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Key Clinical Message: Tuberculosis (TB) pericarditis, while uncommon, should be considered in patients with pericardial masses and effusion. Timely recognition and treatment with anti-TB medications are crucial for a successful outcome. Abstract: TB pericarditis presenting as a pericardial mass is an unusual and rare manifestation of this disease. We report a 59-year-old South Asian male who presented with a 1-week history of dyspnea and cough. He was found to have a hemorrhagic pericardial mass with a massive pericardial effusion. Pleural fluid analysis was positive for TB. The patient was successfully treated with anti-TB medications. Although rare, tuberculous pericardial involvement should be suspected in patients presenting with symptoms of pericardial masses and effusion.
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BACKGROUND: Angiotensin II is a peptide hormone vasopressor that activates angiotensin type 1 (AT1) receptors leading to vasoconstriction, the augmentation of arterial blood pressure (ABP), and organ perfusion. Angiotensin II was found to increase the ABP in catecholamine-refractory vasodilatory shock. Whether this effect improves the chances of survival or not remains inconclusive. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of angiotensin II in vasoplegic shock. OBJECTIVES: To evaluate the clinical significance of angiotensin II effects in vasoplegic shock concerning the hemodynamic impact, mortality outcomes, and side effects. METHODS: Following PRISMA guidelines, we searched PubMed and EMBASE for experimental and observational studies published in English exploring the clinical outcomes of angiotensin II use in vasodilatory shock till 1 July 2024. Two independent authors assessed the quality and risk of bias of the included studies. A random effect model (Mantel-Haenszel) was used to combine data. The primary outcome was in-hospital mortality associated with angiotensin II use in comparison to standard therapy, while the secondary outcomes were mean arterial pressure (MAP) change, multi-organ failure (MOF), and the incidence of atrial fibrillation (AF). The Q test and I2 were used to examine heterogeneity, with I2 > 50% indicating marked heterogeneity. RESULTS: A total of eight studies (n = 974) comparing angiotensin II to standard therapy in vasoplegic shock were included in the systematic review, with three studies comprising 461 patients included in the final analysis of the primary outcome. Only one study evaluated the use of angiotensin II as a primary vasopressor, while the rest reported angiotensin II use in catecholamine-refractory vasodilatory shock. Overall, angiotensin II use was associated with similar in-hospital mortality compared to standard therapy (risk ratio [RR] = 0.83; 95% CI, 0.68-1.02, I2 = 0%). Likewise, there was no difference in MOF and AF (MOF: RR = 1.01; 95% CI, 0.61-1.65, I2 = 0%; AF: RR = 1.27; 95% CI, 0.38-4.23, I2 = 5%). However, angiotensin II use demonstrated a significant MAP increase (mean difference = -9.60; 95% CI, -9.71, -9.49, I2 = 0%). CONCLUSIONS: In vasodilatory shock, angiotensin II use demonstrated comparable in-hospital mortality compared to standard therapy. Nevertheless, it resulted in significant MAP change, which may encourage clinicians to use it in cases of profound hypotension.
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Ascaris lumbricoides infestation can cause a variety of intestinal complications, but severe gastrointestinal bleeding is rare. A thorough evaluation is needed for travelers and migrants with massive gastrointestinal bleeding, especially in those patients who have undergone multiple upper and lower endoscopies with no certain cause. We present a challenging case of massive small bowel bleeding due to Ascaris infection.
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Massive hemoptysis due to pulmonary tuberculosis is a life-threatening complication; it occurs as a result of the erosion of one of the pulmonary vessels. Tuberculous vascular lesions can also lead to arteritis, thrombosis, arterial dilation and Rasmussen aneurysms. "Rasmussen aneurysm" is a rare cause of hemoptysis. The extent of hemoptysis varies in severity from mild to life threatening, which is more common. Here, we report a case of a 45-year-old Indian male who initially presented with cough, and generalized weakness; his clinical, laboratory, and radiological findings were highly suggestive of pulmonary tuberculosis. Following medical ward admission, two weeks later he had worsening of his respiratory status complicated by massive hemoptysis and dropped oxygen saturation requiring intubation and admission to the intensive care unit. His computed tomography angiography revealed localized aneurysmal dilatation of the pulmonary artery in the left lower lobe (Rasmussen aneurysm); embolization was performed successfully. Due to the poor respiratory reservoir in most pulmonary TB cases, interventional radiology is preferred over surgery.
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Datura stramonium (also called thorn apple or Jimson weed) is a plant that contains atropine, scopolamine, and hyoscyamine, giving it anticholinergic effects when consumed. We report the case of a 32-year-old male in Qatar who intentionally ingested seeds from Jimson weed mixed with milk. The patient became severely confused and delirious, eventually requiring admission to the intensive care unit (ICU) for two days for management. The patient was discharged safely with no complications afterward. The case is unique in that Jimson weed is not common in Qatar, and due to the adverse effects of this plant, this case serves to highlight to both the general population and healthcare professionals the effects of ingestion and the appropriate management plan for toxicity caused by Jimson weed.