Acute Cytomegalovirus Infection Associated With Erythema Multiforme-Like Eruption: A Case Report.

Human cytomegalovirus infection usually proceeds asymptomatically in immunocompetent patients. In symptomatic forms, mononucleosis syndrome is the most common manifestation. However, atypical cases of cytomegalovirus infections in immunocompetent subjects are reported in the literature. Here, we describe a case of cytomegalovirus-related mononucleosis syndrome that presented with an atypical erythema multiforme-like skin rash and high fever. Very few cases have been described in the literature previously. In our case, the diagnosis was supported by specific serology, and human cytomegalovirus DNA was detected in the blood sample. The clinical picture resolved without the administration of antiviral therapy.

Myopericarditis Associated With Marijuana Intake: A Case Report and Literature Review.

A 26-year-old male who endorses daily cigarette smoking and marijuana vaping presented to the emergency department with acute onset of left-sided chest pain radiating to the left shoulder. Physical examination was unremarkable, but laboratory investigations showed elevated white blood cells, cardiac biomarkers including troponin and creatine kinase, and mildly elevated C-reactive protein levels and erythrocyte sedimentation rate. Electrocardiogram displayed subtle ST-segment elevation in a diffuse pattern, leading to a diagnosis of acute myopericarditis. The patient was treated with anti-inflammatory medication and supportive care and instructed to cease cannabis use.

Cardiac Syndrome X: The Sensitive Heart of a Young Adult Man.

Cardiac syndrome X (CSX), now well known as microvascular angina, is a mysterious cardiac condition in medical science. While the symptoms suggest obstructive coronary disease, the actual angiography turns out to be negative or nonsignificantly obstructive. Despite being a benign condition, its presence increases the risk of adverse cardiovascular events and leads to poor quality of life in the patients. The prevalence of cardiac syndrome X is higher in women, mostly in postmenopausal states. This case report sets a different clinical picture of cardiac syndrome X, where a young male patient is found to have this syndrome. A 38-year-old male went to the hospital with a chief complaint of substernal chest pain for one hour. An electrocardiogram (EKG) showed nonspecific ST-T wave changes, and the cardiac troponin results were nonsignificant. On the contrary, the myocardial perfusion scan came back positive for significant ischemia in various parts of the heart. The patient underwent a coronary angiogram, which showed normal coronary arteries. In view of similar chest pain episodes in the past and the presence of risk factors, he was discharged with extensive counseling on lifestyle modification and medical management. This case report raises awareness about this syndrome's classic clinical scenario and chronology of events in a rare class of the population. Through this case report, clinicians can learn the art of diagnosing this syndrome and provide appropriate patient care in near-miss situations.

Rare Association of Patent Foramen Ovale and Atrial Septal Aneurysm Leading to Branch Retinal Artery Occlusion in a Young Healthy Man.

Retinal artery occlusion (RAO) occurs in the elderly population above the age of 60 years due to carotid atherosclerosis as a consequence of long-standing hypertension, diabetes mellitus, smoking, and hyperlipidemia. It can also develop due to paradoxical emboli from patent foramen ovale (PFO), which can happen in a relatively younger population. Early diagnosis mandates prompt management; otherwise, it may lead to vision loss. We present a rare case of branch RAO (BRAO) in a healthy young gentleman with concurrent PFO and large atrial septal aneurysm, which has not been reported much in the literature. Our patient presented with sudden left-sided blurriness of vision, which was diagnosed as BRAO on ophthalmoscope examination. Multidisciplinary teams were involved in reaching the underlying etiology of such a presentation in a young, healthy person. Urgent head CT with cerebral angiography and head MRI was unremarkable for any acute insult. The autoimmune screen and thrombophilia workup were unremarkable. After thorough investigations, a small PFO with a large atrial septal aneurysm was found to be correlating with his clinical picture. We aim to highlight the importance of timely diagnosis and further management in such clinical scenarios, where permanent vision loss can compromise someone's quality of life.