RESUMEN
Proteus species belong to the Enterobacteriaceae family and are gram-negative-rods, commonly known to cause urinary tract infections and asymptomatic bacteriuria in elderly patients with risk factors such as diabetes mellitus and urinary catheterization. However, Proteus species are rarely known to cause infective endocarditis. We present a case of an 85-year-old female who presented due to decreased responsiveness with urine and blood cultures growing Proteus mirabilis. While she was being treated for her urinary tract infection, her echocardiogram showed vegetation on the left coronary cusp of the aortic valve and left pulmonic valve leaflet. Uncontrolled tachyarrhythmias and new-onset atrial fibrillation complicated the hospital course. Later, she became bradycardic during the hospital stay, and all rate-control medications were held. Unfortunately, she went into cardiac arrest and spontaneous circulation could not be established with resuscitation attempts and she expired. To our knowledge, this is a rare case of native valve infective endocarditis secondary to Proteus mirabilis, leading to uncontrolled tachyarrhythmias and death.
RESUMEN
Immune thrombocytopenic purpura (ITP) can be acquired or secondary to other drugs, infections, or autoimmune disorders. Legionella is a known intracellular organism that causes Legionnaire's disease and affects the lungs. Presented is the first case showing a direct association between Legionella and ITP. Our patient was a 61-year-old female with a past medical history of asthma whose clinical presentation was consistent with pneumonia secondary to Legionella. Her hospital course was complicated by critical bleeding with severe thrombocytopenia. She responded to antibiotics, steroids, and intravenous immunoglobulins (IVIG). Our case suggests an association between ITP and Legionella and emphasizes its timely diagnosis for appropriate treatment.
RESUMEN
Primary cutaneous nocardiosis accounts for 5-8 % of all nocardiosis cases and represents a diagnostic dilemma among immunocompetent and immunocompromised hosts. Herein, we present a case of a 30-year-old male with history of psoriasis with recent addition of Apremilast. Patient received intralesional triamcinolone injections for psoriatic plaques on the hands and abdomen prior to traveling to warm climate vacation. While on vacation, patient developed hand swelling and painful, red nodules on the dorsal hands and abdomen, sites where he received intralesional injections. Patient was empirically given doxycycline, but continued to develop new nodules. An abdominal lesion was biopsied for H&E and tissue culture. Tissue culture revealed beaded gram-positive rods identified as Nocardia nova by MALDI-TOF. Patient was switched to trimethoprim-sulfamethoxazole with significant improvement. This case represents an atypical primary cutaneous nocardiosis with Nocardia nova most likely in the setting of intralesional steroid injections and possible contribution of Apremilast.