Amiodarone-Induced Immune Thrombocytopenia: A Rare Hematologic Side Effect of a Common Cardiac Drug.

Thrombocytopenia is a rare immune-mediated hematologic complication of amiodarone. We describe a case of delayed-onset amiodarone-induced thrombocytopenia in a 72-year-old male and highlight the process of working it up. A timely diagnosis of drug-induced immune thrombocytopenia is crucial in order to minimize unnecessary testing, avoid treatments with potential harm, and prevent life-threatening hemorrhagic complications.

Cardiac papillary fibroelastoma.

Papillary fibroelastoma (PFE) is a primary, histologically benign endocardial neoplasm. Though PFE has long been reported as the second most common primary cardiac neoplasm, it has since pulled ahead of cardiac myxomas, largely due to evolving cardiac imaging modalities. While PFEs are benign histologically, they have the potential for devastating clinical consequences, transient ischemic attack, stroke, myocardial infarction, syncope, pulmonary, and peripheral embolism. Despite increased detection rate, there remains uncertainty regarding etiology, exact prevalence, and clinical management of PFEs. This paucity of information is reflected by the lack of official guidelines on this matter. In this article, we aim to summarize the current state of understanding regarding PFE and discuss areas of ongoing controversy.

Serratia marcescens Endocarditis with Perivalvular Abscess Presenting as Atrioventricular Block.

Serratia marcescens is an aerobic, Gram-negative bacillus first identified in 1819 (Yeung et al. 2018). S. marcescens infective endocarditis is extremely rare accounting for only 0.14% of all cases (Phadke and Jacob 2016, Hadano et al. 2012, Nikolakopoulos et al. 2019). We present the case of a 33-year-old male with a past medical history of Hodgkin lymphoma, nonischemic cardiomyopathy ejection fraction of 25-30%, severe aortic stenosis, hepatitis C, and active intravenous (IV) drug abuse who was admitted following a motor vehicle accident. Approximately 10 days into his admission, he developed a 39.5 degree Celsius fever, which prompted collection of blood cultures. These cultures were positive (2 out of 2) for S. marcescens for which he was treated with intravenous cefepime. Soon after this diagnosis, patient developed a complete AV block. Given the instability of the patient, he required emergent placement of a temporary pacing wire. Transesophageal echocardiogram was ordered and revealed an aortic root abscess. Given the comorbidities and active IV drug use, conservative management was pursued. Although rare, trends suggest that this pathogen may be on the rise. Further research is needed to better understand how to effectively manage this pathogen.