Subject(s)
Hydroxyurea/therapeutic use , Pulmonary Fibrosis/drug therapy , Pulmonary Fibrosis/radiotherapy , Combined Modality Therapy , Diagnosis, Differential , Dyspnea , Female , Hematopoiesis, Extramedullary , Humans , Leukocytosis , Middle Aged , Pulmonary Fibrosis/diagnosis , Tomography, X-Ray ComputedABSTRACT
Primary cardiac tumors are very rare. Cardiac Papillary Fibroelastoma (CPF) is the third most common primary tumor of the heart and most commonly affects cardiac valves. Those tumors appear like a "sea anemone" with multiple papillary fronds attached to the endocardium by a short stalk. It generally occurs as a single structure and is typically found on the atrial aspect of atrioventricular valves or either side of the semilunar valves. We report a case of aortic valve papillary fibroelastoma which was found on autopsy in a patient with normal coronary artery with evidence of myocardial and cerebral ischemic damage and sudden death.
Subject(s)
Aortic Valve/pathology , Fibroma/pathology , Heart Neoplasms/pathology , Papillary Muscles/pathology , Fatal Outcome , Humans , Male , Middle AgedSubject(s)
Airway Obstruction/diagnosis , Anemia, Sickle Cell/diagnosis , Hemoptysis/diagnosis , Pulmonary Artery/pathology , Sarcoidosis, Pulmonary/complications , Sarcoidosis, Pulmonary/pathology , Adult , Airway Obstruction/etiology , Biopsy, Needle , Bronchoscopy/methods , Disease Progression , Fatal Outcome , Female , Hemoptysis/etiology , Humans , Immunohistochemistry , Radiography, Thoracic , Risk Assessment , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To report a case of steroid-induced myopathy resulting from prolonged administration of corticosteroids in an asthmatic patient in a medical intensive care unit. CASE SUMMARY: A 30-year-old white man presented with status asthmaticus requiring intubation for respiratory failure. His hospital course was complicated by the need for reintubation and the development of "quadriplegia." Electromyography does not identify neuropathy. After rapid tapering of systemic steroids, the patient quickly regained muscle strength, was extubated, and was transferred to a rehabilitation facility for prolonged physical therapy. DISCUSSION: Steroid-induced myopathy is a rare occurrence in the intensive care setting. Cases of myopathy that have been reported have been associated with prolonged and combined use of corticosteroids with neuromuscular blocking agents or aminoglycosides. Corticosteroids are thought to produce deleterious effects through 1 or all of 3 main pathways: altered electrical excitability of muscle fibers, loss of thick filaments, and/or inhibition of protein synthesis. All of these pathways are believed to increase the rate of muscle catabolism and result in loss of muscle movement. CONCLUSIONS: Steroid-induced myopathy is a complication of high-dose steroid use. Unfortunately, in this patient, initial treatment of status asthmaticus required intravenous steroids in high doses to adequately treat the presenting illness. Clinicians should be aware of neuromuscular findings and act aggressively to appropriately eliminate systemic steroids from the treatment regimen.