patient was treated successfully by surgical debridement and pericardiectomy. CONCLUSION In the immunocompromised state of severe hyperglycaemia, purulent pericarditis is a possible complication of uncontrolled infection. If purulent pericarditis cannot be cured using non-surgical treatments, such as antibiotic therapy, pericardiocentesis and intrapericardial thrombolytic therapy, a surgical pericardiectomy should be considered to avoid morbidity and mortality.
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Affiliation(s)
- H-H Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
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Tani T, Okada Y, Kita T, Furukawa Y. Destructive acute infective endocarditis and purulent pericarditis. J Echocardiogr 2013; 11:164-6. [PMID: 27278770 DOI: 10.1007/s12574-013-0184-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 04/11/2013] [Accepted: 05/29/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Tomoko Tani
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toru Kita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Cheng HL, Lin WC, Shih PY, Huang CH, Hsu YC, Yie JC, Chen SY, Lin CP. Streptococcus agalactiae infective endocarditis with large vegetation in a patient with underlying protein S deficiency. Infection 2012; 41:247-50. [PMID: 23001489 DOI: 10.1007/s15010-012-0334-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 09/08/2012] [Indexed: 11/30/2022]
Abstract
We present a case of a patient with underlying protein S deficiency who suffered from infective endocarditis with a large anterior mitral leaflet (AML) mass of approximately 4.5 cm in length. Intraoperative transesophageal echocardiography (TEE) revealed the mass at the AML base and a rupture of the posterior mitral leaflet chordae tendinae. The vegetation's large size may have been caused by one or more of three factors: location, underlying disease, and the microorganism causing infection. Patients with protein S deficiency are prone to thromboembolic events during cardiac surgery. Infective endocarditis caused by Streptococcus agalactiae usually has a poor prognosis, and, thus, early surgery is recommended.
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Affiliation(s)
- H-L Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Elalouf V, Vandwalle J, Viart L, Petit J, Saint F. [Renal colic "ischemic" of renal infarction: A plea for routine helical CT in emergency]. Prog Urol 2011; 21:184-90. [PMID: 21354036 DOI: 10.1016/j.purol.2010.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 08/18/2010] [Accepted: 08/22/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Through a retrospective cohort, to analyse causative factors of acute renal infarction and specific therapeutic. Recall the need to carry a computerised tomoraphy (CT) in any flank pain suggestive of renal colic can hide a renal infarct. METHOD Over a period of 24 months (2008-2009), we have compiled six patients admitted for acute lumbar pain reported in renal colic and showing a renal infarction. We report the risk factors for cardiovascular disease, the clinical presentation, and the interest of heparin therapy started early in the recovery of renal function. We emphasise the need for abdominal-pelvic CT in emergency before a renal colic pain associated with injection of contrast medium if no stone obstacle is identified. RESULTS Five patients had risk factors for cardiovascular disease including one personal history of deep vein thrombosis and pulmonary embolism and two, a family history of myocardial infarction. Five patients were treated early with LMWH, and for one the herapin was started at 72 hours of onset of symptoms. In all cases, no effect on renal function was noted. CONCLUSION Renal infarction is a rare but probably underestimated, occurring on land known cardiovascular often. The abdominopelvic CT without injection is increasingly practiced in front of abdominal pain syndromes, it seems imperative to complete the review by the injection of contrast material if stone obstruction is unconfirmed. Early management by herapin appears to improve the complete recovery of renal function.
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Affiliation(s)
- V Elalouf
- Service d'urologie - transplantation, CHU d'Amiens, université Picardie Jules-Verne, avenue R-Laennec, Salouel, 80054 Amiens cedex 1, France.
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Tokuyasu H, Saitoh Y, Harada T, Touge H, Kawasaki Y, Maeda R, Isowa N, Shimizu E. Purulent pericarditis caused by the Streptococcus milleri group: a case report and review of the literature. Intern Med 2009; 48:1073-8. [PMID: 19525602 DOI: 10.2169/internalmedicine.48.2109] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old woman with a history of diabetes mellitus presented at our emergency room with chest pain and dyspnea. A chest computed tomography revealed a pericardial effusion. Pericardiocentesis was performed; strains of the Streptococcus milleri group were detected on culture of the fluid thus obtained. Therefore, purulent pericarditis was diagnosed. Despite treatment with panipenem/betamipron, the pericarditis worsened leading to the development of cardiac tamponade. Emergency pericardial drainage was performed, after which the condition resolved without any complications. We report an extremely rare case of purulent pericarditis caused by a strain of the Streptococcus milleri group. In addition, we review 5 previously reported cases of purulent pericarditis caused by strains.
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Kansal S, Feldman M, Cooksey S, Patel S. Renal artery embolism: a case report and review. J Gen Intern Med 2008; 23:644-7. [PMID: 18224377 PMCID: PMC2324140 DOI: 10.1007/s11606-007-0489-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 04/18/2007] [Accepted: 12/10/2007] [Indexed: 12/31/2022]
Abstract
Renal artery embolism was first described in 1940, but it is only recently becoming recognized as a clinically significant entity. Although relatively uncommon, it is clearly responsible for considerable morbidity in patients who experience it. The pathogenesis is typically related to cardiac thrombus formation with subsequent embolization, although other etiologies have been described. The authors present a case report followed by a review of the literature to highlight the clinical characteristics of this phenomena. Presentation, diagnostics, and treatment options will be reviewed with the aim of increasing awareness of renal artery embolism. As clinicians become more familiar with this condition, they will be more likely to consider it as a possible diagnosis in patients with a typical presentation. This will hopefully lead to improved care through prompt diagnosis and treatment, particularly as one treatment option may be time sensitive.
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Affiliation(s)
- Sheru Kansal
- Department of Medicine, The Western Pennsylvania Hospital, Pittsburgh, PA, USA.
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Katz LH, Pitlik S, Porat E, Biderman P, Bishara J. Pericarditis as a presenting sign of infective endocarditis: two case reports and review of the literature. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2008; 40:785-791. [PMID: 18609201 DOI: 10.1080/00365540802169106] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pericarditis as a presenting sign of infective endocarditis is rare. Here we describe 2 cases and an additional 19 cases of pericarditis as a presenting sign of infective endocarditis reported during the last 40 y. 71% of patients were young males (mean age 43.2 y). The most commonly reported underlying conditions were diabetes mellitus type 2 (5 patients, 24%), and substance or alcohol abuse (4 patients, 19%). The native aortic valve was the most frequently involved valve. The most common symptoms were fever, cough or dyspnoea, and chest pain. Overt tamponade was diagnosed in 47% of the patients. However, pulsus paradoxus and pericardial friction rub were rare. A heart murmur was heard in 12 patients (57%). Staphylococcus aureus was the most commonly isolated pathogen concomitantly from blood and pericardial fluid. 16 patients (76%) were operated. Six underwent a pericardial procedure, 5 underwent valve replacement, 4 both, and 1 patient was operated for pseudoaneurysm. Mortality rates were 60% and 31% of patients treated with antibiotics alone versus antibiotics and surgical intervention, respectively. In patients presenting with pericarditis with or without cardiac tamponade, the possibility of infective endocarditis should be considered. Optimal therapy should consist of antibiotics and surgical intervention.
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Affiliation(s)
- Lior H Katz
- Infectious Diseases Unit, Department of Internal Medicine D, Rabin Medical Centre, Beilinson Hospital, Petah Tiqwa, Israel
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