Year 2022, Volume 6 - Issue 2

Background: Macrophage activation syndrome (MAS) is a rare but potentially life-threatening condition associated with systemic lupus erythematosus (SLE), as well as several other autoimmune conditions. Case Presentation: We present a case of MAS in a 30-year-old patient with a background of SLE presenting with persistent fever and hemodynamic instability. Broad-spectrum antibiotics were initially started for possible sepsis of unknown origin, but a lack of response or evidence of an infection source led to further laboratory investigations and additional diagnostic imaging. Hyperferritinemia, a low fibrinogen, hypertriglyceridemia, and pancytopenia raised the suspicion of MAS. Echocardiography revealed a pericardial effusion requiring pericardiocentesis. With rapid disease progression, multiorgan failure ensued, and shortly after a high dose, methylprednisolone was commenced; the patient's condition worsened and she died after a cardiac arrest. Conclusion: This case highlights the challenges involved in diagnosing MAS and in differentiating it from more common presentations such as sepsis or autoimmune disease flares, and demonstrates the possible rapid disease progression. Therefore, early recognition of certain clinical features and laboratory markers are essential to enable early diagnosis, commencement of immunosuppressive treatment, and to ultimately improve outcomes in such critically unwell patients.

Background: Apical hypertrophic cardiomyopathy (AHCM) is a relatively rare variant of hypertrophic cardiomyopathy. The condition is associated with numerous clinical and electrocardiogram (ECG) features, some of which are well documented in the literature. Case Presentation: We present a case of a 77-year-old female who presented with a syncopal episode. Her ECG showed lateral ST segment elevation and her cardiac biomarkers were not in keeping with a myocardial infarction. She was diagnosed with AHCM based on characteristic findings on echocardiography. The association between AHCM and lateral ST segment elevation is one that has only been described in a handful of cases in literature. Conclusion: The authors hope that in presenting this case we can add to the body of literature and remind readers to be aware of the possibility that lateral ST segment elevation may be an indicator of AHCM, especially when this electrocardiographic feature occurs in the absence of the other well-known causes of ST segment elevation.

Background: Drug hypersensitivity reactions commonly generate systemic syndromes but can also affect specific organs. Mepolizumab, a monoclonal antibody targeting interleukin-5, is a safe and effective Food and Drug Administration-approved biologic therapy for severe eosinophilic asthma. Case Presentation: A 49-year-old female developed acute pancreatitis complicated by acute hypoxic respiratory failure secondary to fluid overload. Following 72 hours of intravenous fluids and analgesic administration, an urticarial rash developed on the patient's trunk, raising concern for a drug-related exanthem. After medication reconciliation, it was deemed that she had a hypersensitivity reaction to mepolizumab. Conclusion: In several clinical trials, mepolizumab demonstrated few hypersensitivity reactions. This patient presentation highlights the importance of strong clinical suspicion for drug hypersensitivities, especially in patients failing to respond to the standard of care for common medical conditions.