Enterococcus faecalis Endocarditis of All Four Native Valves: A Case Report.

Enterococcus faecalis is commonly implicated in Infective Endocarditis (IE), resulting in remarkable morbidity and mortality. We present an unusual case documenting the clinical course and outcome of an elderly female patient who developed quadruple valve endocarditis due to Enterococcus faecalis infection. She presented with altered mental status, resulting in hospitalization, and was found to have bacteremia complicated by endocarditis, epidural abscess, discitis, and splenic infarction. Urinalysis was consistent with bacterial infection two days before being admitted to the hospital. Unfortunately, despite aggressive therapeutic regimens, the patient died.  This is one of the few documented endocarditis cases involving all heart valves. It reviews the importance of maintaining a high index of clinical suspicion for assessing IE, with a low threshold for performing a transesophageal echocardiogram as a diagnostic tool.

Extreme alkalaemia with mixed alkalosis due to suspected acute-on-chronic respiratory alkalosis.

Herein we present a case of severe alkalaemia (pH 7.81) due to suspected acute-on-chronic respiratory alkalosis in a patient with chronic anxiety and metabolic alkalosis secondary to emesis. The patient was managed in the intensive care unit with significant improvement and discharged in stable condition. The case report emphasises considering a broad differential of aetiologies that can cause acid-base status derangements and identifying the appropriate therapeutic approach.

Crowned Dens Syndrome: A Rare Complication of Calcium Pyrophosphate Crystal Deposition Disease.

Crowned dens syndrome (CDS) is a clinical entity characterized by neck pain associated with fever, headaches, and neck stiffness, along with radiologic evidence of peri-odontoid process calcification in a characteristic "crown" or "halo" distribution. It is likely an underdiagnosed condition and patients can initially be misdiagnosed, leading to costly evaluation and unnecessary treatment interventions. We present the case of a 76-year-old man who presented to the emergency department (ED) with a 3-day history of progressively worsening neck pain that was associated with headaches, malaise, decreased oral intake, chills, and fever. Initial evaluation was significant for the presence of fever, tachycardia, and elevated inflammatory markers. We report a case of CDS attributed to calcium pyrophosphate deposition and review the pertinent literature about the presentation, diagnostic evaluation, and treatment of this rare clinical entity.