Gas-forming pyogenic liver abscess (GFLPA) carries a high mortality rate. Early identification of the source of infection in sepsis results in better survival. Bedside point of care ultrasound (POCUS) can be used to help localize a source of infection. A 59-year-old man presented with systemic inflammatory response syndrome (SIRS) and was diagnosed with GFLPA on the initial encounter via clinical assessment and POCUS examination. After commencing antibiotics, optimal glucose control, adequate fluid resuscitation, and early infective source control, he achieved full recovery and was followed up in outpatient medical and surgical clinics. This case illustrates the role of POCUS as a diagnostic tool in sepsis and raises awareness among clinicians to recognize the features of GFLPA on POCUS.
Dengue fever is an arthropod-borne viral disease that is widespread throughout the world. We report a case of dengue cardiomyopathy that was detected and treated to best effect using point of care ultrasound (POCUS) and the VExUS score. A 75-year-old lady with no known comorbidities presented with a ten-day history of fever, vomiting, loose stool, and poor appetite. Upon arrival, she was febrile and hypotensive. POCUS examination showed reduced left ventricular systolic function, inferior vena cava measuring 2.27 cm and VExUS grading of 2 to 3. Dengue serology IgM and IgG were positive and NT-proBNP was raised at 12500 pg/ml. Instead of fluid resuscitation, diuretic and inotropes were initiated along the line of cardiogenic shock secondary to dengue cardiomyopathy. Serial normal cardiac enzymes and electrocardiogram excluded acute coronary syndrome. She was discharged well, and repeated echocardiography one-month post discharge showed normal left ventricular systolic function with no clinical signs or symptoms of heart failure.
Pericardial effusion is a relatively common classical pericardial syndrome that poses a diagnostic challenge for clinicians. There are varying clinical presentations of pericardial effusion, ranging from asymptomatic incidental findings on chest X-ray (CXR) or point-of-care ultrasound (POCUS) to hemodynamic instability in cardiac tamponade. Pericardial effusion is a notable cardiac manifestation of severe and long-standing hypothyroidism. We report the case of a 57-year-old female with a previous history of Graves' disease treated with radioactive iodine (RAI) more than 30 years prior but who had never been followed up on post-RAI. Admission CXR depicted a water bottle-shaped cardiomegaly. POCUS portrayed a massive pericardial effusion with no echocardiographic evidence of cardiac tamponade. Laboratory investigations showed raised thyroid-stimulating hormone and low free thyroxine. The pericardial effusion gradually subsided during the surveillance echocardiogram after initiation of thyroid hormone replacement therapy. Early POCUS assessments in this case expedite the diagnosis and management of hypothyroidism-induced pericardial effusion. With timely and adequate thyroid hormone replacement therapy, pericardial effusion can be reversed, thereby averting the fatal complications of cardiac tamponade.
BACKGROUND: Gout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis.
CASE PRESENTATION: We report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started.
CONCLUSION: Spinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.