Nocardiosis: When the Side Effects of Therapy Mimic Symptoms.

Nocardiosis is a rare infection caused by gram-positive aerobic actinomycetes, which are common in soil. Inoculation occurs by inhaling agent fragments that cause localized or systemic suppurative lesions. The diagnosis is established based on isolation in cultural examinations. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment, and an antimicrobial susceptibility test is useful in severe cases or when there is no clinical response. The duration of treatment is determined by the affected site. However, the treatment cycles are long, and recurrence is common, which has a negative impact on the prognosis. We describe a case of an immunocompetent male with a recent diagnosis of pulmonary nocardiosis who, after starting therapy, presented with symptoms that could be explained by either disease progression or an adverse pharmacological reaction. Throughout this case, with atypical evolution, the authors review the diagnostic and therapeutic approach to Nocardia infection and alert to the importance of the differential diagnosis and available therapeutic options.

An Atypical Presentation of Diffuse Large B-Cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL) and it can metastasize to extranodal sites. The involvement of the adrenal glands is rare. In this report, we discuss the case of a 65-year-old man with complaints of asthenia, anorexia, hypersudoresis, and a weight loss of 10 kg in the month prior to his presentation. Suprarenal insufficiency and bilateral masses with heterogeneous contrast uptake in the adrenal glands were documented on a thoracoabdominopelvic CT. Infectious causes and functioning tumors were excluded. After an exhaustive study, DLBCL was diagnosed. Through this case report, the authors intend to sound the alert on the existence of a rare presentation of DLBCL.

SIADH in the context of localised Herpes-Zoster infection.

Not required for Clinical Vignette.

Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs.

Tuberculosis remains one of the most common infectious diseases. Miliary presentation is a rare and possibly lethal form, resulting from massive lymphohaematogenous dissemination of Mycobacterium tuberculosis bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected. LEARNING POINTS: Cerebrospinal fluid (CSF) characteristics in central nervous system tuberculosis (CNS TB) are variable and may even be normal. Typical CSF findings include lymphocytic-predominant pleocytosis, although neutrophilic predominance may occur. CSF microbiological testing for Mycobacterium tuberculosis has low sensitivity, so a negative test does not eliminate the diagnosis.Cerebral magnetic resonance imaging is usually the test of choice, given its superiority in CNS TB diagnosis over computed tomography (CT), which can be normal.Chest x-ray may appear normal and miss miliary TB, which however a CT scan can identify.

Renal hydatid cyst: medical treatment.

INTRODUCTION: Hydatid disease is a zoonosis caused by the parasite Echinococcus granulosus. It has a worldwide distribution, being endemic in Portugal. Hydatid disease of the urinary tract is rare, occurring in less than 2% of all cases. CASE REPORT: 14-year-old male with hydatid disease of the kidney. The diagnosis was established by imaging studies and specific serologic testing. Treatment consisted of four 4-week cycles of albendazol and resulted in a progressive reduction of the cyst as well as in a negative specific serology. DISCUSSION: Even though the recommended treatment is surgical excision, studies have demonstrated that medical treatment may be an alternative allowing for organ preservation.

Cisto hidático do rim: tratamento médico / Renal hydatid cyst: medical treatment

Resumo Introdução: A infecção por Echinococcus ou hidatidose constitui-se em uma zoonose causada pelo parasita Echinococcus granulosus. Apresenta distribuição mundial, sendo Portugal considerado endêmico. A doença hidática do rim é rara, ocorrendo em apenas 2% dos casos. Caso Clínico: Adolescente de 14 anos, do sexo masculino, com doença hidática do rim. O diagnóstico foi efetuado por exames de imagem e por teste sorológico específico. Foi instituída terapêutica com albendazol durante quatro ciclos de quatro semanas cada, tendo-se verificado diminuição significativa do tamanho do cisto e negatividade dos anticorpos específicos. Discussão: Embora a terapêutica recomendada seja a excisão cirúrgica, estudos demonstram que a terapêutica médica pode ser uma alternativa a considerar, permitindo a preservação do órgão.

Abstract Introduction: Hydatid disease is a zoonosis caused by the parasite Echinococcus granulosus. It has a worldwide distribution, being endemic in Portugal. Hydatid disease of the urinary tract is rare, occurring in less than 2% of all cases. Case report: 14-year-old male with hydatid disease of the kidney. The diagnosis was established by imaging studies and specific serologic testing. Treatment consisted of four 4-week cycles of albendazol and resulted in a progressive reduction of the cyst as well as in a negative specific serology. Discussion: Even though the recommended treatment is surgical excision, studies have demonstrated that medical treatment may be an alternative allowing for organ preservation.

[Acute gastroenteritis by Cambylobacter spp: a retrospective study of a paediatric emergency department]. / Gastroenterite Aguda por Campylobacter Spp: Casuística de uma Urgência Pediátrica.

INTRODUCTION: Infection by Cambylobacter occurs worldwide and represents the main cause of acute bacterial gastroenteritis within the European Union. AIMS: Determine the prevalence of Campylobacter in stool cultures from patients with gastroenteritis and study their microbiological, epidemiological, clinical, and therapeutic profiles, as well as associated complications. MATERIAL AND METHODS: Review of clinical files of patients presenting to the paediatric emergency department of a general district hospital over a 30 month period with an acute gastroenteritis and a Campylobacter isolated in a stool specimen. RESULTS: Out of 216 stool cultures, 98 (45%) were positive. We identified Campylobacter in 49 (50%) cases; 30 (61%) were female. Median age was 23 months. Fourteen patients were under one year of age, 25 between one and five years old and 10 patients were over five years old. Watery diarrhea was identified in 5 (10%) patients, bloody diarrhea in 44 (90%) and mucosanguineous in 14 (29%), while 23 (47%) had fever, 14 (29%) complained of abdominal pain and 11 (22%) presented with vomiting. One patient was septic. Five patients were admitted as inpatients. Eight patients were treated with azithromycin. DISCUSSION: This is the largest published national series on gastroenteritis by Campylobacter in children and the first in the south region. Campylobacter was the main bacteria isolated. Infection was self-resolving in the majority of cases. Nevertheless, severe forms of this infection should be considered. Increased resistance to quinolones is worrisome. CONCLUSION: Judicious use of stool cultures allows etiological identification of bacterial gastroenteritis. The increase in Campylobacter cases reinforces the need for better control of hygiene measures in handling food products.

Introdução: A infeção por Campylobacter é a principal causa de gastroenterite aguda bacteriana pediátrica na União Europeia.Objetivos: Conhecer a prevalência de isolamento deste agente nas crianças admitidas na urgência com gastroenterite aguda que realizaram coprocultura, caracterizando a microbiologia, epidemiologia, clínica, terapêutica e complicações associadas.Material e Métodos: Casuística por consulta dos processos dos doentes admitidos na Urgência Pediátrica dum hospital distrital, durante 30 meses, com o diagnóstico de gastroenterite aguda e isolamento em coprocultura de Campylobacter.Resultados: Das 216 coproculturas efetuadas, 98 (45%) foram positivas. Identificámos Campylobacter spp. em 49 (50%) doentes. Destes, 30 (61%) eram do género feminino. A mediana de idades foi 23 meses. Catorze doentes tinham idade inferior a um ano, 25 entre um e cinco anos e 10 idade superior a cinco anos. Verificámos diarreia aquosa em cinco (10%) doentes, diarreia com sangue em 44 (90%), sangue e muco em 14 (29%), febre em 23 (47%), dor abdominal em 14 (29%) e vómitos em 11 (22%). Registámos um caso de sépsis. Internámos cinco doentes. Oito doentes foram medicados com azitromicina.Discussão: Esta é a maior casuística nacional publicada de gastroenterite aguda a Campylobacter em idade pediátrica e a primeira no sul do país. Campylobacter foi a principal bactéria identificada, associada maioritariamente a doença auto-limitada. Contudo, há a considerar formas de infeção graves. O aumento da resistência às quinolonas é preocupante.Conclusão: A utilização criteriosa da coprocultura permite a identificação etiológica na gastrenterite aguda bacteriana. O crescente aumento dos casos de Campylobacter diagnosticados reforça a necessidade de maior controlo das medidas de higiene na manipulação dos alimentos.