Pneumocystis pneumonia causing cavitating lung nodules in an immunocompetent individual

2021 ◽  
Vol 14 (4) ◽  
pp. e241061
Author(s):  
Olutobi Ojuawo ◽  
Thidar Htwe ◽  
Onn Shaun Thein ◽  
Adeel Sahal
Keyword(s):  
Case Reports ◽  
Pneumocystis Pneumonia ◽  
Immunocompetent Patient ◽  
Fibreoptic Bronchoscopy ◽  
Severe Malnutrition ◽  
Lung Nodules ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Radiographic Findings ◽  
Radiologic Findings ◽  
Immunosuppressed Patients

Pneumocystis jirovecii pneumonia (PCP) is a potential life-threatening pulmonary infection which commonly manifests in immunosuppressed patients especially with HIV, with underlying malignancies, severe malnutrition as well as those on immunosuppressive treatments. There have been case reports of symptomatic PCP in individuals with a normally functioning immune system with typical clinical features and radiologic findings of bilateral and diffuse interstitial opacities. However, PCP in immunocompetent individuals presenting with lung nodules had been rarely reported. We report a 53-year-old immunocompetent gentleman who presented with subacute cough, progressive shortness of breath and radiographic findings of multiple lung nodules with central cavitation. The diagnosis of PCP was made by detection of PCP DNA PCR in bronchoalveolar lavage sample following fibreoptic bronchoscopy. This case also highlights the atypical radiographic findings of multiple cavitating lung nodules as a presentation of PCP in an immunocompetent patient.

scholarly journals Pulmonary Cryptococcosis in the Immunocompetent Patient—Many Questions, Some Answers

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
John F. Fisher ◽  
Paula A. Valencia-Rey ◽  
William B. Davis
Keyword(s):  
Pulmonary Infection ◽  
Case Reports ◽  
Severe Disease ◽  
Case Series ◽  
Immunocompetent Patient ◽  
Pulmonary Cryptococcosis ◽  
Polysaccharide Antigen ◽  
Prospective Data ◽  
Radiographic Findings ◽  
Oral Fluconazole

Abstract Background.  There are no prospective data regarding the management of pulmonary cryptococcosis in the immunocompetent patient. Clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe disease. It is unclear whether patients who have histological evidence of Cryptococcus neoformans but negative cultures will even respond to drug treatment. We evaluated and managed a patient whose presentation and course raised important questions regarding the significance of negative cultures, antifungal choices, duration of therapy, and resolution of clinical, serologic, and radiographic findings. Methods.  In addition to our experience, to answer these questions we reviewed available case reports and case series regarding immunocompetent patients with pulmonary cryptococcosis for the last 55 years using the following definitions: Definite - Clinical and/or radiographic findings of pulmonary infection and respiratory tract isolation of C. neoformans without other suspected etiologies; Probable - Clinical and radiographic findings of pulmonary infection, histopathologic evidence of C. neoformans, and negative fungal cultures with or without a positive cryptococcal polysaccharide antigen. Results.  Pulmonary cryptococcosis resolves in most patients with or without specific antifungal therapy. Clinical, radiographic, and serologic resolution is slow and may take years. Conclusions.  Persistently positive antigen titers are most common in untreated patients and may remain strongly positive despite complete or partial resolution of disease. Respiratory fungal cultures are often negative and may indicate nonviable organisms.

scholarly journals Discordance Between Radiologic Findings and Molecular Testing in Patients With Underlying Hematologic Malignancy and Coronavirus Disease 2019

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Mohammed Raja ◽  
Yoichiro Natori ◽  
Aditya Chandorkar ◽  
Jose F Camargo ◽  
Jacques Simkins ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Clinical Presentation ◽  
Hematologic Malignancy ◽  
Severe Disease ◽  
Molecular Testing ◽  
Radiographic Findings ◽  
X Ray ◽  
Radiologic Findings ◽  
Immunosuppressed Patients ◽  
Chest X Ray

Abstract Severe acute respiratory syndrome coronavirus 2 is associated with severe disease in patients with hematologic malignancy. We report a series of patients with underlying hematologic malignancy and coronavirus disease of 2019 with discrepancy between radiographic findings and molecular testing. Initial chest x-ray findings should raise suspicion in immunosuppressed patients with typical clinical presentation even with negative initial testing.

Utility of Testing Bronchoalveolar Lavage Fluid for Cryptococcal Ribosomal DNA

2003 ◽  
Vol 31 (4) ◽  
pp. 324-329 ◽  
Author(s):  
T Takahashi ◽  
M Goto ◽  
T Kanda ◽  
A Iwamoto
Keyword(s):  
Bronchoalveolar Lavage ◽  
Ribosomal Dna ◽  
Lavage Fluid ◽  
Pneumocystis Pneumonia ◽  
Immunocompetent Patient ◽  
Antigen Test ◽  
Immunodeficiency Virus ◽  
Immunosuppressed Patients ◽  
Antigen Tests ◽  
Antigen Testing

Bronchoalveolar lavage (BAL) specimens from 88 patients (33 infected with human immunodeficiency virus [HIV], 45 non-HIV immunosuppressed patients and 10 immunocompetent patients with primary pulmonary disease) were analysed for the presence of Cryptococcus neoformans. Staining, culture and an antigen testing were performed, and C. neoformans ribosomal DNA (rDNA) detected using the polymerase chain reaction (PCR). C. neoformans was detected, by staining and culture, in BAL specimens from two HIV-infected patients with pulmonary cryptococcosis, and the antigen test and rDNA assay were also positive in these samples. C. neoformans rDNA was detected by PCR in a non-HIV immunocompromised patient with Pneumocystis pneumonia, whose staining, culture and antigen tests were negative. The antigen test was positive for an immunocompetent patient with sarcoidosis, while staining, culture and the PCR assay were negative. These results do not support routine testing of BAL specimens for C. neoformans rDNA.

scholarly journals Use of β-D-glucan in diagnosis of suspected Pneumocystis jirovecii pneumonia in adults with HIV infection

2021 ◽  
pp. 095646242110222
Author(s):  
Thomas Juniper ◽  
Chris P Eades ◽  
Eliza Gil ◽  
Harriet Fodder ◽  
Killian Quinn ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Tests ◽  
Elevated Serum ◽  
Clinical Information ◽  
High Sensitivity ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Alternative Diagnosis ◽  
Positive Threshold ◽  
Sensitivity Specificity

Objectives: An elevated serum (1-3)-β-D-glucan (BDG) concentration has high sensitivity for a diagnosis of Pneumocystis pneumonia (PCP) in people with HIV (PWH). At the current manufacturer-recommended positive threshold of 80 pg/mL (Fungitell), specificity for PCP is variable and other diagnostic tests are required. We evaluated the utility of serum BDG for diagnosis of suspected PCP in PWH at three inner-London hospitals to determine BDG concentrations for diagnosis and exclusion of PCP. Methods: From clinical case records, we abstracted demographic and clinical information and categorised patients as having confirmed or probable PCP, or an alternative diagnosis. We calculated sensitivity, specificity and positive predictive value (PPV) of serum BDG concentrations >400 pg/mL and negative predictive value (NPV) of BDG <80 pg/mL. Results: 76 patients were included; 29 had laboratory-confirmed PCP, 17 had probable PCP and 30 had an alternative diagnosis. Serum BDG >400 pg/mL had a sensitivity of 83%, specificity of 97% and PPV 97% for diagnosis of PCP; BDG <80 pg/mL had 100% NPV for exclusion of PCP. Conclusions: In PWH with suspected PCP, BDG <80 pg/mL excludes a diagnosis of PCP, whereas BDG concentrations >400 pg/mL effectively confirm the diagnosis. Values 80–400 pg/mL should prompt additional diagnostic tests.

scholarly journals Case Report of Disseminated Pseudomonas Infection with Superadded Burkholderia Infection - A Battle Lost!

2021 ◽  
Vol 6 (06) ◽  
pp. 393-397
Author(s):  
Dr Sangita Kamath ◽  
Dr Murari Bharadwaj ◽  
Dr Manish Kumar ◽  
Dr Ashok Sunder
Keyword(s):  
Risk Factors ◽  
Burkholderia Cepacia ◽  
Case Reports ◽  
Immunocompetent Patient ◽  
Community Acquired Pneumonia ◽  
Healthy Individuals ◽  
Nosocomial Pathogen ◽  
Gram Negative ◽  
Pseudomonas Infection ◽  
Progressive Course

Pseudomonas aeruginosa is a gram-negative pathogen, that often causes nosocomial pneumonia in hospitalized patients. Most of these patients have risk factors for pseudomonas infection. Although uncommon, there have been case reports of previously healthy individuals who developed community-acquired pneumonia (CAP) caused by P. aeruginosa. Such cases have often rapidly progressive course and prove fatal. We, hereby, report a case of pseudomonas pneumonia in a 29-year old immunocompetent patient, who developed disseminated infection and superinfection with yet another nosocomial pathogen, Burkholderia cepacia, eventually leading to septic shock and death, despite appropriate antibiotic therapy.

scholarly journals Middle meningeal artery embolization for chronic subdural hematoma: Endovascular technique and radiographic findings

2018 ◽  
Vol 24 (4) ◽  
pp. 455-462 ◽  
Author(s):  
Thomas W Link ◽  
Benjamin I Rapoport ◽  
Stephanie M Paine ◽  
Hooman Kamel ◽  
Jared Knopman
Keyword(s):  
Subdural Hematoma ◽  
Case Reports ◽  
Cranial Nerves ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Safe Alternative ◽  
Selective Embolization ◽  
Radiographic Findings ◽  
Pathologic Process ◽  
Meningeal Artery

Background and purpose Embolization of the middle meningeal artery (MMA) has recently been proposed as an alternative to surgery for treatment of chronic subdural hematoma (SDH), and several case reports have been published supporting its efficacy. It has been suggested that the primary pathologic process in chronic SDH is repeated microhemorrhaging into the subdural collection from fragile neovasculature within the SDH membrane that arises from distal branches of the MMA. Embolization could thus provide a means of eliminating this chronic rebleeding. Materials and methods Images were selected from MMA embolization procedures performed at our institution in order to illustrate the technique and theory behind its efficacy for treatment of chronic SDH. Results Images from MMA angiograms demonstrate the variability of MMA anatomy and help illustrate the importance of avoiding potential ophthalmic collaterals and branches supplying cranial nerves. The findings of irregular wispiness of the distal MMA vasculature, contrast outlining of the SDH membrane on angiography, and homogenous increased density within the SDH on postembolization head computed tomography are described. Conclusion MMA embolization may provide a safe alternative for treatment of chronic SDH, but careful angiographic assessment of MMA anatomy should be performed to avoid potential complications. The findings illustrated here lend support to the theory that the pathologic process of chronic SDH is repeated leakage of blood products from an inflamed, abnormal arterial neovasculature within the SDH membrane that arises from the MMA, and thus selective embolization could provide an effective treatment.

USE OF CORTISONE IN MALNOURISHED CHILDREN

PEDIATRICS ◽  
1954 ◽  
Vol 13 (5) ◽  
pp. 439-446
Author(s):  
KURT GLASER ◽  
EMIL FREUNDLICH
Keyword(s):  
Experimental Study ◽  
Case Reports ◽  
Severe Malnutrition ◽  
Malnourished Children

Twenty-five case reports of infants with severe malnutrition treated with cortisone are presented and the results of this clinical experimental study are discussed.

Sporothrix brasiliensis meningitis in an immunocompetent patient

2021 ◽  
pp. practneurol-2020-002915
Author(s):  
Marco A Lima ◽  
Renan Vallier ◽  
Marcos M Silva
Keyword(s):  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Subcutaneous Tissue ◽  
Rare Condition ◽  
Immunocompetent Patient ◽  
Diagnosis And Treatment ◽  
Chronic Meningitis ◽  
Regional Lymph Nodes ◽  
Sporothrix Brasiliensis ◽  
Immunosuppressed Patients

Sporothrix brasiliensis usually causes infection limited to the skin, subcutaneous tissue and regional lymph nodes. Contamination occurs through inhalation or accidental inoculation from animal scratches and bites. Meningitis is rare and mostly occurs in immunosuppressed patients. Here, we describe an immunocompetent person who developed chronic meningitis and discuss the diagnosis, differential diagnosis and treatment of this rare condition.

scholarly journals Acute Calcific Tendinitis of the Longus Colli: Not All Retropharyngeal Fluid is an Abscess

2020 ◽  
pp. 014556132094334
Author(s):  
Ellen Ko-Keeney ◽  
Rick Fornelli
Keyword(s):  
Fluid Collection ◽  
Calcific Tendinitis ◽  
Retropharyngeal Abscess ◽  
Upper Cervical Spine ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Radiologic Findings ◽  
Longus Colli ◽  
Anchoring Bias ◽  
Acute Calcific Tendinitis

Objective: This report aimed to present a case of acute calcific tendinitis of the longus colli muscle as an uncommon cause of neck pain and dysphagia and is often misdiagnosed as a retropharyngeal abscess. Methods: Case report and literature review. Results: Acute calcific tendinitis is often misdiagnosed as a retropharyngeal abscess; however, it is distinguished from the latter based on patient history and unique radiologic findings. History, examination, and laboratory findings do not suggest an infectious etiology, and radiographic findings include a non-rim-enhancing fluid collection with or without calcifications anterior to the upper cervical spine. Conclusion: Unlike retropharyngeal abscess, acute calcific tendinitis is managed conservatively. When consulted for a possible retropharyngeal abscess, the otolaryngologist should avoid anchoring bias by independently obtaining a detailed history and examination and personally reviewing radiologic images to avoid unnecessary intervention.

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