Year 2023, Volume 7 - Issue 9

Background: Blood culture-negative infective endocarditis (BCNIE) refers to infective endocarditis (IE) with negative microorganism growth using usual blood culture method. It poses dilemma in terms of diagnosis, associated complication, and treatment. The study aims to highlight the occurrence of acute bilateral lower limb ischemia in BCNIE and its management approach. Case presentation: We present a BCNIE patient who developed acute bilateral lower limb ischemia, Rutherford stage 2b despite on course of antibiotic treatment. Patient underwent emergency bilateral open femoral embolectomy and right profundaplasty. A full six-weeks course of antibiotics and short-term anticoagulant successfully reverse the acute ischemic event. Conclusion: This case highlighted that despite the rarity of BCNIE causing limb ischemia, it can still occur due to significant risk factors. The early recognition of acute limb ischemia and prompt treatment are deemed important in saving the threatened limb from being amputated.

Background: Marcus Gunn syndrome is a rare congenital disorder. The major symptom is unilateral blepharoptosis during mandibular masticating movements and ptosis; although cases with the absence of the ptosis symptom in resting position, even rarer, were also recorded. The aim of this article was to present two cases of familial Marcus Gunn Jaw-Winking Synkinesis (MGJWS) without ptosis in two successive generations. Case Presentation: Upon routine examination, the 41-year-old female patient was diagnosed with MGJWS, with the synkinetic movement of the upper left eyelid only observed during the downward, forward, and lateral mandibular movements. Ptosis was not observed in the resting position. The patient's 12-year-old daughter, who did not have any significant medical history, was also diagnosed with MGJWS, with the same symptoms. No surgical or conservative intervention was performed on the patients, and they are currently under regular follow-up. Conclusion: The absence of the ptosis symptom might make the diagnosis of MGJWS a challenge. The synkinetic movement being observed during masticatory movements presents a diagnostic opportunity for the dental clinician and surgeon since it will be observed during a routine temporomandibular joint examination. Thus, the authors think that it is important for dental clinicians and surgeons to be informed about the syndrome.

Background: Renal arteriovenous fistula is a serious complication that may occur within the first few days following percutaneous nephrolithotomy procedures. It is usually an iatrogenic complication. Case Presentation: We're presenting a case in which a patient had pseudo aneurism following percutaneous nephrolithotomy and that was treated endovascularly, followed by a sudden renal arteriovenous fistula 25 days after the pseudo aneurism treatment, which was treated once again endovascularly. Conclusion: Although renal arteriovenous fistula was not seen in early stage during the Digital subtraction angiography that was performed during the treatment of pseudo aneurism, it suddenly symptomatically appeared in late stage. We should keep hemorrhagic complications in mind during later stages.

Background: Hypogonadism is a common problem in middle-aged males and often encountered in the primary care setting. Failure to accurately diagnose hypogonadism can lead to unintended consequences like missing secondary causes or enabling anabolic steroid abuse. Case Presentation: A 44-year-old male presented to the endocrinology clinic for further evaluation of abnormal testosterone levels. The patient had received a diagnosis of hypogonadism and was prescribed weekly testosterone injections, which he took for several weeks, but then discontinued therapy due to ineffective response. Serial laboratory evaluation revealed contradictory results and upon further investigation, an anabolic steroid screen returned positive for boldenone, an androgen used in veterinary medicine. After 4 months, his labs were repeated and showed a low TT and free T, with LH and FSH inappropriately normal. Therapy was restarted using an FDA-approved formulation of testosterone and on subsequent follow-up, the patient had an improvement clinically and his repeat TT levels were normal, with free T slightly elevated. Conclusion: There are two main takeaway points from this case that we would like to emphasize. First, that a complete diagnostic evaluation of hypogonadism is vital to avoid missing potential secondary causes. Second, initiating TRT prematurely can obscure the diagnostic workup and potentially facilitate testosterone abuse.

Here, we present a case of recurrent chronic massive pericardial effusion without the development of tamponade. The patient was diagnosed with idiopathic chronic massive pericardial effusion, with a history of pericardiocentesis every five years, and no etiology was found. Emergency pericardiocentesis was not considered because the vital signs of the patient who was admitted with the complaint of shortness of breath were stable at the time of admission. However, the patient with simultaneous carbon dioxide retention was connected to a non-invasive mechanical ventilator for treatment. Hypotension and tachycardia developed rapidly. This case, the largest pericardial effusion (16 cm) in the literature, demonstrates the critical importance of pericardial space elastic flexibility on the hemodynamic profile. In addition, mechanical ventilation administration in a patient with pericardial effusion can quickly disrupt the clinic and be fatal. Therefore, pericardiocentesis should be performed first.