ABSTRACT
Actinomycosis is a chronic, indolent, granulomatous disease process caused by the Actinomyces genus of bacteria. More severe forms of actinomycosis include disseminated or central nervous system (CNS) infections. Actinomyces meyeri is the most common species of Actinomyces isolated from brain abscesses. A. europaeus species is commonly associated with skin and soft tissue abscesses. However, it rarely causes brain abscesses. We present an unusual case of A. europaeus brain abscess in a 69-year-old female who presented with acute encephalopathy and bilateral lower extremity weakness. She was diagnosed with left-sided mastoiditis with intracranial extension, left posterior fossa epidural abscess, and transverse sinus thrombosis. The patient's hospital course was complicated by hydrocephalus and declining neurological status. Empiric antimicrobial therapy was initiated, and the patient underwent mastoidectomy and external ventricular drain placement followed by decompression craniotomy and subarachnoid abscess aspiration. Given her poor and unchanged neurologic status, the patient was transitioned to comfort-oriented measures after shared decision-making with the family. It is crucial to identify Actinomyces as a causal agent of severe CNS infections like brain abscesses, meningoencephalitis, or subdural empyema, as untreated infections can lead to irreversible neurologic complications.
ABSTRACT
Clinically significant cryptococcal disease is typically seen in patients with human immunodeficiency virus (HIV). However, Cryptococcosis has also been observed among non-HIV immunocompromised hosts. Cryptococcosis and tuberculosis (TB) infections both occur due to impaired cell mediated immunity but co-infection is rare among immunocompromised patients. Co-infection of these pathogens is even less reported in immunocompetent hosts. We present a case of Cryptococcal left native knee septic arthritis with tibial osteomyelitis in an HIV negative patient with recently active tuberculosis.
ABSTRACT
Histoplasmosis is usually a benign, self-limited disease with lungs predilection. However, it might manifest as a disseminated disease in immunocompromised individuals. The involvement of the central nervous system (CNS) accounts for about 5-10% of cases with disseminated disease. Isolated histoplasmosis of the CNS is rare, and the literature shows only a few reported cases. By imaging studies, it usually presents as an isolated ring-enhancing lesion. Its spectrum of symptoms ranges from acute severe infection to progressive chronic meningitis, which delays the initial diagnosis, correct work-up and initiation of appropriate therapy. We present a case of a 57-year-old man from the Midwest of the United States who misdiagnosed with Gliosarcoma in 2019, for which he underwent appropriate management for Gliosarcoma. Presented for follow-up after new neurological symptoms; worsening in ring-enhancing brain lesions was found on magnetic resonance image MRI. After a re-examination of surgical pathological cases, histoplasmosis of the CNS was diagnosed. Failure of diagnosis CNS histoplasmosis early can lead to poor outcome and decrease chances of recovery.
ABSTRACT
A formal high value, cost-conscious care (HVCCC) curriculum was implemented at a community hospital-based university-affiliated residency program starting January 1, 2014, based on the recommendations of the American Board of Internal Medicine's (ABIM) Choosing Wisely campaign. The program included a competition requiring each resident to write a HVCCC case based on an actual patient experience. Residents completed a questionnaire assessing their understanding of HVCCC near the end of the program. Residents subsequently reviewed two actual cases that had vividly described unexpected adverse outcomes ('anecdotal' cases). Postexposure data were collected and the results were analyzed.
