The Villain Who Saved the Day: The Paradoxical Value of Amiodarone in Managing Recurrent Ventricular Tachycardia Secondary to Amiodarone-Induced Thyroiditis.

Thyroiditis is a rare and serious complication for patients taking amiodarone. It can manifest with symptoms of hyperthyroidism and serious life-threatening arrhythmias. We present a case of a patient with amiodarone-induced thyrotoxicosis presenting with an electrical storm in which rhythm control was achieved with the utilization of amiodarone.

Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL): A Diagnosis to Consider in Atypical Stroke Presentations.

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary cerebral arteriopathy caused by a neurogenic locus notch homolog protein 3 (NOTCH3) gene mutation. This article describes the case of a man in his early 40s who experienced sudden onset temporary left-sided weakness and facial numbness that resolved in two hours, along with residual weakness in the upper and lower limbs. There was a family history of CADASIL with both his mother and brother having experienced strokes. Clinical investigations on admission were unremarkable including a young stroke screen and computed tomography (CT) of the brain. On CT angiography, there was no evidence of significant carotid artery stenosis. Subsequent cerebral magnetic resonance imaging (MRI) revealed an acute infarction in the right corona radiata extending into the right basal ganglia, with the fluid-attenuated inversion recovery (FLAIR) images revealing considerable bilateral symmetrical white matter hyperintensity in the frontal, parietal, and anterior temporal lobes. Based on his clinical presentation, strong family history, and brain MRI findings, a diagnosis of CADASIL was suspected. He received antiplatelet medication for an acute stroke and later underwent genetic testing, which revealed the presence of a NOTCH3 gene mutation.

Theophylline Toxicity: A Differential to Consider in Patients on Long-Term Theophylline Presenting With Nonspecific Symptoms.

Theophylline has been used for decades as a bronchodilator to treat asthma and chronic obstructive pulmonary disease (COPD). The precise mode of action is still uncertain. Since beta-2 agonists are at least as effective as theophylline as a bronchodilator while having fewer side effects, theophylline has become less popular in recent clinical practice as the first-line treatment in patients with airway obstruction due to its narrow therapeutic window, which necessitates frequent level monitoring, severe side effects that can be fatal, and interactions with other medications. Patients with a chronic theophylline overdose often present with nonspecific gastrointestinal symptoms, which can result in misdiagnosis for a variety of gastrointestinal conditions. Convulsions that may be fatal can occur as a result of a theophylline overdose. Therefore, it is important to manage individuals who have been taking theophylline for a long period and have nonspecific cardiac or gastrointestinal symptoms with a high index of suspicion for theophylline toxicity. We present a case of a COPD patient who had no regular theophylline level monitoring for two years. He presented with vague gastrointestinal symptoms for the past six months and was initially suspected of having gastrointestinal cancer due to weight loss caused by decreased oral intake due to nausea and vomiting. He was suspected of having theophylline toxicity because he was on long-term theophylline and did not have frequent theophylline level monitoring. His theophylline level was measured and found to be high at 28.9 mL/L (normal level, 15 mL/L). He was given conservative treatment, including intravenous fluid and electrolyte replacements, and close monitoring of his theophylline levels.

Raoultella planticola Pneumonia: A Rare Causative Organism.

We present a case of Raoultella planticola (R. planticola) infection that resulted in community-acquired pneumonia in an immunocompetent patient with an eight-week history of productive cough. This gram-negative bacterium is typically found in the environment and has the potential to infect humans. Raoultella planticola infections in humans have been recorded in several case reports from throughout the world in recent years, usually affecting immunocompromised patients. Although R. planticola is sensitive to most antibiotic groups, recent studies have revealed an increase in the infrequent acquisition of resistance genes in R. planticola, such as carbapenem resistance, making this pathogen a potential emergent threat. Our patient acquired R. planticola pneumonia in the absence of any underlying risk factors, making this the first case in the UK of R. planticola causing community-acquired pneumonia in an immunocompetent person.