Nocardia farcinica masquerading as intracerebral metastases in advanced metastatic prostatic cancer

2020 ◽  
Vol 13 (9) ◽  
pp. e233678 ◽  
Author(s):  
Claire Livings ◽  
Mayu Uemura ◽  
Reena Patel ◽  
Mehran Afshar
Keyword(s):  
Brain Imaging ◽  
Best Supportive Care ◽  
Antimicrobial Treatment ◽  
Cutaneous Lesions ◽  
Incision And Drainage ◽  
Nocardia Farcinica ◽  
Facial Numbness ◽  
History Of ◽  
Leg Weakness ◽  
Disseminated Nocardiosis

A 67-year-old man with metastatic prostate cancer and underlying asymptomatic pancytopenia presented with a 1-week history of general malaise, left leg weakness and facial numbness. Initial brain imaging demonstrated two rim-enhancing lesions felt to represent intracerebral metastasis. Following neurosurgical referral, a multidisciplinary meeting decision was made for best supportive care and dexamethasone was given. He developed multiple cutaneous lesions, which on incision and drainage revealed Nocardia farcinica. Repeat brain imaging showed enlargement of the existing cavitating lesions and appearance of new lesions, now typical of cerebral abscesses. A diagnosis of disseminated nocardiosis with cutaneous and intracerebral infection was reached. He started taking empirical treatment with intravenous meropenem, co-trimoxazole and subsequent addition of amikacin, with little improvement. On further review of sensitivities, moxifloxacin was added. Following over 1 month of antimicrobial treatment, his neurological symptoms, cutaneous lesions and repeat MRI of the brain had improved.

scholarly journals Disseminated nocardiosis due to Nocardia farcinica: diagnosis by thyroid abscess culture

2005 ◽  
Vol 47 (6) ◽  
pp. 355-358 ◽  
Author(s):  
Cecília Bittencourt Severo ◽  
Flávio de Mattos Oliveira ◽  
Lenine Cunha ◽  
Vlademir Cantarelli ◽  
Luiz Carlos Severo
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
White Male ◽  
Blood Cultures ◽  
Low Back ◽  
Nocardia Farcinica ◽  
Thyroid Abscess ◽  
Days Of Therapy ◽  
History Of ◽  
Disseminated Nocardiosis

A previously healthy 75-year-old white male dentist presented with a 6-month history of low-back pain treated with chronic steroid therapy had a Nocardia farcinica infection diagnosed by aspirate of thyroid abscess and six blood cultures. Despite the treatment with parenteral combination of trimethoprim/sulfamethoxazole, the patient failed to respond and died after two days of therapy. Autopsy revealed disseminated nocardiosis, involving lungs with pleural purulent exudate in both sides, heart, thyroid, kidneys, brain, bones, and lumbosacral soft tissue with destruction of L2-L4.

Reversal of ‘the dying’ diagnosis

2021 ◽  
Vol 14 (6) ◽  
pp. e240133
Author(s):  
Maimoona Ali ◽  
Andrew Goddard ◽  
Eleanor Smith
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Supportive Care ◽  
End Of Life Care ◽  
Surgical Intervention ◽  
Best Supportive Care ◽  
Lower Limbs ◽  
Life Care ◽  
Incision And Drainage ◽  
History Of

A 75-year-old woman was admitted with sepsis and treated with broad-spectrum antibiotics until examination of her lower limbs noted necrotising wounds. Surgical intervention was advised by the plastic surgeons; however, she was deemed unsuitable for intensive care. She underwent incision and drainage of the necrotic area and biopsies were taken. She deteriorated clinically and the decision was made for best supportive care and was therefore transferred to the inpatient palliative care unit for end-of-life care. However, she stabilised, and based on culture sensitivities, antibiotics were restarted. It was also noted that the patient had a 3-month history of loose stools, which had not been addressed previously. The biopsies were suggestive of pyoderma gangrenosum, prompting a dermatology review, and prednisolone and doxycycline were started. The wounds and her loose stools improved, and with ongoing rehabilitation, she made a full recovery. Referral to gastroenterology was made.

Minocycline-Induced Agranulocytosis Presenting as Ecthyma Gangrenosum

2017 ◽  
Vol 1 (3) ◽  
pp. 161-164 ◽  
Author(s):  
Katherine Nolan ◽  
Reema Ishteiwy ◽  
John Alexis ◽  
Martin Zaiac ◽  
Anna Nichols
Keyword(s):  
Care Facility ◽  
Urgent Care ◽  
Severe Neutropenia ◽  
Dramatic Improvement ◽  
Therapy Discontinuation ◽  
Incision And Drainage ◽  
Ecthyma Gangrenosum ◽  
Minimal Improvement ◽  
History Of ◽  
Acute And Chronic Inflammation

A 51-year-old female with a history of rheumatoid arthritis was admitted for progressive fevers, chills and malaise. Five weeks prior, she started minocycline for an RA exacerbation. Two weeks after starting minocycline she developed an abscess on her right ankle that was treated at an urgent care facility with ceftriaxone and trimethoprim-sulfamethoxazole. She had minimal improvement so was switched to clindamycin. She developed additional abscesses on her right ankle and right axilla and spiking fevers so she was treated with incision and drainage under general anesthesia. Routine blood work obtained prior to surgery revealed severe neutropenia (0.74 103/ul) and the patient was urgently referred to the emergency department.  Skin biopsy was obtained on admission and revealed ulceration, necrosis, acute and chronic inflammation, vasculitis with vascular thrombosis and rod-shaped bacteria in blood vessel walls and lumina consistent with ecthyma gangrenosum. The following day tissue and blood cultures confirmed the growth of Pseudomonas aureginosa. Bone-marrow biopsy showed decreased granulopoiesis and hematopoiesis, and a diagnosis of minocycline-induced agranulocytosis presenting as ecthyma gangrenosum was made.  The patient had dramatic improvement with appropriate antibiotic therapy, discontinuation of minocycline and initiation of filgrastrim. She has remained healthy without recurrence for 17 months.    

scholarly journals P129 The utility of routine operative swab culture in uncomplicated peri-anal abscesses

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Apoorva Khajuria ◽  
Tuba Rahim ◽  
Mariam Baig ◽  
Kai Leong ◽  
Apoorva Khajuria
Keyword(s):  
Inflammatory Bowel Disease ◽  
Perianal Abscess ◽  
Female Ratio ◽  
Incision And Drainage ◽  
Common Presentation ◽  
History Of ◽  
Inflammatory Bowel ◽  
Operative Findings ◽  
The Cost ◽  
Male To Female

Abstract Introduction Despite perianal abscess being a common presentation, certain aspects of its management remain controversial, especially the routine use of intra-operative swab cultures. Methods A retrospective review of patients that underwent incision and drainage procedures for a perianal abscess over a six-month period was undertaken. Results Over 6 months, 50 patients were identified. The male to female ratio was 3:1 and median ASA score was 1. Only 6/50 patients presented with recurrent abscess and 1 patient had history of inflammatory bowel disease. On the basis of operative findings, 39 patients (78%) had uncomplicated abscess (not associated with cellulitis, sinus or fistula); swab cultures were performed in 26 (67%) of these patients. All patients were discharged on the same day; microbiology reports did not impact the treatment and no patients were followed up in clinic post-operatively or presented with recurrence. The number of unnecessary microbiology swabs undertaken in this cohort equates to approximately 52 unnecessary swabs a year. The cost of one swab is £10.10p, which means £520 could potentially be saved annually. Conclusion Routine intra-operative swab cultures do not impact management decisions, add to unnecessary costs and therefore should not be undertaken in uncomplicated or first presentation of peri-anal abscesses.

An isolated primary Rathke's cleft cyst in the cerebellopontine angle

2014 ◽  
Vol 121 (4) ◽  
pp. 846-850 ◽  
Author(s):  
Jun Fan ◽  
Songtao Qi ◽  
Yuping Peng ◽  
Xi-an Zhang ◽  
Binghui Qiu ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Imaging Features ◽  
Good Recovery ◽  
Suprasellar Region ◽  
Adjacent Structures ◽  
Facial Numbness ◽  
History Of ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Rathke's cleft cysts (RCCs) are benign cysts typically located in the sellar or suprasellar region; ectopic isolated lesions are extremely rare. The authors describe the case of a 25-year-old man with a giant symptomatic RCC arising primarily at the cerebellopontine angle (CPA), only the second case reported thus far. The patient presented with a 2-year history of right hearing impairment and tinnitus accompanied by vertigo and headache and a 2-week history of right facial numbness. Subsequently, he underwent total cyst removal via retrosigmoid craniotomy with a good recovery. He experienced no recurrence during a 64-month follow-up period. The possible pathogenesis, differential diagnosis, and surgical treatment of such cysts are discussed in this article. Isolated ectopic RCCs can arise from the ectopic migration of Rathke's pouch cells during the embryonic period. It is still difficult to distinguish ectopic RCCs from other cystic lesions of the CPA given the lack of specific imaging features. Aggressive resection of the cyst wall is not recommended, except when lesions do not closely adhere to adjacent structures.

Antimicrobial Treatment of Acute Otitis Media

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 11-14 ◽  
Author(s):  
Daniel M. Canafax ◽  
G. Scott Giebink
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Antimicrobial Agents ◽  
Acute Otitis Media ◽  
Antimicrobial Treatment ◽  
Speech Delay ◽  
Significant Morbidity ◽  
Antimicrobial Drugs ◽  
Etiologic Role ◽  
History Of

Episodes of acute otitis media frequently occur in childhood and are attended by significant morbidity, such as hearing loss and possible speech delay. Bacteria play an important etiologic role in the pathogenesis of otitis media; therefore, antimicrobial agents are the cornerstone in the treatment of this disease. Many antimicrobial choices are available for treating children with acute otitis media. To choose an antimicrobial for each patient, consideration must be given to the patient's age, history of otitis media episodes, and responses to previously used antimicrobial drugs, and the regional antimicrobial susceptibility of the otitis media pathogens.

scholarly journals Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran

2020 ◽  
Vol 14 (1) ◽  
pp. 95-102
Author(s):  
Mohammad Vafaee-Shahi ◽  
Elaheh Soltanieh ◽  
Hossein Saidi ◽  
Aina Riahi
Keyword(s):  
Risk Factors ◽  
Status Epilepticus ◽  
Brain Imaging ◽  
Morbidity And Mortality ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Imaging Results ◽  
History Of ◽  
Abnormal Brain ◽  
Febrile Status Epilepticus

Background: Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus. Methods: This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study. Results: The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36% versus 14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology. Conclusion: Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.

scholarly journals Extraoral Sinus Tracts of Odontogenic Origin: A Case Series

2020 ◽  
Author(s):  
Ellahe Azizlou ◽  
Mohsen AminSobhani ◽  
Sholeh Ghabraei ◽  
Mehrfam Khoshkhounejad ◽  
Abdollah Ghorbanzadeh ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Cutaneous Lesions ◽  
Odontogenic Origin ◽  
The Face ◽  
History Of ◽  
Relationship Of ◽  
Dental Infections

Extraoral sinus tracts of odontogenic origin often develop as the result of misdiagnosis of persistent dental infections due to trauma, caries, or periodontal disease. Due to these lesions' imitation from cutaneous lesions, misdiagnosis, and mismanagement, which we frequently encounter, this article aims to describe four cases with manifestations in different parts of the face and the neck. Patients were referred to an endodontist with a history of several surgical procedures and/or antibiotic therapy due to misdiagnosis. After comprehensive examinations, root canal treatment was performed. The resolution of signs and symptoms during the follow-up period confirmed the correct diagnosis. Dermatologists and other physicians should be aware of the possibility of the relationship of extraoral sinus tracts with dental infections. Precise examination and taking a comprehensive history can aid to prevent unnecessary and incorrect therapeutic and/or pharmaceutical interventions. Elimination of dental infection leads to complete recovery in such patients.

Silent sinus syndrome: an unusual case of facial numbness

2018 ◽  
Vol 18 (6) ◽  
pp. 494-496 ◽  
Author(s):  
Samuel Tribich ◽  
Colin J Mahoney ◽  
Nicholas W Davies
Keyword(s):  
Maxillary Sinus ◽  
Complete Resolution ◽  
Unusual Case ◽  
Clinical Context ◽  
Blurred Vision ◽  
Silent Sinus Syndrome ◽  
Osteomeatal Complex ◽  
Middle Meatal Antrostomy ◽  
Facial Numbness ◽  
History Of

A 49-year-old man presented with a 1-week history of right facial paraesthesia with blurred vision and diplopia. Examination was normal apart from reduced facial sensation. Following appropriate neuroimaging, we considered a diagnosis of silent sinus syndrome. He underwent a middle meatal antrostomy with complete resolution of symptoms. Silent sinus syndrome results from occlusion of the osteomeatal complex, preventing normal aeration of the maxillary sinus. Maxillary sinus hypoventilation typically causes inferior displacement of the globe in the orbit (unilateral hypoglobus). Neurologists will only infrequently see people with silent sinus syndrome but it can have devastating consequences if left untreated and so must be considered in the appropriate clinical context.

Abstract 3173: Imaging Findings at the Earliest Stages of Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Adrian M Burgos ◽  
Nerses Sanossian ◽  
David Liebeskind ◽  
Leonid Groysman ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Imaging ◽  
Early Time ◽  
Field Evaluation ◽  
Imaging Findings ◽  
Imaging Studies ◽  
Lentiform Nucleus ◽  
History Of ◽  
The Mean ◽  
Fazekas Scale

Background: Imaging findings in intracerebral hemorrhage (ICH) patients at ultra-early time points have not been well characterized. Objective: To describe imaging findings in consecutive ICH patients being transported by ambulance within 2 hours from symptom onset. Methods: We analyzed consecutive ICH patients enrolled in the multicenter, NIH Field Administration of Stroke Therapy (FAST-MAG) clinical trial. First brain imaging studies obtained in the ED were independently reviewed by 2 neurologists for ICH location, volume, presence of intraventricular hemorrhage (IVH), heterogeneity (defined as >20 point difference in Hounsfield units), irregular borders, multilobulation, and substantial edema (defined as >0.5cm). Leukoaraiosis was graded using the Fazekas scale for periventricular and deep white matter changes (0-3 for each). Results: Among 127 patients (enrolled en route to 23 hospitals), mean age was 66 (SD 14), 34% were women, 35% had Hispanic ethnicity, 83% were white, and 84% had a history of HTN. At time of first field evaluation by paramedics [mean 31 (SD 23) minutes after last known well time (LKWT)], the initial BP was 177/95 (SD 34/22) and median (IQR) Glasgow Coma Scale of 15 (15-15). First brain imaging studies were obtained a mean of 100 (SD 35, range 54-255) minutes after LKWT, and were CT in 90% and MRI in 10%. Location of ICH was most often in the lentiform nucleus (42%) followed by thalamus (40%), and cortex (4%), with one case each of caudate, pons, and cerebellar deep nuclei. The mean volume of initial hematoma was 19.6 (SD 23) ml. IVH was present in 45 (35%), significant edema in 13 (10%), and midline shift in 24 (19%). Hemorrhage density was heterogeneous in 34 (27%), multilobulated in 55 (43%) and with irregular borders in 77 (60%). Leukoaraiosis (LA) was common, with moderate to severe LA (Fazekas grades 2, 3) present in the periventricular region in 58% and deep regions centrum semiovale in 35%. Conclusions: Among ICH patients presenting within the first 2h, deep hemorrhages predominate over superficial and intraventricular extension is already present in one-third, but ICH volume is moderate and substantial edema present in only one-tenth. These findings suggest substantial opportunities for intervention to avert hemorrhage and edema growth ultra-early after ICH onset.

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