A Rare Case of Aggressive Infective Endocarditis Due to Corynebacterium striatum.

Corynebacterium striatum is considered a rare pathogen in infective endocarditis (IE). C. striatum is a Gram-positive facultative anaerobic bacterium found in the environment and human flora. It is part of the microbiota of the skin and nasal mucosa of humans and has been increasingly reported as the etiologic agent of community-acquired and nosocomial diseases. A 91-year-old female patient was admitted to our clinic with complaints of increased fatigue for a week. Transthoracic echocardiography revealed a labile, echogenic appearance on the mitral valve that may be consistent with infective endocarditis, causing mitral regurgitation. Transesophageal echocardiography (TEE) confirmed this finding on the same day. In three-dimensional (3D) TEE, there was an oval mass of 1.9 cm × 1.1 cm at the level of the P2 scallop of the posterior mitral leaflet, and 1.0 cm of mobile vegetation was observed on it. Three serial blood cultures from peripheral vessels identified C. striatum. Antibiotic treatment of the patient was started with daptomycin 1 × 750 mg and meropenem 3 × 1 g. The cardiology team advised the patient to undergo early surgery, but the patient declined, and the case was followed up medically. On the 10th follow-up day, the patient had a speech disorder. Cerebral computed tomographic angiography showed an appearance compatible with a septic embolism in the left main cerebral artery. The patient's condition worsened throughout follow-ups, and she died on day 12. The purpose of presenting this case is to emphasize the importance of Corynebacterium species, which is a cause of rare native valve infectious endocarditis, and to show the difficulties in its treatment.

Unexpected cause of Kounis syndrome: hypersensitivity reaction to omeprazole.

Kounis syndrome is a rare type of acute coronary syndrome (ACS) that occurs as a result of an allergic or anaphylactic reaction. Kounis syndrome can be induced by various medications including antibiotics, proton pump inhibitors, antihypertensive medications, corticosteroids, and antineoplastic medications. Additionally, cases of Kounis syndrome associated with lansoprazole and pantoprazole have been previously reported in the literature. In this report, we present a case of Kounis syndrome associated with omeprazole use, and discuss the need for a high index of suspicion as it is often underrecognised.

Intravenous Leiomyomatosis with Intracardiac Extension as a Rare Cause of Abdominal Pain in an Adult Patient: A Case Report.

Intravenous leiomyomatosis (IVL) is a rare and benign smooth muscle tumor that arises from intrauterine venules or the myometrium. We herein describe a 49-year-old woman with a history of myomectomy who developed abdominal pain. An intravascular mass with extension to the right atrium was detected in the inferior vena cava. The mass was surgically resected in a single stage under cardiopulmonary bypass. IVL features were indicated by subsequent histopathology. Postoperatively, the patient was diagnosed with massive pericardial effusion and treated with a pericardial window. At 3 months' outpatient clinical follow-up, she was asymptomatic. This case indicates that the diagnosis of IVL with extension to the heart should be kept in mind in patients presenting with abdominal pain.

Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study.

INTRODUCTION: In the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery. MATERIAL AND METHODS: The present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients underwent preoperative cardiac evaluation by a trained cardiologist using the algorithms proposed in the recent preoperative guidelines. The in-hospital mortality was the main outcome of the study. RESULTS: In total, 277 elderly patients undergoing hip fracture surgery were enrolled in this analysis. The overall in-hospital mortality rate was 12.1% (n=30 cases). In a multivariate analysis, we found that insulin dependency, cancer, urea, presence of atrial fibrillation (AF) (OR: 3.906; 95% CI 1.470 to 10.381; p=0.006) and pulmonary artery systolic pressure (PASP) (OR: 1.057; 95% CI 1.016 to 1.100; p=0.006) were the predictors of in-hospital mortality. The receiver operating characteristic curve analysis revealed that the optimal value of PASP in predicting the in-hospital mortality was 35 mm Hg (area under the curve=0.71; 95% CI 0.60 to 0.81, p<0.001) with sensitivity of 87.7% and specificity of 59.5%. CONCLUSION: The present research found that the preoperative cardiac risk factors, namely AF and PASP, might be associated with increased in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery.