Streptococcus intermedius lung infection masquerading as malignancy.

Streptococcus intermedius can cause aggressive infections. One such example as reported in this case is lung abscess which may be mistaken as malignancy on lung imaging.

A Trail to Diagnosis-Finding the Primary Lesions of Bone Metastasis.

This case reports an interesting case of hip pain. A 70-year-old male came to the hospital with lethargy and right hip pain. X-ray of the right hip was concerning for impending pathological fracture of right femur. Blood work was significant for hypercalcemia. He was managed with fluids, bisphosphates, and right hip arthroplasty. A bone biopsy was taken. His initial workup included an X-ray skeletal survey and computer tomography (CT) of the chest and abdomen to diagnose etiology of the right hip lesion. An X-ray skeletal survey showed multiple osteolytic bone lesions very suspicious for multiple myeloma. CT chest and abdomen did not show any concerning relevant findings. However, bone biopsy resulted as poorly differentiated adenocarcinoma of pancreatic or gastrointestinal origin. Magnetic resonance imaging (MRI) of the abdomen/pancreatic protocol was done, which showed normal pancreas and associated ducts. Later he underwent endoscopy showing stricture at the lower esophagus, whose biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma with esophagus as primary site. Further staging workup was completed by positron emission tomography (PET) scan. It was stage four at the time of diagnosis. Right hip pain was secondary to bone metastasis from esophageal cancer (EC). The primary lesion was not noticeable on CT imaging despite the evident extensive metastasis, challenging the diagnosis. He was offered palliative radiation therapy for bone metastasis and associated pain. Unfortunately, he continued to have recurrent hospital admissions with other medical conditions, and his physical health declined rapidly. He died within a few months after diagnosis.

Bacteraemia caused by Escherichia coli in cancer patients at a specialist center in Pakistan.

OBJECTIVE: To analyse the antimicrobial susceptibility patterns of Escherichia coli bacteraemia among cancer patients, and to assess the risk factors and outcomes of multidrug-resistant Escherichia coli bacteraemia. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, and comprised medical records of patients with Escherichia coli bacteraemia presenting between December 2012 and November 2013. Multivariable logistic regression analyses were used to determine the factors associated with the development and 30-day mortality of multidrug-resistant Escherichia coli bacteraemia. RESULTS: Out of 1603 episodes of bacteraemia, 227(35.6%) were caused by E.coli, of which 98(43.2%) were multidrug-resistant. In multivariable analysis, age less than 18 years (adjusted odds ratio 3.92; 95% confidence interval 1.43-10.68), presence of central venous catheter (adjusted odds ratio 2.12; 95% confidence interval 1.04-4.33) and exposure to piperacillin/tazobactam within 90 days prior to infection (adjusted odds ratio 2.37; 95% confidence interval 1.15-4.86) were identified as independent risk factors for acquisition of multidrug-resistant Escherichia coli bacteraemia. The overall 30 day mortality rate was 35.2% (80/227). Risk factors for mortality were intensive care unit admission (adjusted odds ratio 3.95; 95% confidence interval 1.79-8.71) and profound neutropenia (adjusted odds ratio 4.03; 95% confidence interval 1.55-10.49). CONCLUSIONS: Bloodstream infections with multidrug-resistant Escherichia coli were common in cancer patients. However it was not a predictor of mortality.