Kessler Reed (kittydavid40)

st in patients not comfortable with angiography.Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis jirovecii. PCP due to immunosuppressive drugs is rarely reported in the literature. Herein we present a case of PCP in a 49-year-old patient who presented with progressive shortness of breath, dry cough, and low-grade fever. History revealed that he was taking prednisolone daily for his hyperactive airway disease. His temperature was 99oF, and he had bilateral crackles in the lungs with resonant wheezing. High-resolution computed tomography showed diffuse ground-glass haze and cystic lesions in the middle and upper zones of both lungs. He was commenced on intravenous ceftriaxone and methylprednisolone based on provisional diagnosis of interstitial pneumonia. However, his condition worsened. His human immunodeficiency virus (HIV) test was reactive, and his CD4+ count was 275 cells/mm3. Bronchoalveolar lavage revealed PCP by direct immunofluorescent assay. Additional serum testing revealed marked elevation of beta-D-glucan, consistent with PCP diagnosis due to glucocorticoid use. Trimethoprim-sulfamethoxazole and voriconazole were initiated, and his respiratory symptoms started improving. His respiratory condition improved on day 9, and he was discharged with follow-up.Rocky Mountain spotted fever (RMSF) is a tick-borne illness caused by Rickettsia rickettsii. The classic triad of fever, rash, and a recent tick bite is rarely present at diagnosis. Less known, but more common initial presentations include gastrointestinal symptoms such as anorexia, nausea, vomiting, and abdominal pain. In endemic areas, a persistent fever with gastrointestinal symptoms should prompt screening and early initiation of antibiotics to prevent the development of fulminant RMSF and its associated high mortality. This case aims to educate about the gastrointestinal and hepatic manifestations of this diagnostic enigma.Laryngospasm is an uncommon complication of anesthesia in adults but more common in pediatric anesthesia, which could present similarly to supraglottic upper airway obstruction. The management of such airway complications is even more difficult in patients with difficult mask ventilation and intubation. Our case illustrated the management of laryngospasm and negative pressure pulmonary edema in a patient with Treacher Collins syndrome. A literature search revealed few previous similar reports. We demonstrated an algorithm to differentiate between the true laryngospasm from the supraglottic upper airway obstruction, the management of laryngospasm in patients with difficult airways, and the recognition and management of negative pressure pulmonary edema as a complication of laryngospasm.Pericarditis is a rare cardiac complication of coronavirus 19 (COVID-19) infection. Recent case reports describe severe sequelae of pericarditis, including cardiac tamponade, developing within days of initial COVID-19 symptoms. We present a case of pericarditis with slower onset and milder symptoms, developing over a period of a few weeks in an immunocompetent male who recovered from COVID-19 several months earlier. A 65-year-old male presented to an emergency department several times for one week of worsening chest and neck symptoms, along with fever. He had been symptom-free after a three-day course of cough, myalgias, and fever with positive COVID-19 testing, approximately 70 days earlier. He was ultimately admitted for fever and pericarditis with an associated pericardial effusion and positive PCR testing for COVID-19. Pericarditis should be considered in the differential diagnosis for patients with COVID-19 and unexplained persistent chest symptoms. The possibility of recurrent or atypical latent infection should additionally be considered in the months following the initial COVID-19 infection. Bedside ultrasound may facilitate early diagnosis and management of COVID-19 associated pericarditis.Acremonium species are saprophyt