Rapidly fatal disseminated acanthamoebiasis in a single lung transplant recipient.

BACKGROUND: Lung transplant recipients are at great risk for developing various infectious complications. These infections portend a significant morbidity and mortality throughout their lifetime following transplantation. At times, cutaneous manifestations are the only clues to systemic infection. CASE REPORT: A 62 year-old man with a history of idiopathic pulmonary fibrosis presented 6 months after receiving bilateral sequential cadaveric lung transplantation for anorexia, early satiety, weight loss, exertional dsypnea, arthralgia, and depression. On exam, two rapidly growing non-painful 1.5-3 centimeter erythematous nodules with purulent draining on the anterior chest wall were noted. On Hospital Day 7, the patent was found to be un-responsive, hypotensive, and febrile. Brain imaging revealed diffuse thick nodular enhancement of leptomeningeal surface and multiple areas of hypodenisty associated with mass effect in the bilateral vermis and cerebellar hemispheres with effacement of the fourth ventricle. CSF PCR analysis showed Acanthamoeba sp. confirmed by the Center for Disease Control. Despite multi-modal therapy, his clinical course deteriorated and resulted in brain death. CONCLUSION: Acanthamoeba infection is extremely rare in thoracic organ recipients. We report the fifth case of progressive disseminated acanthamoebiasis in a lung transplant recipient.

Gastric sarcoidosis and review of the literature.

Sarcoidosis is a systemic disease with a 90% predilection for the lungs, but any organ can be involved. Gastrointestinal involvement is rare. Within the gastrointestinal system, gastric involvement is the most common. When this organ system is involved, it can be a feature of systemic disease or an isolated case. Gastrointestinal sarcoid can resemble a broad spectrum of other disease processes; thus, it is important for health care providers to be familiar with the various gastrointestinal manifestations. Patients can have subclinical symptoms or have symptoms of epigastric pain, nausea, vomiting, and hematemesis. We present 2 cases of gastric sarcoid and a MEDLINE search of 44 reported cases of gastric sarcoid based on a compatible history and the demonstration of noncaseating granulomas. We describe the clinical manifestations of symptomatic gastric sarcoid in relation to the endoscopic findings.

Localized interstitial pulmonary amyloid: a case report and review of the literature.

PURPOSE OF REVIEW: Diffuse interstitial pulmonary amyloidosis is a fatal disorder that is rare and often undiagnosed. There are many documented cases of diffuse interstitial amyloid occurring with systemic amyloid light-chain amyloid. We present an extraordinary case of localized interstitial amyloidosis, making our case the eleventh documented in the literature. RECENT FINDINGS: We review the subtypes of tracheobronchial-pulmonary amyloidosis and their clinical presentations. There is also a thorough investigation of the literature published on localized diffuse interstitial pulmonary amyloid, and we provided information on the recent advances in treatment and diagnosis of amyloid. SUMMARY: Although localized diffuse interstitial amyloid is a rare finding, it is often not placed in the differential diagnosis, leading to the diagnosis being made at autopsy. With the use of new techniques and fiberoptic bronchoscopy an early diagnosis can be made. More research needs to be dedicated to the advancement of treatment for this fatal disease.

Exudative pleurisy of coccidioidomycosis: a case report and review of the literature.

INTRODUCTION: Community-acquired pneumonia is the most common manifestation in primary coccidioides infections (Coccidioides immitis, C. posadasii). It is essential that this endemic dimorphic fungus be considered in order to proceed with the most appropriate diagnostic tools and therapy. CASE PRESENTATION: We present a rare case of primary pleural coccidioides and a review of the current literature for optimal diagnostic methods and therapeutic strategies. CONCLUSION: With increased domestic and international travel, coccidioidomycosis will likely be encountered in nonendemic regions. Recognition by physicians is critical for a timely diagnosis and therapy. Tissue culture can assist in the diagnosis and polymerase chain reaction analysis shows potential as a possible addition.