Ocular Lens Expulsion Secondary to Fusarium Endophthalmitis: A Case Report.

BACKGROUND: Endophthalmitis is an uncommon yet devastating compilation of Fusarium keratitis. Cases of Fusarium keratitis are seen commonly in tropical regions of the world; however, they have been increasing in frequency in the United States. CASE REPORT: We present the case of a 36-year-old man who experienced an ocular lens expulsion secondary to Fusarium endophthalmitis. Why Should an Emergency Physician Be Aware of This?:Fusarium keratitis is becoming more common and can progress to endophthalmitis without proper management. This infection can be difficult to recognize and treat, so early action by the emergency physician could be the difference between vision loss and vision-sparing care.

Ocular timolol as the causative agent for symptomatic bradycardia in an 89-year-old female.

Bradycardia can present with variations of severity from asymptomatic to life threatening. In this paper we present the case of an 89-year-old female presenting with symptomatic bradycardia for whom the cause was found to be ophthalmic timolol which she had been taking for four years. Prompt recognition of potential causes of bradycardia is essential for correct selection of treatment and disposition.

Pyogenic liver abscess and endogenous endophthalmitis secondary toKlebsiella pneumoniae.

Invasive Liver Abscess Syndrome is a manifestation of systemic infection caused by Klebsiella pneumoniae. This constellation of symptoms has been well-reported throughout Southeast Asia though it is uncommon in the United States. This article reports the identification of a pyogenic liver abscess and associated endogenous endophthalmitis in a patient presenting to the emergency department.

Ticagrelor as an Alternative for Clopidogrel-Associated Acute Arthritis.

A 65-year-old Caucasian man was hospitalized for a non-ST-elevation myocardial infarction. On discharge, the patient was started on multiple new medications, including clopidogrel and atorvastatin. Twenty-six days after discharge, he presented to the Emergency Department (ED) with polyarthralgias. He was instructed to stop atorvastatin and to follow up with rheumatology and cardiology clinic. At cardiology clinic follow-up 43 days after ED discharge, clopidogrel was discontinued and patient was switched to ticagrelor. On follow-up one month later, his symptoms had completely resolved. During the next 4 months, patient had routine follow-up due to participation in Cardiopulmonary Rehab and he had no cardiac events or recurrence of joint symptoms. Our patient had no history of arthritis. Because he initially presented with 2 medication classes associated with arthritis, each was withdrawn separately. The temporal association of patient's symptomatic improvement strongly suggests that the arthritis was caused by clopidogrel. Our patient was able to tolerate ticagrelor with complete resolution of his arthritis and no cardiac events. Clopidogrel-induced arthritis is a rare adverse drug event. For patients with a recent drug-eluting stent, alternative antiplatelet therapy with ticagrelor may provide positive cardiac outcomes without similar adverse effects.