scholarly journals Legionella micdadei: A Forgotten Etiology of Growing Cavitary Nodules: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Daniel Lachant ◽  
Paritosh Prasad
Keyword(s):  
Chest Ct ◽  
Shortness Of Breath ◽  
Negative Bacterium ◽  
Case Presentation ◽  
Atypical Pathogen ◽  
Transthoracic Biopsy ◽  
Immunosuppressed Patients ◽  
Appropriate Therapy ◽  
Immunocompromised Hosts ◽  
Legionella Micdadei

Background.Legionella micdadeiis a Gram negative bacterium that can stain weakly acid fast. It was first described in 1979 after immunosuppressed patients developed pneumonia at a Pittsburgh VA, initially given the name Pittsburgh Pneumonia Agent. It is the second most commonLegionellaspecies causing infection afterpneumophila, and typically infects immunocompromised hosts. It is not easy to be cultured which makes diagnosing difficult.Case Presentation. A 31-year-old female with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis presented with fever, chills, shortness of breath, dry cough, and chest pain for five days after being started on immunosuppression for autoimmune hepatitis two months earlier. The first chest CT showed small bilateral cavitary nodules. The nodules continued to grow on subsequent imaging despite what was thought to be appropriate therapy. A transthoracic biopsy was performed which grewLegionella micdadeiand the patient improved after being treated with levofloxacin.Conclusion.Legionella micdadeiis an atypical pathogen known to cause pneumonia in immunosuppressed patients. This case highlights a typical presentation of an atypical infection not commonly thought about and should be considered when nodules are growing despite being on broad antimicrobial therapy.

scholarly journals Refractory pharyngeal ulceration due to cytomegalovirus in a patient with HIV infection: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Morichika Osa ◽  
Akihiro Sato ◽  
Maki Sakagami ◽  
Masaki Machida ◽  
Takao Sato ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Pathological Examination ◽  
Cmv Infection ◽  
Case Presentation ◽  
Immunodeficiency Virus ◽  
Before And After ◽  
Infected Cells ◽  
Immunocompromised Hosts ◽  
Inflammatory Syndrome ◽  
Nonspecific Inflammation

Abstract Background Cytomegalovirus (CMV) is an important pathogen among immunocompromised hosts. Typically, CMV in human immunodeficiency virus (HIV) infection causes diseases of the retina, digestive tract, lungs and liver, but there are few cases of CMV infection of the pharynx and larynx. Case presentation A 57-year-old man with HIV infection was admitted because of pharyngeal pain. Before and after admission, pharyngeal biopsies guided by laryngeal endoscopy were performed four times, but pathological examination showed nonspecific inflammation, and the cause of pharyngeal ulceration was unclear. Additionally, the ulceration deteriorated after initiation of retroviral therapy. Laryngomicrosurgery was conducted under general anesthesia to remove tissue, and pathological diagnosis confirmed CMV infection. Pathological features included enlargement of the cytoplasm and nucleus in infected cells, and intranuclear bodies called owl’s eye inclusions. Ganciclovir dramatically improved the symptoms and laryngoscopic findings. Conclusions This case was diagnosed as pharyngitis and pharyngeal ulceration caused by CMV infection, related to immune reconstitution inflammatory syndrome. In previous reports of CMV-induced pharyngeal or laryngeal ulceration in HIV infection, we found six cases similar to our present case. All cases were diagnosed by biopsy. The present case indicates the importance of biopsy for definitive diagnosis. CMV infection should be considered as a differential diagnosis of pharyngeal ulceration in patients with HIV infection.

scholarly journals Clinical characteristics of inpatients with coronavirus disease 2019 (COVID-19) in Sichuan province

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen Wang ◽  
Lei Chen ◽  
Qiao He ◽  
Mingqi Wang ◽  
Mei Liu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Features ◽  
Medical Records ◽  
Clinical Characteristics ◽  
Sichuan Province ◽  
Chest Ct ◽  
Shortness Of Breath ◽  
Course Of Disease ◽  
West China ◽  
Radiologic Abnormality

Abstract Background The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. Methods Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. Results Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). Conclusions The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.

Blindness paving the path to the diagnosis of metastatic prostate carcinoma: A unique case presentation

2021 ◽  
pp. 205141582110537
Author(s):  
Aadhar Jain ◽  
Anveshi Nayan ◽  
Sujata Patwardhan
Keyword(s):  
Vision Loss ◽  
Specific Antigen ◽  
Primary Source ◽  
Metastatic Lesion ◽  
Unique Case ◽  
Case Presentation ◽  
Intracranial Metastases ◽  
Appropriate Therapy ◽  
Brain Involvement ◽  
Metastatic Prostate Carcinoma

Background: Intracranial metastases from prostate adenocarcinoma are very unusual and typically occur late in the course of the disease, and initial presentation with symptomatic brain involvement, especially vision loss is very rare (with this being only the sixth such reported case to the best of our knowledge). The present case elucidates how a diagnosis was reached in such a scenario and the management provided. Case presentation: A 66-year-old gentleman presented with loss of vision and headache with no other ocular or neurological complaint. Computed tomography (CT) of his head revealed a destructive lesion involving the clivus and a space-occupying lesion (SOL) in occipito-parietal region. Detailed inquiry regarding the possible primary source of suspected the metastatic lesion revealed an increased frequency of urination, nocturia, and significant weight loss. His serum prostate-specific antigen (PSA) levels were raised. He was treated by surgical hormonal therapy and his visual symptoms improved. Conclusion: Awareness of such a presentation can lead to an accurate diagnosis. Initiation of appropriate therapy can successfully alleviate the neurologic deficits.

scholarly journals Disseminated Nocardia beijingensis Infection in an Immunocompetent Patient

2020 ◽  
Author(s):  
Moni Roy ◽  
Annia Martial ◽  
Sharjeel Ahmad
Keyword(s):  
Literature Review ◽  
Immunocompetent Patient ◽  
Chest Ct ◽  
Primary Site ◽  
Immunocompetent Host ◽  
Onset Seizure ◽  
Pulmonary System ◽  
Life Threatening ◽  
Immunocompromised Hosts ◽  
New Onset

Nocardia is a genus of aerobic, non-motile and non-spore-forming filamentous branching bacteria with fragmentation into bacillary or coccoid forms. Infections caused by Nocardia often occur in immunocompromised hosts and are potentially life-threatening. Nocardia beijingensis has rarely been reported to cause infection in immunocompetent hosts. We present a case of disseminated infection due to Nocardia beijingensis in a patient with no known medical comorbidities, who presented with new-onset seizure. Another interesting finding in our case is that our patient did not have any pulmonary symptoms despite chest CT showing the pulmonary system as the likely primary site of infection. As per our literature review, this is the seventh reported case of infection due to Nocardia beijingensis in an immunocompetent host.

scholarly journals Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Seyed-Hasan Adeli ◽  
Malihe Sehat ◽  
Gholamreza Azarnia Samarin ◽  
Jamshid Vafaeimanesh ◽  
Sajjad Ahmadpour ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Outlet Obstruction ◽  
Diagnostic Procedures ◽  
Shortness Of Breath ◽  
Case Presentation ◽  
Chest Computed Tomography ◽  
Magill Forceps ◽  
Chief Complaints ◽  
Surgery Department ◽  
Pulmonary Ct

Abstract Background Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. Case presentation A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. Conclusions Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

scholarly journals Comprehensive Evaluation of Hepatitis E Serology and Molecular Testing in a Large Cohort

Pathogens ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 137
Author(s):  
Olympia E. Anastasiou ◽  
Viktoria Thodou ◽  
Annemarie Berger ◽  
Heiner Wedemeyer ◽  
Sandra Ciesek
Keyword(s):  
Hepatitis E Virus ◽  
Clinical Laboratory ◽  
Comprehensive Evaluation ◽  
Cost Effective ◽  
Hepatitis E ◽  
Molecular Testing ◽  
Real World Setting ◽  
Immunosuppressed Patients ◽  
Immunocompromised Hosts ◽  
Time Point

Introduction: Reliable and cost-effective diagnostics for hepatitis E virus (HEV) infection are necessary. The aim of our study was to investigate which diagnostic test is most accurate to detect HEV infection in immunocompetent and immunosuppressed patients in a real world setting. Patients and Methods: We performed a retrospective analysis of 1165 patients tested for HEV antibodies and HEV PCR at the same time point. Clinical, laboratory and virological data were taken from patient charts. HEV IgA was measured in a subgroup of 185 patients. Results: HEV RNA was detectable in 61 patients (5.2%); most of them (n = 49, 80.3%/n = 43, 70.5%) were HEV IgM+ and IgG+; however, 12 patients (19.6%) were HEV RNA positive/HEV IgM negative and 17 patients (27.8%) were HEV RNA positive/HEV IgG negative. Ten HEV RNA positive patients (16.4%) had neither HEV IgG nor IgM antibodies. Importantly, all of them were immunosuppressed. HEV IgA testing was less sensitive than HEV IgM for HEV diagnosis. Conclusions: HEV infection can be overlooked in patients without HEV specific antibodies. Performing PCR is necessary to diagnose or exclude HEV infection in immunocompromised hosts. In immunocompetent patients, a screening based on HEV antibodies (IgG/IgM) is sufficient.

scholarly journals Bronchoalveolar carcinoma as an unsuspected cause for worsening shortness of breath in a patient with metastatic breast cancer

2018 ◽  
pp. bcr-2018-226125
Author(s):  
Sukhdeep Kaur Nagpal ◽  
Michael Flynn ◽  
Claire Ryan ◽  
Catherine Harper-Wynne
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Standard Treatment ◽  
Lung Metastases ◽  
Metastatic Breast ◽  
Multimodality Treatment ◽  
Chest Ct ◽  
Postmortem Examination ◽  
Shortness Of Breath ◽  
Radiological Changes

A 70-year-old woman with lung metastases from a breast cancer presented with worsening cough and dyspnoea. She recently had a pleurodesis for a malignant pleural effusion. Chest CT scans demonstrated various radiological changes leading to diagnostic challenges. Differential diagnoses included empyema, pleural disease progression, pulmonary oedema, pneumonitis, lymphangitis and atypical infections. She deteriorated despite a multimodality treatment strategy. Postmortem examination confirmed that lung changes were consistent with a bronchoalveolar carcinoma unrelated to the known metastatic breast cancer. The eventual knowledge of this diagnosis was reassuring to the treating medical team and a comfort to the relatives who witnessed the lack of response to standard treatment.

scholarly journals Evaluation of Radiation Dose and Image Quality using High-Pitch 70-kV Chest CT in Immunosuppressed Patients

2018 ◽  
Vol 191 (02) ◽  
pp. 122-129 ◽  
Author(s):  
Ibrahim Yel ◽  
Simon Martin ◽  
Julian Wichmann ◽  
Lukas Lenga ◽  
Moritz Albrecht ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Image Data ◽  
Ct Imaging ◽  
Chest Ct ◽  
Control Group ◽  
High Pitch ◽  
Dose Length Product ◽  
Subjective Image Quality ◽  
Immunosuppressed Patients

Purpose The aim of the study was to evaluate high-pitch 70-kV CT examinations of the thorax in immunosuppressed patients regarding radiation dose and image quality in comparison with 120-kV acquisition. Materials and Methods The image data from 40 patients (14 women and 26 men; mean age: 40.9 ± 15.4 years) who received high-pitch 70-kV CT chest examinations were retrospectively included in this study. A control group (n = 40), matched by age, gender, BMI, and clinical inclusion criteria, had undergone standard 120-kV chest CT imaging. All CT scans were performed on a third-generation dual-source CT unit. For an evaluation of the radiation dose, the CT dose index (CTDIvol), dose-length product (DLP), effective dose (ED), and size-specific dose estimates (SSDE) were analyzed in each group. The objective image quality was evaluated using signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Three blinded and independent radiologists evaluated subjective image quality and diagnostic confidence using 5-point Likert scales. Results The mean dose parameters were significantly lower for high-pitch 70-kV CT examinations (CTDIvol, 2.9 ± 0.9 mGy; DLP, 99.9 ± 31.0 mGyxcm; ED, 1.5 ± 0.6 mSv; SSDE, 3.8 ± 1.2 mGy) compared to standard 120-kV CT imaging (CTDIvol, 8.8 ± 3.7mGy; DLP, 296.6 ± 119.3 mGyxcm; ED, 4.4 ± 2.1 mSv; SSDE, 11.6 ± 4.4 mGy) (P≤ 0.001). The objective image parameters (SNR: 7.8 ± 2.1 vs. 8.4 ± 1.8; CNR: 7.7 ± 2.4 vs. 8.3 ± 2.8) (P≥ 0.065) and the cumulative subjective image quality (4.5 ± 0.4 vs. 4.7 ± 0.3) (p = 0.052) showed no significant differences between the two protocols. Conclusion High-pitch 70-kV thoracic CT examinations in immunosuppressed patients resulted in a significantly reduced radiation exposure compared to standard 120-kV CT acquisition without a decrease in image quality. Key Points:  Citation Format

scholarly journals Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
D. P. Ramaema ◽  
P. Mpikashe
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Peritoneal Dialysis Patient ◽  
Shortness Of Breath ◽  
Pleural Effusions ◽  
Dialysis Patients ◽  
Case Presentation ◽  
Peritoneal Scintigraphy ◽  
Uncommon Complication

Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion.Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD), which was confirmed on peritoneal scintigraphy.Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

scholarly journals The halo sign: HRCT findings in 85 patients

2016 ◽  
Vol 42 (6) ◽  
pp. 435-439 ◽  
Author(s):  
Giordano Rafael Tronco Alves ◽  
◽  
Edson Marchiori ◽  
Klaus Irion ◽  
Carlos Schuler Nin ◽  
...  
Keyword(s):  
Immune Status ◽  
Ground Glass Opacity ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Ct Scans ◽  
Pulmonary Lesions ◽  
Halo Sign ◽  
Immunosuppressed Patients ◽  
Primary Neoplasm ◽  
Immunocompetent Patients

ABSTRACT Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.

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