Haemophilus parainfluenza-Associated Aortic Root Abscess and Septic Embolic Stroke Post-transcatheter Aortic Valve Replacement: A Case Study.

We present a rare instance of aortic root abscess and septic embolic stroke due to Haemophilus parainfluenza in a 75-year-old male patient who had undergone a recent transcatheter aortic valve replacement. The patient initially presented with generalized weakness and altered mental status. Blood cultures grew Haemophilus parainfluenza. Brain imaging showed multiple infarcts with some areas of hemorrhagic conversion. Echocardiography demonstrated an aortic root abscess as well as vegetation on the tricuspid valve. Surgical correction was deemed high risk; hence, management involved intravenous (IV) antibiotics, resulting in the resolution of both symptoms and the absces

Ascending Colon Ulcerative Mass: An Unusual Manifestation of Ischemic Colitis

Introduction: Ischemic colitis refers to vascular pathology of the gastrointestinal tract involving vessels like superior mesenteric artery (SMA), inferior mesenteric artery (IMA) and internal iliac arteries. It may include thrombosis, embolic arterial occlusion or non-occlusive colitis often affecting \u27watershed\u27 regions such as hepatic and splenic flexure. It commonly presents as moderate to severe pain, tenderness, and bloody stools. Presentation as a colonic mass is rare and can be mistaken for cancer. We present a case with this unusual presentation. Case Description/Methods: 75-year-old woman with medical history of coronary artery disease with stents, smoking, hypertension, presented with 3 days of right sided abdominal pain with no diarrhea, nausea or vomiting. She had no pain with food intake, no recent illnesses or weight loss. She spiked a low-grade fever of 100.4 F but stable vitals. Physical examination revealed right lower quadrant tenderness only. Laboratory tests showed white cell count of 12.4; all other tests, including lactic acid, were normal. Computed tomography scan of abdomen showed ascending colon wall thickening and adjacent wall stranding, with no enlarged lymph nodes. Gastroenterology performed colonoscopy which showed circumferential ulcerated malignant appearing mass in the proximal and mid ascending colon with biopsies sent. Colorectal surgery was consulted and she was tentatively scheduled for surgical resection. Pathology results showed fibrinopurulent exudate with necrotic colonic mucosa and no malignancy. Surgery was cancelled. A CTA abdomen revealed partial improvement of inflammatory changes in ascending colon and mild to moderate stenosis of SMA and IMA. She was discharged with instructions for adequate hydration and seen by Gastroenterology in outpatient. Follow up colonoscopy in 6 weeks showed complete resolution of the mass. Discussion: Ischemic colitis should be considered as a differential diagnosis in patients with a colonic mass. Notably, about 20% of ischemic colitis cases have coexisting colonic carcinoma [1]. Hence, follow up with imaging and colonoscopy is imperative to assess improvement of ischemia after conservative management. No established guidelines for the timing of follow-up colonoscopy exist. Recommendations suggest repeating the scope within 7-10 days [2], adjusted based on the level of suspicion for cancer. This approach ensures timely detection of potential malignancies and avoidance of unnecessary surgical interventions, which carry long term complications (see Figure 1)

Bradycardia, renal failure, atrioventricular nodal blockade, shock and hyperkalemia (BRASH) syndrome: A clinical case study

BRASH syndrome, which stands for Bradycardia, Renal failure, Atrioventricular (AV) Nodal blockade, and shock, is a relatively new clinical condition. Bradycardia develops because of the synergistic effect of AV-nodal blockers and hyperkalemia in a renal failure resulting in a vicious cycle of progressive bradycardia, renal hypoperfusion, and hyperkalemia. We present a case of an 88-year-old man with chronic systolic heart failure, atrial fibrillation, stage 3 chronic kidney disease, and dementia who presented to our emergency department with poor oral intake and weakness. He was found to have symptomatic bradycardia in the 30s secondary to hyperkalemia and beta-blockers in the setting of acute renal failure from dehydration, raising concern for BRASH syndrome. Treatment of each component conservatively resulted in complete resolution without the need for aggressive measures such as dialysis or pacing. This case report also discusses the pathophysiology, management, and the need for recognizing this underdiagnosed and novel clinical condition

Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study.

BRASH syndrome, which stands for Bradycardia, Renal failure, Atrioventricular (AV) Nodal blockade, and shock, is a relatively new clinical condition. Bradycardia develops because of the synergistic effect of AV-nodal blockers and hyperkalemia in a renal failure resulting in a vicious cycle of progressive bradycardia, renal hypoperfusion, and hyperkalemia. We present a case of an 88-year-old man with chronic systolic heart failure, atrial fibrillation, stage 3 chronic kidney disease, and dementia who presented to our emergency department with poor oral intake and weakness. He was found to have symptomatic bradycardia in the 30s secondary to hyperkalemia and beta-blockers in the setting of acute renal failure from dehydration, raising concern for BRASH syndrome. Treatment of each component conservatively resulted in complete resolution without the need for aggressive measures such as dialysis or pacing. This case report also discusses the pathophysiology, management, and the need for recognizing this underdiagnosed and novel clinical condition