Infective Endocarditis in Patient With Uncorrected Patent Ductus Arteriosus: A Case Report From Rural India.

A congenital cardiac defect with an untreated left-to-right shunt is a risk factor for infective endocarditis (IE), particularly right-sided infective endocarditis, which has a distinct clinical presentation and outcomes in comparison to left-sided IE. With a prevalence of at least 2-4 per 1000 term births, patent ductus arteriosus (PDA) accounts for around 10% of all congenital cardiac diseases. Early diagnosis by transthoracic echocardiography and prompt antimicrobial therapy for IE are advised to minimize multiorgan failure and severe pulmonary embolism. Closure of large, hemodynamically significant PDA could have a minimal level of intervention, and it may be done cautiously and efficiently with either surgical or transcatheter procedures. The elimination or minimization of these malformations has been advised to remove or decrease the possibility of IE. We present a case of a 10 years old female who presented with a history of intermittent fevers over two weeks. Clinical examination revealed a PDA murmur. Transthoracic echocardiology (TTE) revealed a PDA with vegetation suggestive of IE. The patient was treated with antibiotics, and two weeks after the antibiotic therapy, a TTE showed resolution of the vegetation. Thereafter, the patient was advised to undergo surgical correction of the PDA. This case report highlights the importance of the association of IE with congenital heart disease.

Lightning Strike-Induced Myocarditis.

Lightning strikes are frequently encountered and are a major cause of morbidity and mortality. It could impair several organs, but the effects of electric current on the cardiovascular system contribute to the primary cause of cardiorespiratory arrest. These effects can be either transient or persistent, ranging from benign or life-threatening arrhythmias, ischemic injury, myocardial contusion, aortic injury, cardiomyopathy, and ventricular failure. Myocarditis has been an important but not very well-understood cause of cardiac dysfunction. Fulminant myocarditis is defined as patients presenting with severe heart failure, having a duration of <2 weeks of symptoms, and requiring inotropic or mechanical circulatory support. This condition can rapidly lead to hemodynamic instability and death. Resuscitation for a longer time increases the probability of favorable outcomes in young and previously healthy patients. This case report accounts for a case of a healthy young male who was struck by lightning while working on the farm and developed electrocardiographic changes along with positive cardiac biomarkers.

Chronic Myeloid Leukemia: Chronic Phase Presenting as Extramedullary Presentation.

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by immature granulocytes in the peripheral blood and bone marrow. In 95% of cases, it is always associated with the presence of the Philadelphia chromosome, which is characterized by the presence of reciprocal translocation between chromosomes 9 and 22. However, 3.1-9.1% of patients also have an extramedullary proliferation of skin, lymph nodes, bone, or central nervous system (CNS), which could be either myeloid, lymphocytic, or mixed lineage in origin. An extramedullary myelogenous neoplasm termed myeloid sarcoma (MS) can originate from myeloblasts or immature myeloid cells. Due to the green, gross appearance caused by the myeloperoxidase enzyme in immature myeloid cells, it is also known as chloroma. According to WHO guidelines, it is a tumor composed of myeloid blasts, mature or immature. Here we report an old female patient with CML - chronic phase who came for imatinib therapy and presented as MS in the right parotid gland.