Gemifloxacin-Induced Allergic Myocardial Infarction: A Case Report.

BACKGROUND: Gemifloxacin given once daily for 5-7 days has been shown to be non-inferior to, or in some instances superior to, comparator agents for the treatment of common lower respiratory tract infections. Gemifloxacin is generally well tolerated and is as safe as many frequently empirically prescribed antimicrobials. CASE REPORT: We report a case of a 46-year-old woman given gemifloxacin for an upper respiratory tract infection who developed allergic myocardial infarction 15 min after taking an oral dose of 320 mg gemifloxacin. To our knowledge, this is the first case of allergic myocardial infarction associated with gemifloxacin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although anaphylactoid/anaphylactic reactions are rare adverse effects of fluoroquinolones, clinicians should be aware of this potentially fatal event. Electrocardiographic interpretation is a critical skill of the emergency physician. Awareness of Kounis syndrome and its specific electrocardiogram findings may help facilitate further testing that will aid in timely diagnosis and interventions. A diagnosis of Kounis syndrome should be considered in young, healthy patients with no atherosclerotic risk factors when they develop an acute coronary syndrome after administration of a potentially allergic agent.

Is there a potential role for echocardiography in adult patients with CAP?

BACKGROUND: The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP. METHODS: A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours. RESULTS: White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P < .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score. CONCLUSIONS: Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.

Allergic myocardial infarction in childhood: Kounis syndrome.

Kounis Syndrome was first described by Kounis as "allergic angina syndrome" progressing to "allergic myocardial infarction". This report describes the first children in the literature presented with Kounis syndrome.

A small pericardial effusion is a marker of complicated hospitalization in patients with community-acquired pneumonia.

OBJECTIVE: Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with adverse events and increased mortality in various conditions. This study aimed to evaluate the frequency and prognostic importance of SPE in a cohort of patients hospitalized for community-acquired pneumonia (CAP). METHODS: We prospectively followed 154 consecutive adult patients hospitalized with CAP. The severity of CAP was evaluated with the pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. All patients underwent transthoracic echocardiography within the first 48h of admission. Patients were followed-up until hospital discharge or death. The outcomes of interest were length of stay in hospital and complicated hospitalization (CH) which is defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. RESULTS: A total 34 episodes of CHs occurred in 21 (13.6%) patients. Older patients and those with more co-morbid conditions such as diabetes, coronary artery diseases, cerebrovascular diseases, and chronic obstructive pulmonary diseases tended to have a higher rate of CH. Patients with CH had higher N-terminal pro-brain natriuretic peptide, troponin and creatinine levels on admission compared to patients without CH. Patients with CH had also higher CURB-65 and PSI scores and had longer durations of stay compared to patients with uncomplicated course. SPE was noted in 24 (15.6%) of the patients in our study cohort. Incidence of CH was greater for patients with a SPE (26 CHs occurred in 14 of the 24 patients) compared to those without an effusion (8 CHs occurred in 7 of the 130 patients, p<0.001). Logistic multivariate analysis revealed that the presence of SPE was an independent predictor of CH (OR: 3.26; 95% CI: 2.19-8.71; p=0.008). CONCLUSION: This study is the first to demonstrate that the presence of SPE is associated with increased adverse events in patients with CAP.