Catheter-Directed Vegetation Aspiration in Tricuspid Valve Bacterial Endocarditis: A Potential Treatment for Poor Surgical Candidates.

Infective endocarditis is a condition that has the potential to cause significant morbidity and mortality. Potential complications include sepsis, heart failure, atrioventricular block, embolic stroke, septic emboli, and intracardiac abscess formation. The backbone of treatment is intravenous antibiotics; however, in certain clinical scenarios, surgical management is also indicated to reduce complications and mortality. There exists a challenging subset of patients who require surgery but carry a high perioperative mortality risk. Percutaneous management of endocarditis is emerging as a potential treatment for this high-risk group of patients: it allows for an attempt at source control while avoiding the high risks of surgery. Herein, we present the case of a 35-year-old male presenting with hemoptysis secondary to pulmonary septic emboli in the setting of Enterococcus faecalis tricuspid endocarditis. He was determined to be a poor surgical candidate and underwent catheter-directed debulking of the tricuspid vegetation with excellent results.

Nonbacterial Thrombotic Endocarditis With Leptomeningeal Carcinomatosis: A Rare Presentation of Advanced Rectal Adenocarcinoma.

Nonbacterial thrombotic endocarditis (NBTE) is a rare condition characterized by the formation of sterile vegetations on valvular structures. Commonly asymptomatic in early stages resulting in systemic emboli as its initial manifestation. NBTE is found to be associated with diseases, which induce hypercoagulability, and, most commonly, is associated with malignancy. Rectal signet ring cell adenocarcinoma is an uncommon histological type of rectal cancer with a poor prognosis and aggressive nature. We present a rare manifestation of advanced rectal signet cell adenocarcinoma discovered due to manifestations of NBTE and leptomeningeal carcinomatosis.

Overlapping Presentations of HELLP Syndrome and COVID-19.

Introduction: Haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome is a leading cause of maternal mortality. The emergence of coronavirus disease 2019 (COVID-19) has led to challenges in diagnosing HELLP syndrome due to overlapping clinical and laboratory presentations. We report a case of HELLP syndrome complicated by COVID-19 infection. Case Description: An otherwise healthy pregnant 31-year-old woman presented with fever, myalgia and headache. She was found to be COVID-positive with laboratory signs of HELLP syndrome. Symptoms and laboratory findings trended toward normal after delivery confirming the diagnosis of HELLP syndrome. Discussion: A prompt diagnosis of HELLP syndrome is essential to avoid maternal and fetal complications. Clinicians should be aware of the similarities in presentation between HELLP syndrome and COVID-19 for timely diagnosis and treatment. LEARNING POINTS: SARS-CoV-2 preferentially binds to ACE2 which is expressed in extrapulmonary tissue including placental tissue.COVID-19, HELLP syndrome and preeclampsia may have similar characteristics including elevated blood pressures, liver dysfunction, cardiopulmonary complaints and hypercoagulability.The temporal relationship of symptomatic improvement with delivery and after delivery may better differentiate HELLP syndrome from COVID-19.