Complications from the use of thrombolytic agents in patients with cocaine associated chest pain

Previous investigators have noted that patients with cocaine associated chest pain frequently have abnormal electrocardiograms, including ST segment elevation, in the absence of ongoing myocardial ischemia. The effects of these nonischemic ST segment elevations have not been evaluated. We report two patients with cocaine associated chest pain and ST segment elevations who received thrombolytic agents in the absence of myocardial ischemia. Neither patient sustained a myocardial infarction, nor had clinical evidence of reperfusion. The ST segment elevations persisted after resolution of chest pain in both patients, and both of the patients experienced complications of thrombolytic therapy. One patient sustained a hemorrhagic stroke and one had minor oral-pharyngeal bleeding. Given the lack of documented efficacy, concerns about safety, and poor specificity of the electrocardiogram for myocardial ischemia in patients with cocaine associated chest pain, thrombolytic therapy should be used with caution in these patients.     

Persistent enterocutaneous fistula associated with intraperitoneal metallic mercury

Summary The case of a patient in whom the formation of a chronic recurrent enterocutaneous fistula possibly related to metallic mercury free in the peritoneal cavity has been reported. The mercury originated from a ruptured Cantor tube. This is a rarely reported phenomenon and the first in which the diagnosis was suggested by finding elemental mercury at the time of biopsy via a sigmoidoscope. The mercury was also grossly visible on histological sections. This report emphasizes the adverse effects of metallic mercury when it gains entrance to the peritoneal cavity through a break in the mucosa of the intestinal tract.     

Headache as the Presenting Symptom in 2 Patients With COVID-19 and a History of Migraine: 2 Case Reports

The coronavirus disease 2019 (COVID-19) pandemic has now affected more than 5 million people globally. Typical symptoms include fever, cough, and shortness of breath. Patients with underlying medical comorbidities such as cardiovascular disease and diabetes are more likely to become severely ill. To date there is limited information on how COVID-19 affects patients with a history migraine. Here, we present the cases of 2 women with a history of migraine whose first symptom of COVID-19 was a severe persistent headache.