Case report of severe PCR-confirmed COVID-19 myocarditis in a European patient manifesting in mid January 2020

Abstract Background Viral genesis is the most common cause of myocarditis. COVID-19-associated myocarditis seems to be a notable extrapulmonary manifestation, which may result in the need for a different treatment. There has been no positive polymerase chain reaction (PCR) testing of SARS-CoV-2 in heart specimens, thus far. Case summary A 48-year-old male patient presented with fever, dyspnoea, and haemoptysis. Laboratory findings showed highly elevated inflammatory and cardiac damage markers. Thoracic computed tomography (CT) revealed bilateral, patchy peripheral ground-glass opacities with a crazy-paving pattern, focal consolidations, and mild pleural effusions. Cardiac imaging with echocardiography and magnetic resonance imaging (MRI) detected a reduced biventricular function. MRI additionally showed myocardial oedema and late gadolinium enhancement. Lung and heart biopsies were performed, revealing alveolitis with necrosis and acute lymphocytic myocarditis. Testing for usual cardiotropic viruses was negative, and no aspects of vasculitis or granuloma could be found. Due to fulfilling the criteria, the patient was diagnosed with rheumatic vasculitis. Treatment with cyclophosphamide and steroids was initiated. Later, the patient reported a history of travel to Tyrol in mid January. Consequently, PCR testing for SARS-CoV-2 was performed, which was positive in the heart specimen. Immunosuppressive treatment was discontinued. During a follow-up visit at the end of April, the patient’s recovery was stable. Discussion In COVID-19 infections, myocardial inflammation can be present as an extrapulmonary manifestation. Positive PCR testing confirms myocardial invasion of the virus. Imaging and laboratory studies correlate with the histopathological findings, and thus should be performed in COVID-19 patients who are suspicious for myocarditis. Supportive treatment with steroids may be useful in these patients.

Download Full-text

Splenic vein thrombosis: rare cause of abdominal pain

Emergency Medicine Journal ◽

10.1136/emermed-2019-208833 ◽

2019 ◽

Vol 37 (1) ◽

pp. 30-48

Author(s):

Antonio J Martín-Jiménez ◽

Oliva Mera-Gallardo ◽

Daniel García-Gil

Keyword(s):

Splenic Abscess ◽

Splenic Vein ◽

Lower Lobe ◽

Splenic Infarction ◽

Point Of Care Ultrasound ◽

Lung Field ◽

List Type ◽

Laboratory Findings ◽

Patient Reported ◽

History Of

An 83-year-old woman with a history of hypertension, diabetes and paroxysmal atrial fibrillation anticoagulated with acenocoumarol was brought to the emergency department due to dyspnoea. At admission, the patient reported a 1-week history of malaise, shortness of breath and non-productive cough. She denied fever but reported pain on the left flank. On examination, auscultation showed arrhythmic tones and crackles in the left lower lung field. Laboratory findings showed leucocytosis of 15.32×103/μL, and the C reactive protein was 177 mg/L. The activated partial thromboplastin time was 54.8 s, and the international normalised ratio was 7.09. A chest X-ray showed left lower lobe consolidation with pleural effusion. Point-of-care ultrasound was performed using a low-frequency curved transducer (2–5 MHz). The probe was placed in the left posterior axillary showing a pulmonary consolidation, but also a hypoechoic lesion in the spleen was found (figure 1).Figure 1Ultrasound image of the spleen in longitudinal section demonstrating a large, hypoechoic, wedge-shaped lesion.QuestionWhat is the most likely diagnosis?Splenic abscessSubcapsular splenic haematomaSplenic infarctionSplenic hydatid cystFor answer see page 2

Download Full-text

Lumbar Intradural Neurenteric Cyst: A Rare Pathology in an Unusual Location

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.148 ◽

2020 ◽

pp. 1-2

Author(s):

Sana Basseri ◽

John P. Rossiter ◽

M. Christopher Wallace ◽

Omar Islam ◽

Donatella Tampieri ◽

...

Keyword(s):

Lower Extremities ◽

Conus Medullaris ◽

Neurenteric Cyst ◽

Low Back ◽

Patient Reported ◽

History Of ◽

Vertebral Anomalies ◽

Characteristic Features ◽

Magnetic Resonance Imaging Mri

A previously healthy 48-year-old female presented to the emergency department with a 2-week history of low back pain, progressive lower extremities weakness, and right leg numbness. There were no bowel or bladder dysfunction symptoms. Spine magnetic resonance imaging (MRI) showed an intradural cystic lesion dorsal to the spinal cord at the level of L1 measuring 1.6 × 2.1 × 4.1 cm, which was T1 hypointense and T2 hyperintense, with a small soft tissue component and no gadolinium enhancement (Figure 1). A small lipomatous component was also noted. There were no associated vertebral anomalies. The patient underwent a T12-L2 laminectomy and cyst resection, which was subtotal due to the cyst adherence to the conus medullaris. Histopathology showed characteristic features of a neurenteric cyst, with respiratory-type epithelium in the cyst wall (Figure 2). Eight months later, follow-up MRI showed no evidence of recurrence. The patient reported improved sensation in the lower extremities; however, there was some residual weakness predominantly in the proximal hip flexors bilaterally.

Download Full-text

Giant cardiac hydatid cyst: case presentation with radiologic survey and review of literature

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v3i4.13377 ◽

2015 ◽

Vol 3 (4) ◽

pp. 165-170

Author(s):

Ravinder Kumar ◽

Amit Kumar ◽

Neha Singh Argahari ◽

Gagan Jaiswal ◽

Jyoti Kundu

Keyword(s):

Computed Tomography ◽

Case Report ◽

Hydatid Cyst ◽

Review Of Literature ◽

Intravenous Contrast ◽

Case Presentation ◽

Thoracic Computed Tomography ◽

Clinical Presentations ◽

Patient Reported ◽

History Of

Hydatid disease is mostly localised to liver and lungs. Cardiac involvement is a rare but potentially very serious complication of echinococcosis, constituting only 0.5–2% of all cases of hydatidosis. Cardiac hydatid cyst is a diagnostic and therapeutic challenge on account of highly variable clinical presentations and non-specifi c symptoms and often numerous unpredictable complications. We present a case report of 20-year-old man who was admitted to our hospital with chief complaint of palpitations and shortness of breath. Using baseline investigations like ECG, transthoracic echocardiography, ultrasonography, non-contrast computed tomography and magnetic resonance imaging, a giant multiloculated cystic lesion (58.4 mm × 43.3 mm) was diagnosed in the apex of left ventricle. Serologic tests (hydatid cyst antibody) confi rmed Echinococcus infection. Thoracic computed tomography with intravenous contrast was not performed because patient reported history of allergy to contrast. This case report is unusual as it is concerned with the description of a rare disease entity (large cardiac hydatid cyst). Its radiological appearances are discussed for early diagnosis and better understanding of the disease, together with a review of the literature.Journal of Kathmandu Medical CollegeVol. 3, No. 4, Oct.-Dec., 2014Page:

Download Full-text

Diagnostic Validity of Patient-Reported History for Shoulder Pathology

The Surgery Journal ◽

10.1055/s-0037-1601878 ◽

2017 ◽

Vol 03 (02) ◽

pp. e79-e87 ◽

Cited By ~ 1

Author(s):

Lyndsay Somerville ◽

Kevin Willits ◽

Andrew Johnson ◽

Robert Litchfield ◽

Marie-Eve LeBel ◽

...

Keyword(s):

Physical Examination ◽

Clinical Decision ◽

Resonance Imaging ◽

Likelihood Ratios ◽

Decision Algorithm ◽

Shoulder Pathology ◽

Patient Reported ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Objective The purpose of this article is to determine whether patient-reported history items are predictive of shoulder pathology and have the potential for use in triaging patients with shoulder pathology to orthopaedic outpatient clinics. Setting It is set at two tertiary orthopaedic clinics. Patients All new patients reporting pain and/or disability of the shoulder joint were prospectively recruited. A total of 193 patients were enrolled, 15 of whom withdrew, leaving 178 patients composing the study sample. Design Patients completed a questionnaire on the history of their pathology, then the surgeon took a thorough history indicating the most likely diagnosis. The clinician then performed appropriate physical examination. Arthroscopy was the reference standard for those undergoing surgery and magnetic resonance imaging (MRI) with arthrogram for all others. We calculated the sensitivity, specificity, and likelihood ratios (LRs) of history items alone and in combination. We used the LRs to generate a clinical decision algorithm. Main Outcome Measures Diagnosis was determined through arthroscopy or MRI arthrogram. Reporting was standardized to ensure review of all structures. Results The physical examination and history agreed in 75% of cases. Of those that did not agree, the physical examination misdirected the diagnosis in 47% of our cases. In particular, history items were strong predictors of anterior and posterior instability and subscapularis tears and were combined in a tool to be utilized for screening patients. Conclusion The patient-reported history items were effective for diagnosing shoulder pathology and should be considered for use in a triaging instrument.

Download Full-text

Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.1.3.8 ◽

2017 ◽

Vol 1 (3) ◽

pp. 156-160

Author(s):

Jacqueline Watchmaker ◽

Sean Legler ◽

Dianne De Leon ◽

Vanessa Pascoe ◽

Robert Stavert

Keyword(s):

United States ◽

Case Series ◽

The United States ◽

Screening Tools ◽

Dermatology Department ◽

Cutaneous Manifestations ◽

Serologic Testing ◽

Patient Reported ◽

History Of ◽

Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas. Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included. Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review. Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion: Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

Download Full-text

Magnetic Resonance Imaging of Pseudo-impingement of Rotator Cuff with Strength Training

10.25259/ijmsr_21_2019 ◽

2019 ◽

Vol 1 ◽

pp. 2-6

Author(s):

Asad Naqvi ◽

Timothy Ariyanayagam ◽

Mir Akber Ali ◽

Akhila Rachakonda ◽

Hema N. Choudur

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Strength Training ◽

Radiology Department ◽

Resonance Imaging ◽

Subacromial Space ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Training Exercises

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

Download Full-text

Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666181005113448 ◽

2019 ◽

Vol 15 (9) ◽

pp. 906-910

Author(s):

Hongzhang Zhu ◽

Shi-Ting Feng ◽

Xingqi Zhang ◽

Zunfu Ke ◽

Ruixi Zeng ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Stable Condition ◽

Resonance Imaging ◽

Mri Findings ◽

Cutis Verticis Gyrata ◽

Essential Form ◽

History Of ◽

Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

Download Full-text

Hepatic brucelloma: a rare complication of a common zoonotic disease

BMJ Case Reports ◽

10.1136/bcr-2020-237076 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237076

Author(s):

George Vatidis ◽

Eirini I Rigopoulou ◽

Konstantinos Tepetes ◽

George N Dalekos

Keyword(s):

Rare Complication ◽

Surgical Excision ◽

Coombs Test ◽

Inflammation Markers ◽

Laboratory Findings ◽

Ct Guided ◽

Rare Manifestation ◽

Bone Marrow Cultures ◽

History Of ◽

The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

Download Full-text

Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis

Clinics and Practice ◽

10.3390/clinpract11020031 ◽

2021 ◽

Vol 11 (2) ◽

pp. 216-218

Author(s):

Marta Brandão Calçada ◽

Luís Fernandes ◽

Rita Soares Costa ◽

Sara Montezinho ◽

Filipa Martins Duarte ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Ketoacidosis ◽

Drug Class ◽

Clinical Suspicion ◽

Laboratory Findings ◽

Sodium Glucose Cotransporter ◽

History Of ◽

High Degree ◽

Euglycemic Diabetic Ketoacidosis

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

Download Full-text

Patients With a History of Oronasal Fistula Repair Exhibit Lower Oral Health Measured With Patient-Centric Outcomes Measures

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620981331 ◽

2020 ◽

pp. 105566562098133

Author(s):

Alyssa Fritz ◽

Diana S. Jodeh ◽

Fatima Qamar ◽

James J. Cray ◽

S. Alex Rottgers

Keyword(s):

Quality Of Life ◽

Oral Health ◽

Cleft Palate ◽

Fistula Repair ◽

Old Patients ◽

Oronasal Fistula ◽

Patient Reported ◽

History Of ◽

The Impact

Introduction: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.

Download Full-text