Miositis por Bartonella henselae: caso clínico en una adolescente / Bartonella henselae myositis: case report in an adolescent

La miositis de origen vírico o bacteriano es frecuente en la edad pediátrica. Causa dolor muscular y debilidad, con fiebre y malestar general. Una causa es la infección por Bartonella henselae, bacteria implicada en la enfermedad por arañazo de gato que, a veces, causa afectación multisistémica. Se presenta el caso de una adolescente que acudió al servicio de urgencias por mialgia intensa, malestar, adelgazamiento y esplenomegalia. En el labortorio se observaron parámetros inflamatorios elevados. Refería contacto con un gato. Entre los estudios realizados, la resonancia magnética (RM) de miembros inferiores mostró una imagen compatible con miositis inflamatoria bilateral. En la RM abdominal, se observaron tres lesiones esplénicas no detectadas previamente y el fondo de ojo mostraba una lesión compatible con oclusión arterial retiniana o vasculitis. Se indicó tratamiento antibiótico por vía intravenosa durante 21 días con cefotaxima y cloxacilina, tras los cuales desaparecieron los signos y síntomas, aunque los reactantes inflamatorios persistieron elevados. Con base en el cuadro clínico (miositis + coriorretinitis + absceso esplénico) se pensó en una posible infección por B. henselae y se inició tratamiento oral con azitromicina y rifampicina durante 14 días. Luego del tratamiento, los valores de laboratorio fueron normales, así como la RM de control, y se constató una IgG positiva para la bacteria

Infectious myositis, whether viral or bacterial, is frequent in pediatric age. It causes muscle pain and weakness, associated with fever and general malaise. One cause is Bartonella henselae, responsible for cat scratch disease, which sometimes causes systemic symptoms. We report the case of an adolescent who came to the emergency room with intense myalgia, malaise, weight loss and splenomegaly. Blood tests showed high inflammatory markers. She had been in touch with a cat. Studies were carried out including: lower limbs MRI suggestive of bilateral inflammatory myositis, abdominal MRI with three previously undetected splenic lesions and dilated fundus examination that showed possible retinal arterial occlusion or vasculitis. After 21 days of intravenous antibiotic therapy (cefotaxime + cloxaciline), she became asymptomatic, but inflammatory markers remained high. Suspecting Bartonella henselaeinfection (myositis + chorioretinitis + splenic abscess), oral azithromycin and rifampicin were prescribed for 14 days. Blood tests and control MRI became normal, and IgG was positive.

Rol de la cirugía en el manejo de la infección invasora por Saprochaete capitata / Role of surgery in Saprochaete capitata (S. capitata) sepsis in a patient with acute myeloid leukemia

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.

Coinfección por Mycobacterium fortuitum y Mycobacterium tuberculosis en abscesos esplénicos en un paciente con VIH / Co-infection by Mycobacterium fortuitum and Mycobacterium tuberculosis in splenic abscesses in a patient with HIV

RESUMEN Los pacientes con VIH son susceptibles a la infección por micobacterias. En el caso de las micobacterias de crecimiento rápido, grupo al que pertenece el Mycobacterium fortuitum (M. fortuitum), se han descrito infecciones en la piel, pulmones, ganglios linfáticos y enfermedad diseminada. Presentamos el caso de un paciente varón de 43 años, con diagnóstico previo de VIH en tratamiento antirretroviral, que acude por fiebre, astenia, pérdida de peso y diarrea crónica. Se realiza tomografía abdominal y se evidencia hepatoesplenomegalia con lesiones nodulares en el bazo. El cultivo esplénico, finalmente, fue positivo para M. fortuitum, con PCR positivo a Mycobacterium tuberculosis. Los protocolos actuales de tratamiento para este tipo de infecciones se basan en la susceptibilidad mostrada en los cultivos realizados. En lo que respecta a coinfecciones entre M. fortuitum y Mycobacterium tuberculosis, en pacientes VIH positivos, la información es aun menor.

ABSTRACT Patients with HIV are susceptible to mycobacterium infection. In the case of fast-growing mycobacteria, the group to which Mycobacterium fortuitum (M. fortuitum) belongs, infections have been described in the skin, lungs, lymph nodes and disseminated disease. We present the case of a 43-year-old male patient with pre-diagnosis of HIV in antiretroviral therapy, which comes as a fever, asthenia, weight loss and chronic diarrhea. Abdominal tomography is performed and hepatosplenomegaly is evidenced with nodular lesions in the spleen. The splenic culture was finally positive for M. Fortuitum, with positive PCR to Mycobacterium tuberculosis. The current treatment protocols for this type of infection are based on the susceptibility shown in the cultures performed. With regard to coinfections between M. Fortuitum and Mycobacterium tuberculosis, in HIV positive patients, there are even less information.

Fusobacterium necrophorum causing infective endocarditis and liver and splenic abscesses / Fusobacterium necrophorum causando endocardite infecciosa e abscesso hepático e esplênico

A 25-year-old male without prior co-morbidities was admitted to hospital with Fusobacterium necrophorum bacteremia, where he was found to have liver and splenic abscesses. Further evaluation with echocardiography revealed a bicuspid aortic valve with severe insufficiency and a 1.68 x 0.86 cm vegetation. The patient required abscess drainage, intravenous antimicrobial therapy and aortic valve replacement. Complete resolution of the infection was achieved after valve replacement and a prolonged course of intravenous antimicrobial therapy. A brief analysis of the patient's clinical course and review of the literature is presented.

Homem de 25 anos de idade, sem antecedentes mórbidos foi admitido ao hospital com bacteremia por Fusobacterium necrophorum e abscessos no fígado e no baço. Avaliação posterior com ecografia revelou válvula aórtica bicúspide com insuficiência severa e vegetação de 1,68 x 0,86 cm. Foi feita drenagem dos abscessos, terapia antimicrobiana intravenosa e substituição da válvula aórtica. Resolução completa da infecção foi conseguida após substituição valvular e curso prolongado de terapêutica intravenosa antimicrobiana. É apresentada breve análise do curso clínico do paciente e revisão da literatura.

Acid-fast bacilli positive isolated tubercular splenic abscess in a HIV-negative patient.

Isolated splenic tubercular abscess in a HIV-negative patient is an exceedingly rare clinical condition. It is even more rare to demonstrate acid-fast bacilli positivity on Ziehl-Neelson stains in such cases. We hereby present one such case.

Febre crônica associada a abscesso esplênico causado por Staphylococcus epidermidis / Chronic fever associated with splenic abscess due to Staphylococcus epidermidis

Abscessos ocultos são causa freqüente de febre crônica. Os abscessos esplênicos são entidades raras, usualmente associadas a quadros subjacentes de cirurgia abdominal, endocardite ou imunodepressão. Apresenta-se um caso de paciente com febre prolongada causada por um abscesso esplênico, cujo principal diagnóstico diferencial era leishmaniose visceral, que provavelmente esteve associado a traumatismo abdominal. O tratamento consistiu em antibioticoterapia seguida de esplenectomia.

Occult abscesses are frequent causes of chronic fever. Splenic abscesses are rare entities that are usually associated with underlying conditions such as abdominal surgery, endocarditis or immunodepression. We report on the case of a patient with prolonged fever caused by a splenic abscess, whose main differential diagnosis was visceral leishmaniasis. However, this condition was probably related to abdominal trauma. The treatment consisted of antibiotics followed by splenectomy.

Infarction of spleen in typhoid fever

Ultrasonography and computed tomography scan with hypo echoic areas diagnosed a splenic infarction in a Salmonella typhi infected 30-year-old man with painful hypochondrium and epigastrium. An antibiotic recipe of ceftriaxone and amikacin resulted in recovery. Imaging techniques contribute remarkably to a rapid diagnosis and rational management of the extra intestinal lesions attributable to the Salmonella typhi/paratyphi group of organisms

Meningoencephalitis, pancytopenia, pulmonary insufficiency and splenic abscess in a patient with brucellosis

A complicated case of brucellosis with some rare features is reported. Brucellosis is a multisystemic disease. However, disseminated brucellosis with cerebral, pulmonary, hematopoietic and splenic involvement in an otherwise healthy patient is a rare event. In this article, we report a case of disseminated brucellosis who was initially diagnosed as myelodysplastic syndrome [MDS] and meningoencephalitis, pulmonary symptoms, and splenic abscess formation occurred thereafter.

Abscesos esplénicos: presentación de nueve casos / Splenic abscess: presentation of nine cases

El absceso esplénico es una entidad poco frecuente, que presenta dificultad diagnóstica y tiene alta letalidad si no se trata. Se estima que la enfermedad está en aumento en relación al incremento en el número de pacientes inmunocomprometidos. Varios serían los mecanismos implicados en su patogenia. Algunos estudios muestran la preexistencia de lesiones esplénicas sumadas a bacteriemia como necesarios en su génesis. En nuestra serie se identificaron 9 pacientes inmunocompetentes en un período de 6 años. Entre los patógenos se aislaron Salmonella sp, Staphyloccus sp y Enterococcus sp. En tres casos se realizó esplenectomía, y en uno se efectuó drenaje percutáneo. Un paciente falleció. En definitiva, aunque infrecuentes, los abscesos esplénicos presentan una gran morbimortalidad. Factores de riesgo como inmunodeficiencia no son tan prevalentes en nuestra experiencia, debiéndose considerar esta patología en la evaluación completa de los pacientes con fiebre de origen no precisado.

Unusual presentation of enteric fever: three cases of splenic and liver abscesses due to Salmonella typhi and Salmonella paratyphi A.

Enteric fever is a multisystem disorder caused mainly by Salmonella typhi and Salmonella paratyphi A. It continues to be a major public health problem, especially in developing countries. Unusual presentations of Salmonellosis are rare. We report 3 such cases of young adult males, one of splenic abscess due to Salmonella typhi and one each of liver abscess due to Salmonella typhi and Salmonella paratyphi A. A brief review of the literature pertaining to the cases is also given.

Absceso esplénico / Splenic abscess: report of 2 cases

Splenic abscess is an uncommon condition associated with a high mortlaity. In most cases an hematogenous focus con be identified. early diagnosis is essential for recovery. CT scan and ultrasound tomography are the best diagnostic tools. The latter was used to establish the diagnosis in 2 patients. Who were successfully treated by surgery