Background: Septic arthritis is a rare but potentially fatal complication of intra-articular corticosteroid injection, commonly caused by Staphylococcus aureus. The risk is higher in older adults and those with diabetes, rheumatoid arthritis (RA), immunosuppression, or a history of recent joint procedures. Diagnostic delay is possible, as non-infectious arthritis can present with similar features. Although rituximab is generally considered safe, rituximab-associated hypogammaglobulinemia may increase susceptibility to severe infections. We report a case of methicillin-sensitive Staphylococcus aureus (MSSA) septic arthritis with hematogenous vertebral seeding following intra-articular corticosteroid injection in a patient receiving rituximab therapy. Case: A 73-year-old man with seropositive RA, treated with prednisone, methotrexate, hydroxychloroquine, and rituximab, presented with one week of progressive knee pain, swelling, and erythema following an intra-articular corticosteroid injection performed several days earlier. He met criteria for severe sepsis. Arthrocentesis revealed purulent fluid, and cultures grew MSSA, consistent with blood culture results. The patient underwent two surgical washouts and received intravenous cefazolin. During hospitalization he developed new thoracic back pain. Magnetic resonance imaging demonstrated T5-T6 osteomyelitis/discitis with early epidural phlegmon, consistent with hematogenous spread. Blood cultures cleared after six days of antibiotic treatment and source control, and he completed eight weeks of intravenous antibiotic therapy. Discussion: Intra-articular corticosteroid injections can precipitate rapidly progressive septic arthritis with potential for distant seeding, particularly in immunosuppressed individuals. Early arthrocentesis, prompt source control, and surveillance for secondary foci, including vertebral osteomyelitis, are critical. Infection risk assessment prior to rituximab initiation and judicious use of intra-articular injections in high-risk patients are recommended.
Background: Takotsubo Syndrome (TTS) is a transient, stress-induced cardiomyopathy that mimics acute myocardial infarction in the absence of obstructive coronary artery disease. Although often self-limiting, TTS may lead to serious complications, including left ventricular (LV) thrombus formation. Case Summary: A 73-year-old woman with a complex medical history was referred to the emergency department for an abnormal electrocardiogram. She reported transient dyspnea and indigestion but denied chest pain. Laboratory evaluation demonstrated elevated high-sensitivity troponin I and B-type natriuretic peptide. Electrocardiography showed new diffuse T-wave inversions. Coronary angiography revealed non-obstructive coronary artery disease. Transthoracic echocardiography demonstrated apical akinesis with a large LV thrombus and mildly reduced ejection fraction. The patient was treated with systemic anticoagulation and supportive therapy, resulting in complete recovery of ventricular function and thrombus resolution on follow-up imaging at five months. Discussion: LV thrombus is an uncommon but clinically important complication of TTS, occurring in approximately 2–3% of cases, likely related to apical hypokinesis and catecholamine-mediated endothelial injury. In the absence of definitive guidelines, anticoagulation for approximately three months is commonly recommended in patients with LV thrombus or severe systolic dysfunction. Conclusion: LV thrombus can complicate TTS even with only mildly reduced systolic function, underscoring the importance of early imaging and timely anticoagulation
Background: Pneumonia remains a major cause of morbidity and mortality among people living with HIV (PLHIV), particularly in low- and middle-income countries. Despite the availability of antiretroviral therapy (ART), early mortality after hospitalization for pneumonia remains high. Indian data on short-term mortality predictors in HIV-associated pneumonia are limited. Methods: We conducted a prospective observational study of HIV-positive adults admitted with pneumonia to a tertiary-care hospital in North India between April and December 2025. Clinical, laboratory, microbiological, and radiological parameters were recorded at admission. Patients were followed for 30 days. The primary outcome was all-cause 30-day mortality. Predictors of mortality were assessed using univariate analysis and multivariable logistic regression. Results: Fifty HIV-positive adults were included. The study flow is shown in Figure 1. Baseline characteristics are summarized in Table 1. Thirty-day mortality was 72%. Hypotension at admission and requirement of inotropic support were independently associated with mortality (Table 2). Disseminated tuberculosis was strongly associated with death. ROC analysis of laboratory predictors is presented in Table 3. Conclusions: Mortality among HIV-positive adults hospitalized with pneumonia remains alarmingly high. Hemodynamic instability and tuberculosis are dominant drivers of early mortality. Early recognition of shock and prompt tuberculosis management are essential to improve outcomes.
Ischemic colitis is the most common form of intestinal ischemia and is typically associated with acute hypoperfusion states such as shock or dehydration.1 Chronic low-flow states related to persistently low baseline blood pressure may represent an underrecognized contributor to recurrent disease in the absence of classic acute triggers.2 We present a case of a 54-year-old woman with recurrent, biopsy-proven ischemic colitis occurring in the setting of persistently low blood pressure documented across multiple clinical encounters. Unlike many patients with ischemic colitis, she lacked documented atherogenic, autoimmune, radiation-related, or vasospastic risk factors, and CT angiography showed patent mesenteric vasculature. Review of her longitudinal course demonstrated recurrent left-sided ischemic colitis over several years, patent mesenteric vasculature on CT angiography, and persistently low outpatient and periprocedural blood pressures. Blood pressure–directed therapy with midodrine and nonpharmacologic measures was associated with improved blood pressure control and decreased frequency of episodes. This case highlights chronic low-flow physiology related to persistently low baseline blood pressure as a plausible contributor to recurrent nonocclusive ischemic colitis and emphasizes the importance of reviewing longitudinal blood pressure patterns in patients without an obvious acute precipitant.
Thoracentesis is a commonly performed bedside procedure for diagnostic evaluation or symptomatic relief of pleural effusions. Although generally considered low risk, prior studies comparing complication rates between aspiration methods, particularly manual and vacuum-assisted aspiration, have reported mixed results. We therefore compared complication rates between these two methods among patients undergoing ultrasound-guided thoracentesis by a hospitalist-led procedure service at a community teaching hospital. Thoracentesis-related complications, including pneumothorax, hemothorax, procedure site bleeding, and re-expansion pulmonary edema were assessed. A total of 96 patients underwent manual aspiration and 97 underwent vacuum-assisted aspiration. Patient demographics and comorbidities were similar between groups with no statistically significant differences. Overall complication rates were low, with no statistically significant difference between manual and vacuum-assisted aspiration (1.0% vs 2.1%, P=1.00). These findings provide additional comparative safety data for bedside thoracentesis. The retrospective design and low event rates may have limited detection of small but clinically meaningful differences, which larger, prospective studies could better define.
