Cytomegalovirus pneumonitis in a patient with nephrotic syndrome receiving low-dose prednisolone and pulmonary tuberculosis.

Cytomegalovirus pneumonitis in a patient with pulmonary tuberculosis has been rarely reported. We report on a patient with nephrotic syndrome and documented pulmonary tuberculosis who received antituberculous therapy. Chest radiography showed a newly developed patch, and he underwent high-resolution computed tomography examination of the chest and open lung biopsy. Histopathologic studies of the lung showed interstitial pneumonitis, which had focal syncytial pneumocytes with focal nuclei atypia, inclusion bodies, and prominent eosinophilic nucleoli. Polymerase chain reactions for cytomegalovirus were positive in the sputum and biopsy specimen. The patient recovered well with ganciclovir treatment. When new pulmonary infiltrates develop in patients with pulmonary tuberculosis during antituberculous therapy, cytomegalovirus pneumonitis should not be overlooked.

Etiology of community acquired pneumonia among adult patients requiring hospitalization in Taiwan.

BACKGROUND: There has not been a comprehensive multi-center study investigating the microbial profile of community acquired pneumonia (CAP) in Taiwan. METHODS: A prospective study of adult CAP patients requiring hospitalization between December 2001 and April 2002 was carried out in 13 hospitals in Taiwan. Etiology was determined based on laboratory data from blood and sputum cultures plus serology from paired serum and urine antigen detection tests. RESULTS: Etiology was assigned to 99 (58.9%) of the 168 patients having the most complete data for etiology determination, with mixed infection in 21 (12.5%) patients. More than half (51.8%) of the patients were>60 years and 63.7% of the patients were males. The most common etiologic agent was Streptococcus pneumoniae (40, 23.8%), the majority (60%, 24 cases) of which was detected by positive urine antigen test. Other common agents included Mycoplasma pneumoniae (24, 14.3%), Chlamydia pneumoniae (12, 7.1%), Influenza A virus (11, 6.5%), Klebsiella pneumoniae (8, 4.8%) and Haemophilus influenzae (8, 4.8%). The prevalence of S. pneumoniae and M. pneumoniae was highest in patients>60 years (25/87, 28.7%), and<44 years (12/59, 19%), respectively; while K. pneumoniae comprised a larger proportion (4/22, 18%) in the 45-59 years group. CONCLUSIONS: S. pneumoniae was the most common etiology agent in adult patients hospitalized due to CAP in Taiwan and the spectrum of other major pathogens was similar to studies conducted elsewhere in the world. Empiric treatment recommendations developed in other parts of the world may be appropriately adapted for local use after taking into account local resistance profiles. Our data also support the recommendation that urine antigen test be added as an adjunct to adult CAP etiology diagnosis protocol.

Community-acquired brain abscess in Taiwan: etiology and probable source of infection.

Brain abscess is a life-threatening infection caused by spread from infected parameningeal or remote foci. Historically, streptococci have been the predominant organisms reported while brain abscess metastatic from liver abscess caused by Klebsiella pneumoniae has been a more recent emerging problem. This study retrospectively analyzed the characteristics of community-acquired brain abscess admitted during an 11-year period. There were 17 men and 7 women with age from 20 to 82 years (median, 41 years). The most common source of infection was liver abscess, followed by otitic infection and sinusitis. The classic triad of fever, headache and focal neurologic deficit was noted in only 25% of cases. Spread of the abscess to multiple lobes was common (n = 6). The most commonly identified organisms were Streptococcus spp. (n = 7) and K. pneumoniae (n = 5). All 5 cases of K. pneumoniae brain abscess also had concomitant pyogenic liver abscess and 4 of them had diabetes mellitus. In this study, brain abscess was common in young patients and in patients with diabetes mellitus. In Taiwan, Streptococcus spp. and K. pneumoniae are leading etiologies for community-acquired brain abscess. Liver abscess is the most likely source of K. pneumoniae brain abscess.

Acute acalculous cholecystitis and pancreatitis in a patient with concomitant leptospirosis and scrub typhus.

Concomitant leptospirosis and scrub typhus is rare. The spectrum of clinical severity for both scrub typhus and leptospirosis ranges from mild to fatal. Acute pancreatitis and cholecystitis are infrequent complications in adult patients with either leptospirosis or scrub typhus. We report a case of leptospirosis and scrub typhus coinfection in a 41-year-old man presenting with acute acalculous cholecystitis, pancreatitis and acute renal failure. Abdominal computed tomography revealed edematous change of the gallbladder without intrahepatic or pancreatic lesions. The patient was successfully treated with doxycycline and ceftriaxone, and supportive management.

Intussusception as the initial manifestation of AIDS associated with primary Kaposi's sarcoma: a case report.

Kaposi's sarcoma (KS) is the most common AIDS-associated neoplasm. It involves the gastrointestinal tract, skin and lymph nodes with about equal frequency. However, most cases of gastrointestinal KS are clinically silent and found incidentally. We report the case of a 31-year-old homosexual man who developed intussusception in association with a primary ileal KS. He was admitted due to abdominal pain lasting 2 hours. Flat abdominal roentgenogram revealed small bowel ileus in the central abdomen. Abdominal sonography and computerized tomography revealed an intraluminal soft tissue mass in the small intestine with an intussusception. Exploratory laparotomy found an ileal tumor mass 90 cm proximal to the ileocecal valve. Pathologic examination of the resected intestine showed KS. HIV-1 infection was confirmed by Western blot. The CD4 T-cell count was 59/mm3. In conclusion, intussusception by enteric KS may present as the initial AIDS-associated neoplasm in patients with HIV infection.

Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency: a case report.

Hypercoagulability is one of the causes of portal vein and superior mesentery vein thrombosis. We report a case of Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency. The patient presented with high fever for more than 3 weeks. Abdominal sonography revealed a liver cyst of 1.7 cm in diameter over segment 4 and a renal stone of 0.7 cm in size over the lower portion of the right kidney but no evidence of hydronephrosis. Elevation of liver enzymes was also noted. Intermittent fever was noted despite treatment with ceftriaxone and doxycycline. On Day 15 of hospitalization, blood culture revealed B. fragilis, which prompted further investigation of the source of intraabdominal and pelvic infection. Abdominal computed tomography revealed portal vein and superior mesentery vein thrombosis. Endoscopic studies of the gastrointestinal tract showed no tumor or diverticulum. Study of coagulation factors disclosed deficiency of antithrombin III and protein C. Clinicians should remain aware of the need to promptly search for a portal or mesentery vein thrombosis in cases of Bacteroides bacteremia of unknown origin.