IDCases最新文献

Pyopericardium is a rare cause of cardiac tamponade. We present a case of a dengue fever patient who presented with cellulitis of the upper limbs, later manifesting cardiac tamponade, which was fatal. Although echocardiography on admission revealed a small pericardial effusion only, it later manifested as tamponade, causing cardiogenic shock. Staphylococcus pyopericardium was found later. Early identification could be possible with bedside point-of-care ultrasonography and echocardiography. Emergent pericardiocentesis or pig tail drain placement is life saving.

Histoplasma vascular graft infection (VGI) is rarely reported, with only a handful of instances documented in the existing literature. Reporting Histoplasma VGI cases is important as they demonstrate previous treatment strategies and their outcomes. In this paper, we report a case of disseminated histoplasmosis with ascending aortic graft infection. Conservative therapy was attempted initially but failed, and our patient eventually required surgical graft explantation. Our case demonstrates the challenges in diagnosing and managing VGI caused by Histoplasma capsulatum.

Antiretroviral (ARV) absorption in persons living with human immunodeficiency virus (PLWH, HIV) with short bowel syndrome is limited. We describe a case of a 28-year-old male with newly diagnosed HIV and plasmablastic lymphoma with proximal jejunostomy necessitating parenteral nutrition. ARV therapy with dolutegravir 50 mg twice daily and once daily tenofovir/emtricitabine was initiated with documented malabsorption and delayed virologic suppression (VS). Dolutegravir dose titration with therapeutic drug monitoring (TDM) resulted in VS at month 12. ARV TDM with dose titration is an option for PLWH with malabsorptive states to maintain VS.

Cytomegalovirus (CMV) can cause a broad range of diseases, with severity depending on immune status, comorbidities, and age. Initial CMV infection usually occurs in childhood and is typically asymptomatic, leading to lifelong latency. In immunocompromised patients, CMV can affect multiple organs, but salivary gland infections are rare. This study presents a case of a 66-year-old woman with B-cell acute lymphoblastic leukemia who developed swelling and pain in the right preauricular region during pre-transplant consolidation therapy. Despite a recent bone marrow biopsy indicating morphological remission and a flow cytometry analysis detecting only 0.04 % B lymphoblasts, she exhibited these symptoms. A CT scan revealed enlargement, hyperdensity, and enhancement of the right parotid glands, with accompanying subcutaneous edema. A biopsy of the right parotid gland showed a dense interstitial lymphoplasmacytic infiltrate with numerous Cowdry bodies and smaller granular cytoplasmic inclusions, all testing positive for CMV immunohistochemistry. The findings confirm the diagnosis of CMV sialadenitis in an immunocompromised patient. This case underscores the importance of considering CMV infections in similar clinical scenarios, particularly in patients with compromised immune systems.

Background

Mycobacterium cosmeticum is an emerging rapidly growing mycobacteria (RGM) species that has been rarely reported to cause human disease. RGM catheter-related bloodstream infections (CRBSI) are often challenging to treat given the need for line removal, variable species-dependent antimicrobial susceptibility, combination antimicrobial treatment, and historically longer courses of antibiotics.

Case presentation

We present a case of an immunocompetent pediatric patient with severe hemophilia B and M. cosmeticum CRBSI. While the patient’s hemophilia B precluded a standard line holiday, he successfully cleared his infection with two line exchanges followed by two weeks of antibiotics.

Conclusions

RGM, including emerging species M. cosmeticum, may be considered in patients with an indolent presentation of CRBSI. Our case suggests source control with shorter courses of antimicrobials can be successful.

Fitz-Hugh-Curtis (FHCS) is characterized by an inflammation of the hepatic capsule concomitant or following pelvic infection due to Chlamydia trachomatis or Neisseria gonorrhea. It is a rare condition occurring most often in a woman of childbearing age and very rare in male patients. Splenic involvement is also a rare form of abdominal tuberculosis. The association of these two conditions is very uncommon. We report the exceptional case of a 58- year-old HIV-positive male patient, with whom abdominal ultrasound helped diagnose FHCS associated with abdominal tuberculosis invovlving the spleen.

A 50-year-old woman living with untreated HIV and injection drug use presented with right shoulder pain. The shoulder exam and computed tomography (CT) scan were concerning for septic arthritis. She was started on empiric vancomycin and cefepime and underwent right shoulder debridement and humeral head resection. Bone cultures grew methicillin sensitive Staphylococcus aureus (MSSA); empiric broad-spectrum antibiotics were changed to cefazolin. The patient subsequently developed severe anemia refractory to blood transfusions approximately 6 days later. Further evaluation disclosed hemolytic anemia attributable to cefazolin. Antibiotic therapy was switched from cefazolin to daptomycin, and the patient was started on prednisone. She had sustained improvement in hemoglobin values above 6 g/dL without requiring further transfusions prior to hospital discharge. Drug-induced immune hemolytic anemia from cefazolin is rare but has been reported primarily in the perioperative setting. Here, we present a case following initiation of treatment for septic arthritis.

Introduction and importance

Case report

Discussion

Conclusion

Background

Case Summary

Conclusion