Complex Management of Septic Joint and Cutaneous Nocardiosis in an Immunocompromised Patient: A Case Report.

Nocardia, an opportunistic, gram-positive, catalase-positive, rod-shaped bacterium found in soil and water, is known to cause infections in humans, predominantly among immunocompromised individuals, through inhalation or direct inoculation. This report details a rare case of a septic joint caused by Nocardia brasiliensis, which subsequently led to cutaneous involvement, in a patient with multiple underlying health issues. The management of this case was complicated by the patient's extensive medical history, including diabetes, chronic urinary tract infections, and recent surgical procedures, which necessitated a nuanced approach to antibiotic therapy. The treatment regimen underwent several adjustments in response to concurrent infections in other organs and the emergence of multidrug-resistant organisms. Despite an expanded arsenal of therapeutic options for Nocardia infections, treating such infections remains challenging due to potential adverse outcomes, particularly in immunocompromised patients prone to infection relapse. This case underscores the complexities involved in diagnosing and managing Nocardia infections and highlights the importance of tailored antibiotic therapy in achieving favorable outcomes while minimizing the risk of relapse.

A Recurrent Case of Mesothelial Pericardial Cyst.

This is a case of a 37-year-old female patient with past medical history of mitral valve prolapse and benign mesothelial pericardial cyst status post laparoscopic resection who presented to the emergency department with a chief complaint of right-sided sharp non-radiating chest pain due to recurrent case of benign mesothelial pericardial cyst. Though this is not a common pathology, it does overlap with common cardiovascular symptoms/conditions; not limited to but including chest pain, dyspnea, palpitations, pericardial effusions, infections and arrhythmias. It is crucial to have appropriate history and physical exam and appropriate evaluation to rule out pericardial cysts as well as their locations and their potential lethal mechanical implication on crucial nearby structures. This is significant in order to avoid uncommon but lethal cardiac complications in this condition such as cardiac arrhythmias, cardiac tamponade, right ventricular outflow tract and even sudden cardiac death.