Utility of Coronary Calcium Scoring (CCS) in Connective Tissue Disorders (CTDs) for the Evaluation of Subclinical Coronary Atherosclerosis – A Systematic Review

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154536/1/acr211107.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154536/2/acr211107_am.pd

The impact of rehabilitation-oriented virtual reality device in patients with ischemic stroke in the early subacute recovery phase: Study protocol for a phase III, single-blinded, randomized, controlled clinical trial

Stroke is considered the most common cause of adult disability. Intensive rehabilitation protocols outperform nonintensive counterparts. The subacute stroke phase represents a potential window to recovery. Virtual reality (VR) has been shown to provide a more stimulating environment, allowing for increased patient compliance. However, the quality of current literature comparing VR with standard therapies is limited. Our aim is to measure the impact of VR versus standard therapy on the recovery of the upper limb motor function in patients with stroke in the early subacute recovery phase.; This is a randomized, controlled trial that will assign 262 patients to tailor-made standard rehabilitation (TMSR) or TMSR plus immersive VR device. The trial will be conducted in an urban rehabilitation clinic in the United States with expertise in the management of poststroke patients. Patients will be 18 to 70 years of age and in the early subacute period (30-90 days post ischemic stroke). The primary outcome will be the change of Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score, measured at baseline and 13 weeks after randomization. The secondary outcome will be the change in the UK Functional Independence Measure and Functional Assessment Measure (UK FIM-FAM) score at the same time points.; If the use of VR in the rehabilitation of patients with stroke proves to have a significant impact on their motor recovery, it will constitute an extremely important step into decreasing the functional impairment associated with stroke and the related health care expense burden

Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with a wide range of clinical and serological manifestations. Cardiac disease among patients with SLE is common and can involve the pericardium, myocardium, valves, conduction system, and coronary arteries. We are reporting a case of SLE in a young woman that is unique is unique in that initial symptoms consisted of pericarditis and hemorrhagic tamponade which remained progressive and resistant to aggressive immunosuppressive treatment and led to severe cardiomyopathy (ejection fraction of 25%) and severe (+4) mitral regurgitation. Her immunosuppressive treatment included hydroxychloroquine, high-dose steroids, intravenous immunoglobulins, azathioprine, and mycophenolate mofetil. Her disease progression was felt to be due to underlying uncontrolled SLE because the complement levels remained persistently low throughout the entire course and PET Myocardial Perfusion and Viability study showed stable persistent active inflammation. Eventually, she was treated with cyclophosphamide which led to improvement in ejection fraction to 55% with only mild mitral regurgitation

A Case Report and Literature Review of Clostridium difficile Negative Antibiotic Associated Hemorrhagic Colitis Caused by Klebsiella oxytoca

Klebsiella oxytoca hemorrhagic colitis is a rare form of antibiotic associated hemorrhagic colitis that is Clostridium difficile negative. Klebsiella oxytoca colitis has been shown to be triggered by penicillin administration, yet other antibiotics have been implicated as well. It can mimic the appearance of ischemic colitis on endoscopy; however it will generally be found in young, otherwise healthy patients without risk factors. We present a case of a 33-year-old Caucasian female who presented to the emergency room with profuse, bloody diarrhea for 5 days, after a one-week course of ampicillin. Colonoscopy was notable for ulcerated mucosa with erythema and easy friability and the biopsy was suggestive of ischemic colitis. Stool culture was positive for many Klebsiella oxytoca. The patient was discharged home with resolution of symptoms after three days in the hospital. She was instructed to avoid penicillin antibiotics and minimize nonsteroidal anti-inflammatory drug use

Mycoplasma Pneumonia: An Unrecognized Cause of Fever of Unknown Origin in an Adult

A 26-year-old female was admitted for fever of unknown origin (FUO), headaches, left ankle edema, and a lower extremity rash consistent with erythema nodosum. She had no respiratory symptoms or family history of autoimmune diseases. A chest X-ray was negative for pneumonia or hilar adenopathy. Extensive autoimmune workup was negative. A chest, abdomen, and pelvis computed tomography scan was unremarkable and laboratory studies revealed no source of infection. On hospital day 5, the patient developed a mild productive cough. Her Mycoplasma pneumonia (MP) IgM was high, confirming the diagnosis of MP induced FUO. She was started on azithromycin 500 mg daily and within 24 hours her fevers and headaches resolved. Her left ankle edema and EN gradually improved over a course of a few weeks. This case report highlights the need for MP testing in the evaluation of fever of unknown origin, even in the absence of pulmonary manifestations

Cardiac Dedifferentiated Liposarcoma Requiring a Mitral Valve Replacement Complicated by Severe Paravalvular Leak: A Rare Case Report with Literature Review

Cardiac sarcomas have a high infiltrative and metastatic potential and are often associated with poor prognosis. These tumors are often identified incidentally by thoracic and cardiac imaging. However, when symptomatic, their presentation can differ based on the localized structural effects on the endocardium, myocardium, pericardium, and valves as well as on dynamic effects on the cardiac function. We report a case of a 61-year-old female who presented to the emergency room with recurrent chest pain, fatigue, and chronic anemia. A transthoracic echocardiogram demonstrated a left atrial mass attached to the septal wall and anterior leaflet of the mitral valve. The mass was further characterized by a transesophageal echocardiogram and cardiac MRI. The patient underwent a resection of the left atrial mass with mitral valve replacement (MVR) and atrial septal defect repair. MVR was later complicated by paravalvular leak leading to acute congestive heart failure. Tissue immune histology was consistent with dedifferentiated liposarcoma. Cardiac dedifferentiated liposarcoma is extremely rare with only few cases reported in literature. We attempt to review the clinical features, diagnosis, and management of cardiac sarcoma with great emphasis

A Very Rare Complication of Hepatitis A Infection: Acute Myocarditis—A Case Report with Literature Review

Hepatitis A is a common viral infection with a benign course but in rare cases can progress to acute liver failure. It usually presents with abdominal pain, nausea, vomiting, diarrhea, jaundice, anorexia, or asymptomatically, but it can also present atypically with relapsing hepatitis and prolonged cholestasis. In addition, extrahepatic manifestations have been reported, including urticarial and maculopapular rash, acute kidney injury, autoimmune hemolytic anemia, aplastic anemia, acute pancreatitis, mononeuritis, reactive arthritis, glomerulonephritis, cryoglobulinemia, Guillain–Barre syndrome, and pleural or pericardial effusion. A rare manifestation of hepatitis A is acute myocarditis. We report a case of a young woman who presented with “flu-like symptoms” and was found to have severe elevation of liver enzymes due to acute hepatitis A infection. On her 3rd day of admission, the patient developed chest pain and nonspecific electrocardiographic changes. Her troponins rose to 16.4  ng/mL, and a transthoracic echocardiogram revealed global hypokinesis and a depressed ejection fraction at 30%. A CT angiography showed no evidence of significant coronary artery disease. The patient was managed supportively, and symptoms and laboratory findings slowly improved over the next 7 days. Her chest pain resolved and a follow-up echocardiogram showed improved ejection fraction to 45%

Cardiac Tamponade as the Initial Presentation of Acute Myeloid Leukemia: A Case Report with Review of the Literature

Acute myeloid leukemia (AML) is a complex disease with a variety of presentations. A large pericardial effusion is rare, occurring in less than 0.5% of all patients with AML prior to treatment. A 34-year-old male presented with dyspnea, malaise, and weight loss. On physical exam, he was noted to be hypoxic, tachypneic, tachycardic, and hypotensive. He had cervical lymphadenopathy and jugular venous distention. His WBC count was 110 bil/L with 33% blasts. Bone marrow biopsy confirmed AML with 60% blasts. Leukemic cells were also seen in the cerebrospinal fluid on lumbar puncture. An echocardiogram revealed a large pericardial effusion causing tamponade. He underwent emergent pericardiocentesis, and malignant cells were present in the pericardial fluid. Induction therapy with standard dose cytarabine and daunorubicin was initiated, and bone marrow biopsy 14 days later showed no residual AML. This case demonstrates the importance of a thorough evaluation of each organ system when caring for a patient with AML

A Gigantic Anal Mass: Buschke–Löwenstein Tumor in a Patient with Controlled HIV Infection with Fatal Outcome

Buschke–Löwenstein tumor of anorectal and perianal area is a rare but highly aggressive tumor, frequently associated with human papillomavirus (HPV) types 6 and 11. It often grows over years in immunocompetent patients and can be highly destructive to local tissue. We present a case of a 61-year-old male with HIV infection who presented with worsening pain and swelling in the anorectal area for one-year duration. Exam revealed a 15 × 10 cm mass in the anorectal area with multiple sinuses and fistulas. MRI revealed extension of the mass through pelvic structures. Biopsy showed squamous epithelium with koilocytes and histochemistry positive for P16, suggestive of HPV infection. Biopsy was negative for malignant transformation. He was not a candidate for surgery or radiation due to extensive infiltration of deeper structures and multiple fistulas. He refused interferon therapy, and diverting colostomy was placed for palliation. He presented two months later with overwhelming sepsis and died despite maximal medical therapy