Fournier's gangrene (FG) is necrotizing fasciitis that affects the penis, scrotum, or perineum. Males are more likely to get affected by this disease. The most common predisposing risk factors are diabetes, alcoholism, hypertension, smoking, and immunosuppressive disorders. FG is a polymicrobial infection caused by both aerobic and anaerobic bacteria. The most common aerobic organisms are Escherichia coli, Klebsiella, Proteus, Staphylococcus, and Streptococcus. The most common anaerobic organisms are Bacteroides, Clostridium, and Peptostreptococcus. The disease carries high mortality and morbidity, so timely diagnosis and treatment are of utmost importance.Here, we report a case of a 61-year-old male with a medical history significant for benign prostatic hyperplasia (BPH), who presented to our hospital with fever, watery diarrhea, and painful swelling of the scrotum and penis. The patient was started on piperacillin-tazobactam, vancomycin, and clindamycin. A computed tomography scan of the pelvis showed prostatic enlargement, edema of the penis and scrotum, and air collection within the corpus cavernosum. The patient underwent multiple surgical debridements of the glans penis. Patient wound cultures were positive for Streptococcus anginosus, Actinomyces turicensis, and Peptoniphilus harei. As mentioned earlier, FG is common in diabetic and immunocompromised patients, and infection is usually polymicrobial. Our patient was immunocompetent and his cultures grew atypical organisms.

Introduction: Penetrating Aortic Ulcer (PUA) is an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows hematoma formation within the medial layer of the aortic wall. As per our literature review, only one case of PUA causing hemopericardium has been reported. Case Presentation 66-year-old male with an unknown past medical history was bought in by the emergency medical services following a cardiac arrest. Initial rhythm was pulseless electrical activity and return of spontaneous circulation was achieved after ten mins of cardio-pulmonary resuscitation on the field. Initial echocardiogram was significant for a 4.6 cm ascending aorta with large hemopericardium causing tamponade physiology. CT chest with contrast revealed an ectatic ascending aorta with mild irregularity along the posteromedial wall, concerning for aortic leak secondary to a penetrating aortic ulcer (as indicated by the yellow arrow in the image below). Controlled pericardiocentesis was planned as a bridging therapy while awaiting transfer to a specialized cardiothoracic unit. But, the systolic blood pressure (SBP) rose to 170 mmHg when the chest tube was first inserted, worsening the hemopericardium. The patient's condition rapidly deteriorated, causing another cardiac arrest and death. Discussion The recommended treatment for Type A and B PUA-associated Intra Mural Hematoma is urgent surgical aortic graft placement. For hemodynamically unstable patients who cannot be taken for urgent surgery, The 2015 European Society of Cardiology guidelines recommend controlled pericardiocentesis to maintain a target SBP of 90 mmHg as a temporary measure. Conclusion In addition to aortic dissection, PAU should be considered in the differentials of patients with dilated ascending aorta and hemopericardium. An acute rise in blood pressure above 90 mmHg during pericardiocentesis is associated with worsening tamponade.

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Coronavirus disease 2019 (Covid-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Initially, COVID-19 was considered a respiratory illness, but later on, it was found out that this disease can affect many organ systems. Cardiovascular manifestations of this disease include myocarditis, heart failure, myocardial infarction, and thromboembolism. Myocarditis related to COVID-19 is thought to be due to the direct viral injury and host immune response. The cases of myocarditis after the COVID-19 mRNA vaccine have been reported in the literature as well. COVID-19 myocarditis can present as chest pain, shortness of breath, acute heart failure, arrhythmia, and possibly death. The initial workup should include an electrocardiogram (ECG) and troponins if myocarditis is suspected. Further screening should be done if troponins are elevated, or the patient has ECG changes concerning myocardial damage. Noninvasive imaging that helps to diagnose COVID-19 myocarditis includes echocardiograms, computerized tomographic (CT) with contrast, and cardiac magnetic resonance imaging (CMR). An endomyocardial biopsy (EMB) can be performed if the diagnosis remains unclear. Initial treatment of COVID-19 myocarditis is mainly supportive, and intravenous immunoglobulin (IVIG) and corticosteroid may be effective, particularly in fulminant myocarditis. If the patient develops life-threatening arrhythmias or shock, advanced mechanical support is required. Early intervention is a critical factor in decreasing morbidity and mortality. Further research is needed to determine the efficacy of different treatment modalities, including IVIG and corticosteroids, in patients with COVID-19 myocarditis.