Subject(s)
Anti-Infective Agents/administration & dosage , Brain Abscess/diagnosis , Brain Abscess/microbiology , Craniotomy , Drainage , Epilepsy, Tonic-Clonic/etiology , Epilepsy/complications , Streptococcal Infections/diagnosis , Viridans Streptococci/isolation & purification , Aged , Anticonvulsants/administration & dosage , Brain Abscess/drug therapy , Brain Abscess/surgery , Ceftriaxone/administration & dosage , Epilepsy/drug therapy , Epilepsy, Tonic-Clonic/microbiology , Humans , Infusions, Intravenous , Magnetic Resonance Imaging , Male , Metronidazole/administration & dosage , Paresis/etiology , Paresis/rehabilitation , Phenytoin/administration & dosage , Streptococcal Infections/drug therapy , Tomography, X-Ray ComputedSubject(s)
Cryptococcus neoformans/isolation & purification , Epilepsy, Tonic-Clonic/microbiology , HIV Infections/complications , HIV Infections/diagnosis , Meningitis, Cryptococcal/complications , Anticonvulsants/therapeutic use , Epilepsy, Tonic-Clonic/drug therapy , Humans , Male , Middle Aged , Valproic Acid/therapeutic useABSTRACT
OBJECTIVES: We report a case of epididymo-orchitis and central nervous system nocardiosis in a 22-year-old man with T-cell acute lymphoblastic leukemia; he was an allogeneic marrow recipient with acute and chronic graft-versus-host disease. MATERIALS AND METHODS: He had microscopic hematuria and cytomegalovirus antigenemia. He deteriorated subsequently while on cyclosporine and steroids, requiring hospital admission owing to fever and swelling of the left testis and generalized tonic-clonic convulsions. RESULTS: Brain magnetic resonance imaging showed abnormal signal area in right parietal and left parieto-occipital lobes. The lesions had mass effect, edema, and ring enhancement. Findings were indicative of a brain abscess. A testicular biopsy from the lower pole of the left testis was done. A white-to-yellowish discharge was seen and subsequently, Nocardia grew in culture. CONCLUSIONS: Trimethoprim-sulfamethoxazole was prescribed, and significant improvement was seen after 2 weeks. The patient was discharged. He was subsequently referred after 3 weeks due to graft-versus-host disease and died of pancytopenia.
Subject(s)
Bone Marrow Transplantation/adverse effects , Brain Abscess/microbiology , Epididymitis/microbiology , Immunosuppressive Agents/adverse effects , Nocardia Infections/microbiology , Orchitis/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery , Acute Disease , Anti-Infective Agents/therapeutic use , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Chronic Disease , Epididymitis/drug therapy , Epilepsy, Tonic-Clonic/microbiology , Fatal Outcome , Graft vs Host Disease/etiology , Humans , Magnetic Resonance Imaging , Male , Nocardia Infections/diagnosis , Nocardia Infections/drug therapy , Orchitis/drug therapy , Pancytopenia/etiology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Young AdultABSTRACT
Isolated cerebral mucormycosis is a rare but life-threatening infection that generally occurs in patients with intravenous drug abuse or immune deficiency. We report a case of primary cerebral mucormycosis in a healthy adult. Whole body autopsy in this case revealed cerebral mucormycosis with prominent vascular pathology and hemorrhagic necrosis. No nasal sinus, orbital or other primary locus of fungus infection was discovered. Review of the previously reported 30 cases of isolated cerebral mucormycosis revealed associated systemic predisposition in 11 patients and history of intravenous drug abuse in 17 cases. In the remaining two cases, the diagnosis of fungal infection was made only after surgical exploration. Early tissue diagnosis and the consequent surgical excision of the necrotic tissue and aggressive antifungal therapy might salvage life in this fatal condition.
Subject(s)
Cerebral Cortex/pathology , Epilepsy, Tonic-Clonic/microbiology , Mucorales/isolation & purification , Mucormycosis/microbiology , Mucormycosis/pathology , Adolescent , Adult , Child , Epilepsy, Tonic-Clonic/complications , Epilepsy, Tonic-Clonic/pathology , Female , Humans , Infant , Magnetic Resonance Imaging/methods , Male , Middle Aged , Mucormycosis/complicationsABSTRACT
INTRODUCTION: Neurological clinical manifestations are often observed in toxic shock syndromes. However they unusually dominate the clinical picture. OBSERVATION: We present a case of recurrent catamenial encephalopathy, with epileptic seizures, revealing a menses toxic shock syndrome.