Primary Chest Wall Abscess Caused by Pseudomonas aeruginosa and Staphylococcus epidermidis.

Primary abscess of the thoracic wall is a very rare condition that occurs spontaneously due to hematogenous dissemination of bacterial, fungal, or mycobacterial pathogens, of which Mycobacterium tuberculosis is the most frequent agent. The authors describe a rare case of primary abscess of the thoracic wall. The patient presented with a painful, growing mass in the chest wall that later fistulized to the skin, draining a purulent exudate. Extensive analytical and imagiological workup was performed, showing no changes other than an expansive soft tissue formation extending from the skin surface and destructing the cartilage of the 7th right costal arch. Culture of the purulent exdudate identified Pseudomonas aeruginosa and Staphylococcus epidermidis. The patient improved under directed antibiotic treatment. The diagnosis of a primary abscess of the thoracic wall and the causative agents contribute to the rarity of this case.

Idiopathic Systemic Capillary Leak Syndrome: A Clinical Case.

Idiopathic systemic capillary leak syndrome (ISCLS) is a rare condition caused by the extravasation of intravascular fluids and proteins into the interstitial space due to increased vascular endothelium permeability. It is characterized by episodes of hypotension, hypoalbuminemia, and hemoconcentration with generalized edema. Its etiopathogenesis is unknown. However, it is associated with monoclonal gammopathy in more than 80% of cases. There is currently no targeted treatment, and the approach during a crisis is supportive, mainly to control blood pressure, maintain perfusion of vital organs, and prevent complications, such as acute pulmonary edema and organ failure due to ischemia, which are the primary causes of death. We present the case of a 72-year-old man with generalized edema and pleural, pericardial, and peritoneal effusions whose laboratory results showed hypoalbuminemia, hypoproteinemia, and immunoglobulin G kappa monoclonal gammopathy. Other etiologies for severe hypoalbuminemia with anasarca were excluded after an exhaustive complementary study, leading to the diagnosis of ISCLS associated with monoclonal gammopathy. The patient showed progressive clinical improvement with albumin and diuretic therapy. However, they were readmitted to the hospital due to hypotension with multiorgan dysfunction and died a few hours later.