ABSTRACT
We present a case of a 19-year-old man with right shoulder pain lasting for several months. Abdominal imaging revealed a right adrenal mass directly invading vascular structures into the right atrium. Widespread metastatic adrenocortical carcinoma was confirmed on biopsy. He opted for palliative mitotane treatment with home hospice care. This case emphasises the importance of considering abdominal masses in the differential diagnosis of persistent right shoulder pain after common causes have been ruled out. Early diagnosis could be potentially life-saving.
Subject(s)
Adrenal Cortex Neoplasms/diagnosis , Adrenal Cortex Neoplasms/drug therapy , Adrenocortical Carcinoma/diagnosis , Adrenocortical Carcinoma/drug therapy , Antineoplastic Agents, Hormonal/therapeutic use , Mitotane/therapeutic use , Shoulder Pain/diagnosis , Shoulder Pain/drug therapy , Adult , Fatal Outcome , Humans , Male , Rare Diseases/diagnosis , Rare Diseases/drug therapy , Young AdultABSTRACT
During 2005, 66 carbapenem-resistant isolates of Acinetobacter baumannii were collected from seven tertiary-care hospitals participating in a nationwide surveillance network in Colombia. The isolates were multidrug resistant and produced the carbapenemases OXA-23 and OXA-51. Forty-five belonged to four clones while 21 were unique pulsotypes. One clone was present in two hospitals within one city, while another had spread between two hospitals in different cities. Blood, secretions, and abdominal fluids were the most frequent sites of isolation. This is the first description of widespread dissemination of OXA-23 in South America.
Subject(s)
Acinetobacter Infections/epidemiology , Acinetobacter baumannii/genetics , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Hospitals , beta-Lactamases/genetics , Acinetobacter Infections/microbiology , Acinetobacter baumannii/classification , Acinetobacter baumannii/drug effects , Bacterial Proteins/metabolism , Carbapenems/pharmacology , Colombia/epidemiology , Humans , Microbial Sensitivity Tests , Polymerase Chain Reaction , Population Surveillance , beta-Lactam Resistance , beta-Lactamases/metabolismABSTRACT
In Medellin, Colombia, three Pseudomonas aeruginosa isolates with high-level carbapenem resistance (MIC>or=256 microg/ml) and an isolate of Citrobacter freundii with reduced susceptibility to imipenem produced the plasmid-mediated class A carbapenemase KPC-2. This is the first report of a KPC-type beta-lactamase identified outside of the family Enterobacteriaceae.
