An Unusual Case of Candida kefyr Fungemia in an Immunocompromised Patient.

An immunocompromised patient with a known history of cerebrovascular accident (CVA) with right-sided hemiparesis of long duration, type 2 diabetes mellitus, and hypertension presented with signs of rhabdomyolysis and later acute kidney injury (AKI). He subsequently developed Guillain Barre syndrome. Initially, hemodialysis was followed by plasmapheresis. After hemodialysis, the patient presented with multiple episodes of vomiting and weakness of all limbs. A culture showed growth of Enterococcus faecalis, and on Day 6, a bloodstream infection with Candida kefyr and a urinary tract infection with Enterococcus faecalis were diagnosed. We report a rare case of bloodstream infection due to C. kefyr.

Diffusion-weighted Magnetic Resonance Imaging in Non-traumatic Vertebral Collapse: A Relook Into Its Utility in Making the Diagnosis in a Population Where Infections of Spine Are a Common Cause.

AIM: Magnetic resonance imaging (MRI) is the imaging investigation of choice in vertebral collapse. In this study, we considered various MRI features and appearance based on morphological features, signal intensity, contrast enhancement characteristics, and diffusion-weighted imaging (DWI) of various types of non-traumatic vertebral collapse for differentiating benign from malignant causes and its role in differentiating cases of infectious causes of vertebral collapse from malignant causes. MATERIALS AND METHODS: Between November 2014 to November 2016 a total of 100 consecutive patients from the MRI centre of JN Medical College and Hospital, Aligarh, were evaluated for the study. Inclusion criteria included patients presenting with backache, limb weakness, and fever who had undergone radiography of the spine that showed features of collapse. All patients underwent MRI on a 1.5 T MR Scanner. Coronal, sagittal and axial spine images were obtained using T1 weighted, T2 weighted, short tau inversion recovery, T1 postcontrast, and DWI sequences. RESULTS: In our study, we found different causes of non-traumatic vertebral collapse that were broadly categorized as benign or malignant. The benign causes were further sub-categorized into osteoporotic or infectious based on morphological features, signal intensity characteristics, and DWI. However, on DWI, the patients with infective collapse showed mean apparent diffusion coefficient values of 884 × 10-6 mm2/s ranging between 700 and 1,100 × 10-6 mm2/s between those of malignant and benign osteoporotic collapse, with significant overlap. The statistical difference between the malignant and infective cases, as well as between osteoporotic and infective cases, was not found to be statistically significant (P > .05). CONCLUSION: MRI plays a key role in establishing the cause of vertebral collapse, classifying it as either benign or malignant. DWI, although described in various studies as highly sensitive in differentiating benign osteoporotic and malignant collapse, was found to be good in differentiating only osteoporotic from malignant collapse, with the infectious cases proving to be a grey zone with significant overlap of quantitative diffusion findings.

Encephalocraniocutaneous lipomatosis: A case report with review of literature.

Encephalocraniocutaneous lipomatosis (ECCL) or Haberland syndrome is an uncommon sporadic neurocutaneous syndrome of unknown origin. The rarity and common ignorance of the condition often makes diagnosis difficult. The hallmark of this syndrome is the triad of skin, ocular and central nervous system (CNS) involvement and includes a long list of combination of conditions. Herein we report a case of a 5-month-old male child who presented to our centre with complaint of seizure. The patient had various cutaneous and ocular stigmatas of the disease in the form of patchy alopecia of the scalp, right-sided limbal dermoid and a nodular skin tag near the lateral canthus of the right eye. MRI of the brain was conducted which revealed intracranial lipoma and arachnoid cyst. The constellation of signs and symptoms along with the skin, ocular and CNS findings led to the diagnosis of ECCL.