A 68-year-old male with a known history of von Hippel-Lindau disease with brain hemangioblastoma status post radiation therapy and recurrent hemangioblastoma in the spine and multiple spinal surgeries presented initially to the emergency department due to hemoptysis and worsening shortness of breath. A CT chest demonstrated a left lung mass and left pleural effusion, which was initially suspected to be lung malignancy given his symptoms and history. However, it was determined to be a lung abscess following workup and consultations. This case highlights the similarities in the presentation of both pathologies and the critical features in lung abscesses.

An 85-year-old woman presented with altered mental status and appeared to be actively agitated due to her medications. During her hospitalization, troponins trended up and an electrocardiogram (ECG) showed diffuse ST elevation. Echocardiogram showed an estimated ejection fraction of 40% with hypokinesis of the apex, suggestive of Takotsubo cardiomyopathy. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, this report discusses a rare case of delirium state causing Takotsubo cardiomyopathy.

Patient: Male, 48-year-old Final Diagnosis: Aerococcus endocarditis Symptoms: Altered mental status • fever • shock Medication: — Clinical Procedure: — Specialty: Cardiology • Infectious Diseases Objective: Rare disease Background: Aerococcus species are a rare cause of endocarditis. Micro-organism identification and antibiotic choice can pose significant management challenges to clinicians who care for patients with this infection. Aerococcus is a gram-positive micro-organism which is commonly misidentified because it shares many similarities with streptococcus and enterococcus species. Aerococcus urinae is usually found to cause urinary tract infections and occurs more frequently in patients with structural urinary tract abnormalities associated with urethral and ureteral obstruction such as kidney stones, phimosis, and prostate hyperplasia. However, it is reported to rarely cause endocarditis. Case Report: A 48-year-old man with a history of cocaine abuse and right hip replacement presented to our emergency department with acute encephalopathy. Through a complicated hospital course, he was found to be septic and the bacteria were initially misidentified as an alpha-hemolytic strep before being correctly identified as Aerococcus urinae . He was found to have multiple cerebral, likely septic, embolic infarcts and aortic valve endocarditis. Identification of the micro-organism on blood cultures was challenging, as were decisions about antibiotic choice. He died despite efforts of a multidisciplinary care team. Conclusions: Our case highlights a unique case of Aerococcus endocarditis and shows the difficulty in initially identifying the bacteria. To our knowledge this is the first case reported in the setting of substance abuse. It also highlights the lack of appropriate guideline-directed therapy with regards to antibiotic choices in this group of patients, emphasizing the importance of further research in this regard.

Epidural abscesses are rare suppurative abscesses of the central nervous system that can expand and lead to severe neurologic complications and even death. Here we describe the case of a 68-year-old female who developed a spinal epidural abscess one month following cervical spinal decompression and fusion. The patient presented with decreased grip strength, flaccid paralysis of the lower extremities with hyporeflexia, urinary incontinence, and decreased sensation in the bilateral lower extremities. A cervical spine MRI revealed a large cervical spinal epidural abscess causing multilevel spinal cord compression that was treated with surgical evacuation and antibiotics. Due to the complications of epidural abscess, we as clinicians must have high clinical suspicion to initiate the correct treatment. In addition, patients without neurological symptoms or symptoms lasting less than 36 hours have the best recovery rate. Our case highlights the importance of timely diagnosis, management, and intervention, which can lead to restored functionality and the prevention of permanent neurologic sequelae.

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