Internal medicine
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Retained placenta can lead to septic shock; however, sepsis-induced cardiomyopathy (SICM) due to retained placenta has not been reported previously. This report presents a rare case of SICM following septic shock due to retained placenta after miscarriage in a 40-year-old woman, accompanied by the "shark fin sign" on an electrocardiogram, a pattern typically linked to myocardial ischemia. ⋯ We also reviewed previous cases of shark fin sign in patients without myocardial infarction. A review showed that half of the cases experienced lethal arrhythmias, even without myocardial infarction.
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Patient 1 (82 years old) had recurrent weakness and numbness in the left upper extremity, Patient 2 (71 years old) had transient dysarthria, and Patient 3 (70 years old) had transient apraxia of speech. Transient ischemic attack (TIA) was suspected; however, all three women had a history of head trauma before the symptom onset, and magnetic resonance imaging revealed subdural hematomas near the responsible lesions associated with sulcal hyperintensity (SHI) in the cerebral sulcus near the hematoma. Patients 1 and 2 improved spontaneously, whereas Patient 3 improved with antiseizure medication. Subdural hematomas associated with SHI may have transient focal neurological deficits that manifest through a mechanism unlike TIA.
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Allergic bronchopulmonary aspergillosis/mycosis (ABPA/ABPM) is characterized by increased serum levels of total and fungi-specific immunoglobulin E (IgE) and eosinophilic mucus plugs in the airways. Its classification as either an allergic or eosinophilic disease remains controversial. ⋯ We also compared therapeutic responses to biologics targeting either IgE (omalizumab) or eosinophils (mepolizumab/benralizumab) to elucidate the role of these components in the pathogenesis of ABPA/ABPM. Based on these analyses, eosinophilic mucus plug formation in the airways is considered a cardinal feature of the development of ABPA/ABPM, whereas IgE responses to fungi are important factors that modulate disease manifestation.