A Case of Rapidly Progressive Coccidioidal Meningitis in an Immunocompetent Patient.

A 50-year-old male with a history of a dull headache and neck pain for a few weeks presented to the ER with complaints of progressive weakness and difficulty walking. Physical examination revealed a lethargic, confused patient with abnormal tremors at rest. Initial lab work was significant for elevated hemoglobin, hematocrit, and hyponatremia. Additionally, CT imaging was significant for prominent ventricles. Several serologies and polymerase chain reaction (PCR) tests were ordered to determine the etiology of the patient's meningitis. On day 10 of admission, serology results returned positive for Coccidioides antibodies. The patient was started on an IV fluconazole treatment and underwent a ventriculoperitoneal shunt and Ommaya reservoir placement procedure. Cases of coccidioidal meningitis are rarely noted in recent literature. We present this clinical case of coccidioidomycosis dissemination into the central nervous system (CNS) to highlight the rare localization of the fungal infection in a baseline immunocompetent patient.

Methicillin-Resistant Staphylococcus aureus Bacteremia of Indeterminate Primary Source: A Case Report and Review of Pain Management During Hospital Course.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria that is present in both hospital and community settings. It commonly spreads through direct contact but may also spread through droplets. Our body's innate and adaptive immunity is typically enough to protect against MRSA entering our body. MRSA has an increased ability to enter and spread throughout the body with the use of infected objects such as needles or even small breaks in the skin. When this spread occurs hematogenously, it is known as MRSA bacteremia. When a patient presents with MRSA bacteremia, it is a critical time-sensitive task to locate the source of infection as continual exposure to MRSA in the bloodstream can prolong infection and may ultimately be fatal. The interesting obstacle in our patient presenting with MRSA bacteremia was the inability to locate a source of infection, a pivotal component of medical management. After extensive testing and detailed history taking, there was no possible external source of infection, making source control a difficult task. Another unique component of this case report included the course of pain management and adjustments made to tailor pain control to this patient with a history of chronic opioid abuse.

Radiographic quantitative assessment of caudal proximal tibial angulation in 100 dogs with cranial cruciate ligament rupture.

OBJECTIVE: To evaluate inter- and intraobserver variability in the measurement of distal tibial axis/proximal tibial axis angle (DPA) from lateral radiographs of canine tibia in dogs with cranial cruciate ligament rupture (CCLR). STUDY DESIGN: Retrospective clinical study. ANIMALS: Dogs (n=100) with cranial cruciate ligament rupture. METHODS: Medical records of dogs diagnosed with CCLR were reviewed. In addition to signalment and TPA measurements, measured DPA (mDPA) was calculated for each lateral view of the tibia in each animal, twice, by 3 blinded observers. Subjective scoring of DPA (sDPA) was also recorded, twice, by 3 additional blinded observers from lateral views of the proximal half of the tibia in each dog. Inter- and intraobserver variability was measured by intraclass correlation coefficient (ICC) for each measurement. Correlation between mDPA and sDPA was also determined. RESULTS: Median tibial plateau angle (TPA) of the subject population was 27.9° (range 18.8-41.3°; IQR: 25.5-30.75°). Mean ± SD mDPA was 6.50 ± 2.81° (confidence intervals [CI]: 5.94-7.06°; range 0-13.33°). There was no correlation between age and weight of dogs and the mDPA (P=.58 and .12). There was a moderate correlation between mDPA and TPA (r(2)=0.49, P<.0001). There was a moderate correlation between sDPA and mDPA (r(2)=0.27, P<.0001). Good inter- and intraobserver agreement was found in the measurement of mDPA. CONCLUSION: mDPA is a reproducible measurement of caudal angulation of proximal tibia. Furthermore, mDPA of dogs with cranial cruciate ligament disease in this report are in concordance with previous reports.

Imaging diagnosis-CT myelography in a dog with intramedullary intervertebral disc herniation.

A 5-year-old Chihuahua was examined for peracute pain and paraparesis. Neuroanatomic localization was consistent with a symmetric T3-L3 myelopathy. Computed tomography (CT) of the T9-L5 vertebrae was normal. Myelography disclosed attenuation of the subarachnoid space from T11 to L1, consistent with spinal cord swelling. CT following the myelogram disclosed a focal area of intramedullary iodinated contrast medium at T13-L1. At surgery, intervertebral disc material was removed from the spinal cord. Based on the findings in this patient, intramedullary disc herniation should be considered a cause for focal intramedullary contrast medium accumulation.

Obstructive lesions and traumatic injuries of the canine and feline tracheas.

Tracheal obstruction and tracheal injury can be life-threatening conditions in dogs and cats. Early identification of associated clinical signs and the use of appropriate diagnostic and therapeutic techniques are important to patient survival. Common causes of tracheal obstruction reported in the veterinary literature include tracheal foreign bodies and tracheal tumors. Tracheal injury has been associated with endotracheal intubation and external trauma. Radiography and tracheoscopy are effective diagnostic modalities, and tracheal repair or resection and anastomosis are the most common treatments.