Salmonella Meningitis Complicated by Ventriculitis and Brain Abscesses in an HIV Positive Adult Patient.

Salmonella meningitis is a rare complication of Salmonella sepsis and is mostly reported in infants and young children. The incidence of Salmonella bacteremia is increased in immunocompromised adult individuals, such as those having human immunodeficiency virus (HIV) infection. Ventriculitis and brain abscess as a complication of Salmonella intracranial infection is particularly rare, even in patients who are immunosuppressed. Herein, we report a case of Salmonella meningitis complicated by ventriculitis and two brain abscesses in an HIV positive adult patient requiring mini-craniectomy and drainage along with a prolonged course of antibiotic therapy with a favorable outcome.

ST-Elevation Myocardial Infarction Presenting as Acute Limb Ischemia.

We describe a case of delayed presentation of ST-segment elevation myocardial infarction (STEMI) complicated by ventricular thrombus and peripheral embolization causing limb ischemia. Our patient initially presented with symptoms of acute limb ischemia. However, on preoperative evaluation, STEMI was diagnosed. He required emergent revascularization of the left anterior descending artery followed by thrombectomy of the femoral artery. The cause of the limb ischemia was deemed to be a late presenting STEMI that was complicated by left ventricular thrombus, hence causing lower extremity embolization. Delayed presentations and complications related to STEMI may manifest as acute limb ischemia in the setting of ventricular thrombus formation and subsequent distal embolization.

Recurrent acute coronary syndrome in a patient with spontaneous coronary artery dissection and fibromuscular dysplasia.

A 51-year-old woman who presented in June 2010 with acute coronary syndrome (ACS) and anterior wall motion abnormality on the echocardiogram but was found to have an insignificant angiogram. Eight years later she presented again with ACS and evidence of worsening cardiac wall motion affecting a similar territory; however, the angiogram revealing spontaneous coronary artery dissection of the distal left anterior descending artery. Extravascular screening revealed evidence of multifocal fibromuscular dysplasia. We suggest offering vascular screening for fibromuscular dysplasia in young women who present with ACS and normal angiograms, after weighing in risks and benefits.

Rare ST-Elevation Myocardial Infarction Mimic: Diabetic Ketoacidosis With Severe Hypercalcemia.

Diabetic ketoacidosis (DKA) is a common complication in patients with type I and ketosis-prone type II diabetes mellitus. A variety of electrolyte derangements are encountered during the presentation and management of DKA. Hypercalcemia has been rarely reported in DKA, particularly when patients develop severe acidosis. However, we describe a patient with DKA and severe hypercalcemia in the absence of severe acidosis. The hypercalcemia quickly corrected back to normal with the treatment of DKA.

Nonseminomatous Extragonadal Germ Cell Tumor Presenting As Early Pericardial Tamponade.

Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic and asymptomatic patients. The most frequent mediastinal masses in adults are thymoma, lymphoma, thyroid masses, and germ cell tumors. Potential complications of these masses due to localized invasion include hemoptysis, post-obstructive pneumonia, and superior vena cava syndrome. Pericardial tamponade is usually secondary to pericarditis, trauma, infections, radiation, uremia, vascular diseases, and uremia. However, this report presents a case of a young patient who was found to have a large pericardial effusion and early signs of pericardial tamponade, which have not previously been reported as complications of extragonadal germ cell tumors, to the best of our knowledge.

Acute Paraspinal Compartment Syndrome in an Unconscious Patient.

Compartment syndrome can be a limb-threatening emergency that may require immediate intervention. It usually involves the extremities but any closed compartment of the body is susceptible to it. Paraspinal compartment extends on both sides of the spine. Prolonged lying on the back in unconscious patients leads to muscle edema which eventually leads to increase pressure in the compartment. Neurovascular comprise is a dreaded complication of compartment syndrome. Paraspinal compartment is a potential site of compartment syndrome particularly in unconscious patients and it requires prompt diagnosis, careful monitoring, immediate medical attention and even warranting surgical intervention in certain cases.