Catastrophic Antiphospholipid Syndrome: A Rare Cause of Acute Heart Failure.

Catastrophic antiphospholipid syndrome (CAPS) is a rare variant of antiphospholipid syndrome (APLS). CAPS is a syndrome characterized by microvascular thrombosis leading to multi-organ failure, including acute heart failure. Diagnosis is challenging, and disease progression is rapid. Treatment includes triple therapy with anticoagulation, glucocorticoids, and plasma exchange. We present a case of a patient with CAPS who developed de novo acute heart failure. With treatment, the patient's multi-organ failure improved, including cardiac function. It is our goal to present this case in order to facilitate greater diagnostic suspicion and the early treatment of CAPS to reduce morbidity and mortality.

Sodium-Glucose Transport Protein 2 Inhibitors Association with Euglycemic Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is a life-threatening medical emergency that occurs in both type 1 and type 2 diabetes mellitus. Here, we describe the case of a 49 year-old male patient with type 2 diabetes mellitus who presented to the emergency department with complaints of epigastric abdominal pain and intractable vomiting. He had been on sodium-glucose transport protein 2 inhibitors (SGLT2i) for 7 months. Considering the clinical exam and lab findings with a glucose level of 229, a diagnosis of euglycemic DKA was made. He was treated according to DKA protocol and discharged. The relationship between SGLT2 inhibitors and euglycemic DKA remains to be explored; given the absence of clinically significant hyperglycemia during the presentation, a delay in diagnosis may be observed. After an extensive literature review, we introduce our case presentation in the setting of gastroparesis in comparison to previous reports and suggest future improvements in terms of early clinical suspicion for euglycemic DKA.

Primary Cardiac Angiosarcoma Presenting as Cardiac Tamponade.

Malignant primary cardiac tumors are rare. The most common presenting symptom is dyspnea, which is non-specific. These tumors pose a significant diagnostic challenge, which when coupled with rapid disease progression can result in significant morbidity and mortality. Appearance of cardiac masses on CT and echocardiography can be non-specific. Cardiac MRI can help delineate cardiac tumors but definitive diagnosis requires mediastinal exploration and biopsy. Treatment includes radical resection followed by radiotherapy and chemotherapy along with targeted therapy. Metastasis often precludes candidacy for surgery, therefore, early diagnosis is pivotal. We present a patient with primary cardiac angiosarcoma who initially presented with cardiac tamponade and at time of diagnosis was not a surgical candidate. We aim to bring greater awareness to malignant primary cardiac tumors in hopes of increasing diagnostic suspicion to facilitate earlier diagnosis and treatment intervention.

Tuberculosis-associated HLH in a patient with chronic kidney disease on haemodialysis.

Haemophagocytic lymphohistiocytosis (HLH) is a rare immunological disorder that is accompanied by a high mortality rate when the underlying aetiology is miliary tuberculosis. We report a case of tuberculosis (TB)-associated HLH in a haemodialysis patient, from a TB-endemic region, who missed two sessions of dialysis before developing the primary symptoms of HLH. The patient presented with non-specific findings including pancytopenia, coagulopathy and transaminitis. Computer-tomography imaging and microbiology from bronchoalveolar lavage evidenced miliary tuberculosis. Further testing revealed the TB-associated-HLH characteristic pattern of thrombocytosis, leukopenia, transaminitis, hyperferritinemia and elevated fibrinogen. The patient initially demonstrated improvement after initiation of anti-TB therapy. However, soon thereafter began to paradoxically deteriorate and then expire from apparent tuberculosis-immune reconstitution inflammatory syndrome. This case highlights the importance of early diagnosis and treatment, and consequently of the utility of diagnostic systems such as the HScore in cases of high clinical suspicion.