Parvimonas micra: A Rare Cause of Pleural Empyema With COVID-19 Co-infection.

Parvimonas micra, an oral anaerobe and a known gastrointestinal microbiota, has also been found to be enriched in mucosal tissues of the colon. Our patient presented with chest pain, productive cough, and hypoxia. He was diagnosed with COVID-19 pneumonia with a suspected superimposed bacterial infection. After the initiation of treatment, the patient developed a right hydropneumothorax/loculated pleural effusion on X-ray. Bedside drainage was done, and cross-sectional imaging showed findings of pleural empyema. Cultures obtained after bedside drainage grew P. micra. The patient underwent right posterolateral open thoracotomy, total lung decortication, wedge resection, pneumonolysis, and mechanical pleurodesis. Antimicrobial therapy was adjusted based on culture sensitivities and infectious disease evaluation. Adequate drainage and source control were achieved, COVID-19 infection was resolved, and the patient was discharged on oral antibiotics. This case report highlights a rare and interesting case of pleural empyema caused by a superimposed bacterial infection with P. micra in a patient with COVID-19 pneumonia.

Cocaine-Induced Kidney, Liver, Lung, and Muscle Injury (C-KLM), Presenting With Foot Drop: A Case Report.

Cocaine-associated organ injury is a well-known phenomenon that may lead to multi-organ failure. Cocaine-induced kidney, liver, lung, and muscle (C-KLM) involvement is an entity with alarmingly high creatinine phosphokinase (CPK) levels exceeding 100,000 U/L. This may have fatal outcomes. Rhabdomyolysis is one of the many mechanisms of kidney injury induced by cocaine intoxication. Sympathomimetic effects of cocaine contribute to muscle Injury in addition to vasoconstriction resulting in muscle ischemia, as well as liver ischemia (shock liver). Furthermore, increased muscular activity from hyperpyrexia, seizures, and agitation due to cocaine use disorder may contribute to muscle breakdown and worsening nephrotoxicity.  The authors detail a case of a 34-year-old male intravenous drug user who presented with an inability to bear weight or move his left lower extremity due to pain, associated with severe edema of his lower extremities of acute onset. He was subsequently noted with foot drop, oliguria, and high blood pressure following cocaine intoxication. The patient began crashing rather quickly and the intensive care unit was recommended. Labs were noted with overwhelming CPK levels over 100,000 U/L and rising for which urgent hemodialysis was initiated. We detail a catastrophic cocaine-induced multi-organ failure with a positive outcome following a multidisciplinary approach.

Right Hepatic Artery Pseudoaneurysm Presenting As Upper Gastrointestinal Bleed: A Deadly Hit and Run Following Blunt Trauma.

Hepatic artery pseudoaneurysm (HAA) is a rare complication of blunt trauma, occurring in only 1% of patients. It is life-threatening with abysmal and atrocious outcomes if not recognized early and managed promptly. Other etiologies include transjugular-intrahepatic portosystemic shunt (TIPS), pancreatitis, cholecystectomy, and liver transplantation. We report a near-miss case in a 38-year-old woman following a motor vehicle accident. She sustained Grade III/IV liver laceration (>50% subcapsular hematoma), presenting with upper gastrointestinal bleeding (UGIB). Our patient was managed emergently intra-operatively, with hemostasis promptly achieved; however, she continued to bleed postoperatively, becoming hemodynamically unstable and unresponsive to both massive blood transfusions and high-dose proton pump inhibitors. Further imaging demonstrated HAA for which coil embolization was carried out by interventional radiology (IR).