Journal of Clinical Case Reports

Background: The coincidence of Moyamoya along with pineal germinoma is not reported in the literature.
Case description: We report an unusual presentation of a 19-year-old young man diagnosed with pineal gland germinoma and Moyamoya syndrome. He presented with Parinaud’s syndrome, with radiological investigations (CT and MRI scans) showing pineal gland enhancing lesion causing obstructive hydrocephalus. Endoscopic third ventriculostomy along with lesion debulking yielded a diagnosis of pineal germinoma. Postoperatively he developed bilateral middle cerebral artery territory infarcts and became aphasic with left hemiparesis. Computed Tomography (CT) angiography revealed bilateral Moyamoya vasculopathy. Two months post-operatively he developed spontaneous left frontal lobe hemorrhage with intraventricular extension; emergent external ventricular drain inserted. The patient was discharged in a vegetative state.
Conclusion: Management of both these conditions pose a therapeutic challenge as chemo-radiation therapy for germinoma holds a risk of potential worsening of neurologic deficits related to Moyamoya.

Background: Post-COVID-19 infection syndrome has been described in children, known as Multisystem Inflammatory Syndrome in Children temporally associated with SARS-CoV-2. Clinical signs and symptoms include conjunctivitis, rash, fever, hypotension, gastrointestinal symptoms, myocarditis and coronary abnormalities. Most case reports were described in children, and there are very few case reports of Post-COVID-19 Multisystem Inflammatory Syndrome in Adults (MIS-A). Case report: We describe a case of a healthy 21-years-old man with symptoms of fever, myalgia and loss of taste, followed by severe dyspnea and hypoxemia. Chest computed tomography scan revealed extensive bilateral lung infiltrates. Shock and acute kidney injury followed. Echocardiography showed severe left ventricular dysfunction. The patient was intubated and ventilated. Due to cardiogenic shock and hypoxemia, veno-arterial Extracorporeal Membrane Oxygenation (ECMO) therapy was initiated. A diagnosis of multisystem inflammatory syndrome due to past COVID infection was made. The patient received methylprednisolone pulse therapy and intravenous immunoglobulin therapy. His condition improved quickly, and the patient was weaned off ECMO support. Conclusion: We presented a case of severe MIS-A in a young adult, with recent asymptomatic COVID-19 infection, manifested as cardiogenic shock and pulmonary edema. As MIS-A presentation may mimic other pathologic conditions; high index of suspicion is required.

Background: Dilated cardiomyopathy with heart failure is a common cause of morbidity and mortality in patients with Becker muscular dystrophy. An early diagnosis, treatment and a close follow-up are crucial in improving quality of life and prognosis. Neuro-hormonal therapy may improve symptoms and cardiac dysfunction and reduce mortality risk. Little is known about the use of sacubitril/valsartan for heart failure in patients with Becker muscular dystrophy and dilated cardiomyopathy.
Methods: We present a case series of four patients with Becker muscular dystrophy cardiomyopathy followed in a dedicated cardiologic neuromuscular program and treated with sacubitril/valsartan because of severe left ventricular dysfunction with heart failure symptoms.
Results: In our experience sacubitril/valsartan was effective in improving symptoms and functional capacity, in reducing hospital admission for HF and, when early introduced, it promoted positive reverse heart remodeling. Despite a fragile population, sacubitril/valsartan was safe, without episodes of hypotension or renal function worsening.
Conclusion: Sacubitril/valsartan may be considered an effective and safe pharmacological option in patients with Becker muscular dystrophy and dilated cardiomyopathy with reduced ejection fraction.

Apergillosis in immunocompetent critical patients has increased incidence over the past two decades. Patients at risk include those with systemic steroid therapies and deteriorate pulmonary functions (COPD). Hemoptysis is a devastating complication of pulmonary aspergillosis reported in 28.9% of cases.