Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of Nocardia species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy.
Takotsubo syndrome is a rare disease and remained ambiguous with its etiology. The disease manifests in various clinical characteristics and even mimicking acute coronary syndrome. We are reporting a case of an elderly lady who manifested by unsteady gaits and recurrent falls. Subacute infarct of the right corona radiata was observed on the brain CT. In addition, coronary angiography and ventriculogram were performed because of dynamic ECG changes and elevated troponin I levels. The angiogram was normal while ventriculogram showed apical ballooning. She was diagnosed and treated as Takotsubo syndrome.
Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.