Search

A previously healthy 26-year-old male was referred to our hospital for fever occurring after getting a tattoo on the left leg. At the emergency department, he was promptly diagnosed with sepsis and necrotizing fasciitis of the left leg. The patient was empirically treated with vancomycin and piperacillin/tazobactam. Blood cultures identified Streptococcus pyogenes. Necrotizing fasciitis required acute surgery. The patient survived as a result of an early clinical diagnosis and surgical intervention. We report the first case of sepsis and severe soft tissue infection, after legal tattooing, which required fasciotomy. All previously reported cases have been about necrotizing fasciitis in young males who received traditional Samoan tattooing, a practice usually realized with handmade tools. In our patient, the tattoo, created in Samoan style, was performed in an authorized center by a professional tattooist using contemporary sanitary techniques.

We report here a case of coronavirus disease 2019 pneumonia in a 40-year-old Caucasian woman with Down syndrome admitted to the Internal Medicine Unit. She was initially treated with hydroxychloroquine and azithromycin. When respiratory conditions dramatically worsened, she was not admitted to the intensive care unit because of impaired cognitive function. Thus helmet-based continuous positive airway pressure was started. The respiratory conditions progressively improved, reaching spontaneous breathing.

In 1 patient the diagnosis was further confirmed at operation. Normal pulmonary venous connection to the left atrium can usually be identified by 2-D echo in 3 views: apical, subcostal and suprasternal.1,3*5 However, failure in demonstrating pulmonary venous connection to the left atrium cannot by itself be construed as evidence for abnormal pulmonary venous drainage. Hence, demonstration of a dilated common pulmonary vein, usually behind the left atrium, is of paramount importance in the diagnosis of TAPVC. To achieve this, proper gain settings and careful scanning of the pulmonary veins in different echo planes by apical, subcostal and suprasternal approaches are mandatory, lest a diagnosis of normal pulmonary venous drainage be falsely made. This is exemplified in our experience with both patients. When examined initially from the subcostal position, we had a false impression of normal connection of the right upper pulmonary vein with the left atrium. Visualization of a dilated descending common pulmonary vein in the liver with subsequent scanning provided a clue for the diagnosis of TAPVC. The small, alleged pulmonary vein most likely represented 1 of the horizontal veins behind the left atrium just above the diaphragm. False connection of this pulmonary vein with the left atrium probably resulted from poor image resolution in this particular subcostal view. In a deeper subcostal cut of the long axis of the 2 atria, a mildly dilated pulmonary venous confluence, clearly separated from the left atrium, was demonstrated.