Lung abscesses caused by Brevundimonas diminuta (B. diminuta) are a rare occurrence, particularly in immunocompetent adults. We present the case of a 47-year-old male with a history of COPD, bipolar disorder, and seizure disorder, who presented with a productive cough, worsening shortness of breath, yellow sputum, weight loss, and fatigue over a period of three weeks. Clinical examination revealed decreased breath sounds in the left upper lung zones. Laboratory investigations showed an elevated white cell count, while blood cultures identified B. diminuta. Imaging with computed tomography (CT) confirmed the presence of a 4.2x2.0 cm cavitary lesion consistent with a lung abscess. The patient was successfully treated with a combination of Ampicillin/Sulbactam and Azithromycin, followed by a course of oral Augmentin. Given the size of the abscess and favorable response to antibiotic therapy, invasive procedures were deemed unnecessary. This case underscores the importance of considering unusual pathogens in the etiology of lung abscesses, even in immunocompetent individuals, and highlights the successful management with appropriate antibiotic therapy.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Its prevalence in cancer patients undergoing treatment with radiation or chemotherapeutic agents has been on the rise. The most common offending agents are alkylating agents and anthracyclines causing various types of arrhythmias, including AF. We report a case of a 62-year-old male who was diagnosed with stage IV pleomorphic rhabdomyosarcoma and was started on chemotherapy with a mesna-ifosfamide and doxorubicin (MAI) regimen. He developed AF with a rapid ventricular rate soon after his second cycle of treatment, which got better with the initiation of beta-blocker therapy. Since low blood counts, including low platelet levels, are expected in patients with chemotherapy, the continual use of anticoagulation therapy varies on a case-to-case basis.

This article presents a case report highlighting the association between fibromuscular dysplasia (FMD) and acute myocardial infarction in a 25-year-old female patient with multiple cardiovascular comorbidities. Initially presenting with a hypertensive emergency, the patient subsequently developed acute coronary syndrome. MRI revealed irregular narrowing of the bilateral renal arteries, consistent with a diagnosis of FMD. Further evaluation through cardiac catheterization confirmed 95% stenosis of the mid-circumflex artery, necessitating percutaneous coronary intervention (PCI). Fibromuscular dysplasia has been frequently reported in conjunction with coronary artery dissection leading to acute coronary syndrome, especially in young females. Here, we describe the case of FMD without any coronary artery dissection. The presence of FMD highlights the need for comprehensive evaluation and management in patients with multiple cardiovascular risk factors. The recognition of FMD as an underlying pathology in acute myocardial infarction is crucial for appropriate intervention strategies. In this particular case, PCI was successfully performed to address the significant stenosis of the mid-circumflex artery. These findings emphasize the importance of considering FMD as a potential contributing factor in young patients presenting with acute coronary syndrome, particularly in the context of renal artery involvement. Increased awareness among healthcare providers regarding the association between FMD and acute myocardial infarction can aid in prompt diagnosis, appropriate management, and improved patient outcomes.

We present a case report of a non-ST segment elevation myocardial infarction (NSTEMI) occurring in an 89-year-old male with severe rhabdomyolysis and COVID-19 infection. The patient had a complex medical history, including non-ischemic cardiomyopathy, sinus bradycardia status post permanent pacemaker placement, and multiple comorbidities. He presented to the emergency department after a mechanical fall and was found to be COVID-19 positive. Despite the absence of typical symptoms, the patient's elevated troponin levels and electrocardiogram findings indicated NSTEMI. The initial management included an acute coronary syndrome protocol and admission to the cardiac intensive care unit. During the hospitalization, the patient developed acute hypoxic respiratory failure and was treated for COVID-19 pneumonia. The patient's renal function and creatine kinase levels showed improvement, and cardiac catheterization revealed non-obstructive coronaries. The patient was discharged in stable condition with a follow-up scheduled.

Immune checkpoint inhibitors (ICI) are a new class of pharmaceuticals that facilitate the immune system in identifying and targeting cancerous cells. However, suppressing immune regulation can often cause immune-mediated adverse events. One such downstream effect recently recognized is ICI-associated myocarditis. This case involves a 67-year-old female patient with a medical history of metastatic small-cell lung carcinoma undergoing chemotherapy with atezolizumab (third cycle) and the carboplatin-etoposide regimen (fourth cycle). The patient presented to the medical service with chest discomfort and fatigue. Elevated cardiac markers were observed, despite the absence of ischemic changes on electrocardiography and patent coronary arteries on cardiac catheterization. Cardiac magnetic resonance imaging (MRI) did not reveal any significant fibrosis in the cardiac muscle; however, an endomyocardial biopsy noted mild fibrosis. Corticosteroid treatment resulted in the normalization of cardiac enzyme levels and subsequent symptom resolution. ICI-associated myocarditis typically manifests within two months of initiating therapy. However, this case report spotlights the occurrence of a milder form of myocarditis after three months of ICI treatment.

This case report presents a rare and intricate clinical scenario involving a 58-year-old male with a history of hypertension, intravenous drug use (IVDU), and cocaine abuse. The patient presented with profound hypotension and symptoms suggestive of impending shock. Septic workup revealed Staphylococcus aureus in all four blood culture bottles, confirming a diagnosis of infective endocarditis (IE). Transthoracic echocardiography demonstrated a large vegetation measuring 1.9x1.7 cm on the mitral valve. Additionally, the patient exhibited non-ST segment elevated myocardial infarction (NSTEMI) type II in the setting of cocaine use, atrial fibrillation, and therapeutic anticoagulation. Subsequent imaging studies raised concerns regarding hemorrhagic stroke. A multidisciplinary team comprising cardiology, cardiothoracic surgery, infectious disease, and neurology collaborated to develop an optimal management strategy. Considering the high-risk features of the IE and the need to address the hemorrhagic stroke, anticoagulation was temporarily halted, and the patient was transferred for urgent mitral valve replacement surgery. This case highlights the complex interplay between substance abuse, cardiovascular complications, IE, and neurological events, underscoring the challenges encountered in managing such patients.