Giant Cell Arteritis Presenting as Recurrent Left Middle Cerebral Artery Territory Infarction - Cureus

Background: Timely reperfusion remains the cornerstone of management in ST-segment elevation myocardial infarction (STEMI). However, a substantial proportion of patients continue to present beyond the recommended reperfusion window, particularly in low- and middle-income countries. The outcomes associated with delayed coronary revascularization in these late presenters remain incompletely defined. This retrospective observational study aimed to compare one-year mortality and left ventricular ejection fraction (LVEF) changes according to treatment strategy among STEMI patients presenting more than 12 hours after symptom onset. Methods: We conducted a retrospective observational cohort study including consecutive patients admitted with STEMI more than 12 hours after symptom onset between January 2020 and December 2025 at Mohammed VI University Hospital, Marrakech, Morocco. Patients were stratified according to treatment strategy into delayed percutaneous coronary intervention (PCI), conservative medical management, and coronary artery bypass grafting (CABG). The primary endpoint was one-year all-cause mortality, and the secondary outcome was change in LVEF. Mortality comparisons were

We report a 22-year-old Gravida 1, Parity 0 (G1P0) woman with cystic fibrosis (CF) maintained on elexacaftor/tezacaftor/ivacaftor (ETI; Trikafta) who sustained four hospitalizations for recurrent extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae urosepsis in the four months preceding this admission, ultimately requiring bilateral percutaneous nephrostomy tube placement. Five days after completing a 14-day course of intravenous meropenem delivered via peripherally inserted central catheter (PICC), she presented at 27 weeks and six days of gestation with fever and left-sided flank pain. On hospital day two, she developed hemodynamic compromise consistent with severe sepsis. Blood and urine cultures confirmed Enterococcus faecalis bacteremia. The emergence of Enterococcus faecalis raised concern for antibiotic-driven enterococcal selection pressure from repeated carbapenem exposure. The hospitalization was complicated by acute anemia requiring transfusion of two units of packed red blood cells (PRBC), with the lowest recorded value of hemoglobin being 6.7 g/dL (normal 11.6-15.0 g/dL). Procalcitonin, a marker of bacterial infection severity, was elevated at 3.64 n

Retroperitoneal fibrosis (RPF) is a rare fibroinflammatory disorder in which fibrous tissue forms around the infrarenal aorta and iliac vessels, often compressing the ureters and causing obstructive uropathy and renal impairment. It typically presents insidiously with back, flank, or abdominal pain and constitutional symptoms. We describe a 52-year-old man with a background of hypertension who presented on three occasions over 10 months with an acutely painful, swollen first metatarsophalangeal (MTP) joint, initially on the left and subsequently on the right. The first two episodes were managed as presumed gout, with naproxen and then a short course of oral prednisolone, and his symptoms settled between attendances. His serum urate and creatinine rose across these attendances. At his third presentation, he was incidentally found to be hypertensive with severe renal impairment and was admitted. Imaging demonstrated bilateral hydronephrosis secondary to ureteric compression by a confluent para-aortic soft tissue mass. Following further investigation and specialist multidisciplinary team review, a working diagnosis of idiopathic RPF was made. Bilateral nephrostomies relieved the obstr

Immunotherapy regimens containing the programmed cell death protein 1 (PD-1) inhibitor pembrolizumab are widely utilised in the management of non-small cell lung cancer (NSCLC). However, the administration of pembrolizumab is associated with unique immune-related adverse events. Adrenal insufficiency is a rare, potentially life-threatening endocrinopathy that can manifest even after the cessation of planned treatment. A male in his 50s with metastatic pulmonary adenocarcinoma developed an acute adrenal crisis 12 days after completing a 24-month course of pembrolizumab immunotherapy. Routine outpatient blood tests first identified critical hypocortisolaemia (morning serum cortisol <50 nmol/L), prompting the patient to attend hospital. The patient subsequently developed severe hypotension (58/45 mmHg) and reported malaise, anorexia, and vomiting after oral intake. Septic shock was considered but felt to be less likely given the absence of infective symptoms. The patient was successfully resuscitated in the emergency department with administration of fluids and high-dose intravenous hydrocortisone. Following clinical stabilisation, under the supervision of the endocrinology team, he w

Acute hemorrhage within the thyroid gland is uncommon but can cause rapid neck swelling and, in severe cases, airway compromise. We report a 65-year-old woman with hypertension and a history of partial thyroidectomy performed more than 25 years earlier who presented with painful neck swelling that developed overnight. The swelling was associated with pain on swallowing, without shortness of breath, voice change, drooling, fever, or recent neck trauma. She was hemodynamically stable with an oxygen saturation of 99% on room air. Examination showed marked neck swelling, thyromegaly, thyroid tenderness, and left-sided neck induration. Contrast-enhanced computed tomography (CT) demonstrated a multinodular thyroid with a large heterogeneous mass in the left thyroid lobe causing mass effect and rightward tracheal deviation. Subsequent ultrasonography demonstrated a heterogeneous intrathyroidal collection consistent with hematoma. The patient remained clinically stable and was discharged after approximately five hours of observation. At otolaryngology follow-up 10 days later, repeat ultrasonography showed a progressively enlarging left thyroid nodule, and fine-needle aspiration cytology wa

We present a case of a six-month-old female with a five-month history of right-sided torticollis that showed little improvement despite physical therapy. She presented to the emergency department due to parental concern for pneumonia, with congestion and cough without respiratory distress. Physical examination demonstrated leftward rotation and right lateral flexion of the head and cervical spine, consistent with the previously diagnosed right-sided torticollis. Chest radiographs were obtained in the workup for pneumonia and incidentally revealed segmentation anomalies of the cervical and upper thoracic spine as well as multiple bilateral bifid and fused ribs, more pronounced on the right. The radiographic findings were interpreted as highly suggestive of Klippel-Feil syndrome (KFS). In the setting of refractory torticollis and characteristic congenital vertebral abnormalities, the diagnosis of KFS was made. No acute complication requiring immediate intervention was documented. Referral to appropriate specialists was recommended for further evaluation and longitudinal management. This case highlights the importance of maintaining a broad differential diagnosis when evaluating refra