A Case of Adult Epiglottitis in a Patient With Uncontrolled Diabetes and Occupational Risks.

Epiglottitis is inflammation of the epiglottis with or without the involvement of supraglottic structures including the hypopharynx. Timely diagnosis is crucial as the treatment of epiglottitis is tailored to the degree of airway obstruction. Most patients improve with conservative measures, while some require an emergent airway intervention. We report a case of a 39-year-old Caucasian male with a history of uncontrolled diabetes mellitus and smoking who presented to the emergency department (ED) with a sore throat, dry cough, odynophagia, and difficulty swallowing. He was afebrile, tachycardic, tachypneic, hypertensive, and saturating at 99% on room air. His physical examination was remarkable for drooling, muffled voice, pharyngeal swelling, and erythema. Laboratory tests were significant for leukocytosis, hyperglycemia, and hemoglobin A1c (HbA1c) of 14.3% with a negative infectious workup. Lateral neck X-ray and emergent direct fiberoptic laryngoscopy revealed findings of epiglottitis with airway patency. The patient did not require intubation and was started on intravenous dexamethasone, vancomycin, ampicillin-sulbactam, and humidified air with suctioning of secretions and quickly recovered. In addition to known risk factors for developing epiglottitis such as uncontrolled diabetes and smoking, our patient was exposed to metal shavings at his new job, an occupational hazard that might have contributed to his clinical presentation. Our case highlights the importance of a prompt diagnosis and risk factor identification in the management of epiglottitis in adults.

A Puzzling Diagnosis of Cerebral Vein Thrombosis in a COVID-19-Vaccinated Patient.

Cerebral vein thrombosis (CVT) is a rare condition equivalent to deep vein thrombosis of the intracranial veins. Delayed diagnosis will result in severe and disabling complications. We report a case of a 59-year-old man with CVT with no significant past medical or surgical history. On admission, he reported right-sided numbness and weakness concerns, preceded by the sudden onset of bilateral vision loss and dysarthria. Magnetic resonance imaging and computed tomography scans confirmed the diagnosis of CVT. The most interesting relative risk factor was flying overseas twice a month for the last 10 years; each flight was longer than eight hours. Another possible contributing factor to our patient's condition was polycythemia, with a hemoglobin level of 19, but the most questionable and puzzling is the recent coronavirus disease 2019 (COVID-19) vaccination two months, eight months, and one year prior to admission. Our case highlights a rare COVID-19 vaccine-related CVT diagnosis and that close monitoring for new symptoms and signs is vital to prevent life-threatening complications, herniation, and hemorrhagic transformation.

Acute Eosinophilic Pneumonia Secondary to Daptomycin.

Daptomycin is an antimicrobial agent with activity against gram-positive bacteria that is usually reserved for severe infections. Acute eosinophilic pneumonia (AEP) is an increasingly rare side effect that can manifest after its use. Our patient is a 79-year-old male who was admitted for a left total knee arthroplasty infection. After daptomycin was started, he developed AEP. The offending agent was stopped, the appropriate medical treatment was given, and his symptoms significantly improved. This case illustrates an uncommon side effect of daptomycin. Prompt medical recognition is paramount for medication discontinuation and adequate medical care.

Endovascular Therapy for Childhood Ischemic Stroke.

BACKGROUND Ischemic stroke can have a tremendously negative impact on the fitness and well-being of a child. Because endovascular interventions may be of benefit in the adult stroke population, many investigators have recently evaluated the safety and benefits of pharmacological and non-pharmacological options in the pediatric stroke population and compared pediatric patients to their adult counterparts. Some of these trials have had promising results, showing the positive effects of endovascular treatment in children with arterial acute ischemic stroke due to large-vessel occlusion (LVO). The 2015 American Heart Association/American Stroke Association guidelines suggest that mechanical thrombectomy with stent retrievers may be a consideration in some patients who are younger than 18 years and have severe LVO, when treatment (groin puncture) is initiated within 6 h of symptom onset. However, the method remains under-studied in this age group. CASE REPORT A 7-year-old girl presented with migraine-like headache, right arm and facial weakness, and expressive aphasia 9.5 h after symptom onset. Her PEDS-NIH stroke scale score was 4. Upon further investigations, she was found to have a left middle cerebral artery cryptogenic stroke with a distal left M1 clot, which was successfully treated with mechanical thrombectomy. Huge improvement was noticed during her subsequent physical examination. CONCLUSIONS Endovascular therapy offers an exciting treatment option for the management of pediatric stroke. The extent of safety of mechanical thrombectomy among children who present with large-vessel occlusion over an extended time window remains unknown and warrants further investigations.

Neurological involvement of coronavirus disease 2019: a systematic review.

BACKGROUND: In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. OBJECTIVE: To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. METHODS: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. RESULTS: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. CONCLUSIONS: Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain-Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.