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Okorie IJ, Appiah-Kubi E, Owusu-Antwi P, Takyi E, Ugwendum D, Fernando A, Atere M, Nfonoyim J. Lupus-Induced Accelerated Heart Failure in a Young African American Female: Cardiovascular and Systemic Complications of Noncompliance to Maintenance Therapy and the Social Determinants of Cardiovascular Disease. Cureus 2024; 16:e51819. [PMID: 38327922 PMCID: PMC10847065 DOI: 10.7759/cureus.51819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder characterized by dysregulations of the immune system with intermittent and remitting symptoms. SLE affects multiple organs and systems, including the cardiovascular system. This condition is associated with an increased risk of cardiovascular disease, particularly in younger patients. Our case report describes a patient who rapidly developed structural, functional, and electrophysiological cardiac abnormalities due to lupus-induced cardiomyopathy. The accelerating cardiac events were the result of medication noncompliance. Myocarditis and other potentially fatal cardiac complications associated with SLE have been the subject of numerous studies. This presentation appears to be the first to emphasize the rarity of lupus-induced cardiomyopathy, the importance of treatment adherence, the adverse cardiac effects of targeted therapeutic interventions, and the influence of social determinants of cardiovascular health on a patient's prognosis.
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Affiliation(s)
| | | | | | - Evans Takyi
- Internal Medicine, American University of Antigua, New York, USA
| | - Derek Ugwendum
- Internal Medicine, Richmond University Medical Center, New York, USA
| | - Annmarie Fernando
- Internal Medicine, Richmond University Medical Center, New York, USA
| | - Muhammed Atere
- Medicine, Richmond University Medical Center, New York, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, New York, USA
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Owusu-Antwi P, Appiah-Kubi E, Krishnamoorthy V, Takyi E, Murukutla S. Molecular Mimicry: An Uncommon Occurrence of Vitamin B12 Deficiency Imitating Thrombotic Thrombocytopenic Purpura in an African American Male. Cureus 2023; 15:e45410. [PMID: 37854729 PMCID: PMC10581396 DOI: 10.7759/cureus.45410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) and vitamin B12 deficiency can share similar symptoms but require different treatment approaches. TTP is a blood disorder with a high mortality rate requiring immediate plasmapheresis treatment. On the other hand, vitamin B12 deficiency usually presents with anemia, low platelet counts, jaundice, and signs of disrupted red blood cell breakdown, resembling a condition called microangiopathic hemolytic anemia. Vitamin B12 deficiency can sometimes lead to or mimic pseudo-thrombotic microangiopathy (pseudo-TMA), a rare occurrence. Pseudo-TMA manifests as microangiopathic hemolytic anemia and thrombocytopenia and is characterized by schistocytes in a peripheral blood smear. Differentiating TTP cases from pseudo-TMA cases is essential and should be done promptly. The etiology, treatments, and prognosis of these two conditions differ and can be fatal if not identified and managed. We present a case that emphasizes the need for familiarity with TTP-like conditions, the use of ADAMTS13 as a diagnostic tool, prompt and accurate treatment decision-making, the complexities of therapeutic plasma exchange, and the importance of excluding an enzyme inhibitor or mutator as the cause of TTP or TTP-like cases. Lack of knowledge can lead to erroneous diagnoses, resulting in unnecessary treatments or delayed life-saving interventions.
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Affiliation(s)
| | | | | | - Evans Takyi
- Medicine, American University of Antigua, New York, USA
| | - Seetha Murukutla
- Hematology and Oncology, Richmond University Medical Center, Staten Island, USA
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Arunthamakun N, Appiah-Kubi E, Amoateng R, Johnston A, Gadani M. ASSOCIATION OF SOCIAL DETERMINANTS OF HEALTH IN PATIENTS WITH HYPERTENSION IN THE OUTPATIENT SETTING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Elkattawy S, Alyacoub R, El-Feki I, Fichadiya H, Appiah-Kubi E, Romero J, Guo X, Edward W. Tricuspid Endocarditis: A Case Report and Comprehensive Literature Review. Cureus 2022; 14:e24027. [PMID: 35573489 PMCID: PMC9092521 DOI: 10.7759/cureus.24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Infective endocarditis is a multisystem disease. Tricuspid valve endocarditis is frequently seen in patients with intravenous (IV) drug users. Cavitating lung nodules predominantly in a peripheral location in IV drug users indicate the possibility of septic emboli. Large vegetation and persistent bacteremia with septic embolic phenomena are the most common indication for surgery. We present a case of a 62-year-old male with a history of IV drug use who presented with epigastric abdominal pain, pleuritic chest pain, and shortness of breath. CT chest showed cavitating lung nodules suggestive of septic pulmonary emboli. A transesophageal echocardiogram (TEE) showed tricuspid valve vegetation despite a normal transthoracic echocardiogram. The patient was treated with intravenous antibiotics. He was deemed a poor surgical candidate; therefore, he was transferred to a tertiary center for AngioVAC (AngioDynamics, Latham, New York).
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Elkattawy S, Ayad S, El-Feki I, Guo X, Appiah-Kubi E, Talpur A, Kessler W. 5q Deletion Myelodysplastic Syndrome in a Young Male Patient. Cureus 2021; 13:e17466. [PMID: 34589360 PMCID: PMC8464316 DOI: 10.7759/cureus.17466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/28/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a diverse group of hematopoietic stem cell malignancies with various phenotypic variability that are categorized by abnormal differentiation of one or multiple cell lines of the bone marrow. A large part of the phenotypic heterogeneity is in part due to the wide set of genetic defects related to MDS. Though clinically, MDS is centered on diagnostic measures that do not incorporate molecular genetic data, an isolated deletion of the long arm of chromosome 5 (del(5q)) is the only subset of MDS to be identified by genetic defects. This distinctive phenotype is termed 5q-syndrome. We report a case of a 25-year-old with a past medical history of polydactyly, severe anemia, and thrombocytopenia who presented to the emergency department with a chief complaint of weakness and fatigue. Bone marrow biopsy showed myeloid neoplasm with complex genetic abnormalities, nearly 100% hyperplastic marrow with marked trilineage dysplasia, relative myeloid hyperplasia with increased abnormal eosinophilic precursors, erythroid left shift, and atypical megakaryocytes. Fluorescence in situ hybridization (FISH) panel showed deletion of 5q-. Herein, we address the clinical course and morphological characteristics as well as possible therapeutic options for 5q syndrome.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sarah Ayad
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Iman El-Feki
- Internal Medicine, St. George's University, West Indies, GRD
| | - Xutong Guo
- Internal Medicine, St. George's University, West Indies, GRD
| | | | - Afrah Talpur
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - William Kessler
- Hematology and Medical Oncology, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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Al-Zakhari R, Atere M, Lim W, Abdulrahman M, Akhtar S, Sheets N, Joyce T, Stefanishina V, Appiah-Kubi E, Owusu-Antwi P, Nfonoyim J, Grodman R, Rotatori F. Corrected QT Interval Prolongation, Elevated Troponin, and Mortality in Hospitalized COVID-19 Patients. Cardiol Res 2021; 12:258-264. [PMID: 34349868 PMCID: PMC8297043 DOI: 10.14740/cr1276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has risen to the level of a global pandemic. Growing evidence has proven the cardiac involvement in SARS-CoV-2 infection. This study aims to evaluate the ability of cardiovascular complications determined by elevated troponin and electrocardiogram findings (e.g., corrected QT interval (QTc)) in predicting the severity of SARS-CoV-2 infection among hospitalized patients. Methods This is a retrospective review of medical records of 800 patients, admitted to Richmond University Medical Center in Staten Island, NY, and tested positive for SARS-CoV-2 between March 1, 2020 and July 31, 2020. A total of 339 patients met the study inclusion and exclusion criteria and were included in statistical analysis. Results Elevated serum troponin levels on admission statistically correlated with mortality in SARS-CoV-2 patients. Prolonged QTc was shown to have an independent statistically significant association with mortality among patients hospitalized with SARS-CoV-2. Conclusions Growing concern for cardiovascular sequelae of coronavirus disease 2019 (COVID-19) has prompted many researchers to investigate the role of cardiovascular complications in mortality due to SARS-CoV-2. Obtaining a simple electrocardiogram for hospitalized patients with COVID-19 could provide an independent prognostic tool and prompt more coordinated treatment strategies to prevent mortality among patients hospitalized with COVID-19.
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Affiliation(s)
- Rana Al-Zakhari
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Muhammed Atere
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - William Lim
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Mustafa Abdulrahman
- Department of Medicine, Zucker School of Medicine at Mather/Northwell Health Mather Hospital, Port Jefferson, NY, USA
| | - Shahnaz Akhtar
- Department of Clinical Research, Richmond University Medical Center, Staten Island, NY, USA
| | - Nicholas Sheets
- St. George's University School of Medicine, Grenada, West Indies
| | - Thomas Joyce
- St. George's University School of Medicine, Grenada, West Indies
| | | | - Edmund Appiah-Kubi
- St. George's University, Building 300, 3500 Sunrise Highway, Great River, NY 11739, USA
| | - Philipa Owusu-Antwi
- St. George's University, Building 300, 3500 Sunrise Highway, Great River, NY 11739, USA
| | - Jay Nfonoyim
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Richard Grodman
- Department of Medicine-Cardiology, Richmond University Medical Center, Staten Island, NY, USA
| | - Francesco Rotatori
- Department of Medicine-Cardiology, Richmond University Medical Center, Staten Island, NY, USA
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