A Case of Pneumothorax Secondary to Marijuana Use Disorder.

In recent decades, the general tendency has switched from the use of tobacco products to the inhalation of marijuana with or without the addition of tobacco. The majority of existing research on marijuana use focuses on its euphoric effects. Pneumothorax, pneumomediastinum, and subcutaneous emphysema are infrequently described in the medical literature in association with cannabis use. It is a diagnostic and therapeutic challenge because of its infrequency of occurrence. We see a huge diversity of multisystem involvement linked with marijuana smoking, and physicians should be aware of this uncommon clinical presentation, which might be observed more often because of the recent upsurge in its consumption. We describe a case of a 20-year-old male with a chronic history of marijuana use disorder who was found to have non-tension type pneumothorax, pneumomediastinum, and subcutaneous emphysema on chest imaging. The patient was managed conservatively and did not require any surgical intervention.

Herpes Simplex Virus Type 2 Encephalitis in an Immunocompetent Adult: A Case Report on an Unusual but Relevant Cause of Significant Neurological Morbidity.

Encephalitis refers to inflammation of the brain that is most frequently caused by viral infection (particularly herpes simplex virus type 1 [HSV-1]). In some instances, it may be associated with substantial neurological mortality and long-term morbidity. Although HSV-1 is the most common agent involved in producing neurological infections and disorders, herpes simplex virus type 2 (HSV-2) can occasionally affect the central nervous system, particularly in immunocompromised patients. We discuss the case of an immunocompetent male patient with a history of well-controlled diabetes who presented with symptoms of encephalitis. Our patient did not have a history of herpes infection, indicating the presence of subclinical infections. His initial magnetic resonance imaging was inconclusive, but the diagnosis was established following a lumbar puncture and subsequent cerebrospinal fluid analyses.

A Rare Case of Coronary Stent Thrombosis in the Modern Era.

In patients with acute coronary syndrome or obstructive coronary artery disease, stents, especially drug-eluting stents (DESs), are used for percutaneous coronary interventions (PCI). DES prevents abrupt closure of the stented artery. Stent thrombosis is an uncommon but serious complication of PCI, especially with the recent advancement of stent technology. We present a case of a 75-year-old male who initially suffered a non-ST segment elevation myocardial infarction (NSTEMI) treated appropriately with PCI and subsequently developed stent thrombosis after 10 days of initial stent placement. He then underwent emergent repeat PCI with successful replacement of stents overlapping previous stents. The patient did well following the procedure. His clopidogrel was changed to a more potent antiplatelet ticagrelor. He remained stable throughout the hospital stay and was discharged home without any further complications following the next 90 days.

Noninvasive Positive Pressure Ventilation (NIPPV)-Associated Expanding Hiatal Hernia Causing Pulmonary Tamponade: A Case Report on Unusual Complication of NIPPV.

Numerous diseases related to gastric distension have been found and shown to be linked with noninvasive positive pressure ventilation (NIPPV). We describe the case of a 93-year-old female who came with progressively worsening shortness of breath that initially responded to NIPPV but subsequently deteriorated. Imaging revealed gaseous distension of a preexisting hiatal hernia with air-fluid levels and compressive effects on the left lower lobe of the lung. She was successfully managed using a conservative decompression strategy. This is the first case to our knowledge of NIPPV causing considerable distension of an existing hiatal hernia to the point of mediastinal tamponade.

A Rare Case of Guillain-Barré Syndrome Associated With SARS-CoV-2 Infection Requiring Mechanical Ventilation.

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic since the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was identified in December 2019. Numerous neurological consequences have been reported with COVID-19 infection and its approved vaccines. However, Guillain-Barré syndrome (GBS) is a rare neurological complication associated with COVID-19 infection. This case report describes a 62-year-old female with a three-week history of COVID-19 infection who presented with symmetric polyneuropathy in bilateral lower extremities that progressed to involve bilateral upper extremities and skeletal muscles of respiration, resulting in respiratory distress and necessitating intubation and mechanical ventilation. Cerebrospinal fluid (CSF) analysis revealed albumino-cytologic dissociation, and our patient met the National Institute of Neurological Disorders and Strokes (NINDS) criteria for diagnosing Guillain-Barré Syndrome, making GBS to be the most likely diagnosis. This case report aims to strengthen the association of GBS with COVID-19 infection and describes the hospital course of GBS.

Transient Ischemic Attack Secondary to Device-Related Thrombus After Left Atrial Appendage Closure.

The patient is an 84-year-old female with a significant past medical history of traumatic subarachnoid hemorrhage, bleeding peptic ulcer disease, permanent atrial fibrillation status post percutaneous left atrial appendage closure (LAAC) initially admitted to the hospital secondary to expressive aphasia. The patient was found to have a transient ischemic attack (TIA). A transesophageal echocardiogram (TEE) showed a thrombus on the watchman device (WD). The patient was treated with unfractionated heparin infusion and later transitioned to apixaban without any further TIA or stroke over 30 days period. Device-related thrombosis (DRT) with systemic thromboembolism occurred almost after 480 days of putting the WD which is very rare.

Pyrexia Unmasking Brugada Syndrome: A Literature Review.

Brugada syndrome (BrS) is an inherited arrhythmia syndrome in which asymptomatic patients tend to develop fatal arrhythmias leading to sudden cardiac death (SCD) in asymptomatic or undiagnosed cases. This review tries to shed light on pyrexia being one of the triggers to cause SCD secondary to fatal arrhythmias in patients of BrS. Pyrexia, electrolyte imbalance, alcohol intake, and drugs are common triggering factors for fatal arrhythmias in patients with BrS. Most patients are asymptomatic, while the most common form of presentation that brings the patient under medical attention is syncope or SCD. Hence, patients, especially young, who present with syncope or aborted episode of SCD with typical EKG patterns, should undergo further workup. It is essential to educate patients about the condition, possible triggers, and the importance of refraining them.

Lyme Carditis Manifesting as Wenckebach Heart Block.

Lyme disease caused by Borrelia burgdorferi is a multisystem disease and can lead to Lyme carditis. The most common presentation of Lyme carditis is conduction system disturbances such as atrioventricular (AV) block. A 72-year-old male with a past medical history of gastroesophageal reflux disease (GERD) and prostate cancer presented with chest tightness, lightheadedness, and presyncope. During hospitalization, he developed bradycardia with heart rates ranging between 30 and 40 beats per minute and Wenckebach heart block. Lyme serology was consistent with a recent Lyme infection. He was treated with antibiotics and was eventually discharged home without requiring pacemaker implantation.

Travel Trouble With Legionella in the Era of COVID-19: A Case Report.

A 56-year-old male was admitted to the hospital with severe sepsis secondary to pneumonia. His presentation was challenging and confusing due to the accompanying coronavirus disease 2019 (COVID-19) infection attributed to his travel history and diagnosed via radiological findings. He received dexamethasone with ceftriaxone and azithromycin. Despite the fact he was on appropriate antibiotics, his condition worsened, and he was eventually diagnosed with Legionella pneumonia, which was thought to be resistant to macrolides. His condition improved significantly when antibiotics were switched to levofloxacin. It is important to keep in mind other causes of community-acquired pneumonia (CAP) during the ongoing COVID-19 era. What makes this case unique is that it presented a confusing scenario due to the patient's concurrent COVID-19 infection and his failure to improve with the administration of azithromycin.