ABSTRACT
Objective: to describe a case of severe sepsis and complicated bacteremia caused by Arcanobacterium haemolyticum and review similar cases in the literature. Case summary: A 26-year-old gentleman with a history of epilepsy presented with symptoms of sore throat, productive cough, periumbilical abdominal pain, watery diarrhea, nausea and vomiting, subjective fevers along with progressive jaundice for seven days. The patient had acute fulminant liver failure, septic shock, and Multi-organ failure. He required vasopressors, underwent intubation, and had grown Arcanobacterium haemolyticum in the blood and Bronchoalveolar lavage samples. He developed a peritonsillar abscess and cavitary pneumonia and required chest tube drainage followed by thoracotomy for hemothorax. The patient improved on Ampicillin-Sulbactam treatment and was treated with a total antibiotic duration of 6 weeks. He fully improved on post-discharge follow-up. Discussion: Arcanobacterium haemolyticum is a Gram-positive (sometimes Gram variable), catalase-negative facultatively anaerobic, non-motile, non-spore-forming, and variably ß-hemolytic and is known to be a cause of pharyngitis and skin and soft tissue infections. Rarely A. Haemolyticum can be associated with severe systemic infections such as infective endocarditis, systemic abscesses, osteomyelitis, and septicemia. In previous literature reviews, the source of A. haemolyticum depended on the host, and pharyngeal and upper respiratory sources were likely to be associated with immunocompetent hosts. Conclusion: A. haemolyticum should be included in the differential diagnosis of bacterial pharyngitis complicated by severe systemic illness. Penicillins are the most commonly used antibiotics for treating A. haemolyticum bacteremia, and macrolides can be used for Penicillin's treatment failure.
ABSTRACT
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is an ongoing pandemic that has affected over 400 million people worldwide and caused nearly 6 million deaths. Hemorrhagic encephalitis is an uncommon but serious complication of COVID-19. The etiology of this disease is multifactorial, including secondary to severe hypoxemia, systemic inflammation, direct viral invasion, hypercoagulability, etc. The clinical spectrum of COVID-19-related hemorrhagic encephalitis is also varied, ranging from leukoencephalopathy with microhemorrhage, acute necrotizing hemorrhagic encephalitis (ANHE) involving the cortex, basal ganglia, rarely brain stem and cervical spine, hemorrhagic posterior reversible encephalopathy syndrome (PRES) to superimposed co-infection with other organisms. We report a case series of three young patients with different presentations of hemorrhagic encephalitis after COVID-19 infection and a review of the literature. One patient had self-limiting ANHE in the setting of mild COVID-19 systemic illness. The second patient had self-limiting leukoencephalopathy with microhemorrhages in the setting of severe systemic diseases and ARDS, and clinically improved with the resolution of systemic illness. Both patients were healthy and did not have any premorbid conditions. The third patient with poorly controlled diabetes and hypertension had severe systemic illness with neurological involvement including multiple ischemic strokes, basal meningitis, hemorrhagic encephalitis with pathological evidence of cerebral mucormycosis, and Epstein-Barr virus coinfection, and improved after antifungal therapy.
