CASE REPORT: Mycobacterium tuberculosis pericardial cyst presenting as right heart failure in an immunocompromised patient

Outcomes of COVID-19 in an Advanced Heart Failure Practice: A Single Center Study

Cavitary Pulmonary Infarct in Immunocompromised Hosts

Case Presentation: A 71-year-old man with coronary artery disease, left ventricular (LV) systolic dysfunction (ejection fraction, 30%), and recent admission for heart failure presented with acute dyspnea and hypoxemia. A pro-brain–type natriuretic peptide level was elevated at 2450 pg/mL (normal <350 pg/mL). Chest x-ray demonstrated cardiomegaly and small bilateral pleural effusions. After an hour of diuresis, the patient developed systemic arterial hypotension and worsened hypoxemia, prompting cardiology consultation. Based on the absence of rales on physical examination and lack of pulmonary edema on chest x-ray, an alternative diagnosis of pulmonary embolism (PE) was suggested, and contrast-enhanced chest tomography (CT) was obtained. Chest CT demonstrated large bilateral proximal PE. Venous thromboembolism (VTE), which encompasses deep vein thrombosis and PE, is an increasingly common and challenging complication of heart failure. The relative risk of PE is at least double that of patients without heart failure and increases as LV systolic function declines.1 PE patients with heart failure have a higher overall mortality rate than those without heart failure (17% versus 10%).2 In addition, PE is an independent predictor of death or rehospitalization among heart failure patients.3 ### Risk Factors Heart failure patients often have a high medical acuity and multiple risk factors that amplify the risk of VTE.4 The increased risk of VTE observed with heart failure itself has been attributed to reduced flow caused by low cardiac output and abnormalities of hemostasis, platelet function, and endothelial function. Central venous catheters and leads from implantable cardiac defibrillators and pacemakers are common among heart failure patients and have been shown to increase the risk of upper-extremity deep vein thrombosis. Heart failure patients tend to be older, and VTE in the elderly is problematic.5 ### Hemodynamics Acute PE increases pulmonary vascular resistance and right ventricular (RV) afterload through direct physical obstruction, hypoxemia, and pulmonary …

Candida cellulitis is a rare disease, primarily reported in immunocompromised patients. Atypical Candida spp. infections are increasing, largely due to the growing number of immunocompromised patients. This case report describes a 52-year-old immunocompetent patient with facial cellulitis caused by Candida guilliermondi. Candida guilliermondi has not previously been reported as a cause of facial cellulitis in either immunocompromised or immunocompetent patients. A 52-year-old, otherwise healthy, male patient presented with facial cellulitis that did not respond to intravenous antibiotics. Culture of the drained pus revealed Candida guilliermondi. The patient was successfully treated with intravenous fluconazole. This case highlights the possibility of atypical Candida spp. causing deep facial infections in immunocompetent patients. Candida guilliermondi has not been previously reported as a cause of facial cellulitis in either immunocompromised or immunocompetent patients. Healthcare providers should consider atypical Candida spp. infections in the differential diagnosis of deep facial infections in both immunocompromised and immunocompetent patients. Candida guilliermondi can cause facial cellulitis in immunocompetent patients. This has not been previously reported.Atypical Candida spp. infections should be considered in the differential diagnosis of deep facial infections in both immunocompromised and immunocompetent patients.Healthcare providers should be aware of the increasing incidence of non-Candida albicans Candida species infections, especially in immunocompromised patients.

Left Atrial Appendage Inversion Presenting as Acute Right Ventricular Failure after Left Ventricular Assist Device Implantation

The aim of this study was to review the available literature concerning Madura foot ("mycetoma") caused by Madurella mycetomatis in immunocompromised patients. With a systematic literature search, we identified only three papers, describing a total of three immunocompromised patients. Hence, the clinical presentation and prognosis of the disease in this patient population have not yet been well described. In addition, we present a case from our institution, illustrating the complexity of the treatment of this rare disease. Although very rare in non-endemic countries, we emphasize that mycetoma should be included in the differential diagnoses of (immunocompromised) patients who have been residing in a geographical area where the disease is endemic and presenting with soft tissue inflammation of one of the extremities.

Recurrent flash pulmonary edema due to rate-dependent left bundle branch block

090 Direct involvement of Bortezomib in the occurrence of heart failure

Left bundle pacing in a patient with atrioventricular canal defect presenting with atrial standstill and junctional bradycardia

BackgroundSphingobacterium spiritivorum is a glucose non-fermenting Gram-negative rod, formerly classified as one of the Flavobacterium species. It is characterized by a large number of cellular membrane sphingophospholipids. Sphingobacterium species are ubiquitous and isolated from natural environments, such as soil and water. However, they rarely cause infections in humans. Only a limited number of cases have been reported in elderly and immunocompromised patients with underlying diseases and predisposing factors.Case presentationAn 80-year-old Japanese man with chronic obstructive pulmonary disease and congestive heart failure visited the Kariya Toyota General Hospital, Aichi, Japan with the chief complaint of fever accompanied by chills and left leg pain. At initial presentation, he was distressed and dyspneic. He was febrile (38.8 °C), and his left foot was swollen with reddening and tenderness. We diagnosed him as having cellulitis, and he was hospitalized for antibiotic therapy. Initially, he was treated with intravenously administered cefazolin, but after the isolation of a glucose non-fermenting Gram-negative rod from blood cultures, we decided to switch cefazolin to intravenously administered meropenem on day 4, considering the antibiotic resistance of the causative organism. The causative organism was identified as S. spiritivorum on day 6. His condition gradually stabilized after admission. Meropenem was switched to orally administered levofloxacin on day 12. He was discharged on day 16 and treated successfully without any complications.ConclusionsAlthough S. spiritivorum is rare, with limited cases isolated from cellulitis, it should be considered as a causative organism in elderly and immunocompromised patients with cellulitis. Blood cultures are the key to correct diagnosis and appropriate treatment.

Background:Reported studies have shown that expression levels of microRNAs (miRNAs) are related to survival time of patients with heart failure (HF). A systematic review and meta-analysis were conducted to study circulating miRNAs expression and patient outcome.Methods:Meta-analysis estimating expression levels of circulating miRNAs in HF patients from January 2010 until June 30, 2018, through conducting online searches in Pub Med, Cochrane Database of Systematic, EMBASE and Web of Science and reviewed by 2 independent researchers. Using pooled hazard ratio with a 95% confidence interval to assess the correlation between miRNAs expression levels and overall survival.Results:Four relevant articles assessing 19 circulating miRNAs in 867 patients were included. In conclusion, the meta-analysis results suggest that HF patients with low expression of serum miR-1, miR-423-5p, miR-126, miR-21, miR-23, miR-30d, miR-18a-5p, miR-16-5p, miR-18b-5p, miR-27a-3p, miR-26b-5p, miR-30e-5p, miR-106a-5p, miR-233-3P, miR-301a-3p, miR-423-3P, and miR-128 have significantly worse overall survival (P < .05). Among them, miR-18a-5p, miR-18b-5p, miR-30d, miR-30e-5p, and miR-423-5p are strong biomarkers of prognosis in HF.

CON: Persistent Central Sleep Apnea/Hunter-Cheyne-Stokes Breathing, Despite Best Guideline-Based Therapy of Heart Failure With Reduced Ejection Fraction, Is Not a Compensatory Mechanism and Should Be Suppressed.

Probiotics are defined by the Food and Agriculture Organization of the United States as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.”1 They are considered nutritional supplements and, as such, are classified as Generally Regarded as Safe (GRAS). Organisms of the probiotic groups are added to all sorts of foods, particularly yogurts, but are also found in drinks and other common food supplements. They are commonly sold as pills or powders, and there is no control on their quality other than control of any marketing claims. As a consequence, patients purchase probiotics and foods containing them over the counter. There is no government control. The probiotic industry is reaching almost $20 billion a year2 in the westernized world and it is growing extensively worldwide. Very few complications have been reported with their use. However, there are risks, particularly in immunocompromised patients. In this issue, a case report has been published in which a 17-year-old with universal ulcerative colitis treated with both corticosteroids and antibiotics was given Lactobacillus rhamnosus GG by his parents.3 The authors carefully identified a case of sepsis. They identified, genetically and by culture, that the circulating organism was the same as from the probiotic Culturelle. The patient responded to antibiotic therapy, but there was some clinical question as to whether the septic symptoms could have been from a viral infection. The virus was identified before and after manifestation of symptoms. This case was reported as an immunocompromised patient and that appears to be a risk factor status for infection with probiotics, although the incidence is extremely low.4 As noted in our recent book “Probiotics: A Clinical Guide,” there are risk factors for possible infection that should be observed before probiotics are administered.5 The risk factors are clearly outlined by Boyle et al.6 Major risk factors are immunocompromised and premature infant patients. Minor risk factors are presence of central venous catheters, impaired intestinal epithelial barriers, administration of probiotics by jejunostomy, concomitant administration of broadspectrum antibiotics, to which probiotics are resistant, properties of high mucosal adherence of known pathogenicity, and cardiac valve disease. The cardiac valve disease risk factor appears to be only for Lactobacillus probiotics. Although these risk factors are not widely used, Boyle and associates felt they were significant. This patient was both on antibiotics and on corticosteroids. In 2010, Whelan and Meyers7 conducted an extensive systematic review of case reports, randomized controlled trials, and nonrandomized trials in patients administered probiotics while on nutrition support. There were 52 articles reporting 53 trials in which 4131 patients received probiotics. There were only 3 trials that showed increased complications, which were largely noninfectious in nature. In all, 20 case reports of adverse events in 32 patients were published. The organisms involved in the adverse reports were either Lactobacillus rhamnosus GG or Saccharomyces boulardii, and the risk factors of either the presence of central venous catheters or disorders associated with increased bacterial translocation were present. They felt that the very low incidence of complications in patients on nutrition support resulted in no contraindication to their use. The use of probiotics should always be subjected to a risk/benefit analysis before they are administered. Healthy people do not face any risk. Regular surveillance for adverse events should always be carried out when probiotics are used in the presence of a central venous catheter. An extensive review of the literature by other authors is reassuring. There is a long history of safe use of probiotics in foods and as supplements, and they are generally regarded as safe by the Food and Drug Administration and by EFSA.8 Patients and physicians should feel comfortable in recommending the use of probiotics. However, risk factors should be evaluated, and when a patient is on significant antibiotic or immunocompromising medication

BackgroundConsecutive intraocular infections with candida and cytomegalovirus in the same eye are exceptionally rare. This case report describes the unique presentation, diagnostic challenges, and management of sequential presumed endogenous candida endophthalmitis and presumed cytomegalovirus uveitis in an immunocompromised patient, highlighting the importance of vigilant clinical assessment and aggressive treatment for preserving visual function.Case presentationA 46-year-old immunocompromised Caucasian male patient with history of rheumatoid arthritis on long-term oral methylprednisolone presented with blurry vision and floaters in his left eye. Initial examination revealed yellowish fluffy retinal lesions with emerging fungal balls in the vitreous compatible with presumed endogenous candida endophthalmitis. His condition progressed despite intravitreal injections, necessitating pars plana vitrectomy. Two months post-surgery, the patient developed recurrent hypertensive uveitis with bleeding along the retinal vessels compatible with intraocular cytomegalovirus infection. The patient’s visual acuity fluctuated significantly throughout the course of treatment, from hand motion to 20/70, before ultimately improving to 20/40 with appropriate management.ConclusionThis case highlights the risk of severe, sequential intraocular infections in immunocompromised patients and the importance of astute clinical observation and high index of suspicion. Favorable visual outcomes can be achieved through prompt, tailored treatment and long-term follow-up.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13256-025-05712-2.

AN UNUSUAL CULPRIT FOR EXERTIONAL DYSPNEA