Fifth-Generation Cephalosporins Is Not Spared From Drug-Induced Liver Injury.

Ceftaroline fosamil is a fairly new parenteral cephalosporin antibacterial approved by the US Food and Drug Administration (FDA) for use in the treatment of acute bacterial skin and skin structure infections (ABSSSI). Drug-induced liver injury (DILI) is an important side effect profile to consider with antibiotic use. This case reports DILI in a previously healthy individual associated with a widely used antibiotic, ceftaroline, after only two doses.

Deep Vein Thrombosis in a Patient with Negative Age-Adjusted D-Dimer Level.

D-dimer level, along with a clinical probability tool that uses the Wells score, is commonly used to exclude deep vein thrombosis (DVT). Age-adjusted D-dimer values are routinely used in clinical practice to increase the negative predictive value and avoid unnecessary Doppler ultrasound imaging. We describe a patient with a low pre-test probability of DVT upon admission and a negative D-dimer level based on age-adjusted values who was later diagnosed with DVT.

A Case of Prolonged Fever in a Patient Infected With COVID-19 on Ofatumumab.

We discuss a case of a 53-year-old woman with multiple sclerosis on monthly ofatumumab injections, who was infected with SARS-CoV-2 with persistent fevers for seven weeks. She was hospitalized for fever with diagnostic workup being unremarkable with negative SARS-CoV-2 IgM and undetectable nucleocapsid IgG antibodies four weeks out from the initial infection, indicating she may not have mounted an appropriate immune response to the infection. Patients on immunosuppression therapy may have a prolonged course of disease given that medications such as ofatumumab can take up to 24 weeks of B-cell recovery post-treatment discontinuation and a longer road to recovery.

Ketamine as an Analgesic Adjunct for Opioid-Induced Hyperalgesia in a Patient With a Sickle Cell Pain Episode.

Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that has been proposed as a safe and effective nonopioid analgesic when given in lower doses than those historically used for general anesthesia. Case reports have demonstrated efficacy using low-dose ketamine for pain management and opioid weaning in patients with chronic noncancer pain, but reports of successful use in patients with sickle cell pain are limited. A 35-year-old African American male with sickle cell disease presented to the emergency department with severe generalized body aches and left flank pain.

Pathobiology and evolving therapies of coronary artery vasospasm.

Coronary artery vasospasm is a known cause of chest pain and requires a high level of clinical suspicion for diagnosis. It also remains in the differential diagnosis for patients presenting with type 2 myocardial infarction. There are few randomized controlled trials for guideline-based prevention and treatment for coronary artery vasospasm.