Early-Onset Atrial Fibrillation Complicated by Substance Use Disorder and Psychiatric Comorbidities: A Case Report.

Atrial fibrillation (AFib) is predominantly diagnosed in older adults, with early-onset AFib being relatively rare and often associated with preexisting heart conditions or due to hereditary familial AFib. This case report highlights the unusual diagnosis of AFib in an adolescent and the subsequent management complexities exacerbated by drug dependence and severe psychiatric comorbidities. The case shows the challenges in recognizing and treating AFib masked by psychiatric symptoms and substance abuse. A 33-year-old male with a history of AFib, diagnosed at 18, presented to the emergency department with symptoms suggestive of cardiac arrhythmia exacerbated by acute psychological stress and drug use. Despite a history devoid of classic cardiovascular risk factors, the patient developed drug dependence and psychiatric conditions over 15 years, potentially complicating and delaying effective AFib management. The patient's treatment was further complicated by self-medication with illicit drugs, initially aimed at managing palpitations and anxiety, which may have masked or mimicked cardiac symptoms, thereby delaying appropriate AFib diagnosis and management. His recent hospitalization provided multidisciplinary interventions, including cardiology and psychiatric care, aiming to stabilize his cardiac and psychological conditions. This case illustrates the critical importance of considering early-onset AFib in differential diagnoses regardless of patient age and highlights the need for integrated care approaches in patients with complex comorbidities such as illicit drug use and severe mental health disorders. Moreover, it emphasizes the necessity of educating patients on the interactions between illicit drugs, psychiatric symptoms, and cardiac health. Early and accurate diagnosis, alongside comprehensive management, is crucial for improving outcomes in young patients with AFib complicated by noncardiac conditions. This report encourages further discussion and research into the management strategies for AFib in the context of psychiatric and substance abuse disorders.

Malignant Pleural Effusion Due to Uterine Serous Carcinoma: An Unusual Presentation.

Endometrial cancer is the most common cancer of the female genital tract. It can rarely metastasize to the pleura and present as a malignant pleural effusion. Here we present the case of a 61-year-old female with two primary malignancies, breast and endometrium, who presented to us with shortness of breath. Imaging was suggestive of a malignant pleural effusion. Diagnostic and therapeutic thoracentesis were performed that were initially suggestive of a breast source. However, final pleural fluid studies showed endometrial serous carcinoma as the source of the effusion. The patient received pembrolizumab and lenvatinib treatment and continues to be followed up in our clinic.

A Case Report of Probable Sporadic Creutzfeldt-Jakob Disease: How to Approach Early Diagnosis?

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and fatal spongiform encephalopathy characterized by rapidly progressive dementia and myoclonus. The rarity of this disease and varied initial symptoms make the early diagnosis fairly challenging. Here, we present a case initially admitted for confusion and bizarre behaviors. She had acute deterioration of mental status, akinetic mutism, and myoclonus jerks four weeks later. Cerebrospinal fluid (CSF) analysis was positive for protein 14-3-3. Brain magnetic resonance imaging (MRI) showed hyperintensities in the bilateral cortex, basal ganglia, and thalami in diffusion-weighted imaging (DWI). Electroencephalogram (EEG) showed bihemispheric periodic lateralizing epileptiform discharges. The probable diagnosis of sCJD was reached based on the clinical features, characteristic findings in her MRI, the EEG, and a positive 14-3-3 CSF assay. The literature was also reviewed for early diagnosis of sCJD.