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Mousa A, Hassan A, Oudah B, Arslan KI, Parang P. Acute Spontaneous Subdural Hematoma in a Patient With an End-Stage Renal Disease After Starting Dual Antiplatelet Therapy Post Drug-Eluting Stent Insertion: A Case Report. Cureus 2023; 15:e41761. [PMID: 37575833 PMCID: PMC10416268 DOI: 10.7759/cureus.41761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Dual antiplatelet therapy (DAPT) has been widely utilized for secondary prevention in patients with cardiovascular diseases, such as post-drug eluting stent insertion, stroke, and peripheral vascular disease. The occurrence of bleeding complications, including intracranial hemorrhage, has been extensively studied in relation to DAPT. However, the occurrence of acute spontaneous subdural hematomas in this context is relatively rare. These hematomas can manifest through various symptoms, including altered mental status (AMS) and confusion. The risk of intracranial hemorrhage is particularly higher in patients receiving aspirin with ticagrelor, especially in those with reduced estimated glomerular filtration rate (eGFR) and liver disease. In this case report, we present the case of a patient with end-stage renal disease undergoing peritoneal hemodialysis and a remote history of liver transplant. The patient presented to the hospital with chest pain, subsequently underwent drug-eluting stent placement, and was initiated on DAPT. Following the initiation of DAPT, the patient developed confusion and was diagnosed with an acute spontaneous subdural hematoma. The patient underwent middle meningeal artery embolization to manage the hematoma.
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Affiliation(s)
- Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Ahmed Hassan
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Bashar Oudah
- Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA
| | | | - Pirouz Parang
- Cardiology, Capital Health Regional Medical Center, Trenton, USA
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Arshad H, Oudah B, Mousa A, Kakhktsyan T, Abu-Abaa M, Agarwal A. Tick-Borne Myopericarditis With Positive Anaplasma, Lyme, and Epstein Barr Virus (EBV) Serology: A Case Report. Cureus 2023; 15:e40440. [PMID: 37456368 PMCID: PMC10349210 DOI: 10.7759/cureus.40440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Myopericarditis has been reported only rarely in those with anaplasmosis and is typically difficult to diagnose. Lyme carditis can also be difficult to diagnose as it is relatively rare but potentially fatal and usually has nonspecific manifestations. We are presenting a 61-year-old male patient who presented in New Jersey, United States with unremitting fever, chills, and myalgia for two weeks along with nausea, vomiting, and diarrhea. Investigations were suggestive of perimyocarditis as was indicated by diffuse ST segment elevation on electrocardiography (EKG) with the presence of small pericardial effusion on echocardiography. A mild troponin leakage was also seen. This progressed to septic shock that required vasopressor therapy. Further history-taking revealed recent tick exposure and prompted empirical initiation of doxycycline. This proved to be successful with fever defervescence and clinical improvement. Serological tests confirmed both acute Lyme and anaplasma infections along with positive serology of Epstein Barr virus (EBV). This case highlights an uncommon presentation of carditis in acute Lyme and anaplasma infections with the associated false-positive serology of EBV.
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Affiliation(s)
- Hassaan Arshad
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Bashar Oudah
- Internal Medicine Residency Program, Eisenhower Medical Center, Rancho Mirage, USA
| | - Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Tigran Kakhktsyan
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Mohammad Abu-Abaa
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Ashish Agarwal
- Cardiology, Capital Health Regional Medical Center, Trenton, USA
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Oudah B, Al-Ameri N, Mousa A, Arshad H, Abu-Abaa M, Park S. Variant Angina and Cannabis-Induced Myocarditis: A Rare Presentation of Myocardial Inflammation. Cureus 2023; 15:e41196. [PMID: 37525794 PMCID: PMC10387264 DOI: 10.7759/cureus.41196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
Myocarditis is a rare but serious inflammatory disease of the myocardium, often caused by viral infections. We present a unique case of myocarditis in a previously healthy 29-year-old male who developed symptoms and electrocardiography changes of variant angina following cannabis use. This case report discusses the patient's atypical presentation, diagnostic evaluation, management, and outcome.
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Affiliation(s)
- Bashar Oudah
- Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA
| | - Noor Al-Ameri
- Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA
| | - Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Hassaan Arshad
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Sandy Park
- Cardiology, Eisenhower Medical Center, Rancho Mirage, USA
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Oudah B, Abu-Abaa M, Al-Ameri N, Ghazaleh J, Vanam V. A Possible Association Between COVID-19 Vaccine and Complicated Pleural Effusion: A Case Report. Cureus 2023; 15:e39133. [PMID: 37332399 PMCID: PMC10274251 DOI: 10.7759/cureus.39133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
As COVID-19 vaccines gain more prevalence, previously unrecognized side effects continue to be reported. We report a case of 78 male with no significant past medical history who was found to have a unilateral pleural effusion with symptoms that started two days after the administration of a COVID-19 vaccine. The initial presumption was bacterial pneumonia with parapneumonic effusion. However, the lack of clinical response prompted surgical intervention, and a diagnosis of empyema was established. No evidence of infectious etiology was found. This case helps to support the previously limited evidence in the recent medical literature that suggests a possible association between COVID-19 vaccines and pleurisy/effusion.
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Affiliation(s)
- Bashar Oudah
- Internal Medicine, Eisenhower Medical Center, Ranch Mirage, USA
| | - Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Noor Al-Ameri
- Internal Medicine, Eisenhower Medical Center, Ranch Mirage, USA
| | | | - Vijay Vanam
- Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA
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Arshad H, Mousa A, Oudah B, Kakhktsyan T, Abu-Abaa M, Kass R. Cannabis-Induced ST-Segment Elevation Myocardial Infarction With Possible Coronary Artery Dissection: A Case Report. Cureus 2023; 15:e39594. [PMID: 37384079 PMCID: PMC10294736 DOI: 10.7759/cureus.39594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
Spontaneous coronary artery dissection is a rare and commonly underdiagnosed cause of acute coronary syndrome. Here, we report the case of a 36-year-old male patient who presented with an acute onset of left-sided chest pain, preceded by several hours of nausea and vomiting. Past medical history was significant for chronic marijuana use and multiple episodes of nausea and vomiting requiring multiple hospitalizations. Urinary drug screen was positive for cannabinoids only, and electrocardiography revealed an ST-segment elevation myocardial infarction. This was complicated by an episode of ventricular fibrillation that was successfully defibrillated and prompted cardiac catheterization, which revealed a coronary intraluminal filling defect and a segmental lesion, suggestive of coronary dissection. No evidence of atherosclerotic plaque was noticed. Stent placement and thrombectomy were pursued and the patient was stabilized. As cannabinoid use is gaining legality and becoming widespread, this case aims to enhance physicians' awareness of potentially life-threatening complications of its use.
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Affiliation(s)
- Hassaan Arshad
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Bashar Oudah
- Internal Medicine Residency Program, Eisenhower Medical Center, Rancho Mirage, USA
| | - Tigran Kakhktsyan
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Mohammad Abu-Abaa
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Richard Kass
- Cardiology, Capital Health Regional Medical Center, Trenton, USA
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Abaya Ghazaleh J, Cacdac R, Lim A, Oudah B, Naderi Mohabadi A. Aorta to Right Ventricular Fistula Status Post-TAVR. J Investig Med High Impact Case Rep 2023; 11:23247096231191875. [PMID: 37560796 PMCID: PMC10413882 DOI: 10.1177/23247096231191875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that involves replacing a damaged aortic valve using a catheter, typically inserted through a small incision in the leg, leading to faster recovery and reduced risks compared with traditional open-heart surgery. It is a common procedure; however, it is not without adverse events. We report a case of an 83-year-old man who underwent TAVR for the indication of severe symptomatic aortic stenosis. Shortly thereafter, he complained of progressive shortness of breath and was hospitalized for acute on chronic heart failure. Transesophageal echocardiography (TEE) was the first indication of a potential aorta to right ventricular fistula, and this was confirmed by a cardiac computed tomography angiography (CTA). He underwent a period of medical observation but did not do well, requiring re-admission to the hospital for acute on chronic heart failure. He was ultimately treated by percutaneous low-profile shunt closure using a septal occluder device. Percutaneous shunt closure in symptomatic patients using percutaneous low-profile shunt closure devices seems to be the best treatment option in high surgical risk patients.
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Affiliation(s)
| | - Robert Cacdac
- Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Anthony Lim
- Eisenhower Medical Center, Rancho Mirage, California, USA
| | - Bashar Oudah
- Eisenhower Medical Center, Rancho Mirage, California, USA
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Abu-Abaa M, Hassan M, Oudah B, Al-Ameri N. Rapidly Progressive Bronchiectasis and Pulmonary Fibrosis in Yellow Nail Syndrome with Possible Association with Selective IgM Deficiency. Eur J Case Rep Intern Med 2022; 9:003577. [PMID: 36299846 PMCID: PMC9586509 DOI: 10.12890/2022_003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
A 67-year-old man with a history of IgM deficiency and pulmonary fibrosis and bronchiectasis was admitted for management of worsening symptoms. Investigations revealed exudative pleural effusion with rapidly progressive bronchiectasis. Although a potential trigger of bronchiectasis and pulmonary fibrosis was not identified despite extensive work-up by several physicians in the past, a bedside observation of yellow dystrophic nails on all extremities revealed the diagnosis. This case report helps to remind clinicians of a rare medical disorder of still uncertain aetiology and no available cure. This case is consistent with a few previous case reports that suggest a potential association with selective immunoglobulin deficiency.
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Affiliation(s)
- Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Mohamed Hassan
- Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | | | - Noor Al-Ameri
- Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
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