This 44 year-old male (see connected case) was started on Le | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

This 44 year-old male (see connected case) was started on Levofloxacin, Doxycycline and Tamiflu (Oseltamivir). However, his fever persisted and dyspnea worsened, and was transferred to the MICU. His blood pressure dropped to 84/50 mmHg after intubation, and vasopressors were given via CVC (central venous catheter). A 12-lead ECG revealed sinus tachycardia and the CXR obtained 2 days later (attached) revealed diffuse infiltrations over both lungs. HBsAg and anti-HCV were negative. The abdominal echo showed no lesions of the liver, gallbladder or biliary tract. Coronary angiography (performed due to elevated cardiac enzymes) did not show coronary artery thrombosis. Lumbar puncture showed no evidence of central nervous system infection. PCWP was 16 mmHg. A dx. was made of pneumonia, septic shock, ARDS and myocarditis. Two days later, lab results came back negative for dengue fever, Q fever, scrub typhus, Rickettsia, but was positive for influenza B. What is the next step in the management of this pt.?

Similar cases

IDWeek case. A man had fevers, headaches and weight loss for two months; swollen hands and feet for 1 week, and left eye blurred vision for 3 days. On exam, he had fever to 101.7°F (38.7°C), edematous hands and feet, splinter hemorrhages of the fingernails, and left branch retinal artery occlusion. The white cell count was 13,000/microliter, the ESR 103 mm/h, and there was hematuria. Multiple sets of blood cultures were drawn, intravenous vancomycin was begun. Echocardiography showed possible thickening of the aortic valve. The symptoms improved. All blood cultures were negative and vancomycin was stopped. He went home. Two weeks later, his hands worsened.

a 39-year-old woman presenting with sharp back pain between shoulder blades. She has a medical history of only hypertension and is on medication (lercanidipine). She was referred to the ER with clinical suspicion of acute coronary syndrome (ACS). However, she was later diagnosed with acute aortic dissection. Initial vital signs at the ER were stable besides blood pressure (Rx arm 184/95 mmHg , Lx arm 188/75 mmHg). Electrocardiogram (EKG) showed NSR with nonspecific ST deviation. Laboratory findings were normal includes negative Troponin. CXR was normal. #aorticdissection #dissection

Man in 60s brought by ambulance with infective respiratory symptoms (cough, fever, later found to be flu A+), his ICD/pacemaker for an underlying cardiac conditions had fired more than 20 times. His ECG showed AF (known) with RBBB and runs of VT triggering ICD activation. The ICD was not defective, rather it was saving the patient’s life every time it fired. His infection was driving a fast AF which degenerated into VT, causing the ICD to fire and cardiovert the patient to the intended atrial-sensed ventricular-paced rhythm. I loaded the patient with amiodarone, magnesium sulphate, and gave him his daily dose of bisoprolol 5 mg, but also focused on the treatment of infection as the underlying culprit in this presentation. The dual approach of treating the infection and administering antiarrhythmic medication ultimately reverted the patient to his original rhythm after a couple of hours. Understanding the sequence of pathologies leading to one another is vital to adopting the right treatment strategy - was my take-home lesson.

14yo M with fever, chills, body aches for four days. He didn't get his flu shot this fall. This rapid flu test is pretty strongly positive for Flu A.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?