Severe Plasmodium vivax malaria complicated with acute respiratory distress syndrome: a case associated with focal autochthonous transmission in Greece.

In 2011, autochthonous Plasmodium vivax malaria emerged in a focal geographical area in Greece after importation by immigrants from the Indian subcontinent. We report the case of complicated P. vivax malaria in a previously healthy 42-year-old Greek female. The patient presented acute respiratory distress syndrome (ARDS), worsening jaundice, and thrombocytopenia after the administration of antimalarial treatment and despite a decreasing burden of parasitemia. She recovered fully after admission in the intensive care unit and support with mechanical ventilation. We discuss the risks potentially associated with the reappearance of P. vivax malaria in a previously malaria-free area.

Acute steatohepatitis, due to extreme metabolic dysregulation, as the first presentation of non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is a slowly progressive chronic disease, with a high prevalence among obese, dyslipidemic or diabetic people, commonly presented as an asymptomatic mild elevation of serum aminotransferases. We report a patient who experienced an acute form of non-alcoholic steatohepatitis, as the first manifestation of NAFLD, due to exacerbation of pre-existing metabolic disorders by an extremely unhealthy lifestyle. A 50-year old, obese, diabetic man presented with a one-week history of jaundice and malaise. Analysis revealed elevated liver enzymes, bilirubin, lipids, and glucose. Based on patient's history, physical examination, laboratory results, and imaging findings, acute non-alcoholic steatohepatitis was established as a diagnosis of exclusion. The patient was started on a low-calorie diet free of carbohydrates and fats, in combination with insulin. A dramatic improvement of clinical and laboratory parameters was observed. In the context of extreme metabolic dysregulation, induced by unhealthy diet, NAFLD may present as an acute steatohepatitis.

Reversible Cortical Blindness as a Prominent Manifestation of Cerebral Embolism due to Infective Endocarditis.

Introduction. Infective endocarditis in the left heart may be complicated by stroke, due to embolisation from infectious valvular vegetations. Infarction of both occipital lobes, which are supplied by the posterior cerebral arteries, is infrequent, and is the cause of cortical blindness from lesion of the visual cortex. Cortical blindness is characterized by intact pupillary reflexes, a normal fundoscopy, and, rarely, denial of visual loss. Case Presentation. We report the case of a 58-year-old woman, recipient of a mechanical aortic valve, who presented with fever, multiple organ dysfunction, and cortical blindness. Transesophageal echocardiography and blood cultures confirmed the diagnosis of infective endocarditis caused by methicillin-sensitive Staphylococcus aureus. Computed tomography of the brain without contrast revealed the presence of infarctions in both occipital lobes. It is noteworthy that the visual loss resolved after treatment of endocarditis. Conclusions. A stroke occurring in a patient presenting with fever and a history of valvular heart disease strongly suggests the presence of infective endocarditis. Bilateral thromboembolic infarcts of the occipital lobes cause cortical blindness, that can resolve after treatment of endocarditis.