Medicine
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Carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections are a severe complication resulting from granulocyte deficiency following chemotherapy for hematologic malignancies and have a high mortality rate. However, reports of disseminated organ infections secondary to bloodstream infections are rare. ⋯ Ceftazidime-avibactam exhibited satisfactory efficacy and safety in the 2 cases of disseminated organ infection secondary to CRKP bloodstream infection following chemotherapy for acute lymphoblastic leukemia.
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Case Reports
All-positive HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb in a patient with hepatitis B: A case report.
Mass vaccination, low cost of immunoglobulins, and new drugs led to the emergence of new, unusual patterns of hepatitis B serum markers. This study reported a rare case of hepatitis B with all 5 positive serum markers, including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. ⋯ The rare pattern of all 5 positive hepatitis B markers may occur in patients with chronic hepatitis B. Improvements can be achieved using first-line drugs and conventional treatment. Nevertheless, more attention should be paid to the patient's condition.
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We report the efficacy of combination prednisolone and intravenous (IV) rituximab as an immunosuppressive regimen for a young male presenting with extensive venous thromboembolism including a submassive pulmonary embolism secondary to life-threatening nephrotic syndrome from very high risk anti-phospholipase-A2 receptor (PLA2R) positive membranous nephropathy. Initial treatment was with mechanical thrombectomy and anticoagulation. Thereafter, oral prednisolone was initiated to induce remission, during a period of uninterrupted anticoagulation. He subsequently underwent a kidney biopsy for histological confirmation and IV rituximab was administered as definitive treatment. ⋯ This case demonstrates that preemptive treatment in patients with anti-PLA2R positive membranous nephropathy can initiated without a histological diagnosis when there are strong contraindications against a kidney biopsy. Treatment with a combination of steroids and IV rituximab could be a viable treatment option for patients with very high-risk membranous nephropathy over conventional therapy with cyclophosphamide.
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Spontaneous retroperitoneal hematoma (SRH) is a rare but potentially fatal condition, often associated with anticoagulation therapy. With the global prevalence of COVID-19 and the widespread use of anticoagulants in its management, there is an increasing need to recognize rare but serious complications like SRH. This case report aims to emphasize the importance of early recognition and intervention of SRH in patients with COVID-19 undergoing anticoagulation therapy, to improve patient outcomes and reduce mortality. ⋯ This case underscores the critical need for vigilance in monitoring patients on anticoagulation therapy, particularly those with COVID-19, for signs of SRH. Early recognition and prompt intervention are essential to improve outcomes. Clinicians should maintain a high index of suspicion for SRH in patients presenting with unexplained abdominal pain and hypovolemic shock, even in the absence of typical risk factors.
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Case Reports
Blind nasoenteric tube placement risks: A case report of misplacement into the pleural cavity.
Enteral nutrition is a critical component of care for critically ill patients. However, the blind insertion of a nasoenteric tube, despite being a simple procedure, carries inherent risks that necessitate a reevaluation of the technique. ⋯ The case prompts a reevaluation of blind placement techniques and calls for the adoption of more reliable technologies to prevent similar incidents and ensure patient safety, such as electromagnetic and visualized guided placement technique.