Recurrent Episodes Of Vomiting Research Articles

Unilateral peroneal neuropathy in a patient following laparoscopic sleeve gastrectomy.

Peroneal neuropathy, characterized by the occurrence of a foot drop, can develop due to a variety of factors, such as tumors, trauma, or metabolic conditions, making it one of the most prevalent peripheral neuropathies of the lower limbs. This condition is becoming more identifiable among patients who have undergone substantial weight reduction through bariatric surgery. The condition may present with symptoms like pain, sporadic paresthesia, and functional restrictions, primarily linked to foot drop. This case study explores an episode of acute foot drop in a patient who underwent a sleeve gastrectomy, leading to substantial weight loss.The patient, a middle-aged woman with a history of obesity, underwent sleeve gastrectomy and achieved normal body mass index (BMI) within a year. Eleven months post-surgery, she experienced a right-sided foot drop following a minor knee injury. Detailed history taking revealed noncompliance with vitamin supplementation, recurrent vomiting episodes, and a recent diagnosis of pancreatic insufficiency. Peripheral neuropathy, particularly peroneal nerve involvement, was confirmed through nerve conduction studies and radiological imaging. The mechanism of injury was attributed to rapid weight loss, potential nutrient deficiencies, and possible traction to the nerve.This case underscores the importance of early identification, comprehensive nutritional assessment, and timely intervention in managing neurological complications of post-bariatric surgery. Increased awareness among healthcare providers, particularly musculoskeletal specialists, is crucial as the prevalence of bariatric surgery continues to grow, ensuring optimal care for patients in this vulnerable population.

Isolated embryonal rhabdomyosarcoma of the anterior petrous bone in a young child: Focusing on the intra-operative diagnosis and differentials.

Rhabdomyosarcoma is a common soft tissue tumor, but isolated involvement of anterior portion of petrous bone is exceedingly rare. Here, we present a case of embryonal rhabdomyosarcoma involving the anterior petrous without involvement of the mastoid and middle ear. A 6-year-old boy presented with a progressive right side lower motor neuron facial paresis for 1-month duration along with headache and recurrent vomiting episodes. Radiology showed a contrast-enhancing lesion involving the right petrous apex. He underwent craniotomy and excision of the lesion. Based on the frozen section, a diagnosis of rhabdomyosarcoma was rendered, and gross total resection could be achieved. Postoperative course was uneventful. Isolated petrous bone involvement of embryonal rhabdomyosarcoma is a rare presentation. Intra-operative frozen section plays a key role in decision making regarding the extent of excision. Hence, a prompt and accurate diagnosis is essential in managing these cases.

Evaluation and Management of Achalasia Cardia in Children: A Retrospective Observational Study.

Achalasia cardia is a neuromuscular disorder of unknown etiology characterized by aperistalsis of the body of the esophagus and failure of relaxation of the lower esophageal sphincter. The diagnosis of achalasia cardia is delayed due to the rarity and the ability to mimic other common conditions in children. Hence, a study was conducted to evaluate the clinical presentation and the management of achalasia cardia in children. A retrospective observational study was conducted in the department of pediatric surgery at a tertiary center. The children with achalasia cardia who presented between January 2014 and December 2021 were included. A total of 12 patients were treated for achalasia cardia during the study period. All children presented with recurrent episodes of vomiting, whereas dysphagia was seen in six (50%) children. Eighty-three percent of the children presented with a history of weight loss, whereas failure to thrive was seen in nine (75%) children. Five (42%) children were managed as gastroesophageal reflux disease (GERD) for more than a year before presenting to us. Three (25%) children underwent open cardiomyotomy with Thal fundoplication and the rest nine (75%) underwent laparoscopic cardiomyotomy. All are thriving well. Achalasia is an important differential diagnosis in children with suspected GERD. The most common symptom of achalasia cardia is vomiting followed by dysphagia. Weight loss and failure to thrive are important presenting features in children with achalasia which are uncommon in adults. Cardiomyotomy without fundoplication is safe and effective to treat achalasia cardia in children without having any extra complications.

Prevalence and incidence of cyclic vomiting syndrome in Japan: A study using Japanese claims data.

Cyclic vomiting syndrome (CVS) is a gastrointestinal disorder that is characterized by recurrent episodes of vomiting. Previous studies have provided reliable data on the prevalence of CVS among children in Japan; however, neither prevalence data nor incidence of CVS is available for adults. Hence, we obtained detailed prevalence and incidence data for CVS and estimated the total number of CVS cases in Japan. This retrospective cross-sectional study was conducted using the JMDC (JMDC, Inc.; formerly known as Japan Medical Data Center Co., Ltd.,) database, which is a de-identified Japanese claims database. Individuals enrolled between January 2017 and December 2017 were included in this study. Longitudinal data for eligible populations were used to identify patients who displayed CVS symptoms throughout the follow-up period. Due to the lack of a specific diagnosis code for CVS in 2017, the Rome IV criteria were applied to identify CVS cases in the pediatric and adult populations. The prevalence was standardized to the 2017 Japanese census and extrapolated to estimate the number of CVS cases. A total of 2,093 patients with CVS were identified from 3,506,144 individuals. The overall age-and-sex-standardized prevalence was 0.32 per 1,000 population (95% confidence interval [CI]: 0.30-0.34), projected to approximately 49,000 patients with CVS across Japan. The pediatric age-and-sex-standardized prevalence was 2.10 per 1,000 population (95% CI: 2.01-2.19), and the adult prevalence was 0.05 per 1,000 population (95% CI: 0.04-0.06). Marked sex differences were observed before and after 12 years of age. Thus our study provides the first large-population-based estimates of CVS prevalence and incidence in Japan, and currently, the only estimates for adult CVS in Japan.

Comparison of the Effect of Adding L-Carnitine to Propranolol in the Prevention of Cyclic Vomiting Syndrome Attacks in Children

Background: Cyclic Vomiting Syndrome (CVS) is an idiopathic, complex, multifactorial disorder that is often characterized by recurrent episodes of vomiting and is usually separated by asymptomatic episodes. Prophylaxis should be considered in children with frequent or severe periods. Prevention and treatment of CVS in children is very difficult and no specific and effective treatment has been proven in clinical trials. Propranolol is approved for the prophylaxis of CVS in children of all ages, but its effectiveness has been variable. In this study, we investigated the efficacy and safety of adding L-Carnitine to propranolol therapy in the prevention of pediatric CVS. Methods: 76 children who were diagnosed with CVS were included in this study. They were divided into two equal groups. The first group received high dose of Propranolol and the case group received L-Carnitine with low dose of propranolol for 6 months. Results: CVS attacks’ frequency in both groups of treatment with propranolol alone and in combination with L-Carnitine and propranolol, before and after the treatment was significantly reduced. But there is no significant difference between the two groups 70.6%) vs. 90.9%) (p-value=0.062). There was no significant reduction in the duration days between vomiting attack index in both groups (31.6 % vs.43.2%) (p-value= 0.345). Conclusion: Our research revealed that combination of low dose propranolol with L-Carnitine has comparable efficacy with high dose Propranolol in prophylaxis of CVS.

White glue intoxication in a plain parakeet (Brotogeris tirica) – Case report

Despite the lack of information on avian sensitivity to toxic agents, it is known that several products that are relatively harmless to humans may have profound effects on birds. Thus, the objective of this work is to report the case of a plain parakeet (Brotogeris tirica) that was intoxicated after ingesting white glue and to discuss the pathophysiological aspects involved in intoxication. For this, the case study methodology was used, with a qualitative character, describing the case in detail and posteriorly seeking subsidies in the literature centered on the subject under study to complement the knowledge necessary to carry out this study. Twelve hours after ingesting white glue, the plain parakeet (Brotogeris tirica) began to experience recurrent vomiting episodes, which rapidly progressed to a critical condition of dyspnea, prostration and death. Although Polyvinyl Acetate (PVAc), the main component of that type of glue, is described as a non-hazardous substance, necroscopic and histopathological findings, consisting of pulmonary and hepatic congestion and hemorrhage, were very similar to that seen in some avian toxicoses. A thorough review on in vivo and in vitro mechanisms of PVAc degradation suggests that an association of high-dose exposition and B-esterase insufficiency in birds was the probable cause of PVAc poisoning, serving as an alert to veterinarians and bird owners.

Diagnosis of Cornual Pregnancy in the Emergency Room: a Rare Case Report

Introduction: Ectopic or extrauterine pregnancy is a life-threatening medical condition in which a fertilized egg is implanted elsewhere than in the uterine cavity, commonly in the fallopian tubes. However, it can also occur in the peritoneal cavity, ovaries, and cervix. There are several etiological factors contributing to ectopic pregnancies, such as a history of pelvic inflammatory diseases, habitual abortions, and miscarriages, previous ectopic pregnancies, fertility procedures, as well as increased maternal age that has been correlated with a higher risk of carrying an ectopic pregnancy. Often, the first alerting sign in any ectopic pregnancy is a pain in the pelvic region, along with vaginal bleeding usually spotted between the 6th and 11th gestational week. Other symptoms include vomiting, nausea, tachycardia, and in severe cases hypovolemic shock due to internal bleeding induced by the rupture of the tubes. The key to diagnosing an ectopic pregnancy is transvaginal ultrasound, alongside the measurement of beta human chorionic gonadotropin hormone (beta-hCG) concentrations, which are usually found to be low in such cases. The management of ectopic pregnancy is either medical or surgical. Case report: We are reporting the case of a 32-year-old pregnant woman, who presented to the emergency department for diffuse abdominal pain and recurrent episodes of vomiting and diarrhea of one-week duration. The patient was stable on admission, but later on, she showed a rapid shift in her vital signs. Blood tests were obtained, and pelvic ultrasound was done, followed by a Computed Tomography (CT) scan that revealed the presence of a right cornual ectopic pregnancy. A rapid surgical intervention was carried out to save the patient’s life and alleviate the pain. Conclusion: Ectopic pregnancy is an urgent condition that needs to be treated immediately to avoid its fatal consequences. Several risk factors stand behind it, and a usual history and physical gynecological examinations are insufficient to detect it, hormone screening tests additionally to ultrasounds are highly recommended to decrease the incidence of mortality. A proper follow-up with a specialist could avoid the risk of an ectopic pregnancy as well as its undesirable outcomes.

Bartter Syndrome in A Nigerian Child with Recurrent Vomiting

Bartter syndrome is a rare renal tubular disease characterized by hypokalemic metabolic alkalosis and renal salt wasting. There is paucity of report of this condition from Africa. We report a case of a four–year–old Nigerian boy who presented with growth failure, recurrent episodes of vomiting, features of severe dehydration and normal blood pressure warranting in–hospital care on several occasions over a period of 16 months. This patient had hypokalemia, hypochloremia, hyponatraemia and hypercalciuria. He also had abdominal x-ray findings of a triangular-shaped calcific density in the right renal bed suggestive of right medullary nephrocalcinosis. Diagnosis of Bartter syndrome was confirmed by elevated plasma renin of 8.1ng/ml/hr (normal 0.5 – 5.9). The patient was managed with intravenous normal saline, potassium chloride infusion, calcium gluconate, and then oral potassium, calcium and magnesium supplements. Follow up at the clinic revealed significant weight gain and stable clinical state. A high index of suspicion is needed for early diagnosis of this rare syndrome, particularly in children presenting with persistent vomiting, failure to thrive and dyselectrolytemia. This, invariably, will improve survival and health-related quality of life of such children, hence the need for this report.

Organic Acidemias.

Organic Acidemias.

Panayiotopoulos syndrome: Unusual clinical manifestations

PurposeWe retrospectively analyzed the electroclinical features, treatment, and outcome of patients with Panayiotopoulos syndrome (PS) who presented with unusual clinical manifestations. MethodA retrospective, descriptive, multicenter study was conducted evaluating 44 patients with PS who had seizures with an unusual semiology. Data from patients with PS seen at eight Argentine centers between April 2000 and April 2019 were collected. ResultsTwelve patients (29.2%) had ictal syncope or syncope-like epileptic seizures. Three children (7.3%) had recurrent episodes of vomiting. Four patients (9.7%) presented with urinary incontinence associated with autonomic signs and consciousness impairment. One child had hiccups with autonomic manifestations followed by eye deviation. One boy had episodes of laughter with autonomic symptoms followed by loss of consciousness. Six patients (14.6%) had hyperthermia without acute febrile illness with autonomic symptoms as the first manifestation. Six others (14.6%) had focal motor seizures characterized by eye and head deviation in four and eyelid blinking in two. Four patients (9.7%) had ictal headache as the initial manifestation followed by nausea and vomiting. Two children (4.8%) had their first seizure while asleep associated with cardiorespiratory arrest. Two children (4.8%) had oral automatisms, such as sucking and chewing. In two children (4.8%) coughing was the initial manifestation followed by emetic symptoms. One patient (2.3%) had vertigo with a sensation of fear, with eye deviation and unresponsiveness. One child started with continuous spikes and waves during slow sleep, behavior disturbances, and emetic symptoms. ConclusionIn this study, evidence of the existence of unusual clinical cases of PS with typical EEG patterns was found. Outcome was excellent.

Impact de la pandémie COVID-19 sur le raisonnement clinique des médecins

Nous rapportons le cas d’une patiente de 65 ans, admise aux soins intensifs pour détresse respiratoire aiguë. Elle avait présenté la veille, suite à un repas copieux pris à l’occasion de la fête des mères, des épisodes récurrents de vomissements dont un avait été suivi d’une douleur rétro-sternale intense compliquée d’une dyspnée d’aggravation progressive.
 La patiente avait été admise aux soins intensifs avec initialement une suspicion d’insuffisance respiratoire aiguë secondaire à une affection à SARS-CoV-2. Mais suite à l’intégration de l’anamnèse à l’état clinique de la patiente, le diagnostic de syndrome de Boerhaave est d’emblée évoqué. L’objectif de cet article est de tenter de comprendre, à travers cette présentation clinique pourtant typique du syndrome de Boerhaave, comment cette crise sanitaire peut influencer le raisonnement clinique des soignants.
 Mots clés: syndrome de Boerhaave, biais cognitif, raisonnement clinique, COVID-19, SARS-CoV-2

OTO MASTOIDITIS AND SEPTIC CEREBRAL VENOUS THROMBOSIS

11 yr old female child, admitted with history of fever, left ear pain, swelling behind the left ear of 5 days duration, for which she was treated by a nearby doctor. After 1 week the child had left ear discharge, headache, neck pain, recurrent episodes of vomiting. On general examination she is thin built, febrile, toxic and dehydrated. On local examination she had ear discharge, swelling behind the left ear. On neurological examination, she had neck stifness. Routine blood investigations including, CBC, LFT, RFT were normal. On CSF examination Protein-188 mg%,Sugar- 16 mg%,Cell count-165 cells/cumm,85% were Neutrophils. Aural swab C/S showed growth of Klebsiella sensitive to Amikacin, Ciprooxacin, Piperacillin / Tazobactum and Cotrimoxazole. ENT opinion was in favour of doing Mastoidectomy. HRCT Temporal bone showed complete opacication of external auditory canal, tympanic cavity and mastoid air cells with a possibility of lling up with pus. MRI BRAIN showed Left mastoid and postauricular abscess, mastoiditis, ventriculitis, venulitis with thrombosis of left transverse and sigmoid sinuses. Patient was treated with parenteral piperacillin tazobactum, Ciprooxacin, Amikacin, Metronidazole, Mannitol, Dexamethasone and Low molecular weight heparin.Patient improved in 3 weeks.Ear discharge dried up, mastoid abscess subsided, and the child became active and ambulant

Cutaneous non-epitheliotropic large T-cell lymphoma in an English Bulldog

Cutaneous lymphoma is histologically classified in epitheliotropic and non-epitheliotropic, the first showing higher incidence in dogs, and the second, in cats. Non-epitheliotropic lymphoma presents lymphocyte aggregates in the dermis and subcutaneous tissue, however cutaneous annexes are not infiltrated. It is usually more aggressive than epitheliotropic lymphomas. The aim of this study was to report a case of non-epitheliotropic lymphoma in a 9-year-old, female, English Bulldog presented with non-ulcerated skin nodules adhered to deep tissues. Microscopic and immunophenotypic features supported the diagnosis of non-epitheliotropic large T-cell lymphoma. Treatment was initiated with modification of the LOPP protocol, replacing procarbazine by dacarbazine (600 mg/m²) for up to six cycles, with a three-month survival. In the 11th week of treatment, after recurrent episodes of vomiting and diarrhea, abdominal ultrasound was performed and revealed an infiltrative mass in the stomach's greater curvature topography, showing an expansive and accentuated increase in one week, when euthanasia was elected.

Griscelli Syndrome Type 2: A Rare Case With Apparently Normal Skin and Hair Pigmentation

t- Griscelli syndrome (GS) is a rare autosomal recessive disease that affects hair, skin, and immune system. Here, we describe an 8.5-month-old infant with multiple admissions due to fever, petechial purpura, and several recurrent vomiting episodes with a presumptive diagnosis of recurrent sepsis. He was born from parents with consanguineous marriage. The initial examinations revealed huge splenomegaly and hepatomegaly without any source of infection. Laboratory tests revealed a hemophagocytic lymphohistiocytosis (HLH) like a picture with a high blood level of ferritin in all episodes, but the bone marrow test result was normal. Although he had normal hair and skin pigmentation on physical examination, the accumulation of melanosomes was found in his hair shafts on microscopic investigations. Eventually, a genetic test revealed a mutation in the RAB27A gene, which confirmed GS-II diagnosis. Our case is the first case of GS-II from Iran without any apparent clinical features of GS, such as hypopigmented skin and silvery-gray hair. Therefore, a genetic test, together with the microscopic examination of hair and skin, is necessary for the diagnosis and confirmation of GS-II. Since GS-II is an autosomal recessive disorder and consanguineous marriages are popular in Iran, premarital genetic counseling is recommended for this region.

2602 Strongyloidiasis Presenting as Gastric Outlet Obstruction

INTRODUCTION: Strongyloides Stercoralis is an intestinal parasite mostly seen in tropical areas. Commonly patients are asymptomatic with non-specific gastrointestinal manifestations. We present a case of strongyloidiasis presenting as gastric outlet obstruction. CASE DESCRIPTION/METHODS: Our patient is a 67-year- old woman, originally from Jamaica, recently diagnosed with Diabetes Mellitus who presented with 50 pounds weight loss, anorexia postprandial epigastric pain and recurrent episodes of vomiting. Her symptoms have been progressively getting worse and let her to doctor visits over the past several months. On physical exam she was afebrile but appeared cachectic. She did have minimal tenderness to palpation of the epigastric area and had minimal bilateral pedal edema. Laboratory testing revealed normocytic normochromic anemia, thrombocytosis, Hyponatremia and hypoalbuminemia. An Abdominal CT scan revealed dilatation of the second portion of duodenum and tapering of third portion of duodenum plus mild intrahepatic and extrahepatic bile ducts dilatation as well as dilation of the proximal pancreatic duct (Figures 1 and 2). The patient was admitted to the hospital for hydration and subsequently had an upper endoscopy. The procedure revealed marked retention of bilious fluid as well as evidence of severe duodenitis. Narrowing of the lumen of the duodenum was also seen (Figure 3). Biopsies from the duodenum were obtained and confirmed the presence of Strongyloides Stercoralis. Pt was given two days of Ivermectin with dramatic improvement of her symptoms and subsequent discharge. DISCUSSION: 1. Stercoralis is a nematode with a complex life cycle. The parasite infects humans and replicates within its host for years or even decades (autoinfection). Patients would have positive serologies for S. Stercoralis but usually are asymptomatic. Immunosuppressive medications, HIV, HTLV1, Chronic diseases and in our case the new onset diabetes cause the parasite to replicate and leads to life-threatening dissemination of larvae to multiple internal organs called hyperinfection.

Gastric outlet obstruction and intussusception following Frey's procedure in a patient with chronic pancreatitis - A case report

Most commonly reported postoperative complications of Frey's procedure include sepsis, delayed gastric emptying, and endocrine insufficiency. Here, we report unusual complications such as gastric outlet obstruction and intussusception following Frey's procedure in the late postoperative period. A 40-year-old patient with chronic pancreatitis with common bile duct stricture who underwent Frey's procedure, presented with recurrent vomiting episodes 3 months postoperatively. Contrast-enhanced computed tomogram (CECT) abdomen showed features of gastric outlet obstruction. A gastrojejunostomy was carried out. The patient was asymptomatic for 2 months following which the patient presented with features of jejunojejunal intussusception confirmed on CECT, which was managed conservatively. The patient remains asymptomatic on follow-up for the past 9 months. Our experience reveals that although reports of such complications following Frey's procedure are rare, gastric outlet obstruction and intussusception can occur following Frey's procedure, and hence, the surgeon should have an index of suspicion in patients with atypical presentation.

Colon Cutoff Sign

Abstract not availableBangladesh Crit Care J March 2016; 4 (1): 61

Pediatric Emergency Update: Cyclic Vomiting Syndrome

Vomiting is a common chief complaint in the pediatric ED population. Emergency nurses should develop a systematic approach that is age and developmentally appropriate to evaluate the child with vomiting to identify life-threatening emergencies. Vomiting isasymptomthatcanindicateavastarrayofmedicalproblems from catastrophic to benign. Some children have chronic recurrent vomiting episodes, diagnosed as cyclic vomiting syndrome. Emergency nurses caring for pediatric patients must be objective and open to all differential diagnoses that vomiting could represent. Misdiagnosis of children with the chief complaint of vomiting is not uncommon. It is important to look at each body system of a child brought to the emergency department with recurrent vomiting. The following case report of a 4-month-old infant brought to the pediatric emergency department for frequent vomiting can serve as an example. The child was beautiful, well developed, chubby, awake, and alert, being evaluated in the outpatient setting by both his pediatrician and a gastroenterologist for recurrent vomiting. The child’s primary nurse in the pediatric emergency department noted that a complete workup was ordered, which included blood tests, urine tests, radiographs, and a computed tomography (CT) scan of the head. The child’s mother was concerned that he kept spitting up (vomiting) for no apparent reason. Part of the complete workup for this infant involved obtaining a straight catheter urine specimen. When the diaper was removed to obtain this specimen, abnormal urine flow was noted. The child’s urine stream would start and stop and then repeat this pattern. Documentation of this was placed in his medical record, and the ED pediatrician was notified. A brain tumor was identified on CT scan. Fortunately, during this pediatric emergency visit, this child with a history of recurrent vomiting was evaluated objectively, using a systematic format. The child was admitted with the newly diagnosed brain tumor for further evaluation and treatment. When all differential diagnoses—both life-threatening and benign—that may cause the child’s vomiting are eliminated, cyclic vomiting syndrome can be diagnosed. Cyclic vomiting syndrome is a chronic gastrointestinal condition identified in children as long ago as in the 1800s. The description of cyclic vomiting syndrome includes the following: the child has 3 or more distinct episodes of recurrent severe vomiting, with completely normal health between episodes, and the child’s vomiting occurs with similar timing, symptoms, and duration. The vomiting episodes of children diagnosed with cyclic vomiting syndrome have variable duration from hours to days, with no exact cause identified. The exact pathophysiology of recurrent cyclic vomiting is unknown. Emergency nurses who care for pediatric patients need to ensure that all potential life-threatening differential diagnoses are eliminated before labeling pediatric patients as having cyclic

Severe Complication and Shoplifting Behavior in a Young Man with Atypical Anorexia Nervosa: A Case Report

Anorexia nervosa (AN) is an eating disorder characterized by excessive restriction on food intake and irrational fear of gaining weight, often accompanied by a distorted body self-perception. It is rare among men. We report a case of a 20-year-old man who presented with gradual loss of weight and recurrent episodes of vomiting. Several biochemical and hormonal alterations, multiple medical complications, and cortical atrophy were ascertained. During hospitalization, he was at high risk due to those life-threatening severe refeeding syndrome. Furosemide and human serum albumin were used to control the refeeding syndrome, which achieved a rapid and significant curative effect. Body weight significantly gained, and the patient was discharged with various stable parameters. One year later, he was caught for shoplifting. There was no evidence suggesting any misdeeds to support that the stealing was intentional. The aim of this report was to remind us pay more attention to the male AN. A greater awareness of this condition in the male may lead to an early diagnosis and therapy for reducing morbidity and mortality.

The diagnostic challenge of acute heart failure: the heart interacting with systemic organs

We present a clinical case of a 56-year-old woman with medical history of obesity and asthma treated with bronchodilators and inhaled corticosteroids. Because of a severe bronchospasm episode she initiated oral corticosteroid and 48 hours later she started epigastric discomfort, vomiting, diaphoresis and palpitations. She presented to our emergency department with hypertension (190/100 mmHg) and tachycardia (130 beats per minute). Electrocardiogram identified sinus tachycardia with anterolateral ST segment depression. Cardiac biomarkers were elevated (peak troponin I of 11.2 ng/mL) and chest radiograph was normal. Transthoracic echocardiogram revealed mild left ventricular (LV) systolic dysfunction with inferior hypokinesia. She was transferred to our coronary care unit with the diagnosis of non-ST elevation myocardial infarction. Coronary angiography demonstrated absence of obstructive coronary disease. Patient developed acute heart failure and progressive pulmonary congestion. She also manifested recurrent episodes of vomiting and palpitations associated with sinus tachycardia (120-160 bpm), cyclic hypertensive crisis (blood pressure of 210/120 mmHg) alternating with hypotension as well as hyperthermia. Laboratory values revealed elevated leukocyte count and C-reactive protein values which led to consider as the most probable the diagnosis of acute myocarditis. Echocardiography reevaluation showed severe LV dysfunction with basal segments akinesia and apex hypercontractility suggesting the pattern of inverted Takotsubo cardiomyopathy. Patient was subsequently referred for a cardiac magnetic resonance study to further evaluate LV function and myocardial tissue characterization. LV cine images revealed total systolic function recuperation, T2-weigthed imaging without edema and absence of late gadolinium enhancement. In addition, a large masse was identified in the right suprarenal gland, suggesting pheochromocytoma. Serum catecholamines were increased and functional imaging by I-123 labeled meta-iodobenzylguanide scan demonstrated abnormal uptake in the right adrenal only. Patient underwent surgical resection of the adrenal mass and histology confirmed the diagnosis of secreting pheochromocytoma. Patient was then discharged asymptomatic. Although rare, pheochromocytoma should be considered in the differential diagnosis of Takotsubo-like cardiomyopathy and systemic glucocorticoids should also be considered as a probable trigger for serum catecholamine release in those patients.