A Rare Case of Autopsy Proven Achromobacter xylosoxidans Endocarditis Involving Tricuspid Valve: A Case Report.

Infective endocarditis refers to infection of one or more valves of the heart, with Achromobacter xylosoxidans (A. xylosoxidans) being a rare cause. So far, 24 cases of A. xylosoxidans endocarditis were reported, with only one case describing tricuspid valvular involvement. Despite the rarity of A. xylosoxidans endocarditis, it is important for clinicians to be aware of atypical presentation and the high mortality associated with it. We present an autopsy-proven case of tricuspid valve endocarditis in the setting of A. xylosoxidans bacteremia in a 43-year-old female.

Unresectable Primary Tracheal Synovial Sarcoma.

Synovial sarcoma (SS) comprises less than 1% of head and neck cancers, and less than five cases of adult primary tracheal SS have been described. This case describes a patient encountered at a community-based academic hospital, and retrospective chart review was performed for data collection. A woman in her forties presented with shortness of breath due to a superior mediastinal mass found to be an unresectable primary tracheal SS. Primary treatment resorted to curative-intent radiation therapy. Subsequent metastasis required systemic chemotherapy with pazopanib. To the best of our knowledge, this is the first reported case of this nature and adds to understanding the presentation, diagnosis, natural history, and treatment outcomes of primary tracheal SS. This case was exempt from review by the institutional review board and complied with privacy policy standards.

Psychosis-Induced Exertional Rhabdomyolysis without Acute Kidney Injury or Myoglobinuria.

BACKGROUND Rhabdomyolysis is a clinical syndrome that results from skeletal muscle breakdown and the release of intracellular enzymes into systemic circulation [1,2]. We present a case of non-traumatic rhabdomyolysis with transaminitis, without myoglobinuria or acute kidney injury. Cases reports of rhabdomyolysis with elevation of serum creatine kinase (hyperCKemia) in the absence of myoglobinuria or renal failure are limited in the literature. CASE REPORT A 21-year-old man presented to the Emergency Department following an acute psychotic episode. One week earlier, his bloodwork had been within normal limits. Biochemical investigations on admission revealed hyperCKemia (590 000 U/L), transaminitis (AST, 628; ALT, 160), and normal creatinine (0.83), without myoglobinuria. Non-traumatic rhabdomyolysis was suspected, and the patient was treated with aggressive intravenous fluid resuscitation and transferred to Inpatient Psychiatry on day 10 of hospitalization. The complete metabolic panel was trended daily, without indication of kidney injury. The creatine kinase (CK) and liver function tests trended downward. CONCLUSIONS This report presents a rare case of exertional rhabdomyolysis with CK levels nearly 3000 times the upper limit of normal, without myoglobinuria or acute kidney injury. Acute kidney injury is a dangerous complication of rhabdomyolysis. Traditionally, clinicians use serum CK levels to predict the likelihood of acute kidney injury and/or renal failure in rhabdomyolysis. Ultimately, this patient was diagnosed with exertional rhabdomyolysis with hyperCKemia and transaminitis without myoglobinuria or acute kidney injury. More research is needed to elucidate the protective patient characteristics against rhabdomyolysis-associated acute kidney injury, associations between CK and myoglobinuria, and diagnostic criteria for psychosis-associated hyperCKemia.

Cystocerebral Syndrome: An Updated Review and a New Proposed Mechanism for an Often Forgotten Cause of Delirium.

Cystocerebral syndrome is an often forgotten cause of delirium in elderly males, which is quite easily treated. We reviewed the current body of literature documenting cystocerebral syndrome and proposed a new mechanism of action explaining why all patients identified thus far have been male. Data was obtained from articles describing cases of cystocerebral syndrome, urinary retention, and confusion in addition to delirium via a PubMed database search. We reviewed all articles describing cases of cystocerebral syndrome via the PubMed database using the Medical Subject Headings (MeSH) keywords of "cystocerebral syndrome," urinary retention and confusion," and "delirium and urinary retention or cystocerebral syndrome," and identified eight cases of cystocerebral syndrome including the original publication by Blackburn and Dunn. We found that all patients reported in the literature were males older than 70 years and often with concomitant benign prostatic hypertrophy (BPH) who presented with acute episodes of delirium that rapidly responded to bladder decompression. The authors seek to update the medical community regarding this uncommon phenomenon of delirium in elderly male patients. We also propose that the lack of female patients in the literature is reflective of their decreased intraurethral flow resistance as is currently being described in other avenues of research in the field of urodynamics.