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  • ISSN: 2373-9819
    Volume 4, Issue 2
    Case Report
    Jeffrey W Brown, Kishore Vipperla, Swapna Vattikuti and Dayakar Kancherla*
    Rheumatoid arthritis (RA) is a chronic systemic inflammatory condition of unknown etiology that affects the joints and the visceral serosa of heart, lungs and peritoneum. Pericarditis and pericardial effusion are the most common presentations of cardiac involvement. Pericardial tamponade is extremely rare affecting <1% of these patients. We report an interesting case of a young female with poorly controlled RA who presented with progressive dyspnea. Initial work-up was concerning for pericardial effusion based on chest radiographic and electrocardiographic findings. A transthoracic echocardiogram confirmed a large pericardial effusion. Elevated inflammatory markers and serological evidence of an active disease were detected on blood tests. A repeat echocardiogram performed to evaluate worsening of dyspnea and hypotension revealed increase in pericardial effusion. A right heart catheterization revealed equalization of diastolic pressures in the right atrium, right ventricle, and pulmonary artery wedge pressure diagnostic of pericardial tamponade. An emergent pericardiocentesis was performed to relieve the pericardial pressure. She was treated with steroids to prevent reaccumulation of the pericardial fluid. An echocardiogram at follow-up visit 4 weeks later showed stable small pericardial effusion. Our case underscores the significance of early detection and treatment of a rare but potentially life-threatening complication such as cardiac tamponade to prevent bad outcome.
    Bang Guy Aristide, Savom Eric Patrick, Essiene Agnes, Handy Eone Daniel and Ngo Nonga Bernadette*
    Xanthogranulomatous pyelonephritis is a severe, rare, form of chronic pyelonephritis characterized by the destruction of the renal parenchyma and replacement by granulomatous tissue. This disease has been called as the "great imitator" because clinical and radiological findings often mimics other inflammatory or neoplastic renal disorders leading to diagnostic challenge before histopathologic analysis. Herein, we report a case of a 72-years-old woman who presented with a 4-year history of left flank pain with intermittent lumbar purulent discharge. The CT scan findings advocated a pyonephrosis. After a left nephrectomy, the per-operative and macroscopic appearance of the mass was in favor of a renal replacement lipomatosis. Microscopic examination finally revealed the diagnosis of Xanthogranulomatous pyelonephritis. Clinicians, radiologists and pathologists should be aware of thtis rare "great imitator" entity.
    Ashish P. Sharma, Abdullah Alismail*, Evelyn Massey, Cassaundra Song, Laren Tan and Takkin Lo
    A 33-year-old woman suffered an out-of-hospital cardiac arrest and was found un-responsive lying on an asphalt parking lot surface. Bystander and Emergency Medical Service (EMS) personnel provided Cardiopulmonary Resuscitation (CPR). However, the victim sustained deep second degree burns on her right upper arm and right forearm. Safety guidelines for victims and rescuers do not address the possibility of skin exposure to extreme surface temperatures in regions where surface temperature varies depending on the season. This case report is a prime example where additional awareness may have prevented secondary complications like thermal cutaneous burns.
    Daniel Paramythiotis*, Konstantinia Kofina, Christos Poulios, Valentini Tzioufa-Asimakopoulou, Vasileios Papadopoulos, and Antonios Michalopoulos
    Perivascular epithelioid cell tumors (PEComas) are a relatively rare group of mesenchymal tumors that may occur in uncommon sites, including the kidney. We present the case of such a renal tumor that was found incidentally after a radiologic examination in a 53-year-old female. The patient was treated surgically and pathologic examination was diagnostic for the disease.
    Michael K. Tom*, Dennis Thomas Bolger Jr, and Erlaine F. Bello
    Importance: Citrobacter koseri rarely causes infection in immunocompetent, non- hospitalized hosts and is rarely associated with infective endocarditis. Observations: We present a single case of a 77-year-old man with known chronic C. koseri prostatitis who developed blood culture-negative infective aortic valve endocarditis and C. koseri diskitis. Valve replacement was required for definitive treatment. Conclusions and relevance: Holding cultures for an extended period helped to identify the organism. Chronic prostatitis may be a rare but potentially serious source for infective endocarditis.
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