Right heart failure in the setting of thyrotoxic valvulopathy: the pathophysiology of an often neglected diagnosis: a case report.

Background: Hyperthyroidism has a significant, well-established impact on the cardiovascular system on both a molecular and circulatory level. The cardiac consequences of thyrotoxicosis are not uncommon, indicated by a 1.2% prevalence of this disorder in the United States. However, our case describes the less widely observed association between thyrotoxicosis and valvulopathy. Case summary: A 69-year-old Hispanic male presented with a 3-week history of shortness of breath, intermittent chest pain, and lower extremity swelling. Transthoracic echocardiogram revealed a dilated left and right atrium with severe tricuspid regurgitation, moderate mitral regurgitation, malcoaptation of the tricuspid valve leaflets, and a myxomatous mitral valve. In addition, right ventricular systolic function was moderately reduced. A right and left heart catheterization was performed with findings of normal right heart pressures and normal coronary arteries, respectively. To further evaluate the aetiology of the patient's heart failure, thyroid studies were sent, revealing a thyroid-stimulating hormone value of <0.010 uIU/mL and a free T4 of 1.96 ng/dL. A 4.9 cm lesion was seen on thyroid ultrasound. We concluded that the patient's heart failure and notable valvular abnormalities were likely as a result of thyrotoxic heart disease. Furosemide and methimazole were initiated while inpatient, and the patient was discharged with close follow-up. Discussion: We demonstrate a unique case of the possible hemodynamic and cellular effects of thyroid hormone on the development of primary and secondary valve dysfunction. This association is important for clinicians to be aware of, as treatment of its underlying aetiology can lead to improvement in a patient's cardiac outcomes.

Case Report of COVID-19 Positive Male with Late-Onset Full Body Maculopapular Rash.

Each day, novel information is being learned about Coronavirus disease 19 (COVID-19), a disease increasingly seen in the emergency department (ED). Our case adds to reports of a maculopapular rash among the newer symptoms to be aware of in diagnosing COVID-19. A 35-year-old male presented with an 11-day history of fever, dry cough, diarrhea, and change in taste. He endorsed two known exposures to COVID-19 and had previously tested negative twice for the virus. The patient additionally complained of a whole-body, pruritic rash that presented six days after his initial symptoms. A workup was completed for the patient's fever and labs only revealed a potassium of 3.3 mEq/L. A chest X-ray showed right basilar patchy opacities consistent with pneumonia, and the patient tested positive for COVID-19 and negative for Epstein-Barr Virus, a commonly missed culprit in those with a rash, via polymerase chain reaction (PCR). The patient's vitals were stable, and he was discharged with supportive measures at home. COVID-19 was determined as a likely etiology for the rash. With new insights into COVID-19 every day, we demonstrate a case of viral exanthema as a potential presenting manifestation in a COVID-19 patient and one that medical providers should be familiar with in these patients in the ED. Topics: COVID-19, dermatology, infectious disease, viral exanthema.