Tennantpehrson7364

We present a 26-year-old woman who came to the emergency department with chest pain of 1 hour duration that started while she was exercising on the treadmill. At presentation, ECG showed sinus bradycardia. Initial troponin level was 0.05 ng/mL and her chest pain resolved within 3 hours of onset. Troponins were trended serially, which continued to rise and peaked at 28.77 ng/mL and so heparin drip was started. On the second day of admission, a coronary angiogram was performed along with intravascular ultrasound, which revealed type 3 spontaneous coronary artery dissection. No obstructive atherosclerotic disease was noted in any of the coronary vessels. No coronary intervention was performed. Patient was started on aspirin and clopidogrel. Patient was discharged home in stable condition and was followed outpatient, where she remained in excellent health condition at her first clinic visit. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.A rare case of syphilitic uveitis presenting as a choroidal granuloma is described in this case report. The clinical picture resembled that of a tubercular choroidal granuloma. However, the patient was positive for treponemal (treponema pallidum hemagglutination assay) as well as non-treponemal tests (venereal disease research laboratory test) for syphilis. Therefore, the patient was treated for ocular syphilis and responded to antisyphilitic therapy. There was a complete resolution of the lesion at the end of 14 days of treatment. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Meningioma, the second most common primary tumour of the central nervous system, is classified into three different grades based on their characteristics. Each tumour grade includes different molecular subtype, growth potential, and thus, different prognosis. Grade I meningioma is the most common subtype with a benign course, in which systemic dissemination rarely occurs. We present the case of a 48-year-old male patient with a history of grade I meningioma who was referred 3 years after the initial diagnosis to our centre due to pelvic pain. Computed tomography (CT) images showed new pelvic bone lesions whose histopathological report was compatible with a grade I meningioma. Neither hormonal therapy concomitant with octreotide nor hydroxiurea treatments were effective. Very little is known about this entity's prevalence and treatment when disseminated disease occurs. Thus, we think it is important to increase the positive and negative clinical experiences in this setting. © BMJ Publishing Group Limited 2020. Y-27632 No commercial re-use. See rights and permissions. Published by BMJ.A 50-year-old woman presented with complaints of palpitations and breathlessness of 6 months' duration. She was being treated elsewhere as a case of dilated cardiomyopathy. On evaluation she had racoon eyes, poor progression of R wave on ECG and low-voltage complexes in the limb leads. Echocardiography revealed biventricular hypertrophy, diastolic dysfunction and moderate systolic dysfunction. Cardiac MRI showed features suggestive of amyloidosis. Bone marrow biopsy revealed raised plasma cell count, and endomyocardial biopsy showed amyloid deposits in the myocardium. Free lambda light chain levels were elevated, even though serum and urine electrophoresis did not show any monoclonal band. In this 'text book case of cardiac amyloidosis', apart from cardiovascular system no other organ system was affected, which is uncommon in primary light chain amyloidosis. The patient was started on CyBorD (cyclophosphamide, bortezomib and dexamethasone) regimen. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of Actinomyces israelii and a diagnosis of cervicofacial actinomycosis with mandibular osteomyelitis. The patient was successfully treated with prolonged antibiotics. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.A 57-year-old man with a history of diabetes and coronary artery disease was referred to haematology for the evaluation of anaemia in the setting of non-cardiac chest pain, fatigue, dyspnoea and dizziness. Previous investigations into these recurrent symptoms focused on a re-evaluation of his known ischaemic heart disease, which required multiple percutaneous interventions with stenting several years ago. In the year leading up to his referral, the patient required two transfusions during separate hospitalisations. Previously, his chronic anaemia was attributed to chronic inflammation because of unrevealing micronutrient and endoscopic evaluations. The patient underwent a bone marrow biopsy, which demonstrated normal karyotype myelodysplastic syndrome with ringed sideroblasts. This patient was found to have favourable cytogenetics and low-risk disease. His anaemia and associated symptoms improved with the administration of an erythroid-stimulating agent. Now 75 years old, he has remained on single-agent therapy for 10 years without need of transfusion. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.