Levofloxacin-Induced Hepatotoxicity in Patients With Legionnaires' Disease: Implications and Management

Legionnaires' disease (LD), caused by the Legionella bacterium, primarily manifests as pneumonia and could result in a spectrum of clinical severity. As treatment necessitates the use of antibiotics, levofloxacin, a fluoroquinolone, is a commonly preferred option due to its broad-spectrum activity. However, the potential side effects of levofloxacin, including rare instances of hepatotoxicity, introduce a therapeutic challenge. This case report explores the association between levofloxacin and hepatotoxicity and its implications for treating LD.

A Rare Case of Allergic Bronchopulmonary Aspergillosis Progressing to Cardiac Tamponade in the Al Qassim Region of Saudi Arabia

Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterized by an exaggerated response of the immune system (a hypersensitivity response) to the fungus Aspergillus. Aspergillus-associated pericarditis leading to pericardial tamponade is rare. In our case, we presented a case of a 22-year-old female asthmatic patient with no other medical conditions who presented to the emergency department (ED) complaining of severe chest tightness and shortness of breath. Echocardiography revealed significant pleural and pericardial effusion consistent with cardiac tamponade. Both pleural and pericardial fluids were hemorrhagic. Four months later, she presented to the ED with chief complaints of shortness of breath and a cough lasting two days. She was admitted as a case of asthma exacerbation. In the following months, when the patient visited the pulmonology outpatient clinic, the doctors recommended for specific IgE test. Allergen-specific IgE testing was positive for A. fumigatus to confirm the presence of ABPA. As we rolled out other causes of cardiac tamponade, we link the development of cardiac tamponade secondary to an underlying Aspergillus infection. We report this case with the aim of improving clinical knowledge regarding probable causes of cardiac tamponade in patients with asthma, which may facilitate the establishment of early diagnosis and treatment protocols.

ECG Changes in a Patient Presenting With Chest Pain Secondary to Left-Sided Primary Spontaneous Pneumothorax: A Case Report-Based Literature Review

Pneumothorax is the accumulation of air in the extrapulmonary space between the pleura and the chest wall. Spontaneous pneumothorax can present with various electrocardiographic (ECG) findings including axis deviation, bundle branch block and T waves inversion. A 23-year-old young male patient of slim build presented to the accident and emergency department with sudden-onset chest pain and shortness of breath. He had pleuritic chest pain, worse on breathing. Electrocardiogram showed right axis deviation, diminished or low-amplitude R waves and small-amplitude QRS complexes in the precordial leads. Vital signs were stable and physical examination showed reduced air entry on the left side. Chest radiography showed significant left-sided pneumothorax and the patient had an emergency chest drain inserted. ECG changes resolved with the resolution of pneumothorax. He was discharged home after four days of hospital admission and complete resolution of pneumothorax.

A Case Report of Pacemaker-Induced Cardiomyopathy in a Patient With Post-atrioventricular Node Ablation for Atrial Fibrillation

Pacemaker-induced cardiomyopathy (PICM) is a rare but well-recognised phenomenon in patients requiring right ventricular (RV) pacing. It can be caused by single-chamber or dual-chamber pacemakers. We present a case of a 64-year-old female patient presenting to the pacemaker clinic with worsening shortness of breath and legs swelling. She was found to have atrial fibrillation and underwent atrioventricular node ablation followed by a dual chamber permanent pacemaker (PPM) implantation as part of a 'pace and ablate' strategy to treat refractory symptomatic atrial tachycardia, and the patient was entirely dependent on RV pacing. In the immediate two months following PPM implantation, the patient was seen in the clinic and reported shortness of breath that was attributed to interstitial lung disease. However, a month later her symptoms worsened, stimulating a referral for echocardiography, which demonstrated a fall in her left ventricular ejection fraction (LVEF) from 60% to 30% in just four months after the device implantation. The patient was diagnosed with PICM. The patient's prognostic heart failure treatment was optimised and her device was upgraded to a cardiac resynchronisation (CRT) device with pacing functionality in an attempt to improve biventricular synchrony. The patient's symptoms have improved significantly since and a repeat echocardiogram 2 months later showed significant improvement in LVEF to 45-50%.