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A 42-year-old woman presented with fever, dyspnea, lower-leg edema, significant pulmonary congestion, pleural effusion, and severely reduced left ventricular contractions. She was resistant to treatment for heart failure, including catecholamines, furosemide, phosphodiesterase III inhibitors, and human atrial natriuretic peptide, and antibiotics failed to reduce her inflammation. She had renal dysfunction and hypocomplementemia and was positive for anti-nuclear and anti-ds-DNA antibodies. The patient was diagnosed with myocarditis and pleurisy associated with systemic lupus erythematosus (SLE). Prednisolone administration improved her general condition, reducing inflammation and improving left ventricular function. On day 1, an electrocardiography (ECG) revealed a T-wave inversion similar to a T-U complex configuration in leads II, aVF, and V3-6. By day 8, however, ECG showed prolonged corrected QT (QTc) and T-wave alternans (alternating beat-to-beat T-wave patterns) in lead V3-6. Careful ECG monitoring should be used to identify potentially fatal ventricular arrhythmias during the recovery phase of SLE-related myocarditis. .

Background D-dimer shows high sensitivity but low specificity for the diagnosis of acute aortic dissection (AAD). Previous reports indicated that negative D-dimer patients have shorter dissection length. However, whether patients with negative D-dimer results have a good prognosis is unknown. This study aimed to elucidate the clinical characteristics and implications of a negative D-dimer result on AAD diagnosis. Methods The study group comprised 126 patients (71 males, 55 females; mean age, 69 ± 11 years) with AAD admitted to our hospital between April 2009 and March 2015. Blood samples on presentation were used for D-dimer measurement. Clinical characteristics and outcomes were assessed. Results Nine (7.1%) and 117 (92.9%) exhibited negative and positive D-dimer results, respectively. The negative group showed a significantly lower extension score and a higher platelet count than the positive group. Multivariate analysis demonstrated that platelet count (odds ratio, 1.31 (1.09–1.58), p = 0.003) and extension score (odds ratio, 0.56 (0.33–0.96), p = 0.03) were significantly related to a negative result. Notably, 44% of patients in the negative group had type A dissection and 33% underwent an emergency operation due to cardiac tamponade. Conclusion We found that high platelet count and low extension score were independent factors related to a negative D-dimer result. Even if the length of the dissection is short, an emergency operation is necessary in some patients with a negative D-dimer result. Physicians should recognize that a negative D-dimer result alone cannot exclude patients with fatal AAD conditions.

Background: Spontaneous spinal epidural hematoma (SSEH) is a rare disease. Despite numerous case reports, the clinical characteristics and prognosis of patients with SSEH in the contemporary aging population are unknown. The purpose of this study was to clarify the clinical characteristics, prognostic factors, and optimal management of SSEH. Methods: We retrospectively reviewed and analyzed patients with SSEH who were admitted to Shinshu University Hospital between July 2009 and October 2019. The modified Rankin Scale (mRS) was used to measure the degree of disability in patients with SSEH at discharge as a functional outcome and patients were classified accordingly. Clinical variables of patients with good (mRS 0–2) and poor (mRS > 2) outcomes were compared. Results: We identified 30 patients with SSEH (17 men and 13 women) aged 36–89 years (median age, 67 years). Twelve patients had hypertension. Surgical treatment was performed in 11 patients. The number of patients who had taken anticoagulants was higher in the poor outcome group than in the good outcome group (p = 0.01). The poor outcome group were older (p = 0.048), had a higher operation rate (p = 0.04) and longer lengths of hospitalization (p