No abstract

Streptococcus Pneumoniae (S. pneumoniae) is a common cause of community-acquired pneumonia, although its manifestation as a skin infection is a rare phenomenon. Most skin infections are secondary to Staphylococcus aureus or Streptococcus pyogenes, however, cellulitis caused by pneumococci is an infrequent finding. Pneumococcal cellulitis most often occurs due to bacteremia in patients with chronic illnesses such as diabetes, underlying malignancies, immunosuppressed patients, and patients with the history of injection drug abuse. The nature of the infection can be very fatal leading to fasciitis, myonecrosis, septic shock and ultimately death. We present a case of a 61-year-old female who developed painful swelling and redness of the right face along with bilateral leg involvement. In the emergency room, physical examination revealed multiple cervical lymphadenopathies. Further diagnostic investigations disclosed Low-grade B-cell non-Hodgkin lymphoma upon cervical lymph node biopsy. Blood culture grew Streptococcus pneumoniae as a source of cellulitis. This case demonstrates the importance of immune defects and the ensuing development of pneumococcal-induced cellulitis. Physicians should be vigilant while treating Pneumococcal cellulitis as this may be a sign of the serious underlying medical condition.

Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening cause of acute coronary artery syndrome. Although, SCAD may be attributed to underlying medical illness such as connective tissue disease, vasculitis or atherosclerosis, its occurrence in young healthy females is an uncommon phenomenon. Pregnant females, particularly in their peripartum or post-partum periods are affected the most. The etiology remains unclear but certain factors such as hemodynamic and hormonal changes during pregnancy have thought to play a significant role. Spontaneous coronary artery dissection has a very high mortality rate and physicians should be vigilant when an otherwise young healthy female presents with symptoms of acute coronary syndrome.

Latex-induced anaphylactic reactions are often underestimated in patients having procedures in a catheterization lab, intensive care units, or in operating rooms. Most physicians are not aware that almost all balloons in the Swan-Ganz catheter (SGC) are made up of latex. Direct exposure of these latex balloons in the blood can cause severe anaphylactic reactions, even in patients with no previous history of allergies. We present a case of a 53-year-old male, who underwent a SGC placement for cardiovascular evaluation. Immediately after the SGC insertion, he developed circulatory shock. On further investigation, we discovered that SGC balloon contained latex as one of the components. Physicians should be aware of latex-based products such as SGC balloon, which can cause anaphylactic shock even in case of no prior allergies to latex.

Listeria endocarditis is a rare, but serious disease with high mortality rate. Currently, little is known regarding the optimal treatment modality of Listeria endocarditis in affected individuals. Here, we present the case of a 66-year-old female with history of mitral and aortic replacement with bioprosthetic valve, and hospital course complicated by Listeria monocytogenes infective endocarditis with atrial-ventricular (AV) block. Listeria monocytogenes infection was eradicated by a 6-week antimicrobials course involving ampicillin and gentamicin, culminating in the resolution of AV block. On further investigation, the patient admitted to frequent consumption of salami and provolone cold-cut sandwiches, which based on previous evidence in literature is hypothesized to be the source of infection. Our findings suggest the development of perivalvular abscesses as the cause of the AV block. To our knowledge, this is the first reported case in literature where AV block secondary to listeriosis resolved with treatment solely by antimicrobials. While further research and larger studies are needed to extend our findings, patients with AV block secondary to listeriosis may benefit from optimized management with antimicrobials.