Chest wall abscess and costochondritis due to Salmonella enterica serotype Choleraesuis: a case report.

BACKGROUND: Salmonella enterica serotype Choleraesuis infections usually cause self-limited gastrointestinal diseases. Extra-abdominal infections are often secondary to bacteremia in immunocompromised individuals and are relatively rare in immunocompetent hosts. CASE PRESENTATION: A 65-year-old Caucasian female initially presented to the thoracic surgery clinic due to a poorly healing wound on her chest. Her condition started after a mechanical fall hitting her chest with interval development of a tender lump that later spontaneously drained. A chest computed tomography scan with intravenous contrast demonstrated an abnormal infiltration with small foci of fluid and air consistent with a small abscess anterior to the left seventh costal cartilage. Aspirate culture of the abscess grew S. enterica serotype Choleraesuis susceptible to ampicillin and trimethoprim/sulfamethoxazole. The patient had no prior history of signs or symptoms of gastrointestinal infection. Blood cultures were negative. With a background of penicillin allergy, she was treated with trimethoprim/sulfamethoxazole, and later with ceftriaxone due to persistent drainage of the wound. Follow-up chest computed tomography scan with intravenous (IV) contrast showed continued abnormal findings previously seen in the computed tomography scan with the appearance of a sinus tract. The patient subsequently underwent surgical debridement and partial resection of the left seventh costochondral cartilage and excision of the fistula. She had an uneventful recovery and complete resolution of her condition. CONCLUSION: We report a rare case of chest wall abscess with associated costochondritis due to S. enterica serotype Choleraesuis in a patient with no evidence of immunodeficiency nor history of bacteremia. Extraintestinal infections due to Salmonella without documented bacteremia have been previously reported in the literature. History of local trauma to the affected area might contribute to the seeding of infection. Diagnosis is often accomplished by clinical evaluation and culture of the affected area. Treatment often involves targeted antibiotic therapy but may require surgical intervention to achieve source control and cure.

A case of native tricuspid valve Neisseria mucosa/sicca species infective endocarditis complicated by septic pulmonary emboli.

We report a rare case of native tricuspid valve infective endocarditis caused by Neisseria mucosa/sicca, a gram-negative diplococcus which colonizes the upper respiratory tract. A female in her late 20 s with a history of injection drug use (IDU) who recently completed treatment for methicillin-sensitive Staphylococcus aureus (MSSA) native tricuspid valve infective endocarditis presented to the hospital with a 6-week history of increasing chest pain, shortness of breath and night sweats. Blood cultures grew Neisseria mucosa/sicca species in 3 of 3 sets. Transthoracic echocardiogram showed a large 3 cm × 2.2 cm vegetation on the tricuspid valve with severe regurgitation. The patient was initially treated with ceftriaxone and gentamicin. Her case was complicated by ongoing septic pulmonary emboli ultimately require pulmonary endarterectomy and repair of her tricuspid valve. We hope this case highlights a rare but known cause of infective endocarditis especially in patients with a history of IDU who may lick their needles, which predisposes those individuals to intravenous introduction of oral bacteria.

A Case of a COVID-19-positive Patient.

The coronavirus (COVID-19), discovered in 2019, has been creating havoc since it first emerged in China and is now spreading worldwide. Its presentation is somewhat similar to influenza. We hereby discuss the salient features of the coronavirus and present the case of a 33-year-old male who was tested positive for COVID-19.

Thrombotic Thrombocytopenic Purpura Associated with Myelodysplastic Syndrome.

Myelodysplasia and thrombotic thrombocytopenic purpura (TTP) are both rare diseases. TTP is a blood abnormality in which blood clots form in blood vessels leading to fatal outcomes. Myelodysplastic syndrome is a group of disorders caused by poorly formed blood cells or ones that do not work properly. We are hereby presenting the case of a 69-year-old female who presented with anemia, thrombocytopenia, changes in mental status and reduced kidney function, and further investigations revealed that the patient had underlying myelodysplasia.

Intersphincteric proctectomy for rectal mucocele in a Crohn's patient with anal stenosis. A case report and review of literature.

In patients who have undergone a colonic resection with creation of an end colostomy, drainage of mucus secreted by the mucosa of the rectal stump may not be possible if there is an outlet obstruction. With an outlet obstruction, formation of a rectal mucocele occurs. A rectal mucocele is a rare condition which has only been reported sporadically in case reports. We present here the utility of an intersphincteric proctectomy for treatment of a rectal mucocele in a 47 year old male Crohn's patient resulting in negligible post-operative or long-term morbidities.

Safety and efficacy of rivaroxaban compared with warfarin in patients undergoing peripheral arterial procedures.

OBJECTIVE: Rivaroxaban is a United States Food and Drug Administration-approved oral anticoagulant for venous thromboembolic disease; however, there is no information regarding the safety and its efficacy to support its use in patients after open or endovascular arterial interventions. We report the safety and efficacy of rivaroxaban vs warfarin in patients undergoing peripheral arterial interventions. METHODS: This single-institution retrospective study analyzed all sequential patients from December 2012 to August 2014 (21 months) who were prescribed rivaroxaban or warfarin after a peripheral arterial procedure. Our study population was then compared using American College of Chest Physicians guidelines with patients then stratified as low, medium, or high risk for bleeding complications. Statistical analyses were performed using the Student t-test and χ2 test to compare demographics, readmissions because of bleeding, and the need for secondary interventions. Logistic regression models were used for analysis of variables associated with bleeding complications and secondary interventions. The Fisher exact test was used for power analysis. RESULTS: There were 44 patients in the rivaroxaban group and 50 patients in the warfarin group. Differences between demographics and risk factors for bleeding between groups or reintervention rate were not statistically significant (P = .297). However, subgroup evaluation of the safety profile suggests that patients who were aged ≤65 years and on warfarin had an overall higher incidence of major bleeding (P = .020). Patients who were aged >65 years, undergoing open operation, had a significant risk for reintervention (P = .047) when they received rivaroxaban. CONCLUSIONS: Real-world experience using rivaroxaban and warfarin in patients after peripheral arterial procedures suggests a comparable safety and efficacy profile. Subgroup analysis of those requiring an open operation demonstrated a decreased bleeding risk when rivaroxaban was used (in those aged <65 years) but an increased risk for secondary interventions. Further studies with a larger cohort are required to validate our results.