Severe form of lymphocutaneous sporotrichosis: a case report

ABSTRACT Sporotrichosis is the most frequent subcutaneous mycosis in Latin America. It is caused by species of the genus Sporothrix. Infection in humans occurs through the entry of the fungus into the skin. Zoonotic outbreaks involving cats in the transmission of the disease have been frequently reported. The lymphocutaneous form is the most commonly observed and the upper limbs are the most affected sites. We report a case of a 64-year-old healthy female patient with a lymphocutaneous form with rapid progression of lesions, which was refractory to initial treatment with itraconazole. Treatment with liposomal amphotericin B was performed with a satisfactory resolution, but aesthetic and functional sequelae in the left upper limb were installed.

Absceso glúteo por Rhodococcus Equi: presentación atípica de enfermedad emergente / Gluteus abscess due to RhodococcusEqui: atypical presentation of emerging disease

Resumen Rhodococcusequi, bacteria aislada principalmente en potros, se considera en la actualidad un patógeno zoonótico emergente en seres humanos, la mayoría inmunocomprometidos, coincidiendo con la epidemia de VIH y los avances en la medicina de trasplantes y la quimioterapia del cáncer, lo que justifica la revisión sobre su patogenia, características clínicas, diagnóstico y tratamiento. Más frecuente en hombres que en mujeres, el inicio de las infecciones es generalmente insidioso y los síntomas que presentan varían según el sitio de la infección, la enfermedad respiratoria, caracterizada por neumonía necrosante es la manifestación más común, y tiende a seguir un curso subagudo, mientras las personas inmunocompetentes son afectadas con baja frecuencia y suelen presentarse con enfermedad localizada. Las infecciones de la piel o partes blandas, incluyendo abscesos, son poco frecuentes incluso en huéspedes inmunocomprometidos y están usualmente relacionadas con contaminación ambiental. El laboratorio de microbiología juega un papel clave en la identificación del organismo, ya que este puede confundirse con flora normal de la piel. El caso que se presenta corresponde a una paciente adulta inmunocompetente, con infección de herida quirúrgica por R equiluego de una cirugía estética, requirió tratamiento antibiótico, múltiples lavados quirúrgicos y debridamientos, más drenaje de absceso, con mejoría del proceso infeccioso. Este caso sugiere la importancia clínica de la identificación precisa de patógenos inusuales, capaces de entorpecer la evolución normal de un proceso quirúrgico y de producir un alto costo de atención de salud y el alcance medidas preventivas relacionadas con la vigilancia de la salud.

Abstract Rhodococcusequi, a bacterium isolated mainly in foals, is currently considered an emerging zoonotic pathogen in humans, most of them immunocompromised, coinciding with the HIV epidemic and advances in transplant medicine and cancer chemotherapy, which justifies the review on its pathogenesis, clinical characteristics, diagnosis and treatment. More frequent in men than in women, the onset of infections is usually insidious and the symptoms they present vary according to the site of infection, the respiratory disease, characterized by necrotizing pneumonia is the most common manifestation, and tends to follow a subacute course , while immunocompetent people are affected with low frequency and usually have localized disease. Infections of the skin or soft tissues, including abscesses, are rare even in immunocompromised hosts and are usually related to environmental contamination. The microbiology laboratory plays a key role in the identification of the organism, since it can be confused with normal flora of the skin. The case presented corresponds to an adult immunocompetent patient, with surgical wound infection by R equiafter cosmetic surgery, required antibiotic treatment, multiple surgical washes and debridements, and abscess drainage, with improvement of the infectious process. This case suggests the clinical importance of the precise identification of unusual pathogens, capable of obstructing the normal evolution of a surgical process and of producing a high cost of health care and the scope of preventive measures related to health surveillance.

Chronic Invasive Aspergillus Sinusitis Affecting the Maxillary Sinus: A Case Report.

Background: Chronic invasive Aspergillus sinusitis is an uncommon fungal infection that usually occurs in immunocompromized patients and rarely in healthy immunocompetent individuals. Chronic invasive Aspergillus sinusitis affecting the maxillary sinus may cause tremendous effects as maxillary bone destruction, displacement of teeth, bronchopulmonary infection and orbital involvement that may lead to proptosis and decreased vision. The maxillary sinus infection may result from direct inhalation of spores and not as a secondary infection from the oral cavity, endodontic treatment, or oro-antral fistulae. Case Summary: A 30 years old male patient presented to clinic complaning of right sided facial swelling and nasal obstruction. Clinical examination, Ortho-Pantomogram (OPG) and Cone Beam Computerized Tomography (CBCT) revealed a right maxillary sinus mass; laboratory investigations exclude presence of any systemic disease. Antrostomy of the lateral sinus wall (Caldwell-Luc surgery) was performed under local anesthesia to remove the sinus lining and mass. The mass was sent for histopathological investigation. The defect of bone was covered with the integrum periostium (the mucosal flap) without any bone graft or meshes. No antifungal drugs were prescribed. Post operative OPG and CBCT revealed complete removal of the lesion and clearance of the right side nasal air way. The histopathological examination found that the aspergillus Hyphae, fruits bodies and spores are present which confirmed the diagnosis. One year follow-up revealed that there is no recurrent infection; the drifted teeth realigned again and the maxillary sinus returns to its normal size. Conclusion: Early diagnosis and therapeutic intervention is the key to successful treatment of chronic invasive aspergillosis of the maxillary sinus. Surgical debridement can be done under local anesthesia without antifungal drug prescription and good prognosis was achieved.

Tuberculosis ineection might increase the risk f invasive candidiasis in an immmunocompetent patient / Tuberculose pode aumentar o risco de candidíase invasiva em paciente imunocompetente

Deep Candida infections commonly occur in immunosuppressed patients. A rare case of a multiple deep organ infection with Candida albicans and spinal tuberculosis was reported in a healthy young man. The 19-year-old man complained of month-long fever and lower back pain. He also had a history of scalded mouth syndrome. Coinfection with Mycobacterium tuberculosis and Candida albicans was diagnosed using the culture of aspirates from different regions. Symptoms improved considerably after antifungal and antituberculous therapy. This case illustrates that infection with tuberculosis might impair the host's immune system and increase the risk of invasive candidiasis in an immunocompetent patient.

As infecções profundas por Candida ocorrem geralmente em pacientes imunossuprimidos. Relatamos caso raro de infecções profundas em múltiplos órgãos por Candida albicans e neuro tuberculose em homem jovem saudável. Um jovem de 19 anos de idade queixou-se de febre e lombalgia há um mês. Relatava ainda histórico de síndrome da boca escaldada. Foi diagnosticada co-infecção por Mycobacterium tuberculosis e Candida albicans em cultura do aspirado de diferentes regiões do organismo. Os sintomas melhoraram significativamente após a terapia antifúngica e antituberculosa. Este caso é apresentado para mostrar que a tuberculose pode prejudicar o sistema imune do hospedeiro e aumentar o risco de candidíase invasiva em paciente imunocompetente.

Anterior Chest Wall Tuberculosis Involving Lungs, Pleura and Lymph Nodes in an Immunocompetent Patient: A Case Report.

Aims: The chest wall tuberculosis accounts for 1-5% of all cases of musculoskeletal tuberculosis. Here we are presenting a rare case of anterior chest wall tuberculosis in an immunocompetent patient. Presentation of Case: A 20-year-old male came for routine medical check-up, which was prerequisite for his job. He had no respiratory complaints with no history of fever and weight loss. Local examination revealed a swelling over the right chest in the infraclavicular region. Discussion: Tubercular anterior chest wall abscess is a rare form of extra pulmonary TB. Simultaneous involvement of lung, pleura and lymph nodes of mediastinum, neck and axilla has rarely been reported in an immunocompetent individual. Conclusion: Cold abscess of chest wall is not common. Anti-tubercular therapy should be recommended as initial treatment.

Varicella Zoster Viral Myelitis in Immunocompetent Patient

No abstract available.

Rhizomucor variabilis : A rare causative agent of primary cutaneous zygomycosis.

Rhizomucor variabilis is a rare cause of human infections. We report a case of primary cutaneous zygomycosis in an immunocompetent host. Although microscopy reveals the fungal aetiology, the need for species identification is highlighted to better understand the species and establish an epidemiological pattern as it is reported from restricted geographical locations.

A Case of Invasive Aspergillosis Involving the Orbital Apex and Occipital Lobe:Successful Treatment with Voriconazole

PURPOSE: To report an immunocompetent patient with more than 1-year survival after treatment with voriconazole, despite invasive paranasal sinus aspergillosis involving the orbital apex. CASE SUMMARY: A 74-year-old woman with only preexisting hypertension visited our clinic complaining of pain and immovable left eye that occurred approximately 4 days prior. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a sphenoid sinusitis with suspicious lesion involving the orbital apex of the left eye. A biopsy by functional endoscopic sphenoid surgery (FESS) was performed through the sphenoid sinus, which enabled us to diagnose aspergillosis. The patient had esotropia, ophthalmoplegia, positive RAPD, and ptosis in the left eye. On follow-up, a new MRI showed acute to subacute stage infarction at the left occipital lobe. After the patient was treated with intravenous voriconazole, ptosis, and ophthalmoplegia improved. At the 13-month follow-up, she was alive with no disease recurrence. CONCLUSIONS: Invasive aspergillosis of orbit and cerebrum in healthy patients is a rare clinical entity. In case of central nervous system involvement, the survival outcome is poor with high mortality; however, good results can be obtained by treatment with voriconazole.

A Case of Disseminated Mycobacterium bovis Infection after BCG Vaccination (Tokyo strain) in an Apparently Immunocompetent Infant / 소아감염

Bacille Calmette-Guerin (BCG) vaccine is a live attenuated vaccine derived from Mycobacterium bovis. Frequent complications after BCG vaccination are localized ulcer formation and regional lymphadenitis, but there could be rarely severe systemic reactions to BCG vaccine such as osteomyelitis and disseminated BCG infection. Although disseminated BCG infection can be complicated in infants with underlying immunodeficiency after BCG vaccination, it is very unlikely to develop in immunocompetent infants or children. We report a 13-month-old infant who presented with fever, skin nodules, and multiple enlarged lymph nodes 5 months following BCG vaccination. She was diagnosed with disseminated BCG infection by PCR-confirmed M. bovis BCG infection at > or =2 anatomical sites beyond the region of vaccination. The patient showed no obvious evidence of immunodeficiency as judged on the basis of previous disease history, plasma immunoglobulin levels, B and T lymphocytes counts in peripheral blood, DHR (dihydrorhodamine 123 fluorescence) test and HIV test. She started antituberculous treatment with isoniazid and rifampin, and now, apparently her symptoms have been improved.

A Case of Arthritis due to Mycobacterium Intracellulare in a Immunocompetent Patient

Nontuberculous mycobacteria (NTM) are widely distributed in nature and are usually of low pathogenic potential. NTM rarely has been recognized as a cause of musculoskeletal infections that involve joints, bone and soft tissue in immunocompetent patients. The risk factors of its infection are local traumas caused by surgery, injury, or injection. A fifty five-year-old immunocompetent patient visted to hospital due to right wrist mass and pain. Excisional biopsy was done. Histologically granulomatous inflammation was identified and Mycobacterium intracellulare was cultured. Although very rare, NTM should be suspected at least once as a causative pathogen of chronic arthritis when the cause is uncertain.

A Case of Syphilitic Uveitis in an Immunocompetent Patient / 감염과화학요법

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

A Case of Syphilitic Uveitis in an Immunocompetent Patient / 감염과화학요법

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

Prostatic cryptococcosis: a case report

Cryptococcosis is a systemic mycosis usually affecting immunodeficient individuals. In contrast, immunologically competent patients are rarely affected. Dissemination of cryptococcosis usually involves the central nervous system, manifesting as meningitis or meningoencephalitis. Prostatic lesions are not commonly found. A case of prostate cryptococcal infection is presented and cases of prostatic cryptococcosis in normal and immunocompromised hosts are reviewed. A fifty-year-old HIV-negative man with urinary retention and renal insufficiency underwent prostatectomy due to massive enlargement of the organ. Prostate histopathologic examination revealed encapsulated yeast-like structures. After 30 days, the patient's clinical manifestations worsened, with headache, neck stiffness, bradypsychia, vomiting and fever. Direct microscopy of the patient's urine with China ink preparations showed capsulated yeasts, and positive culture yielded Cryptococcus neoformans. This fungus was later isolated from cerebrospinal fluid and blood cultures, demonstrating thus its dissemination. The patient was discharged after 27 days in hospital and, despite a regimen of amphotericin B, he died four months later. This case points to cryptococcosis as a possible cause of prostatic disease and reinforces the importance of communication between the medical team and pathology and microbiology laboratories aiming at a more accurate diagnosis and successful treatment.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A Case of Pulmonary Cryptococcosis in an Immunocompetent Patient / 결핵및호흡기질환

We experienced a case of pulmonary cryptococcosis in an immunocompetent patient who presented with uncommon radiological findings. He complained of a dry cough for 3 weeks. The chest X-ray and CT showed multiple, variable sized, and irregular patch consolidations with cavities combined with some ground glass opacities in both lower lung fields. The diagnosis was made histologically via a thoracoscopic lung biopsy. The patient was administered oral fluconazole has since been well.

Pulmonary Cryptococcosis in Immunocompetent Patients: CT Findings / 영남의대학술지

PURPOSE: To evaluate the computed tomography (CT) findings of pulmonary cryptococcosis in immunocompetent patients. MATERIALS AND METHODS: CT scans of 25 patients with biopsy-proven cryptococcosis [surgery (n=3), percutaneous needle biopsy (n=21), and bronchoscopic biopsy (n=1) ] were analyzed. Thirteen patients were men and 12 patients were women, with a mean age of 53.7 years. Presenting symptoms were cough, sputum, and dyspnea and 12 patients presented with incidentally found chest radiographic abnormalities. RESULTS: Nodule or multiple conglomerate nodules (n=10, 40%) and segmental or lobular consolidation (n=9, 36%) were most common, followed by mixed patterns (n=5, 20%). Predilection sites were lower lobe (n=21/37, 57%) and subpleural areas (n=23, 92%). Air bronchograms within consolidations (n=11/14, 79%) with mild volume loss (n=10/14, 71%) were common. While interlobular septal thickening (n=11, 44%) and cavitation or central low-attenuations (n=11, 44%) were relatively common, lymphadenopathy (n=2, 8%) or free pleural effusions (n=1, 4%) were uncommon. CONCLUSION: Nodules or airspace consolidation with a predilection of lower lobe and subpleural area are the most common appearances of pulmonary cryptococcosis in immunocompetent patients.

Aspergillosis of Central Nervous System

OBJECTIVES: Aspergillosis of central nervous system(CNS) is a rare pathologic condition and it has been known to be difficult to diagnose and treat. We analyzed seven cases of central nervous system aspergillosis. The clinical characteristics, and the problems in diagnosis and treatment are discussed with review of previous literatures. MATERIALS AND METHODS: We reviewed the clinical records, radiological findings, and pathologic reports of 7 patients with aspergillosis which involved CNS. RESULTS: Five patients were immunocompetent, and infection was related with previous operation in 4 of them. Two patients were immunocompromised and had no history of operation. Five patients had intracranial lesions and two had spinal lesions. Mean duration from the onset of initial symptom to pathologic diagnosis was 2.4 months. Mean duration from the previous operation to the onset of symptom was 9.3 months, and from the onset of symptom to diagnosis was 2.9 months in the patients who had histories of operation. All of them were treated with surgical procedures and intravenous and oral antifungal agents, resulting in cure in 6 cases. Mean duration of the treatment was 4.9 months. CONCLUSION: Because aspergillosis of CNS is a rare disease and is difficult to be differentiated from the pyogenic abscess or recurrent tumor, the pathologic diagnosis is very important for adequate treatment. Although the prognosis of aspergillosis of CNS has been known to be poor, adequate surgery for both diagnosis and treatment and antifungal chemotherapy resulted in good outcome.

A Case of Primary Cutaneous Mucormycosis in a Immunocompetent Patient / 대한피부과학회지

Mucormycosis is an infectious disease caused by fungi of the order Mucorales. Almost all patients have a serious uriderlying condition such as diabetes mallitus, imrnunosuppression, starvation, burn, but a few cais have been reported in previously heilthy subjects. In order to successfully treat this infection, diagnosis must be prompt and acior. panied by aggressive debridement and parenteral administration of amphotericin B. We report a case of primary cutaneous mucormycosis in 58-year-old man. The lesion was a well-circumscribed erythematous plaque with central necrcis Histopathologically, a biopsy revealed broad, nonsptate with branches occuring at right anghles.