Serratia marcescens Endocarditis in Prosthetic Valves.

Serratia marcescens endocarditis is a rare occurrence. We describe a case of Serratia endocarditis in a patient with a prosthetic valve. The clinical course was complicated by widespread embolic phenomena causing stroke, gangrene of extremities, and septic emboli to the lungs, spleen, and eyes. She was not considered suitable for surgery due to severe consumptive coagulopathy and thrombocytopenia in the setting of widespread emboli. The patient was transitioned to do not resuscitate status and discharged to a long-term care facility with a grave prognosis explained to the family.

Effect of the duration of protease inhibitor therapy in HIV-infected individuals on the severity of obstructive sleep apnea.

BACKGROUND: Protease inhibitors (PIs) are a vital part of the antiretroviral therapy. Long-term use of PIs may cause lipodystrophy, a clinical syndrome characterized by peripheral lipoatrophy and central fat accumulation, which may increase the risk of developing obstructive sleep apnea (OSA) in HIV-infected patients. We hypothesize that a longer duration of PIs' use might be associated with increasing severity of OSA in HIV-infected patients. MATERIALS AND METHODS: This was a retrospective cohort study of HIV-infected patients who were treated with PIs, who presented with symptoms suggestive of OSA, and underwent nocturnal polysomnography. The primary objective of the study is to evaluate the association between the duration of PIs' use and the severity of OSA. The duration of PIs' use measured in months was recorded for each patient. The primary outcome of interest was the apnea-hypopnea index (AHI) obtained at the time of the sleep study. Data were analyzed using univariate and multivariate linear regression between AHIs with PIs' use as well as other predictors. RESULTS: A total of 54 patients diagnosed with HIV and OSA were included in the study cohort for the analysis. Sleep study body mass index (BMI; P = 0.042) and change in BMI (ΔBMI; P = 0.027) were the only statistically significant independent predictors of AHI. The association between AHI and PIs' use duration was found to be nonlinear and nonsignificant. Gender differences evaluation suggested possible duration-related effect relationship between PIs and OSA severity among HIV-infected men exposed to PIs within a 66-month duration. CONCLUSION: We did not observe a significant association between PIs' use duration and the severity of OSA.

CT scanning in the evaluation of pulmonary hypertension.

BACKGROUND: Right-heart catheterization is currently the gold standard method for detecting pulmonary hypertension (PH) and grading its severity. Our study determined the utility of computerized tomography (CT) scans for detecting PH in patients with left-sided heart disease, thereby potentially avoiding the overuse of invasive right-heart catheterization. METHODS: A retrospective review was conducted on 40 patients with left-sided cardiac pathology who had undergone both right-heart catheterization and CT scanning of the chest. Mean pulmonary artery diameters (MPADs) were measured on CT scans and compared with pulmonary artery pressures measured by right-heart catheterization. RESULTS: Patients with mild-to-moderate PH had significantly greater CT-measured MPADs (34.89 ± 1.01) than patients without PH (controls) (27.36 ± 0.83, p < 0.001). Patients with severe PH had significantly greater MPADs (38.31 ± 0.88) than both mild-to-moderate PH patients (p < 0.01) and controls (p < 0.001). Receiver operating characteristic curve analysis showed that CT scanning predicted PH with an area under the curve of 0.95 (p < 0.0001). A cutoff MPAD of >33.3 mm had 100% specificity and 100% positive predictive value (N = 40, p < 0.0001), and a cutoff MPAD of <27.3 mm had 100% sensitivity with 100% negative predictive value (N = 40, p < 0.001). CONCLUSIONS: CT scanning correctly identified all patients with PH with MPADs >34 mm and excluded all patients without PH when MPADs were <27 mm. We advocate that the measurement of MPAD by CT scanning can be quickly and easily performed by the clinician to screen for the presence of PH.

Postpneumonectomy-like syndrome presenting in a patient with treated pulmonary tuberculosis: a case report.

INTRODUCTION: Postpneumonectomy syndrome is a rare condition that is characterized by dyspnea resulting from an extreme mediastinal shift and bronchial compression of the residual lung following surgical pneumonectomy. It is even rarer for this syndrome to present in patients without a history of prior lung surgery but induced by autopneumonectomy due to parenchymal disease, an entity termed 'postpneumonectomy-like syndrome'. CASE PRESENTATION: We present a rare case of a 91-year-old Puerto Rican man presenting with progressively worsening dyspnea with a history of pulmonary tuberculosis diagnosed 40 years earlier who developed severe unilateral lung fibrosis. Plain X-ray and computed tomography scans confirmed the presence of postpneumonectomy-like syndrome secondary to his parenchymal lung destruction. The patient developed cor pulmonale due to his extensive lung disease and as a consequence was not a suitable candidate for surgical intervention. The patient was otherwise stable until he developed acute respiratory distress from an acute upper gastrointestinal bleed and died four days into his hospital course. CONCLUSION: We present a rare case of postpneumonectomy-like syndrome as sequelae of severe pulmonary parenchymal tuberculosis infection along with a review of literature, in the hopes of aiding clinicians to include the differential of postpneumonectomy-like syndrome in patients presenting with worsening dyspnea without a history of surgical lung resection.

Hepatic hydrothorax without any evidence of ascites.

Hepatic hydrothorax usually presents in association with ascites, but there are rare cases when it does not. This case helps to support the differential of hepatic hydrothorax in patients who have a history of liver cirrhosis, portal hypertension, and recurrent pleural effusions without ascites. We hope to support the conclusion that a patient with recurrent pleural effusions, without ascites, does not exclude gastrointestinal involvement in its etiology.

Mounier-Kuhn syndrome: a case report.

Mounier-Kuhn syndrome is a rare clinical entity. It was described in 1932 to refer to the presence of tracheobronchomegaly. The clinical presentation is variable and it can occur in several different age groups. We present the case of a young man who was admitted to the hospital for an asthma exacerbation and was found to have tracheobronchomegaly on his CT scan. A review of the literature for this rare, but interesting, phenomenon is included.

Granulomatous pneumonitis following exposure to the World Trade Center collapse.

We describe a 37-year-old male engineer who presented with cough and dyspnea 3 weeks after exposure to dust resulting from the collapse of the World Trade Center (WTC). Radiographs of the chest and high-resolution CT demonstrated diffuse miliary nodularity. Lung biopsy specimens confirmed the presence of diffuse, noncaseating granulomatous nodules. Scanning electron microscopy and energy-dispersive radiograph analysis revealed large quantities of silicates. Cellular immunologic studies showed normal response to beryllium, and results of Kveim testing were negative. We suspect that exposure to one or more materials resulting from the WTC catastrophe may be implicated in the development of granulomatous pulmonary disease.