A rare case of an infected aortoiliac graft complicated with Eggerthella lenta bacteremia and septic shock.

We describe the successful medical management of an infected aorto-bi-Iliac endograft. In this case report, we provide an example of a patient with an infected aorto-bi-iliac endograft and how appropriate medical management may result in a positive outcome. We report a case of a 67-year-old man with several medical comorbidities who developed aorto-bi-iliac endograft infection one year after graft placement. The patient presented to our E.R. with fever, lethargy, tachycardia, tachypnea, and hypotension. The diagnosis of an infected endograft was established after excluding any other possible source of infection plus the strong radiological evidence by computed tomographic scan and WBCs labeled Indium-111 tropolone scan. Blood cultures revealed the development of Eggerthella lenta, Escherichia coli Extended-spectrum beta-lactamase (ESBL), and Enterococcus Faecalis. To our knowledge, this is a rare case of an infected endograft and bacteremia due to Eggerthella lenta. After the administration of vancomycin and Meropenem, no improvements were noted to the patient's clinical condition. However, upon the administration of Tigecycline, the patient's clinical condition improved. Two days later, repeat blood cultures were negative. After completion of the course of antibiotics and stabilization of other comorbidities, the patient was discharged home with long term antibiotic therapy under close control of inflammation markers.

COVID-19-Induced Diabetic Ketoacidosis and Acute Respiratory Distress Syndrome in an Obese 24-Year-Old Type I Diabetic.

BACKGROUND In early 2020, severe acute respiratory syndrome-corona virus 2 caused an outbreak of a viral pneumonia that rapidly progressed to a global pandemic. Most cases presented with mild respiratory symptoms and required only supportive care with instructions to self-quarantine at home. Others had more severe symptoms that became complicated by acute respiratory distress syndrome (ARDS) and required hospitalization. CASE REPORT In this report, we present the case of a young patient in New York City who presented to our hospital with coronavirus disease 2019-induced diabetic ketoacidosis (DKA) that progressed to ARDS and subsequent death. The patient was managed for DKA on presentation with insulin protocol and acidosis management. However, it became evident that he had underlying respiratory complications, which later presented as ARDS requiring mechanical ventilation and antibiotics. CONCLUSIONS We recommend that clinicians be aware of this potentially fatal complication in all patients with pre-existing diabetes. Simultaneously, a low threshold for intubation should be advocated for patients with concurrent COVID-19 and type I diabetes mellitus since the potential for poor clinical outcomes from respiratory demise may be lessened by early respiratory intervention.

What are we missing? Three cases of severe COVID-19 pneumonia with negative testing.

The COVID-19 pandemic has drastically affected health care systems globally. Reverse transcriptase-polymerase chain reaction is currently the preferred method of detecting COVID-19; however, sensitivity of this test remains questionable. Incidental transmission and potential harm to infected individuals are some consequences of the failure to identify high-risk patients. We report three cases of symptomatic patients that required intensive care management with labs and imaging consistent with COVID-19 with initial false-negative reverse transcriptase-polymerase chain reaction testing. Improper sampling, viral load, and manufacturer variances of tests all contribute to reduced sensitivity. A clinical diagnosis should supplant such cases.

It's complicated: A case report on a COVID-19-positive HIV patient presenting with rhabdomyolysis and acute kidney injury.

The SARS-Cov-2/COVID-19 pandemic in early 2020 has had a devastating impact on health systems around the world. While viral pneumonia remains the most common complication, reports are surfacing of cases with neurological, cardiac, and renal involvement. Even less is known about the implications in special high-risk populations. In this report, we discuss a unique case of an HIV-positive patient in New York City who presented with a 2-week history of worsening fatigue, cough, dyspnea, and myalgias and was found to have COVID-19 pneumonia and acute kidney injury. He was managed for severe uremic metabolic acidosis and electrolyte abnormalities with emergent hemodialysis and supportive therapy with subsequent improvement. Direct involvement of SARS-CoV-2 and pneumonia-induced rhabdomyolysis were identified as the precipitating factors of his acute kidney injury. The pathophysiologic mechanisms of acute kidney injury, SARS-CoV-2 renal tropism, and the impact of highly active antiretroviral therapy on COVID-19 pneumonia are discussed. We highlight the importance of clinician awareness of this potentially fatal complication of COVID-19 pneumonia, particularly in the HIV-positive population as early recognition and management can have favorable outcomes.

Infected Hemodialysis Arteriovenous Fistula with Distant Explosive Pleuritis: A Rare Phenomenon.

BACKGROUND The management of patients with end-stage kidney disease can be accomplished with hemodialysis via a surgically created arteriovenous fistula. An arteriovenous fistula has an advantage because of the ability to serve as permanent access for hemodialysis over several months to years; however, it has a disadvantage because of its associated vascular and infectious complications. An infectious complication such as explosive pleuritis, which is usually due to respiratory infections, in the setting of an infected arteriovenous fistula site infection, is extremely rare. CASE REPORT A 36-year-old man with a past medical history of IgA nephropathy on hemodialysis with a left forearm arteriovenous fistula presented to the Emergency Department because of left flank pain. Despite no recent history or evidence of a respiratory tract infection, he developed explosive pleuritis within 48 h. The presence of Group A Streptococcus at the arteriovenous fistula site coincided with Streptococcus pyogenes infection. The pleural effusion was drained and he was treated with antibiotics. He recovered and was eventually discharged home. CONCLUSIONS Explosive pleuritis, although less frequent, is almost always secondary to respiratory tract infections. An arteriovenous fistula site infection may be the source of infection of an internal organ if no apparent source is identified.

A Case of Atraumatic, Streptococcal Pneumocephalus: A Rare Complication of Influenza B Infection.

BACKGROUND Pneumocephalus is a rare occurrence without trauma, neurosurgery, or intracranial pathology. It is an uncommon complication of bacterial meningitis, and it is usually diagnosed with a CT head. Bacterial pneumocephalus in the setting of influenza B virus infection is an extremely rare complication; however, vaccination against influenza and early diagnosis and treatment help prevent mortality. CASE REPORT A 51-year-old woman presented to the Emergency Department in early winter because of worsening mental status over seven days prior to presentation. She was not vaccinated against influenza. Before and upon presentation to our facility, she was diagnosed with influenza B virus infection and was positive for streptococcal meningitis. A CT head revealed pneumocephalus, likely due to Streptococcus infection. She was treated with antibiotics, and a repeat CT head showed resolution of the lesion. CONCLUSIONS Bacterial pneumocephalus in the background of influenza is an uncommon occurrence. Influenza vaccination and early diagnosis with a CT of the head and prompt initiation of antibiotics are essential in preventing mortality.

COVID-19: The Case of Three Patients with the Same Diagnosis but Different Clinical and Laboratory Features.

SARS-CoV-2 is an RNA virus that causes COVID-19, which has been responsible for the pandemic that was declared in early 2020. Its pathological effect is majorly in the respiratory tract, but its full pathogenicity remains a mystery. Symptoms associated with COVID-19 include fever, cough, and shortness of breath. Some patients develop other symptoms like diarrhea. However, it is possible for other organs to be affected including the central nervous system, liver, and blood cells. The purpose of this case series is to unravel other factors associated with this disease, so we report three cases of COVID-19 that were hospitalized during the pandemic.

A fatal case of congenital pulmonary airway malformation with aspergillosis in an adult.

Congenital cystic adenomatoid malformation, currently referred as congenital pulmonary airway malformation (CPAM), is one of the rare lung malformations seen in adults. We report a case of a 59-year-old male with a chronic cough and hemoptysis that was not amenable to bronchial embolization. Further work up revealed cystic changes with fungal ball and type 1 CPAM. Patients with this condition who survive to adulthood usually suffer from recurrent respiratory bacterial infections. Only three cases of fungal involvement have ever been described. We present a fatal case, as well as the oldest patient.