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Lemierre's syndrome is a rare but potentially severe complication of bacterial infections that usually affects previously healthy adolescents and young adults. It commonly presents as septic thrombophlebitis of the internal jugular vein and bacteremia following a recent oropharyngeal infection. The most commonly isolated organisms are Fusobacterium necrophorum , followed by Fusobacterium nucleatum and other anaerobes. Atypical Lemierre's syndrome is characterized by thrombophlebitis at sites distant from the head and neck veins and is far less encountered than typical Lemierre's syndrome. Here, we present a case of an elderly African American female with pylephlebitis, a rare abdominal variant of Lemierre's syndrome with extensive portal vein, splenic vein, and mesenteric vein thrombosis following perforated diverticulitis and resultant F. nucleatum bacteremia. She demonstrated complete recovery following appropriate long-term intravenous antibiotics and anticoagulation. This case calls attention to the re-emergence of the rare manifestation of this forgotten disease and highlights improved outcomes with prompt recognition and early treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mohammadian et al.)

A pericardial cyst is one of the rare causes of mediastinal masses. Most of the cases are secondary to congenital incomplete fusion of the pericardial sac. More than two-thirds of the cases are present in the right cardiophrenic angle, and the left cardiophrenic angle is the second most common location. In our study, we illustrated an incidental finding of the pericardial cyst in a patient who presented with nonspecific symptoms and was found to have a left-sided cardiophrenic pericardial cyst, which is only found in about 20% of the cases. A CT scan and echocardiogram confirmed the diagnosis of a 4.39-centimeter cyst with no signs of complications like tamponade or pericarditis. As the patient's symptoms resolved, outpatient follow-up with serial echocardiogram was advised. Through this report, we aim to raise awareness of the importance of further investigation for nonspecific symptoms like atypical chest tightness and differentiating simple pericardial cysts from other pericardial lesions. Based on the symptoms, size, and compression effect of the cyst, management may vary from serial echocardiogram to aspiration or surgical resection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Noori et al.)

Levine's sign is a universal sign of ischemic chest pain, defined as an individual holding a clenched fist over the chest that has a low sensitivity but is relatively specific for ischemia. Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic and a very unusual cause of acute myocardial infarction.In literature,   it has been more common in young women, postpartum, or with fibromuscular dysplasia. Strenuous exercise is a rare cause of SCAD. We describe a case of a healthy 46-year-old Hispanic male who presented to ER after his morning gym session. The initial EKG was unremarkable. However, due to Levine's sign, a repeat EKG was done and showed hyperacute T waves with J-point elevation in the anterior leads. An immediate coronary angiogram revealed a spontaneous coronary artery dissection in the mid-left anterior descending artery (LAD) segment. Given the resolution of the chest pain and thrombolysis in myocardial infarction (TIMI) 3 flow, no intervention was done. The patient was managed medically with an uneventful recovery. In the current times, with the advent of high sensitivity troponin along with other rapid multimodality imaging techniques, the importance of physical signs and symptoms like Levine's sign has diminished. Yet, they still remain a vital part of patient evaluation. Additionally, SCAD is uncommon in males. However, this patient was consuming energy booster powder that may have predisposed him to the SCAD. In our opinion, Levine's sign still has high clinical value in the right context. We also postulate that energy booster supplements may have serious deleterious cardiovascular effects, and large studies are necessary to understand their full effects on the cardiovascular system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mohammadian et al.)

Unilateral Isolated oculomotor nerve palsy is a rare neurological complication after cardiac catheterization. Concomitant thalamus and midbrain infarction secondary to embolic events involving the artery of Percheron after cardiac catheterization have been reported in the literature. However, isolated midbrain infarction is a rare neurological deficit. Here, we present the case of a patient who presented with mild left-sided ptosis, binocular diplopia, and partially impaired left eye adduction two hours after cardiac catheterization. Brain magnetic resonance imaging revealed a focal area of restricted diffusion within the midbrain tegmentum, confirming this rare brainstem stroke., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mohammadian et al.)

Infective endocarditis (IE) secondary to Staphylococcus aureus and streptococcus species comprises the majority of cases in literature with Gram negative bacterial insults occurring infrequently. Serratia marcescens is a Gram negative bacillus which is classified as motile, non-lactose fermenting, and a facultative anerobe. The presumed risk factor for the development of S. marcescens IE is intravenous drug use (IVDU). We report two cases of IE causes by S. marcescens : first case describes IE of tricuspid and aortic valve requiring surgical intervention further complicated by epidural abscess. The second case was associated with renal and splenic infarct. These cases highlight the severity and complicated nature of S. marcescens IE. Given S. marcescens IE has been infrequently described in the literature, we believe that our cases are worth reporting to contribute to the present incidence and management of S. marcescens IE., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Elkattawy et al.)

SARS-CoV-2 has created universal disarray since its outbreak in 2019. Emergent measures were taken worldwide to mitigate the morbid outcomes of the pandemic. Multiple organ systems have been shown to be negatively impacted secondary to the heightened inflammatory response to the novel virus. In this report, we focus on the respiratory system. The novel virus impact on the respiratory system has been well documented, leading to acute respiratory distress syndrome. Here, we present a case of a patient with no risk factors for pneumothorax (smoking, underlying lung disease, prior history of pneumothorax, age, family history) who was found to be SARS-CoV-2 positive and developed a significant pneumothorax requiring transfer to the intensive care unit., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Younes et al.)