Complexities of Infective Endocarditis in a Young Patient With Hypertrophic Obstructive Cardiomyopathy: A Case of Dual Valve Involvement and Neurological Complications.

Infective endocarditis (IE) is a life-threatening infection predominantly affecting the endocardium and heart valves, commonly seen in older patients and those with pre-existing cardiac conditions. Although rare in younger individuals with intact cardiac valves, certain structural heart diseases such as hypertrophic obstructive cardiomyopathy (HOCM) can increase the risk. We present a unique case of a 39-year-old female with a known history of HOCM, a condition characterized by abnormally thickened cardiac muscle primarily affecting the left ventricle. This patient was diagnosed with group B streptococcus infective endocarditis. Notably, this case was complicated by septic emboli to the brain. This case underscores the significant risk of IE in patients with HOCM, a demographic usually less susceptible to IE. It underscores the importance of early recognition and aggressive management of IE, especially in patients with structural heart diseases.

Hantavirus-induced cardiac tamponade: A diagnostic dilemma.

Herein we describe a case of a 60-year-old white male from New York City who was admitted to hospital due to worsening dyspnea. He presented with an acute onset of fever, night sweats, and progressively worsening nonproductive cough and orthopnea over the preceding week. Electrocardiogram findings revealed atrial fibrillation. Manifesting signs of hypoperfusion, a trans-esophageal echocardiography was performed, which demonstrated the presence of a cardiac tamponade. An emergency pericardiocentesis was performed, draining 750 cc of serosanguinous content. Laboratory investigations depicted an inflammatory milieu marked by lymphocytic leukocytosis, cardiac function impairment, and remarkably elevated d-dimer and brain natriuretic peptide levels. Notably, high-sensitivity troponin T remained within normal limits. Comprehensive viral panel assays, including COVID-19, Influenza A + B, Respiratory Syncytial Virus, Hepatitis C, HIV, Cytomegalovirus, Coxsackie A + B, and Herpes Simplex Virus, returned negative results. Furthermore, antinuclear factor and rheumatoid factor titers were negative. Blood and fungal cultures, as well as assessments for Mycobacterium tuberculosis, yielded negative findings. On further history-taking, he reported that he had occupational exposure to rat droppings and urine two weeks ago. Serological analysis demonstrated positive hantavirus IgG and IgM antibodies. Supportive management was initiated. Consequently, the patient was discharged asymptomatic, without pericardial effusion. Evaluation after two weeks revealed no recurrence of symptoms.