A 19-Year-Old Male With Orbital Cellulitis and Abscess Due to Fusobacterium necrophorum With Chronic Aspergillosis Resulting in Orbital Compartment Syndrome.

Orbital cellulitis is a dangerous condition that has a variety of etiologies and risk factors such as chronic sinusitis. If left untreated, it may result in orbital compartment syndrome. A 19-year-old male presented with evidence of orbital cellulitis, increased intraocular pressures, and orbital compartment syndrome as a result of a retrobulbar abscess. He was started on ampicillin/sulbactam, the emergency clinician performed a lateral canthotomy and cantholysis, and the case was discussed with ophthalmology and otolaryngology on call. The patient was taken to the operating room for further surgical therapy. Cultures revealed Fusobacterium necrophorum and Aspergillus spp. Orbital cellulitis is an infection of the tissue posterior to the orbital septum. Common bacterial etiologies of orbital cellulitis include Staphylococcus spp, Streptococcus spp, and Haemophilus spp. Chronic sinusitis secondary to an Aspergillus infection increases the risk of superinfection given the inability to clear nasal secretions. Diagnosis of orbital cellulitis can be clinical, but imaging with computed tomography of the orbits with intravenous contrast can assist. Treatment includes broad-spectrum antibiotics and ophthalmology consultation. If left untreated, orbital cellulitis may lead to orbital compartment syndrome, requiring lateral canthotomy and cantholysis. Prompt identification of orbital compartment syndrome and surgical intervention with lateral canthotomy and cantholysis can help restore the function of the optic nerve if performed in a timely manner. Clinicians should consider broadening the antibiotic coverage to include carbapenems or adding on anaerobic coverage with metronidazole in patients with concern for abscess formation in the setting of chronic sinusitis.

Neurologic toxicity of carbamazepine in treatment of trigeminal neuralgia.

Carbamazepine is a medication used to treat a variety of neurological and psychiatric conditions including seizure disorders, neuropathic pain syndromes, and bipolar disorder. Unfortunately, its pharmacokinetics and side effect profile may lead to significant toxicities due to its sodium channel blockade. In 2019, there were over 1500 cases of isolated carbamazepine toxicity reported to poison centers across the United States. Carbamazepine toxicity may result in vague neurological symptoms in milder cases, but in severe toxicity, it can cause cardiovascular instability, intractable seizures, and coma. In this article, we describe a case of a 40-year-old female who presented to a local emergency department with focal neurological deficits after repeated supratherapeutic dosing of carbamazepine.. This case highlights a key cerebrovascular accident mimic that emergency physicians should consider from acute toxicity that can be seen with carbamazepine in a patient who was taking the medication as prescribed.

A first trimester pregnancy with cerebrovascular accident treated with thrombolytic therapy.

Pregnant patients are at increased risk of cerebrovascular accident due to the prothrombotic state of pregnancy. This risk is highest in those with pre-eclampsia and eclampsia as well as those of Asian descent. Despite this increased risk, pregnancy was an exclusion criterion for major stroke intervention trials. As a result, there are significant challenges concerning the management of this unique patient population. We describe a case of an early first trimester cerebrovascular accident treated with systemic thrombolysis.

Pediatric volvulus induced thyroid storm.

Thyroid storm is an unusually rare but life-threatening pediatric occurrence, carrying significant mortality. Skewed towards the adolescent population, thyroid decompensation occurs due to inciting factors ranging from infection, trauma, surgery, burns, medications, direct thyroid trauma, and rarely volvulus. Emergent care focuses on both reversing the inciting event as well as quelling the metabolic hyperactivity associated with thyroid storm. In review of the available literature, this case is the first to date of thyroid storm secondary to malrotation with midgut volvulus in a previously euthyroid adolescent patient.

A coronavirus disease-2019 induced pancytopenia.

As the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) pandemic progresses, various hematologic complications have emerged, often centered around the hypercoagulable state. However, pancytopenia represents a rare but serious complication from SARS-CoV2 infection. While lymphopenia is a common finding, concomitant acute anemia and thrombocytopenia are not commonly reported. We describe a novel case of SARS-CoV2 pancytopenia in a 40-year-old male without active risk factors for cell line derangements but subsequent critical illness.

Native Mitral Valve Infective Endocarditis From Flossing: A Case Report and Emergency Department Management.

Infective endocarditis (IE) is a rare, elusive disease, carrying a 10%-30% mortality. Requiring a high index of suspicion, IE affects damaged native valves and prosthetic valves. While there are a number of inherent risk factors that predispose patients to IE, dental work in the preceding six weeks is often a culprit of disease, colonizing damaged native mitral valves with Streptococcus viridans species. Traditionally, flossing has been suggested to be protective against IE. We present a case of S. gordonii subacute IE on a regurgitant native mitral valve secondary to vigorous flossing.