No abstract

Renal infarction is an underdiagnosed condition with multiple possible causes, including atrial fibrillation. The treatment approach includes percutaneous endovascular therapy (PET) to restore blood flow, antiplatelet therapy, anticoagulation, or combination therapy, depending on the patient's status and available modalities. Warfarin is the standard anticoagulation therapy, although direct oral anticoagulation (DOAC) therapy is getting more popular. Here, we present a 60‐year‐old male patient with hyperthyroidism complicated by acute renal infarction, which was successfully treated with dabigatran, evident by non‐recurrence and restoration of blood flow in a follow‐up CT angiogram. This case report may open the door for the use of DOAC in acute renal infarction though more studies are needed to prove the efficacy.

Endogenous bacterial endophthalmitis results from bacterial seeding of the eye during bacteremia. A diagnosis of endogenous bacterial endophthalmitis requires clinical findings such as vitritis or hypopyon along with positive blood cultures. Serratia marcescens is the second most common pathogen causing hospital‐acquired ocular infections. This report describes a case of endogenous bacterial endophthalmitis caused by S. marcescens in an older adult with end‐stage renal disease (ESRD) on peritoneal dialysis, who had late‐onset pleural empyema secondary to coronary artery bypass grafting (CABG). A 61‐year‐old gentleman presented with a two‐day history of cloudy vision, black floaters, pain, swelling, and gradual vision loss in his right eye. There was no history of trauma, ocular surgeries, or previous similar episodes. He had myocardial infarction treated with CABG 3 months back. Examination showed a 3 mm hypopyon in the anterior chamber. He had classic signs of endophthalmitis with positive blood cultures for S. marcescens. He was treated with high‐dose intravenous meropenem and intravitreal ceftazidime without vitrectomy. Endophthalmitis progressed to complete vision loss in his right eye, requiring evisceration. Endophthalmitis caused by S. marcescens is rare, but long‐term outcomes can be severe, causing complete vision loss in about 60% of the patients. It is usually hospital‐acquired, and the source can be late‐onset empyema several months after cardiac surgery, in an immunocompromised patient. Systemic antibiotics should be supplemented with intravitreal agents with or without pars plana vitrectomy.

The novel Coronavirus (COVID-19) is one of the most recent Pandemics that invaded the earth and is still active. It caused and is still causing hundreds of thousands of patients high morbidity and mortality rates, with no definitive cure at this moment. COVID-19 has been proven to be associated with pathologic changes in coagulation, characterized by either thromboembolic or bleeding events. We describe this case of a 44year-old male patient who walked into our emergency department with flank pain and was later discovered to have had renal angiomyolipoma (AML) rupture during his COVID-19 infection, ultimately requiring admission for hemorrhage control via interventional radiology (IR) drainage. Here, we discuss the role of front-line physicians and how they should keep a low threshold for the different presentations that could be associated with COVID-19 infection, such as what was found in this case.