ABSTRACT
Propionibacterium acnes has long been considered a contaminant organism. However, recently the isolation of this emerging pathogen has become a more difficult clinical challenge. Infections of the central nervous system caused by P. acnes have been strongly associated with neurosurgical procedures. We describe a patient with Propionibacterium acnes cerebral abscess developed as consequence of a severe chronic sinus disease.
Subject(s)
Brain Abscess/microbiology , Gram-Positive Bacterial Infections/microbiology , Propionibacterium acnes/isolation & purification , Sinusitis/microbiology , Aged , Brain Abscess/diagnosis , Brain Abscess/diagnostic imaging , Chronic Disease , Fatal Outcome , Humans , Magnetic Resonance Imaging , Male , Neurosurgical Procedures , Risk Factors , Sinusitis/diagnosis , Sinusitis/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
IRIS is described as a paradoxical deterioration of clinical status upon initiation of combined anti-retroviral therapy (cART) in patients with HIV infection. Immune reconstitution inflammatory syndrome (CNS-IRIS) involving the central nervous system is rarely reported. We describe the case of 57-year-old man who developed a fatal case of CNS- IRIS. A rapid deterioration of neurological status was associated with progression of patchy T2-weighted hyperintensities involving different vascular territories on brain MRI. Diagnosis of CNS-IRIS is based of laboratory and radiologic findings, however brain biopsy is supportive. Despite immune restoration being involved in clinical deterioration, discontinuation of cART is not recommended. The use of corticosteroids is highly controversial. Prompt recognition of CNS-IRIS is crucial for preventing neurological complications and ensuing sequelae.
Subject(s)
AIDS-Related Opportunistic Infections/pathology , Antiretroviral Therapy, Highly Active/adverse effects , Central Nervous System Diseases/etiology , HIV Infections/complications , Immune Reconstitution Inflammatory Syndrome/drug therapy , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , Brain/pathology , Bronchoalveolar Lavage Fluid/microbiology , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes , Central Nervous System Diseases/drug therapy , Central Nervous System Diseases/pathology , Drug Therapy, Combination , HIV Infections/drug therapy , HIV Infections/immunology , HIV-1 , Humans , Immune Reconstitution Inflammatory Syndrome/complications , Immune Reconstitution Inflammatory Syndrome/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Pneumocystis carinii/isolation & purificationABSTRACT
Unilateral ptosis is seen in a limited number of conditions such as Horner syndrome, cluster headache, trauma, tumor, stroke, old age, nerve injury, lacrimal gland tumor, temporal arteritis or disorders of the upper eyelid. The authors present a case of unilateral ptosis secondary to Burkitt lymphoma metastasis to brain with excellent response to chemotherapy and complete resolution of ptosis in a man with human immunodeficiency virus. This vignette emphasizes the importance of recognizing ptosis as an initial presentation of Burkitt lymphoma in a patient with human immunodeficiency virus under appropriate clinical settings.
Subject(s)
Blepharoptosis/etiology , Burkitt Lymphoma/complications , Lymphoma, AIDS-Related/complications , Brain Neoplasms/complications , Brain Neoplasms/secondary , Humans , Male , Middle AgedABSTRACT
Acquired hemophilia A, also known as acquired factor VIII deficiency, is an exceedingly rare bleeding diathesis that does not require any personal or family history of bleeding or clotting disorder. Because treatment is available, misdiagnosing or completely missing this diagnosis can be life threatening for patients. Clinicians should be aware that acquired forms of hemophilia do exist and are associated with high morbidity and mortality in elderly adults. We present a case of a 74-year-old man who was diagnosed with acquired factor VIII inhibitor during an admission for community-acquired pneumonia.
Subject(s)
Hemophilia A , Scrotum , Aged , Factor VIII/therapeutic use , Hemophilia A/complications , Hemophilia A/diagnosis , Hemophilia A/drug therapy , Hemophilia A/etiology , Hemorrhage/etiology , Humans , Male , Recombinant Proteins/therapeutic useABSTRACT
CONTEXT: Intestinal flora and anaerobes are frequently implicated in causing infectious necrotizing pancreatitis however Bifidobacterium and Veillonella have rarely been isolated as the causative agents. Bifidobacterium and Veillonella are commensal anaerobes which reside in gastrointestinal tract and help deconjugate bile acids. Bifidobacterium is also frequently used in probiotics. CASE REPORT: We present a 68-year-old man who initially presented with gallstone pancreatitis but eventually developed Bifidobacterium and Veillonella species induced necrotizing pancreatitis and pseudocyst formation. CONCLUSION: Under rare circumstances commensal gut flora can turn pathogenic which can lead to life-threatening morbidity and may even result in mortality.
Subject(s)
Bacterial Physiological Phenomena , Gastrointestinal Tract/microbiology , Pancreatitis, Acute Necrotizing/etiology , Pancreatitis, Acute Necrotizing/microbiology , Aged , Bifidobacteriales Infections/complications , Bifidobacteriales Infections/diagnosis , Bifidobacterium/physiology , Gallstones/complications , Gallstones/microbiology , Gram-Negative Bacterial Infections/complications , Gram-Negative Bacterial Infections/diagnosis , Humans , Male , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/microbiology , Pancreatitis, Acute Necrotizing/diagnosis , Symbiosis/physiology , Veillonella/physiologyABSTRACT
Moxifloxacin is a newer-generation synthetic fluoroquinolone that is used for treatment of acute bacterial sinusitis, acute exacerbation of chronic bronchitis, community acquired pneumonia, intra-abdominal infections and skin/skin structure infections. We describe a case of fatal hepatotoxicity caused by Moxifloxacin in a 72-year-old man. He presented with jaundice and epigastric tenderness that started one week after being treated for acute exacerbation of his chronic bronchitis with Moxifloxacin by his primary care physician. He was admitted to intensive care unit for close monitoring. His labs showed marked elevation in liver enzymes and bilirubin. His condition continued to deteriorate in intensive care unit despite supportive care. Acute hepatic failure which resulted in his death was attributed to idiosyncratic reaction to Moxifloxacin.
