RESUMO
Pyogenic liver abscesses (PLAs) secondary to bacterial etiologies are most often seen in developing countries and are less common in North America. The predominant etiology is infection occurring in the setting of direct extension of hepatobiliary or intestinal infection. The most common pathogen isolated from a PLA in the United States is Escherichia coli, whereas Streptococcus viridans is a rare entity in the developed world. Herein we report a rare case of a complicated isolated PLA in a patient without any known comorbidities which lead to hepatectomy. The patient was born and raised in the United States with no recent travel history. The patient was found to have 10 cm isolated multicystic mass on imaging confirmed later as vancomycin-resistant Streptococcus viridans PLA. The patient was treated with multiple intravenous antibiotics and underwent multiple ultrasound-guided percutaneous abscess drainages by interventional radiology, but all unsuccessful. The patient underwent right posterior liver lobectomy, thereafter making a quick recovery and was discharged. Our case underlines the significance of considering liver abscess as a differential even in previously healthy individuals with no known prior comorbid conditions, as prompt recognition is imperative in preventing morbidity and mortality.
RESUMO
Cervical necrotizing fasciitis (CNF) is a rapidly spreading deep neck infection with a high mortality rate if left untreated. The occurrence of necrotizing infections in the head and neck region is uncommon; therefore, it is a rare cause of chest pain presenting to the emergency department. Here, we present an interesting case of fungal cervical skin abscess complicated by necrotizing fasciitis that progressed to involve the mediastinum, causing necrotizing mediastinitis with pneumomediastinum in an elderly female. The patient presented to the emergency department with chest pain, shortness of breath, and fever. She had a 10-day history of a mass in the anterior midline of her neck with odynophagia. After radiologic confirmation, she was taken to the operating room where she underwent incision and drainage with debridement and washout. Postoperatively, she was given broad-spectrum antibiotics empirically, which were later replaced with intravenous (I/V) fluconazole after culture reports. Prompt diagnosis and treatment lead to the early recovery of the patient and subsequent discharge without any complications. We report this case to draw the attention of emergency medicine physicians and clinicians to this rare and life-threatening but treatable condition. Expeditious diagnosis and treatment lead to early recovery and fewer postoperative complications.
RESUMO
A unicornuate uterus with an accessory horn is one of the rarest congenital uterine anomalies; hence, the possibility of ectopic pregnancy in the accessory uterine horn is highly uncommon. It poses a significant risk to maternal life, as it is difficult to identify before surgery due to the severe hemoperitoneum in the event of rupture of the ectopic pregnancy. We report a case of a 20-year-old primigravida who presented to the emergency department of Civil Hospital Karachi, with sudden onset of generalized abdominal pain, vomiting, and dizziness at 17 weeks of gestation. Emergency ultrasonography of the abdomen showed extensive echogenic fluid, which was considerably obscuring the view. An empty uterus was seen with a complex cystic mass on its right side separate from the ovary. A ruptured ectopic pregnancy was suspected, and hence, the patient was immediately shifted to the operating room. Emergency laparotomy was done which then showed ruptured ectopic pregnancy with a viable fetus in a right-sided rudimentary horn of the uterus. The horn was excised. The patient recovered well, and the postoperative course was uneventful.
