Infectious Mononucleosis-Induced Splenic Infarction: Perhaps More Common in Healthy Individuals Than Previously Thought.

Infectious mononucleosis (IM) is a clinical syndrome that presents as a triad of fever, pharyngitis, and lymphadenopathy. In most cases, it is caused by the Epstein-Barr virus (EBV), which spreads through upper respiratory secretions, particularly saliva, earning its name as the Kissing Disease. In most cases, IM is self-limiting and resolves in two to four weeks without significant sequelae following supportive care. Although rare, IM has been associated with several serious and sometimes life-threatening complications, involving almost any organ system. Splenic infarction is one rare complication of IM due to EBV infection. In the past, IM-induced splenic infarction in the setting of EBV was believed to be rare and mostly limited to patients with underlying hematologic comorbidities. However, we propose this condition to be more common and more likely to occur in individuals without significant medical history than previously suspected. We report a relatively healthy young male patient in his thirties, with no previous history of coagulopathy or complex medical conditions, who was found to have IM-induced splenic infarction.

Factors Influencing Thirty-Day Readmission Rate in Patients With Heart Failure Exacerbation.

Background: The purpose of this study is to further investigate the leading causes of readmission at 30 days in heart failure exacerbation patients, along with associations to mortality and intensive care unit (ICU) admissions. Methods: A retrospective data analysis was performed on a total of 33,400 patients between January 1, 2016, and December 31, 2020. The primary endpoints were to determine whether guideline-directed medical therapy (GDMT), length of stay, and time to first diuretic affect readmission rates. Secondary endpoints include time to first chest X-ray, time to first echocardiogram, administration of intravenous fluids, diet, presence of cardiology consult, and ICU admission. Results: Patients who received GDMT had decreased likelihood of mortality (odds ratio (OR): 0.518; 95% confidence interval (CI): 0.394 - 0.682; P < 0.001). Patients who had an echocardiogram done within 1 day of admission had less likelihood of death (OR: 0.606; 95% CI: 0.483 - 0.759; P < 0.001). In addition, patients who had a cardiac diet during their hospitalization were 0.632 times less likely to experience mortality (95% CI: 0.502 - 0.797; P < 0.001). Patients that received their first intravenous diuretic 2 h or more after admission were 1.290 times as likely to be readmitted within 30 days (95% CI: 1.018 - 1.634; P = 0.035). In addition, patients that did not receive intravenous diuretics were even more likely to be readmitted within 30 days (OR: 1.555; 95% CI: 1.237 - 1.955; P < 0.01). Patients who were treated with GDMT had a decreased chance of being readmitted within 30 days (OR: 0.781; 95% CI: 0.647 - 0.944; P = 0.01). Conclusions: This study stresses the importance of initiating GDMT, cardiac diet, diuretics, and echocardiogram in timely manner.

Emphysematous Cholecystitis Secondary to Fusobacterium nucleatum.

Fusobacterium nucleatum may be implicated in cases of emphysematous cholecystitis (EC) and carries a high mortality risk, especially in individuals with heart disease, renal insufficiency, and underlying malignancy. Fusobacterium infections are rarely detected in the setting of cholecystitis possibly due to the difficulty with properly culturing the bacteria. We describe a case of a patient with EC in whom blood cultures were positive for growth of F. nucleatum in one of two samples. The patient was treated with empiric antibiotic therapy consisting of metronidazole and cefepime. In patients with EC and negative cultures, it is possible that they may have an undetected infection with fusobacteria, which carries a high mortality risk. As such, clinicians should maintain a high degree of suspicion of obligate anaerobic infection in patients who have negative blood culture for growth in the setting of EC and consider continuation of adequate antimicrobial coverage.

Seizure as an Initial Presentation for Posterior Reversible Encephalopathy Syndrome in Undiagnosed Systemic Lupus Erythematosus and Lupus Nephritis: A Case Report.

Posterior reversible encephalopathy syndrome (PRES) is a syndrome presenting with neurological manifestations including headaches, seizures, and notable changes in brain imaging. It is typically associated with an acute increase in blood pressure, metabolic abnormalities, and/or medication effects. PRES is challenging to diagnose due to its variable presentation and low incidence. Herein we describe a compelling case of PRES syndrome secondary to uncontrolled hypertension in the setting of systemic lupus erythematosus (SLE) and lupus nephritis.