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1.
J Infect Chemother ; 27(10): 1504-1507, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34052111

RESUMO

A 74-year-old man with diabetic nephropathy undergoing dialysis after total knee arthroplasty presented to our hospital with dyspnea and abnormal behavior such as wearing his pants on his head. The patient was in shock with ventricular tachycardia. Urine and blood cultures showed MAM with sterile pyuria. We administered amikacin and imipenem cilastatin, but repeated cultures were persistently positive. Although we initially chose not to administer azithromycin because of a higher risk of fatal arrhythmia, we had no choice but to administer azithromycin because of treatment failure. Upon close monitoring, we observed no arrhythmia, and the blood cultures became negative. The patient was discharged on day 106 without any symptoms. However, 2 months after discontinuation of antibiotics, he was readmitted and diagnosed with prosthetic joint infection due to MAM. He could not undergo total knee arthroplasty resection because of his low tolerance to surgery. We re-administered same antibiotics, and repeated draining and cleaning of his left knee for several weeks. The inflammation in the knee joint gradually improved, and the patient was discharged while treatment with azithromycin and amikacin was continued. After being discharged, the patient did not experience recurrent disease for at least 6 months. Our case suggests that MAM can cause sterile pyuria and infection in a patient with diabetic nephropathy. The macrolide agent is a key drug for MAM infection, and repeated joint lavage in addition to administering antibiotics may be an alternative treatment for prosthetic joint infection in patients with intolerance to surgery.


Assuntos
Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Idoso , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Diálise Renal/efeitos adversos
2.
J Infect Chemother ; 26(7): 741-744, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32147376

RESUMO

Although infectious mononucleosis due to Epstein-Barr virus (EBV) is a common disease among young individuals, central nervous system (CNS) complications are rare. In this report, we describe a case of CNS complications caused by EBV in a previously healthy young woman. She presented to our hospital with a 9-day history of headache and sore throat, followed by the development of fever and facial edema 6 days prior to admission. On Day 2 of admission, she was confused (Glasgow Coma Scale score: 10 points) and had fever, muscle weakness in her right arm and leg, stiff neck, and roving eye movement. We detected EBV in a cerebrospinal fluid (CSF) sample using a polymerase chain reaction (PCR) test. The magnetic resonance imaging of her brain revealed dural enhancement and right parietal and temporal lobe lesions. She was treated with acyclovir and high-dose steroid therapy. She responded well to treatment, recovered without neurologic sequelae, and was discharged home on Day 12. Our experience suggests that PCR detection of EBV DNA in CSF may be useful in diagnosing EBV encephalitis and that prognosis may be associated with an area of the brain that is affected and the time from symptom onset to starting treatment.


Assuntos
Encefalite Viral/diagnóstico , Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4/isolamento & purificação , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Encéfalo , DNA Viral/líquido cefalorraquidiano , DNA Viral/isolamento & purificação , Quimioterapia Combinada/métodos , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/tratamento farmacológico , Encefalite Viral/virologia , Infecções por Vírus Epstein-Barr/líquido cefalorraquidiano , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Infecções por Vírus Epstein-Barr/virologia , Escala de Coma de Glasgow , Glucocorticoides/uso terapêutico , Herpesvirus Humano 4/genética , Humanos , Imageamento por Ressonância Magnética , Reação em Cadeia da Polimerase , Resultado do Tratamento , Adulto Jovem
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