Loeffler endocarditis with intracardiac thrombus: case report and literature review

Abstract Background Loeffler endocarditis is a relatively rare and potentially life-threatening heart disease. This study aimed to identify the characteristic features of Loeffler endocarditis with intracardiac thrombus on a background of hypereosinophilic syndrome (HES). Case presentation We described a 57-year-old woman with Loeffler endocarditis and intracardiac thrombus initially presenting with neurological symptoms, who had an embolic stroke in the setting of HES. After cardiac magnetic resonance (CMR), corticosteroids and warfarin were administered to control eosinophilia and thrombi, respectively. During a 10-month follow-up, the patient performed relatively well, with no adverse events. We also systematically searched PubMed and Embase for cases of Loeffler endocarditis with intracardiac thrombus published until July 2021. A total of 32 studies were eligible and included in our analysis. Further, 36.4% of recruited patients developed thromboembolic complications, and the mortality rate was relatively high (27.3%). CMR was a powerful noninvasive modality in providing diagnostic and follow-up information in these patients. Steroids were administered in 81.8% of patients, achieving a rapid decrease in the eosinophil count. Also, 69.7% of patients were treated with anticoagulant therapy, and the thrombus was completely resolved in 42.4% of patients. Heart failure and patients not treated with anticoagulation were associated with poor outcomes. Conclusions Cardiac involvement in HES, especially Loeffler endocarditis with intracardiac thrombus, carries a pessimistic prognosis and significant mortality. Early steroids and anticoagulation therapy may be beneficial once a working diagnosis is established. Further studies are needed to provide evidence-based evidence for managing this uncommon manifestation of HES.

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Perforation of the atrial wall and aortic sinus after closure of an atrial septal defect with an Atriasept occluder: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01441-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zai-Qiang Zhang ◽

Jia-Wang Ding

Keyword(s):

Case Report ◽

Atrial Septal Defect ◽

Septal Defect ◽

Emergency Operation ◽

Atrial Wall ◽

Aortic Sinus ◽

Case Presentation ◽

Lethal Complications ◽

Life Threatening

Abstract Background While the perforation of the atrial wall and aortic sinus after closure of an atrial septal defect (ASD) is rare, it’s life-threatening, with rapid progress and high mortality. To the best of our knowledge, 21 similar cases have been reported since 1976. Case presentation We report a 16-year-old male whose atrial septal defect (ASD) was closed using a 12-mm Amplatzer septal occluder (ASO). Atrial wall and aortic sinus perforation occurred 3 months after transcatheter closure, and the patient was discharged after emergency operation. He was discharged on the 12th postoperative day in good overall condition. Conclusions With this case report, we want to illustrate that although percutaneous closure of ASD is regarded as a routine procedure, we should not forget the potentially lethal complications, especially cardiac erosion. Therefore, we should carefully evaluate the risk of erosion before surgery, and careful lifelong follow-up is needed.

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Successful treatment of pulmonary mucormycosis caused by Rhizopus microsporus with posaconazole

European Journal of Medical Research ◽

10.1186/s40001-021-00602-x ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

F. Yuan ◽

J. Chen ◽

F. Liu ◽

Y. C. Dang ◽

Q. T. Kong ◽

...

Keyword(s):

Fungal Culture ◽

Rhizopus Microsporus ◽

Pulmonary Tissue ◽

Case Presentation ◽

Common Cause ◽

Pulmonary Mucormycosis ◽

Threatening Condition ◽

Life Threatening ◽

One Year

Abstract Background Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation We report a case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up. Conclusions Pulmonary mucormycosis is a life-threatening condition and posaconazole is an effective treatment for pulmonary mucormycosis caused by Rhizopus microspores.

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Anticoagulation may contribute to antimicrobial treatment of Lemierre syndrome: a case report

Thrombosis Journal ◽

10.1186/s12959-021-00336-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Jie Ge ◽

Peipei Zhou ◽

Yifei Yang ◽

Tianshu Xu ◽

Xu Yang

Keyword(s):

Anticoagulation Therapy ◽

Filling Defect ◽

Antimicrobial Treatment ◽

Lemierre Syndrome ◽

Case Presentation ◽

Intravenous Antibiotics ◽

Left Neck ◽

Wbc Count ◽

Evidence Based Guidelines

Abstract Background Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial. Case presentation A 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous 2 days, decreased instantly after initiation, and follow-up controls showed thrombus resolution. Conclusions Our case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.

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Coeliac crisis mimicking nephrotic syndrome in a post-partum patient

Scottish Medical Journal ◽

10.1177/0036933019853170 ◽

2019 ◽

Vol 64 (3) ◽

pp. 116-118

Author(s):

Özant Helvacı ◽

Seyma Yıldız ◽

Berfu Korucu ◽

Ulver Derici ◽

Turgay Arinsoy

Keyword(s):

Nephrotic Syndrome ◽

Coeliac Disease ◽

Post Partum ◽

Lower Extremity Weakness ◽

Case Presentation ◽

Multisystem Involvement ◽

Life Threatening ◽

History Of ◽

Rare Occasion

Background Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. Case presentation A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months’ follow-up. Conclusion Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.

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Anticoagulation May Contribute to Antimicrobial Treatment of Lemierre Syndrome: A Case Report

10.21203/rs.3.rs-104611/v2 ◽

2021 ◽

Author(s):

Jie Ge ◽

Peipei Zhou ◽

Yifei Yang ◽

Tianshu Xu ◽

Xu Yang

Keyword(s):

Anticoagulation Therapy ◽

Filling Defect ◽

Antimicrobial Treatment ◽

Lemierre Syndrome ◽

Case Presentation ◽

Intravenous Antibiotics ◽

Left Neck ◽

Wbc Count ◽

Evidence Based Guidelines

Abstract Background: Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial. Case presentation: A 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous two days, decreased instantly after initiation, and follow-up controls showed thrombus resolution. Conclusions: Our case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.

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Penetrating Orbitocranial Injury With a Good Aesthetic and Functional Outcome: A Case Report

Iranian Journal of Neurosurgery ◽

10.32598/irjns.7.1.8 ◽

2021 ◽

Vol 7 (1) ◽

pp. 61-66

Author(s):

Youssef Fahde ◽

◽

Davis Mpando ◽

Mehdi Laghmari ◽

Houssine Ghannane ◽

...

Keyword(s):

Case Report ◽

Multidisciplinary Approach ◽

Violent Behavior ◽

Case Presentation ◽

Frontal Horn ◽

Patient Reported ◽

Long Term Follow Up ◽

Life Threatening

Background and Importance: Transorbitocranial assaults with sharp objects like a knife are rare neuro-ophthalmologic emergencies. However, they can have dramatic functional and life-threatening consequences. Our presentation aims to report the importance of an urgent multidisciplinary approach and to raise awareness among the general population on the importance of preventing violent behavior. Case Presentation: A 33-year-old man was a victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial part of the orbit. Neurological examination was normal, and Computed Tomography (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications. The patient reported spectacular improvement in visual acuity without neurological or oculomotor deficit at long-term follow-up. In this case report, we will discuss the radiological diagnosis and surgical management of transorbital and orbitocranial injuries by foreign body penetration. Conclusion: Urgent multidisciplinary management in orbitocranial trauma by stabbing is mandatory to avoid life-threatening complications and irreversible damages.

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Left coronary button aneurysm presenting with progressive enlargement after aortic root replacement

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01645-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kimihiro Kobayashi ◽

Yoshinori Kuroda ◽

Masahiro Mizumoto ◽

Atsushi Yamashita ◽

Eiichi Ohba ◽

...

Keyword(s):

Computed Tomography ◽

Surgical Treatment ◽

Aortic Root ◽

Postoperative Recovery ◽

Aortic Root Replacement ◽

Case Presentation ◽

Life Threatening ◽

Conservative And Surgical Treatment ◽

Progressive Enlargement

Abstract Background Aneurysmal degeneration of the coronary button after aortic root replacement using the button technique is a rare but potentially life-threatening complication. However, the appropriate management of this complication, including the indications for conservative and surgical treatment, is still unknown. Case presentation Here we present a 38-year-old woman who successfully underwent surgical repair of a left coronary button aneurysm using the graft interposition technique 24 years after aortic root replacement. Because follow-up computed tomography after aortic root replacement showed a progressively enlarging left coronary button aneurysm, the patient was judged an acceptable candidate for surgical treatment, considering the potential risk of aneurysmal rupture and subsequent myocardial infarction. The postoperative recovery was uneventful. The patient is doing well 1 year after the surgery. Conclusions We believe that serial follow-up using computed tomography is mandatory for coronary button aneurysms, and surgical intervention may be considered if progressive enlargement of the aneurysm is observed, especially in younger patients.

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Successful Treatment of Pulmonary Mucormycosis Caused by Rhizopus Microsporus With Posaconazole

10.21203/rs.3.rs-302265/v1 ◽

2021 ◽

Author(s):

Fan Yuan ◽

Jun Chen ◽

Fang Liu ◽

Yongchao Dang ◽

Qingtao Kong ◽

...

Keyword(s):

Fungal Culture ◽

Rhizopus Microsporus ◽

Pulmonary Tissue ◽

Case Presentation ◽

Common Cause ◽

Pulmonary Mucormycosis ◽

Threatening Condition ◽

Life Threatening ◽

One Year

Abstract Background: Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation: We report the case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis has mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up.Conclusions: Pulmonary mucormycosis is a life-threatening condition and based on direct microscopy, histopathology, and culture for the diagnosis.

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A Review Of Computed Tomography Pulmonary Angiograms In Three Teaching Hospitals: The Rise Of Sub-Segmental Pulmonary Emboli and Their Management

Blood ◽

10.1182/blood.v122.21.932.932 ◽

2013 ◽

Vol 122 (21) ◽

pp. 932-932

Author(s):

Jennifer Goy ◽

Justin Y. Lee ◽

Oren Levine ◽

Salman Chaudhry ◽

Mark A. Crowther

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Chart Review ◽

Anticoagulation Therapy ◽

Teaching Hospitals ◽

Bleeding Complications ◽

Recurrent Thrombosis ◽

Alternative Diagnosis ◽

Life Threatening

Abstract Background The availability of Computed Tomography Pulmonary Angiography (CTPA) has led to an increase in the number of investigations for Pulmonary Embolism (PE). With more widespread use of these high resolution scans, the frequency of identification of isolated Small Sub-segmental Emboli (SSPE) is also expected to increase. Current clinical practice guidelines do not make any treatment distinctions for SSPE, though the benefits of anticoagulation for SSPE have not been established. Aims To review the frequency of Pulmonary Embolism and Sub-segmental Pulmonary Embolism identified through CTPA as well as their management Methods Retrospective review of 2213 patient charts who underwent CTPA in three Hamilton teaching hospitals from 2009-2011. In depth chart review of patients with SSPE was undertaken to determine the frequency with which patients who received anticoagulation therapy for SSPE. The frequency of bleeding complications and recurrent thrombosis were also investigated in this detailed SSPE chart review. Results Our patient population (mean age 65) consisted of 1099 medical inpatients (50%), 702 surgical inpatients (32%) and 412 (18%) emergency department patients. PE was identified in 26 % of scans (n=576). Of these, SSPEs were the only identified thrombus in 82 patients (4% of total scans and 14% of identified PEs). In 55 of these 82 SSPEs, in addition to the SSPE, an alternative diagnosis that might explain the PE symptoms was found. Fifty-two percent (n=43) of the patients with an SSPE received therapeutic anticoagulation. In these life threatening bleeding occurred in 2 patients. There was no documented recurrent thrombosis or thrombosis-related deaths in three month follow-up among the 39 patients who did not receive anti-coagulation for SSPE. Of the 1,608 CTPAs that did not identify PE, an alternative diagnosis to account for the patient’s symptoms was identified on CT in 1078 (67%) and no alternative cause was found in 531 (33%). Summary/Conclusions Our study demonstrated a much lower frequency of pulmonary embolism in comparison to approximate 50 % pre-test probability of a positive scan seen in studies which validated CTPA for the diagnosis of PE. Isolated SSPEs accounted for 14% of all PEs found in our study population – and were present in 4% of all patients undergoing CTPA. A substantial proportion of patients were anti-coagulated SSPE (52%) and two developed life-threatening bleeding complications. No recurrent VTE was documented in patients who were not anticoagulated for PE, though follow-up was limited to hospital records. Randomized controlled trial data is needed to further investigate the risks and benefits of anticoagulation in patients with SSPE. Disclosures: No relevant conflicts of interest to declare.

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An abdominal-sacral approach with preoperative embolisation for vulvar solitary fibrous tumour: a case report

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02206-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Akimasa Takahashi ◽

Hiroki Nishimura ◽

Tsukuru Amano ◽

Mari Deguchi ◽

Fumi Yoshino ◽

...

Keyword(s):

Perioperative Complications ◽

Female Genital Tract ◽

Maximum Diameter ◽

Case Presentation ◽

Solitary Fibrous Tumours ◽

Life Threatening ◽

Feeding Vessels ◽

The Right ◽

Transperineal Biopsy

Abstract Background Solitary fibrous tumours (SFTs) in the female genital tract are uncommon. Resection of these tumours is controversial because it can cause life-threatening haemorrhage. We report a case of vulvar SFT that was excised in a combined abdominal-sacral approach after preoperative embolisation. Case presentation At another hospital, an inoperable intrapelvic tumour was diagnosed in a 34-year-old woman. Computed tomography and magnetic resonance imaging showed that the uterus, urinary bladder and rectum were compressed laterally by a pelvic tumour with a maximum diameter of 11 cm. This mass was hypervascular and had a well-defined border. Transperineal biopsy was performed, and immunostaining revealed that the mass was an SFT. The tumour was supplied by feeding vessels from the right iliac arteries. First, we embolised the feeding vessels. Second, we performed surgical resection in a combined abdominal-sacral approach; no blood transfusion was necessary, and no perioperative complications occurred. The final pathological diagnosis was SFT that was positive for CD34 and signal transducer and activator of transcription 6 according to immunohistochemical staining. Conclusion During a year of follow-up, the disease did not recur. Treatment of pelvic SFT should aim at complete resection through various approaches after careful measures are taken to prevent haemorrhage.

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