Invasive Klebsiella pneumoniae Syndrome in Qatar: A Case Report.

Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacteria that can infect most of the body's organs, from the lungs to the central nervous system. It is notorious for causing pneumonia in alcoholic, diabetic, and hospitalized patients. It is now emerging as a cause of abscesses involving multiple organs. Invasive K. pneumoniae is most commonly observed in the Asian population but has been reported in other geographical areas as well. We present a case of invasive K. pneumoniae. The patient was initially admitted with diabetic ketoacidosis (DKA); further investigations showed multiple abscesses involving the liver, lungs, brain, and muscles. K. pneumoniae was identified in blood and liver abscess cultures. The patient was managed for DKA as per protocol, and was administered broad-spectrum antibiotics with percutaneous drainage of liver abscess for invasive K. pneumoniae syndrome. In this paper, we highlight the invasive nature of K. pneumoniae, which may aid clinicians in diagnosing and managing similar cases, thereby preventing the associated high morbidity and mortality.

Acute Renal Failure Due to Bile Cast Nephropathy: An Overlooked Cause of Kidney Injury.

Acute kidney injury in the setting of hyperbilirubinemia presents a diagnostic challenge. Hepatorenal syndrome takes precedence as a diagnosis in these cases. Bile cast nephropathy is a diagnosis that gets relatively low consideration. The most accurate diagnostic tool for bile cast nephropathy is a renal biopsy, which may present a challenge in certain clinical settings. There are no set guidelines for its management. While the exact cause of the condition is unknown, it is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstruction caused by bile casts, and systemic hypo-perfusion from vasodilation. It is believed that plasmapheresis and albumin dialysis have been associated with some recovery of renal function. We present a case of acute renal failure in a patient with obstructive jaundice, who responded to dialysis and biliary drain insertion.

Non-Conforming Still's Disease With Low Ferritin and No Skin Rash: A Case Report.

Adult Still's disease (ASD) is an inflammatory disorder with an unclear etiology. It is a rare disease that was first described more than a century ago. Its common characteristics are daily fevers, arthritis, and skin rash. ASD is diagnosed after excluding infections, malignancies, and connective tissue diseases. It has a female predominance. Classic skin rash and high serum ferritin levels are commonly associated with this condition and help in the diagnosis. Due to a lack of pathognomic clinical and laboratory features, a valid diagnostic criterion, the Yamaguchi criteria, is generally used for the diagnosis. The disease has a good prognosis with appropriate treatment. We present the case of a young gentleman who presented with fever, anemia, and leucocytosis; however, his serum ferritin levels were normal, and there was no typical salmon-colored skin rash. Hyperferritinemia developed later in the disease course, leading to a diagnosis of ASD.

Non-Atherosclerotic Myocardial Infarction With a Presentation of Wellens Syndrome.

Myocardial infarction (MI) is a critical event that needs timely diagnosis and prompt management. Wellens syndrome can progress to MI if not managed in a timely manner. It implies the underlying critical stenosis of the left anterior descending (LAD) artery of the heart. In this report, we discuss an interesting presentation of pseudo-Wellens syndrome in a hypertensive middle-aged woman admitted as a case of Non-ST-elevation myocardial infarction (NSTEMI). During the hospital stay, she had an episode of chest pain with typical ECG changes, suggesting Wellens syndrome. However, upon intervening with coronary angiography, it turned out to be unremarkable for any coronary artery stenosis. She developed another episode of chest pain during her hospital stay with abnormal ECG patterns requiring further investigations with a non-invasive CT scan of coronary arteries and cardiac MRI for any infiltrative diseases. All workups were unremarkable. A multidisciplinary team involving the medical and interventional cardiology departments were involved in the diagnosis, and the patient was labeled as a case of vasospastic angina. She was treated with calcium channel blockers and was followed up as an outpatient for seven months with no further complications. Our main objective was to highlight the interesting phenomenon of Wellens and pseudo-Wellens syndrome. The condition requires early diagnosis and timely management to make sure that no underlying critical pathology is present that can result in fatal complications like MI or cardiac arrest.

Profile of Patients With Tuberculous Pleural Effusion in Qatar: A Retrospective Study.

Introduction Tuberculosis (TB) remains one of the top 10 causes of death globally. Around 1.7 billion people are infected with mycobacterium TB worldwide, and almost 90% of cases each year are found in 30 high TB burden countries. Due to the influx of a large expatriate population mainly from the high TB burden countries, there is an increased number of pulmonary TB as well as tuberculous pleural effusion cases reported in Qatar. Objectives The demographic, clinical, laboratory, and histopathological parameters of patients with tuberculous pleural effusion were assessed. Methods A single-center study was conducted at Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Adults diagnosed to have tuberculous pleural effusion were included, and those with clinical suspicion of tuberculous pleural effusion with positive sputum acid-fast bacillus (AFB) but negative AFB in pleural samples were excluded. Results A total of 106 patients were reviewed, of whom 100 were included for the final analysis, with 86% being men. Majority were from the Asian subcontinent, and the mean age was 33.8 years (SD ± 10.3). Main symptoms in decreasing order were cough (77%), fever (56%), and chest pain (54%). Of the patients, 72% had normal BMI, and rest were above the normal range. Anemia and hypoalbuminemia were found in 36.7% and 89.8% of the patients, respectively. Positive AFB culture was observed in pleural biopsy (79%), pleural fluid (13%), and sputum (16%). Positive AFB by polymerase chain reaction (PCR) was observed in pleural biopsy (57%), pleural fluid (3%), and sputum (2.2%), whereas AFB smear was positive in 2% of pleural biopsy samples. Caseating granuloma was seen in 80% of patients. All the three Light's criteria were met by 30% of the patients whereas 52% had two criteria fulfilled. No association between the number of Light's criteria and AFB yield was observed. Conclusions TPE was more common in healthy young adults. The AFB yield on pleural biopsy, PCR, and culture was significantly higher than that on all other samples. The number of positive Light's criteria did not have any association with positive AFB yield.