Ischemic Stroke Revealing Libman-Sacks Endocarditis: A Case Report.

Libman-Sacks endocarditis (LSE) is a characteristic but rare feature of systemic lupus erythematosus (SLE), which can be found in association with antiphospholipid syndrome (APS), exposing the patient to an increased embolism risk, particularly the occurrence of ischemic stroke. We present a case involving a 64-year-old man who was admitted for ischemic stroke accompanied by a fever. Cardiac investigation revealed mitral vegetations along with severe mitral regurgitation. The diagnosis of Libman-Sacks endocarditis associated with SLE and APS was made after a laboratory work-up showing negative blood cultures and positive antibodies. This case underlines the importance of early diagnosis for better management of this pathology.

Lactococcus lactis endocarditis and liver abscess in an immunocompetent patient: a case report and review of the literature.

BACKGROUND: Over the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections. CASE PRESENTATION: A 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcus cremoris, is a rare cause of human infections. The first case of Lactococcus lactis cremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases. CONCLUSIONS: To our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis.

Infective endocarditis following COVID-19 pneumonia: about two cases.

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis across the world. The severity of this situation is escalating in certain populations, particularly when the COVID-19 diagnosis may delay the recognition of more dramatic illnesses such as infective endocarditis, which is a dreaded complication in patients with cardiac disease. We report the case of two patients who presented with infective endocarditis initially mistaken for COVID-19 pneumonia, which was responsible for a delay in diagnosis. We discuss the diagnostic difficulties as well as the management of this complication in the COVID-19 era. As a physician, one must remain alert to this dreaded complication, especially in patients with a cardiac history, in order to prevent it, detect it early, and manage it in time.

Co-existence of severe coarctation of the aorta and aortic valve stenosis in adulthood: a case report.

Aortic coarctation is a congenital heart disease that usually presents and is treated in the childhood. The aortic coarctation is often associated with concomitant cardiac pathologies, such as aortic stenosis and bicuspid aortic valve. We report the case of a 56-year-old man, admitted in our cardiologic unit, for sudden onset of chest pain, dyspnea and syncope. Aortic coarctation with aortic valve stenosis was diagnosed. The aortic valve was successfully replaced in the first stage; the coarctation had to be treated in a second time.

Acute pulmonary embolism in a child following SARS-CoV-2 infection: a case report.

In children, coronavirus disease 2019 infection is rarely symptomatic. Severe forms with respiratory distress are rare, thromboembolic complications are exceptional. We report a rare case of a 14 years old girl with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was admitted to the hospital for bilateral pulmonary embolism with intracardiac thrombus. The girl progressed well on anticoagulation.

Ovarian vein thrombosis after coronavirus disease (COVID-19) mimicking acute abdomen: two case reports.

Coronavirus is a source of deep venous thrombosis (DVT) due to complications such as over-coagulation, blood stasis, and endothelial damage. Ovarian vein thrombosis (OVT) is a very serious and rare disease. In this study, we report tow rare case of women with coronavirus who were hospitalized with a right ovarian vein thrombosis mimicking acute abdomen who progressed well on anticoagulation. Our report adds further document in Side effects and rare localisation of obstruction of veins and arteries in patient with corona virus.

Thrombocytopenia induced by glycoprotein (GP) IIb-IIIa antagonists: about two cases.

In this paper, we report two cases of induced thrombocytopenia after the infusion of glycoprotein (GP) IIb/IIIa receptors antagonists, following a coronary angioplasty. The first patient is a 65-year-old woman, admitted with acute coronary syndrome requiring percutaneous angioplasty with stenting. The patient was given tirofiban + unfractionated heparin (UFH). Ten hours later, the patient revealed very severe thrombocytopenia and went into hemorrhagic shock (hematemesis and hematoma at the injection site). The patient was transfused with nine units of red blood cells (RBCs), 24 platelets pellets and 4 units of fresh frozen plasma (FFP). The second patient is a 76-year-old woman. She was admitted to hospital for acute coronary syndrome necessitating percutaneous angioplasty with stenting and a glycoprotein IIb/IIIa receptor antagonists, tirofiban + unfractionated (UFH). Four hours later, the patient presented with gingivorrhagia associated thrombocytopenia. She received six platelet pellets transfusion with well clinical and biological improvement. These two observations raise the significance of a close monitoring of platelet count after the initiation of GP IIb/IIIa antagonists infusion, which are sometimes responsible for life-threatening adverse events.

Undiagnosed apical hypertrophic cardiomyopathy in an old amateur soccer player: a case report.

Hypertrophic cardiomyopathy is a primary muscle disorder characterized by an abnormal thickness of the left ventricular wall. It is often going undiagnosed because many patients have few symptoms and can lead normal lives. This is a case report about an apical cardiomyopathy diagnosed at a very late stage in an old amateur soccer player. He was hospitalized due to acute chest pain; neurologic disorder related to a hypertensive emergency, he underwent successful percutaneous coronary intervention, echocardiography and CMR revealed Apical hypertrophic cardiomyopathy. The development of sports cardiology has major importance in the detection of cardiac disease which may have poor prognosis. Our patient had the chance to achieve his entire career without rhythmic complications.

Brain tumor revealed by atrial sinus block.

Bradycardia is rare in children and may be asymptomatic or cause fatigue or discomfort leading to syncope. It may be a warning sign of underlying pathology. A check-up for a cardiac or extra-cardiac organic cause should be performed. We report the case of an 8-year-old child admitted to the emergency room for bradycardia with a sino-atrial block that caused syncope. The assessment has objectified a brain tumor. We will discuss the different mechanisms that can explain the occurrence of bradycardia during a brain tumor, and the specificities of the management.

Hydroxychloroquine and Azithromycin as a Treatment of COVID-19: Electrocardiogram Variability.

During the COVID-19 pandemic, the effectiveness of the combination of hydroxychloroquine and azithromycin is widely discussed. This treatment can cause many severe cardiac side effects that makes us discuss its utility. The aim of this study is to describe the cardiovascular effect of hydroxychloroquine and azithromycin by analyzing surface ECG in patients with COVID-19. This observational cohort study included Moroccan patients with COVID-19 diagnosis and were hospitalized in Cheikh Khalifa International University Hospital, Casablanca, Morocco between March 26 and April 20, 2020. Patients were treated with a combination of hydroxychloroquine and azithromycin over a period of at least ten days. We were interested in the effects of this combination on the electrocardiogram. A total of 118 eligible patients were enrolled in the study. QT interval prolongation was observed in 19% of patients under the treatment. Only 5 patients required discontinuation of treatment. The factors associated with QT prolongation are male gender (P value 0,043), age over 68 years (P value 0,09), cardiovascular comorbidity (P value 0,013), tisdale score ≥11 (P value < 0,001), and a severe form of COVID-19 (P value < 0,001). First degree atrioventricular block was observed in 2 patients. No serious rhythm or conduction disorders were observed in this study. QT prolongation is a real risk with the combination of hydroxychloroquine and azithromycin. In the current context, it is necessary to select patients at high risk of severe rhythm disturbances that require closer ECG monitoring. Treatment should be discontinued if there are alarming signs such as QTc prolongation beyond 550 ms and the development of ventricular extrasystole or torsade de pointe.

Elevated levels of D-dimer in patients with COVID-19: prognosis value.

INTRODUCTION: coronavirus disease is now a global pandemic due to rapid human-to-human transmission. It can cause mild to fatal respiratory, cardiovascular, and neurological diseases. We aimed to find out whether elevated D-dimer levels are a predictor of the bad progression of COVID-19 to help reducing the mortality. METHODS: the data of COVID-19 patients from March 21, 2020 to April 24, 2020 were retrieved from the Cheick Khalifa Hospital database. We used the receiver operating characteristic (ROC) curve to get the optimum cutoff value of D-dimer levels on admission and after 5 days. We used these cutoffs to divide patients into two groups and compare the in-hospital mortality between them to assess the prognosis value of D-dimer levels. RESULTS: the data of COVID-19 patients from March 21, 2020 to April 24, 2020 were retrieved from the Cheick Khalifa Hospital database. We used the receiver operating characteristic (ROC) curve to get the optimum cutoff value of D-dimer levels on admission and after 5 days. We used these cutoffs to divide patients into two groups and compare the in-hospital mortality between them to assess the prognosis value of D-dimer levels. 89 patients were included in this study, of whom 79 were discharged and 10 died in hospital. The optimum cutoff value to predict mortality in patient using D-dimer levels on admission was 668 ng/ml (sensitivity 90%, specificity 63.3%, Areas under the ROC curve 0,775). As for D-dimer levels on day 5, it was 1360 ng/ml (sensitivity 100%, specificity 88,6%, Areas under the ROC curve 0.946). The group with D-dimer levels on day 5 > 1360 ng/ml (19 patients) had a worst evolution and a higher incidence of mortality compared to the group with D-dimer < 1360 ng/ml (69 patients) (10/19 vs 0/69, P = 0,0002). CONCLUSION: D-dimer greater than 1360 ng/ml on day 5 could help clinicians identify patients with poor prognosis at an early stage of COVID-19.

Brain and Cardiac Concomitant Localization of the Hydatid Cyst.

Hydatid cyst is a parasitic infestation that is usually observed in the liver and lungs. The localization in the brain and the heart is exceptional. Here, we report a 11-year-old boy who was diagnosed to have two large hydatid cysts of the heart and brain. We discuss this unusual presentation of hydatid cyst and its management.

[A rare mode of revelation of Wegener's granulomatosis: myocarditis associated with a fibroblastic endocarditis]. / Un mode de révélation rare de la maladie de Wegener: une myocardite associée a une endocardite fibroblastique.

We report, through this observation, a rare case of Wegener's disease revealed by myocarditis associated with fibroblastic endocarditis. The patient was initially admitted to hospital with global heart failure. The ECG showed atrial flutter rhythm disorder. Echocardiographic examination revealed non-dilated left ventricle with severe dysfunction and positive troponin dosage. Severe renal failure was discovered fortuitously and required hemodialysis. It was associated with an inflammatory anaemia confirmed by serum ferritin and myelogram. c-ANCA dosage was strongly positive, confirming the diagnosis. Chest CT scanning objectified right basal pneumonia. After starting appropriate treatment, including corticotherapy and immunosuppressive treatment, evolution was favorable with the normalization of left ventricular systolic function. Although obvious clinical cardiac events are rare, cardiac involvement in Wegener's disease is described, requiring rapid diagnostic orientation and rigorous knowledge of this serious disease.