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Hlaing KM, Monday LM, Nucci M, Nouér SA, Revankar SG. Invasive Fungal Infections Associated with COVID-19. J Fungi (Basel) 2023; 9:667. [PMID: 37367603 DOI: 10.3390/jof9060667] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic caused >6 million deaths worldwide, often from respiratory failure. Complications frequently occurred in hospitalized patients, particularly in the intensive care unit. Among these, fungal infections were a cause of high morbidity and mortality. Invasive aspergillosis, candidiasis and mucormycosis were the most serious of these infections. Risk factors included alterations in immune defense mechanisms by COVID-19 itself, as well as immunosuppression due to various therapies utilized in severely ill patients. Diagnosis was often challenging due to lack of sensitivity of current testing. Outcomes were generally poor, due to significant co-morbidities and delayed diagnosis, with mortality rates >50% in some studies. High index of clinical suspicion is needed to facilitate early diagnosis and initiation of appropriate antifungal therapy.
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Affiliation(s)
- Kyaw M Hlaing
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Lea M Monday
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Marcio Nucci
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Simone A Nouér
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Sanjay G Revankar
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Hlaing KM, Aung TT, Kravitz K, Riaz K. Who Watches the "Watchman" and How Often? Cureus 2020; 12:e10077. [PMID: 32999792 PMCID: PMC7522047 DOI: 10.7759/cureus.10077] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia that is encountered during the hospitalization. Sometimes, many patients cannot be anticoagulated to prevent AF-related cardiovascular accidents because of the risk of bleeding. In these cases, we recommend putting left atrial appendage (LAA) to prevent thrombus formation in the left atrium due to AF. There is no clear time frame of how long we need to follow up with echocardiogram to monitor device-related blood clot formation and continue anticoagulation therapy if there is recurrent thrombus formation after LAA placement. We would like to present a case with AF in which the patient had epistaxis, which required to hold anticoagulation and arterial embolization. The patient agreed to the placement of the Watchman device and subsequently it was complicated by device-related thrombosis (DRT). The patient required prolonged anticoagulation treatment and follow-up echocardiogram to prevent DRT in the future.
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Affiliation(s)
- Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Thein T Aung
- Cardiology, Miami Valley Hospital, Wright State University, Dayton, USA
| | - Kevin Kravitz
- Cardiology, Miami Valley Hospital, Wright State University, Dayton, USA
| | - Kamran Riaz
- Cardiology, Miami Valley Hospital, Wright State University, Dayton, USA
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Moursy S, Gaballa S, Ahmed A, Hlaing KM, Patel BB. Impending Cardiac Tamponade as the Initial Manifestation of BCR-ABL Positive Chronic Myeloid Leukemia. Cureus 2020; 12:e9631. [PMID: 32923232 PMCID: PMC7478927 DOI: 10.7759/cureus.9631] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Leukemia involves all organs and tissues of the body. Leukemic infiltration of the pericardium has been documented frequently at post-mortem examinations. Clinically, however, pericardial effusion with cardiac tamponade is rare, and only isolated case reports have been described. In all the reported cases, therapeutic pericardiocentesis was required for the relief of cardiac tamponade with the risk of bleeding since these patients often had deranged hemostasis. We are reporting a rare case of hemorrhagic pericardial effusion in chronic myeloid leukemia before starting the tyrosine kinase inhibitors. The patient required therapeutic pericardiocentesis and hydroxyurea treatment.
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Affiliation(s)
- Safa Moursy
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | | | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Brijesh B Patel
- Internal Medicine/Pulmonary and Critical Care, LewisGale Medical Center, Salem, USA
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Gaballa S, Hlaing KM, Bos N, Moursy S, Hakami M. A Rare Case of Subacute Painful Thyroiditis Causing Thyroid Storm and a Successful Trial of Propylthiouracil. Cureus 2020; 12:e9461. [PMID: 32760639 PMCID: PMC7392358 DOI: 10.7759/cureus.9461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
There are few literatures highlighting the presence of a mycotic aneurysm in the setting of bloodstream infection by Serratia. A 33-year-old male with a history of Marfan syndrome, mitral valve prolapse, and intravenous drug use (IVDU) presented to the ED with fever, nausea, and non-bloody emesis, and vague abdominal pain with concern for sepsis. With the strong association between IVDU and infective endocarditis, transthoracic and transesophageal echocardiograms were performed and were negative for vegetations. Abdominal CT and positron emission tomography (PET) scan were performed and revealed thrombosis at the first jejunal branch of the superior mesenteric artery (SMA), left renal pole infarct, and superior splenic pole infarct. Following CT angiography for potential thrombolysis, aneurysmal formation was discovered proximal to the filling defect within mid-SMA. Blood cultures drawn at presentation grew Serratia marcescens. The patient was treated with appropriate antibiotic, and recommended indefinite anticoagulation. The patient was then recommended to follow up with vascular surgery within two weeks for repeat abdominal CT angiogram.
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Affiliation(s)
- Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Jasmine Saini
- Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Dave Fintel
- Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Kashyap Patel
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Gaballa S, AlJaf A, Lindsay J, Patel K, Hlaing KM. Rare Etiology of Renal Failure in a 25-Year-Old Caucasian Man: Fabry Disease With a Novel Mutation of GLA Gene. Cureus 2020; 12:e9136. [PMID: 32699723 PMCID: PMC7372230 DOI: 10.7759/cureus.9136] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fabry disease (FD) is an X-linked recessive lysosomal storage disease caused by a mutation of the galactosidase alpha (GLA) gene, leading to deficiency of α-galactosidase A (alpha-Gal A). This deficiency results in a progressive, multiorgan accumulation of glycolipids, most notably globotriaosylceramide (Gb3), leading to multiorgan failure and subsequently premature death. Gb3 accumulation in the podocytes, epithelial, and mesangial cells of the glomeruli results in progressive renal disease and eventually renal failure and hemodialysis (HD). There are two types of FD: early-onset classical type 1 and late-onset type 2. Although nearly a thousand mutations of the GLA gene have been identified, the majority of them are of unknown significance. Herein we report the case of a 25-year-old Caucasian male with no significant medical history who presented with peripheral neuropathy and end-stage renal failure, requiring HD. He was diagnosed with FD based on the electron microscopy findings of renal biopsy and severely reduced alpha-Gal A activity (<0.4 nmol/mL/hour). A novel mutation of c.281G>T; p.Cys94Phe was identified. On discharge from our facility, he was referred to a renal transplant center and genetic counseling.
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Affiliation(s)
- Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Avan AlJaf
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Jane Lindsay
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Kashyap Patel
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Gaballa S, Lindsay J, AlJaf A, Hlaing KM, Patel K. Acute Unilateral Oculomotor Nerve Palsy as the Initial Presenting Sign of Nonfunctioning Apoplectic Gonadotroph Adenoma. Cureus 2020; 12:e8819. [PMID: 32742834 PMCID: PMC7384734 DOI: 10.7759/cureus.8819] [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] [Indexed: 11/12/2022] Open
Abstract
Pituitary macroadenoma usually presents with visual field defects. Oculomotor nerve palsy is a rare presentation, and usually a sign of para-sellar growth and cavernous sinus extension. The oculomotor nerve is more susceptible to laterally transmitted pressure by pituitary mass expansion because of its anatomical location. A slow onset oculomotor nerve palsy results from either gradual compression of the nerve in the sinus wall or direct infiltration of the nerve by the pituitary tumor. We are reporting a unique case of a 68-year-old African American patient who presented to an ophthalmology clinic with left eye complete ptosis, blurry vision, and a progressive headache for a few weeks. He was found to have a nonfunctioning pituitary adenoma (NFPA) that required urgent transnasal transsphenoidal tumor resection. The patient's ocular movements significantly improved a few days postoperatively, and repeated computed tomography (CT) of the head showed complete resection of the pituitary adenoma. The postoperative morning cortisol level was significantly low, confirming the diagnosis of secondary adrenal insufficiency. The patient was treated with corticosteroid replacement therapy.
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Gaballa S, AlJaf A, Patel K, Lindsay J, Hlaing KM. COVID-19 Fears May Be Worse Than the Virus: A Case of Cardiogenic Shock Secondary to Post-Myocardial Infarction Ventricular Septum Rupture. Cureus 2020; 12:e8809. [PMID: 32724754 PMCID: PMC7381854 DOI: 10.7759/cureus.8809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/03/2022] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been a growing and justifiable fear of catching the virus from the emergency rooms, thus decreasing the hospital visits. With Virginia State slowly reopening and HCA local hospitals resuming elective procedures, the number of emergency room visits, are recovering and increasing. We report a sad and unfortunate case of an 87-year-old female who was experiencing pressure-like chest pain but presented to the emergency room five days later out of fear of catching COVID-19 from the hospital. On presentation to the ED, she was found to have an non-ST-elevation myocardial infarction, which required urgent stenting of the left anterior descending artery. Unfortunately, several hours later, she developed fatal cardiogenic shock due to ventricular septal rupture. We are reporting this case to highlight one of the many potential bad outcomes as a result of a delay in seeking necessary medical attention due to the fear of contracting the virus.
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Affiliation(s)
- Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Avan AlJaf
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Kashyap Patel
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Jane Lindsay
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Gaballa S, Hlaing KM, Mahler N, Hargrove R, Roberts M. Eosinophilic Gastroenteritis Presenting As Unexplained Chronic Abdominal Pain. Cureus 2020; 12:e8640. [PMID: 32685309 PMCID: PMC7364395 DOI: 10.7759/cureus.8640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023] Open
Abstract
A 27-year-old Caucasian female was hospitalized three times over a four-month period for recurrent, intermittent abdominal pain associated with nausea and diarrhea. No signs or symptoms of gastrointestinal (GI) bleeding were present. A stool occult blood test and stool enteric pathogen tests were negative. A complete blood count (CBC) revealed a peripheral blood eosinophil count of 1080 cells /µL without any inflammatory reaction. An upper endoscopy showed grossly normal-appearing esophageal and duodenal mucosa; however, a gastric mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/high power field (HPF). Based on these findings, she was diagnosed with eosinophilic gastroenteritis (EGE). A definitive diagnosis of EGE should be confirmed with both an analysis of gastrointestinal mucosal biopsy and an elevated peripheral blood eosinophil count. Specifically, histological evaluation of the mucosal tissue must show an eosinophilic infiltration rate of 20 eosinophils/HPF. The diagnosis should be followed by an extensive review of the patient's allergic disease history.
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Affiliation(s)
- Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Nathan Mahler
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Gaballa S, Hlaing KM, Mahler N, Moursy S, Ahmed A. A Rare Case of Immune-Mediated Primary Adrenal Insufficiency With Cytotoxic T-Lymphocyte Antigen-4 Inhibitor Ipilimumab in Metastatic Melanoma of Lung and Neck of Unknown Primary. Cureus 2020; 12:e8602. [PMID: 32676241 PMCID: PMC7362642 DOI: 10.7759/cureus.8602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 12/19/2022] Open
Abstract
Immunotherapy with checkpoint inhibitors such as ipilimumab, a cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitor, and nivolumab, a programmed death-1 (PD-1) inhibitor, has significantly improved the survival of patients with metastatic melanoma. The immune-related endocrinopathies of these treatments have been well documented, such as hypothyroidism, hyperthyroidism, primary adrenal insufficiency (PAI), insulin-dependent diabetes, and hypophysitis. We report the onset of PAI in a patient with metastatic melanoma to the lung and neck of unknown primary origin who was treated with ipilimumab. The patient's symptoms resolved with steroid replacement. After the completion of 16 cycles of another checkpoint inhibitor, nivolumab, full remission was achieved.
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Affiliation(s)
- Salem Gaballa
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Kyaw M Hlaing
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Nathan Mahler
- Internal Medicine, LewisGale Medical Center, Salem, USA
| | - Safa Moursy
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Gaballa S, Hlaing KM, Moursy S, Ahmed A, AlJaf A. Non-Ketotic Hyperglycemia Causing a Transient Unilateral Homonymous Hemianopia: A Manifestation of Occipital Lobe Seizure. Cureus 2020; 12:e8527. [PMID: 32656040 PMCID: PMC7346296 DOI: 10.7759/cureus.8527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Focal seizures related to non-ketotic hyperglycemia (NKH) are rare in clinical practice. Plasma glucose levels are usually above 16.6 mmol/L and with normal or slightly elevated serum osmolality. The occurrence of focal seizures may be augmented by the absence of ketoacidosis. Electroencephalogram (EEG) during seizures usually confirms the diagnosis, however, the absence of epileptiform discharges does not rule out seizures. A non-ketotic hyperglycemia-associated occipital lobe seizure can manifest itself as color flashes, blurry vision with periodic confusion, and usually resolves with insulin treatment and rehydration. We are reporting a 65-year-old male patient who presented with intermittent confusion and left-sided visual disturbances, found to have a blood glucose of 33.7 mmol/L with a normal anion gap of 10 and calculated serum osmolality of 303 mOsm/L. The patient's visual disturbances responded very well to rehydration and insulin treatment.
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Gaballa S, Hlaing KM, Bos N, Junko G, Alcharif A. Choked Vein: Unusual Etiology of Extensive Deep Vein Thrombosis. Cureus 2020; 12:e8292. [PMID: 32601566 PMCID: PMC7317119 DOI: 10.7759/cureus.8292] [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] [Indexed: 11/21/2022] Open
Abstract
Deep venous thrombosis (DVT) is a commonly encountered diagnosis in clinical practice with a variety of established risk factors. Inferior vena cava atresia (IVCA) is a rare vascular anomaly, but an established risk factor, associated with DVT, found in approximately 5% of cases of unprovoked lower extremity DVT in young adults. Patients who develop DVT are at high risk of long-term complications, including DVT recurrence and post-thrombotic syndrome. Thirty percent of inferior vena cava (IVC) anomalies are associated with hypercoagulable conditions in the younger population, Therefore, a hypercoagulable workup is beneficial in this population. We report a rare case of a 31-year-old male who presented with an extensive DVT of bilateral lower extremities secondary to IVC atresia. The treatment of choice for IVC atresia associated with extensive DVT is catheter-directed thrombolysis (CDT), endovascular IVC reconstruction with nitinol stent, and long-term anticoagulation.
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