Risky business

Article Abstract:

A 31-year-old woman with recurrent endocarditis received a mitral valve replacement. Endocarditis is an infection of the endocardium, or the lining of the heart. The patient was admitted to the hospital with recurrent endocarditis and mitral valve damage. She had been using intravenous drugs since she was 18-years-old, and was currently using 30 milligrams of heroine a day. She frequently shared needles, and was HIV-positive. She had been treated for endocarditis caused by bacterial infections four and seven months earlier. Two weeks before admission, she had developed fever, chills, weakness, a cough, and shortness of breath. Treatment with antibiotics was started after admission to the hospital, and an echocardiogram revealed that her mitral valve was infected. The consequences of intravenous drug use were discussed with the patient, and she underwent surgery for mitral valve replacement. Her recovery was uneventful, and she was released from the hospital. She agreed to attend a neighborhood program for drug addicts, and was waiting to be admitted to a halfway house for addicts.

Health aspects, Intravenous drug abuse, Mitral valve insufficiency, Endocarditis

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Weak reasoning: diagnosis by drug reaction

Article Abstract:

A 40-year-old woman suffering from respiratory distress was diagnosed with myasthenia gravis following a reaction to drugs given to ward off a suspected bacterial infection. She did not smoke and had no signs of chronic illness. Two days prior to admission she developed chest congestion, a cough and shortness of breath. Upon admission she could no longer talk and was gasping for breath. Laboratory tests and the fever she developed suggested a bacterial infection, and she was given a preliminary diagnosis of pneumonitis. Initially she responded to treatment with antibiotics, but then her respiratory distress returned and her diaphragm moved paradoxically during deep breaths. Both of her eyelids were drooping and she was slumping in bed. These observations suggested she had a neuromuscular disease. Her sister reported previous episodes of pronounced muscular weakness, and the patient was diagnosed with myasthenia gravis. A consulting neurologist's report that antibiotics given intravenously can worsen myasthenia gravis confirmed the diagnosis.

Myasthenia gravis, Respiratory insufficiency

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Diverted by the chief complaint

Article Abstract:

An obese man who had isolated episodes of high blood pressure and facial flushing was hospitalized. Previous tests revealed asbestos deposits around his lungs. His liver function and the hormones that control blood pressure were normal. However, his liver and jugular veins were enlarged. Initial diagnoses of carcinoid syndrome, pheochromocytoma, and mastocytosis were eventually dismissed in favor of constrictive pericarditis, an inflammation of the sac that surrounds the heart. An echocardiogram confirmed this diagnosis and the patient successfully underwent surgery to remove the inflamed pericardium. The cause of the pericarditis was not clear, though it may be related to asbestos. Swollen jugular veins are the most common symptom of constrictive pericarditis. However, the physicians were initially focussed on a disorder originating in the liver.

Diagnosis, Heart diseases, Pericarditis

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