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Contrary to humans, candidiasis is a rare infection in animals. However, in reptiles, candidiasis can cause gastrointestinal, cutaneous, or rarely systemic infections in stressed animals. The infections due to Yarrowia lipolytica have been increasingly described in human medicine, and hundreds of cases are reported, comprised of granulomatous lung lesions. Herein, granulomatous pneumonia of a spectacled caiman, Caiman crocodilus , was described, and the presence of Y. lipolytica in the lesion was confirmed through histopathology, microbiologic cultures, and molecular methods. The cause of death of the spectacled caiman was ascribed to bacterial shock septicemia consequentially to a traumatic lesion. However, in the right lung, several nodules containing white exudate were evidenced. At mycological and molecular analyses, Y. lipolytica was evidenced, and the histological finding confirmed the presence of a Candida infection in the lung granulomatous lesions. The comparison of ITS sequences with 11 Yarrowia spp. isolates, recently described in green sea turtles, and with a human strain was conducted, and the whole genome of a strain isolated in the spectacled caiman was sequenced. Even though Y. lipolytica is considered a non-pathogenic yeast and has been rarely described in animals, it seems to cause granulomatous lesions in reptiles as in humans., Competing Interests: The authors declare no conflict of interest.

Acute profound thrombocytopenia is a serious complication of glycoprotein IIb/IIIa inhibitor therapy characterized by a precipitous decline in platelet count to <20 x 10(9)/l within few hours of therapy initiation. This potentially devastating event is extremely uncommon in patients receiving small molecule inhibitors such as eptifibatide and tirofiban. The authors present a case of a patient with acute coronary syndrome scheduled for urgent percutaneous coronary intervention who developed acute profound thrombocytopenia during treatment with intravenous tirofiban. The platelet count decreased to a nadir of 3 x 10(9)/l 2 h after initiation of inhibitor administration. All other possible etiologies of thrombocytopenia were unlikely and the low platelet count had to be attributed to tirofiban. Tirofiban was discontinued and the patient was treated with steroids, immunoglobulin and platelet transfusion. No bleeding events occurred and the patient was discharged on day 18. Interestingly, the patient underwent a percutaneous coronary intervention 1 month before and received the same dosage regimen of tirofiban without complications. Implications for the incidence, diagnosis and treatment of thrombocytopenia disorders are discussed.

Infective endocarditis, a serious microbial infection of the cardiac endothelial surface, may involve any heart valve. However, right-sided endocarditis is uncommon in non-intravenous drug abusers without underlying heart disease, and the contextual involvement of the left-sided valve is exceptional. A 63-year-old man with no evidence of intravenous drug abuse or heart disease, presented with persistent fever, worsening of breath, and aphasia. His medical history was notable for mild arterial hypertension and serious lymphangitis with cutaneous erosions on the legs. Transesophageal echocardiography was performed for suspicious endocarditis and showed a pedunculated and highly mobile vegetation adhered to the atrial portion of the posterior leaflet of the mitral valve, protruding into the left ventricle through the valvar orifice. Another large vegetation was seen at the tricuspid valve surface and protruded into the right ventricle during diastole. Cerebral and thoraco-abdominal computed tomography scan revealed multiple embolism to the left kidney, spleen, lungs and central nervous system. Blood cultures identified Staphylococcus aureus. The only risk factor was large skin sepsis. Despite successful antibiotic therapy, the patient died for development of renal and respiratory failure.

Radiation therapy is an effective and common treatment modality for Hodgkin's lymphoma, with proven long-term high survival rates and freedom from recurrences. However, the development of radiation-induced coronary artery disease, characterized by severe and widespread coronary involvement and by a high mortality secondary to acute ischemic events, is one of the most feared complications of this treatment modality. Furthermore, in such patients the optimal approach to revascularization remains to be determined, owing to some specific technical surgical difficulties and, as reported in the literature, to the limited experience available to date with percutaneous intervention, especially in case of acute ischemic syndromes. We report on a case of acute anterior myocardial infarction with cardiogenic shock in a 29-year-old male who had undergone radiation therapy to the chest for Hodgkin's lymphoma 10 years previously. He was immediately transferred to the catheterization laboratory: intra-aortic balloon counterpulsation was followed by coronary angiography which revealed severe, widespread triple-vessel disease and an acutely suboccluded very large left anterior descending coronary artery providing collaterals to large segments of the right and circumflex coronary territories. Primary angioplasty and stenting of the left anterior descending coronary artery was performed successfully, with a gradual amelioration of the hemodynamic and clinical parameters. Angiographic follow-up at 6 months demonstrated a widely patent stent, with minimal neointimal hyperplasia but no evidence of restenosis. The patient remained asymptomatic. We discuss our therapeutic strategy and review the relevant literature on the subject.

Misplacement of a permanent pacemaker lead has been described in several locations but rarely in the left ventricle. Less commonly, as described in our report, malposition may occur when the lead perforates the interatrial septum and extends across the left atrium and through the mitral valve into the left ventricle. The actual incidence of this pacemaker complication is unknown. Consequences may include perforation and systemic or cerebral thromboembolic events. We report the case of a patient with unintentionally misplaced left heart pacemaker lead admitted for neurological symptoms consistent with embolic stroke. The patient was on aspirin when symptoms occurred. The lead misplacement was not recognized at the time of implantation. Pacing threshold was normal. A 12-lead electrocardiogram showed right bundle branch block configuration paced complexes. By two-dimensional and transesophageal echocardiography, the pacemaker lead was carefully evaluated. The pacemaker lead crossed the interatrial septum, the left atrium, the mitral valve to be implanted in the left ventricular endocardium. To avoid the risk of future embolization, it was felt that the lead should be removed and right ventricular pacing established, once anticoagulation treatment was initiated. Successful percutaneous lead replacement was accomplished without sequelae. Measures to avoid lead misplacement are suggested.