Happy Easter Day from Juniper Online Journal of Case Studies

 Happy Easter Day from Juniper Online Journal of Case Studies 

 

Wishing you an egg-ceptionally wonderful Easter. Celebrate this day with peace, love, and gratitude. Have a blessed Easter. Hope your day is blooming with love and laughter.

 

 

Malignant Arterial Hypertension Revealing Focal Segmental Hyalinosis

 

Abstract

Malignant arterial hypertension (MAH) is a hypertensive emergency associated with grade III or IV retinopathy. Focal segmental hyalinosis (FSH), of late onset, is one of its rare entities, with an incidence of 7 per million, responsible for 15-20% of nephrotic syndromes in adults. We report a case of segmental and focal hyalinosis in a 27-year-old patient with no previous history of malignant hypertension, who consulted us for neurosensory signs and ocular redness. The clinical examination showed a hypertensive peak at 240/150mm Hg with myocardial hypertrophy confirmed by electrocardiogram and transthoracic echo. A fundus examination completed by an optical coherence tomography revealed a KIRKENDAL stage III retinopathy associated with an occlusion of a branch of the central retinal vein. An impure nephrotic syndrome associated with renal failure was observed. A biopsy of a fragment of renal parenchyma supplemented by pathology was performed in favour of FH with chronic tubulointerstitial disease. The patient was managed urgently with nicardipine 3-5mg/hr by electric syringe within 24 hours, followed by a triad of antihypertensive drugs consisting of amlodipine, indapamide and Ramipril at full dose combined with prednisone 60mg/day for 4 months with a 6 month taper. The evolution was marked by a normalisation of the renal function, disappearance of the proteinuria and even a normalisation of his eye fundus after one year. FSH constitutes a group of heterogeneous pathologies with multiple causes, of which malignant hypertension is a secondary one, requiring not only symptomatic but also etiological management.

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Takotsubo Caused by Pulmonary Embolism

 

Abstract

Takotsubo is a transient acute coronary myocardial infarction due to a catecholaminergic discharge accounting for 1 in 36,000 adults after intense physical or psychological stress. Most often found in women over 50 years of age. Its association with pulmonary embolism is very rare.

With this in mind, we report the case of a 76-year-old female patient with poorly followed chronic obstructive pulmonary disease (COPD). She presented to the emergency department with acute respiratory distress and lipothymia. Clinical examination revealed hypoxia with SaPO2 at 86% in free air, blood pressure at 120/80mmHg, tachycardia at 112 beats/min. The electrocardiogram showed S1Q3, hyper-right axial deviation, complete right bundle branch block with fragmented QRS, positive AVR with a tachycardia of 125 beats/min. A thoracic angioscan was performed, showing a bilateral pulmonary embolism of segmental and sub-segmental level. Ultrasensitive troponins were highly elevated at 1530ng/l with transthoracic echocardiography showing signs of acute pulmonary heart disease associated with apical ballooning, very akinetic with hyperkinesia of the bases, LVEF 26% suggestive of takotsubo confirmed by coronary angiography coupled with ventriculography giving an amphora-like appearance with a healthy coronary. The patient was initially admitted to the intensive care unit and then to the hospital for an intermediate-high risk pulmonary embolism complicated by takotsubo. The etiological work-up of the pulmonary embolism was normal. She received apixaban, Ramipril and bisoprolol. The evolution was marked by a recovery of the bi ventricular function with an LVEF of 58% in 1 month.

Takotsubo was secondary to respiratory failure caused by pulmonary embolism through catecholaminergic discharge resulting in a redistribution of beta receptors in the myocardium.

 

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An Uncommon Localization of a Hydatid Cyst Presenting with Pulmonary Embolism

 

Abstract

Human echinococcosis is an important infection in undeveloped and developing countries, caused by larval forms of the genus Echinococcus. In western countries this disease is sporadic. The organs mostly involved by the cysts are the liver (70%) and the lungs (20%) [1]. Cardiac hydatid cyst is a rare condition, and the location of a hydatid cyst in the interventricular septum is exceptional. Cardiac echinococcosis is not frequent, only 0.01%-2% of all hydatid infestations [2]. The left ventricle is the heart chamber most frequently involved (55-60%) and the involvement of the interventricular septum is reported in 4% of cardiac cases. Chest pain, palpitations, and dyspnea are the most frequent symptoms associated with cardiac echinococcosis. We describe a case of an unusual presentation of this disease.

 

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