Rapidly Progressive and Almost Lethal Pneumonia.

We herein describe the case of a 65-year-old male patient who presented with Osler's triad, which is the combination of endocarditis, pneumonia, and meningitis. This report is even more unusual since the pathogen isolated was the invasive and virulent strain of Streptococcus pneumoniae serotype 3. The clinical entity described is also called Austrian syndrome. Even though rare in this antibiotic era, the syndrome remains one of high morbidity and mortality. This particular case is of paramount importance for the clinician reader. First, it documents the clinical features associated with invasive pneumococcal disease and the Austrian syndrome. Second, and equally important, it highlights why following the Surviving Sepsis Campaign guidelines saves lives. For this case, the following steps were taken: 1. As a surrogate for perfusion, early and aggressive fluid resuscitation therapy (guided by lactic acid levels) was instituted; 2. also early in the treatment, broad spectrum antibiotics were administered; 3. to guide antibiotic therapy, microbiological cultures were obtained. The patient subsequently improved and was transferred to the internal medicine ward to complete 4 weeks of antibiotic therapy.

Transient AV Block as a Hemodynamic Complication of the Influenza A Virus: A Case Report.

Influenza virus causes annual epidemics of respiratory illness characterized by sudden onset of fever, malaise, myalgias, headache, cough, and other respiratory complains. Each year in the United States, it is estimated that this debilitating respiratory illness accounts for 294,000 excess hospitalizations and 36,000 attributable deaths. Epidemiological studies describe increased cardiovascular mortality during influenza seasons. Cardiovascular involvement in acute influenza infection can occur through direct effects of the virus on the myocardium or through exacerbation of existing cardiovascular disease. The purpose of this report is to document a transient atrioventricular (AV) block with hemodynamic compromise after infection with the influenza virus in a patient with underlying cardiac disease without myocarditis.

A rare cause of altered mental status and fever in a young military recruit in Puerto Rico.

Heat stroke (HS) is a medical emergency characterized by increased core body temperature with associated systemic inflammatory response leading to a syndrome of multi-organ damage in which encephalopathy predominates. We describe a case of a 29 year old male recruit presenting with altered mental status during military training in Puerto Rico. Associated symptoms included high grade fever, dizziness, nausea, vomiting, blurred vision and profuse sweating followed by loss of consciousness. Upon arrival to medical evaluation the patient was found with dry skin and depressed Glasgow Coma Score. Initial laboratories, clinical evolution of symptoms and imaging studies were consistent with the diagnosis of HS. Patient was managed with mechanical ventilatory support, intravenous fluids and external cooling measures. He was later discharged home without any neurological sequelae. To our knowledge this is the first documented case of HS in Puerto Rico.