Copper Deficiency Myeloneuropathy Following Roux-en-Y Gastric Bypass in a 72-Year-Old Female.

Following the implementation of gastric bypass for weight management, copper deficiency has become an increasingly recognized cause of myeloneuropathy. This condition typically presents with primarily sensory deficits leading to ataxia, similar to subacute combined degeneration from Vitamin B12 deficiency. We describe the case of a 72-year-old female patient who initially presented for insidious loss of sensation in her hands and feet, along with intermittent urinary retention. MRI findings included T2 hyperintensities of the dorsal cervicothoracic spinal cord. After identification of low serum copper, intravenous supplementation was started, with immediate improvement in symptoms by the time of discharge. Clinicians should recognize copper deficiency as a potential cause of progressive sensory neuropathy, particularly in patients with a history of gastric bypass.

Not Your Usual Case of Culture-Negative Endocarditis: A Case Report of Bartonella Endocarditis.

Advancements in transcatheter interventions have revolutionized the treatment of adult congenital heart disease. We present a case of a 32-year-old male with a history of tetralogy of Fallot with pulmonary atresia diagnosed with Bartonella spp. culture-negative infective endocarditis (IE) of his Melody valve, necessitating Melody valve replacement.

Heart failure ejection fraction class conversions: impact of biomarkers, co-morbidities, and pharmacotherapy.

AIMS: Temporal conversions among ejection fraction (EF) classes can occur across the heart failure (HF) spectrum reflecting amended structural and functional outcomes unaccounted for by current taxonomy. This retrospective study aims to investigate the differences in serum laboratory values, guideline-directed medical therapy (GDMT), and co-morbidity burden across EF conversion groups. METHODS AND RESULTS: Heart failure patients at least 18-year-old who obtained at least two echocardiograms between January 2018 and January 2020 were identified using ICD-10 codes. Analysis of variance, chi-square tests, and analysis of means for proportions were used as appropriate to identify associations with class conversion groups. A total of 874 patients who underwent 1748 echocardiograms on unique visits were categorized according to initial EF as HF with preserved EF (HFpEF) (n = 531, 61%), HF with mildly reduced or midrange EF (HFmrEF) (n = 132, 15%), or HF with reduced EF (HFrEF) (n = 211, 24%). In accordance with follow-up EF, class conversions were categorized into HF with improved EF (HFiEF) (n = 143, 16%), HF with worsened EF (HFwEF) (n = 171, 20%), or HF with stable EF (HFsEF) (n = 560, 64%). The average age was 75 ± 13 years old; 54% were male, 85% were Caucasian, 11% were African American, and 4% other. The mean time between EF assessments was 208.6 ± 170.2 days. Serum sodium levels were greater in HFwEF (139 ± 3 mmol/L) when compared with HFsEF (138 ± 4 mmol/L) (P = 0.05). Pro-BNP levels were higher in HFiEF (12 150 ± 19 554 pg/mL) versus HFsEF (6671 ± 10 525 pg/mL) (P = 0.007). Angiotensin receptor-neprilysin inhibitors (ARNI) were more frequently ordered on index visit in HFiEF (P = 0.03), but no other significant differences in GDMT were identified. Despite similar Elixhauser Co-morbidity Measure (ECM) scores, ECM categorical analysis revealed that HFwEF was more likely to have an established diagnosis of depression (P = 0.03) and a spectrum of psychiatric illnesses (P = 0.03) on preliminary visit. HFsEF was less likely to have an established diagnosis of blood loss anaemia (P = 0.04). Metastatic cancer was more likely to have been diagnosed in HFiEF and less likely in HFsEF (P = 0.002). CONCLUSIONS: Despite similar ECM scores, EF class conversion groups demonstrated salient differences in average serum sodium and pro-BNP levels. Inpatient ARNI orders, psychiatric, hematologic, and oncologic co-morbidity patterns were also significantly different. Findings demonstrate blood-based biomarker patterns and targetable co-morbid conditions which may play a role in future EF class conversion. Dedicated studies evaluating measurements related to GDMT dose-titration, quality of life, and functionality are the next steps in this field of HF.

Effectiveness of COVID-19 Convalescent Plasma Infusion Within 48 Hours of Hospitalization With SARS-CoV-2 Infection.

On January 30, 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic a worldwide emergency. Worldwide there have been 170 million cases of the resulting disease coronavirus 2019 (COVID-19), of those, 3.53 million have resulted in death. The Food and Drug Administration (FDA) with Mayo Clinic as the lead institution authorized COVID-19 convalescent plasma (CCP) for treatment of SARS-CoV-2 infection. Effective therapeutic window for CCP administration had yet to be defined. We addressed this gap by characterizing longitudinal biologic response and clinical outcomes of COVID-19 patients treated with CCP. Primary outcome was discharged to home/home health.

More Than Meets the Eye: Infective Endocarditis Presenting as Endogenous Endophthalmitis.

Endogenous endophthalmitis (EE) is a potentially blinding ophthalmological emergency with poor visual prognosis requiring a high index of clinical suspicion to obtain a prompt diagnosis. The main factors associated with poor visual outcomes include the virulence of the causative organism and timing of intervention. Infective endocarditis can present with nonspecific ocular complaints and remains an important risk factor for developing EE. We report an unusual case of EE in a 78-year-old male caused by infective endocarditis secondary to Streptococcus viridans resulting in bioprosthetic aortic valve abscess with dehiscence.

Idiopathic Granulomatous Mastitis Presenting in a Patient With Hypothyroidism and Recent Hospitalization for Myxedema Coma: A Rare Case Report and Review of Literature.

Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast. Clinical features may include painful breasts, erythema, subcutaneous nodules, and ulcerative lesions. It can mimic various other breast pathologies, and it is a diagnosis of exclusion after infection, malignancy, and other inflammatory conditions have been ruled out. In this article, we present a case of IGM developing in a 40-year-old female 3 months after hospitalization for myxedema coma. A contrast-enhanced magnetic resonance imaging of the breasts showed bilateral edema, and a biopsy was negative for malignancy or infection. She was started on prednisone and had noticeable improvement of ulcerations within several weeks. IGM is a rare condition that requires a multimodal treatment approach. Often recalcitrant disease is encountered and requires surgical intervention, immunosuppression, and antimicrobial therapy. The diagnosis should be entertained in patients with bilateral breast inflammation to avoid unnecessary surgical resection early on.

Hypersecretory Paraganglioma Presenting as Acute Aortic Dissection.

Abrupt, transient, and severe hypertension evoked by catecholamine-secreting tumors has the potential to manifest as acute aortic dissection. We report the successful, multidisciplinary management of an insidious, extra-adrenal, functional paraganglioma, suddenly presenting as acute aortic dissection. (Level of Difficulty: Beginner.).