scholarly journals Rat Bite Fever Resembling Rheumatoid Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ripa Akter ◽  
Paul Boland ◽  
Peter Daley ◽  
Proton Rahman ◽  
Nayef Al Ghanim
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Presentation ◽  
Blood Cultures ◽  
Zoonotic Infection ◽  
Presumptive Diagnosis ◽  
Rat Bite Fever ◽  
Rare Manifestation ◽  
History Of ◽  
High Index Of Suspicion ◽  
Culture Positive

Rat bite fever is rare in Western countries. It can be very difficult to diagnose as blood cultures are typically negative and a history of rodent exposure is often missed. Unless a high index of suspicion is maintained, the associated polyarthritis can be mistaken for rheumatoid arthritis. We report a case of culture-positive rat bite fever in a 46-year-old female presenting with fever and polyarthritis. The clinical presentation mimicked rheumatoid arthritis. Infection was complicated by discitis, a rare manifestation. We discuss the diagnosis and management of this rare zoonotic infection. We also review nine reported cases of rat bite fever, all of which had an initial presumptive diagnosis of a rheumatological disorder. Rat bite fever is a potentially curable infection but can have a lethal course if left untreated.

scholarly journals Vaping in today’s pandemic: E-cigarette, or vaping, product use–associated lung injury mimicking COVID-19 in teenagers presenting with respiratory distress

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096959
Author(s):  
Daphne O Darmawan ◽  
Kriti Gwal ◽  
Brian D Goudy ◽  
Sanjay Jhawar ◽  
Kiran Nandalike
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Respiratory Distress ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Product Use ◽  
Abdominal Symptoms ◽  
History Of ◽  
High Index Of Suspicion

The clinical presentation of children and adolescents infected with severe acute respiratory syndrome coronavirus 2 can range from asymptomatic to mild or moderate manifestations. We present a case series of three adolescents who presented during the coronavirus disease 2019 (COVID-19) pandemic with symptoms concerning for COVID-19, including fever, abdominal symptoms, cough, respiratory distress, and hypoxemia. Their laboratory results showed elevated inflammatory markers that are also commonly seen in COVID-19. The chest imaging studies mimicked COVID-19 with non-specific ground glass opacities and interstitial prominence patterns. However, severe acute respiratory syndrome coronavirus 2 testing was negative and further questioning of these adolescents and their parents revealed a history of vaping marijuana-related products leading to the eventual diagnosis of e-cigarette, or vaping, product use–associated lung injury. Our patients were successfully treated with corticosteroids. The providers caring for pediatric patients, especially adolescents, should continue to have a high index of suspicion for e-cigarette, or vaping, product use–associated lung injury in patients presenting with unexplained respiratory failure, while ruling out COVID-19.

scholarly journals Scrotal Ulcer is a Rare Presentationof TB Epididymis in Young Male

2021 ◽  
pp. 146-149
Author(s):  
Rekadi Srinivasa Rao ◽  
Senthil Kumar ◽  
R. Anantharamakrishnan ◽  
P. Varadaraju
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Clinical Presentation ◽  
Young Male ◽  
High Index ◽  
History Of ◽  
Scrotal Swelling ◽  
High Index Of Suspicion

Introduction: Scrotal tuberculosis (TB) is rare and may present as painful scrotal swelling with ulceration and discharging sinus. Case Report: A 28 years male with 2 months history of swelling and pain over left scrotum. Developed ulcer over the scrotal region with multiple sinus associated with pus discharge. Conclusion: The clinical presentation of TB scrotal ulcer can be atypical and a high index of suspicion is required for early diagnosis. Diagnosis is by using ultrasonography, microbiology, and biopsy. Treatment requires prolonged ATT for 6 months.

scholarly journals Disseminated intravascular coagulation in an under-recognised zoonotic infection

2017 ◽  
Vol 16 (3) ◽  
pp. 138-141
Author(s):  
Sarah Lawrence ◽  
◽  
Andrew Claxton ◽  
Mark Holland ◽  
Jack Hodd ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Platelet Transfusion ◽  
Purpura Fulminans ◽  
Blood Cultures ◽  
Organ Support ◽  
Zoonotic Infection ◽  
Intravascular Coagulation ◽  
Prompt Treatment ◽  
History Of

A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic. Treatment is with penicillins and fluoroquinolones. Identification of risk factors for unusual organisms and recognition of DIC allowing prompt treatment is critical for the acute physician.

scholarly journals Isolated gross haematuria: A rare clinical presentation in neonate with urinary tract infection

2017 ◽  
Vol 4 (3) ◽  
pp. 104-106
Author(s):  
Pawana Kayastha ◽  
Rydam Basnet ◽  
Ramesh Kant Adhikari
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Clinical Presentation ◽  
Older Children ◽  
Male Baby ◽  
History Of ◽  
Gross Haematuria ◽  
Culture Positive

Gross haematuria is uncommon in the fi rst month of life and etiologies of haematuria in the newborn is different from those in older children. we reported a six days old term male baby who was brought by parents with isolated complain of red colored urine for one day and his mother had culture positive urinary tract infection prior to delivery. The baby was diagnosed to have culture positive urinary tract infection. Our fi ndings suggest the diversity of clinical presentation of urinary tract infection in neonates and also some relationship between the history of urinary tract infection in mother and occurrence of urinary tract infection in neonate.

scholarly journals Pneumatosis intestinalis: cost paid for rheumatoid arthritis treatment

2019 ◽  
Vol 12 (7) ◽  
pp. e229329 ◽  
Author(s):  
Pratyusha Tirumanisetty ◽  
Jose William Sotelo ◽  
Michael Disalle ◽  
Meenal Sharma
Keyword(s):  
Rheumatoid Arthritis ◽  
Bowel Wall ◽  
Loop Ileostomy ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Right Hemicolectomy ◽  
Necrotic Bowel ◽  
History Of ◽  
High Index Of Suspicion

A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.

scholarly journals Unexpected Etiology in a Case of Bilateral Maculopathy

2021 ◽  
pp. 622-628
Author(s):  
Prem Patel ◽  
Kaylie Jones ◽  
Deborah I. Friedman ◽  
David G. Birch ◽  
Rafael L. Ufret-Vincenty
Keyword(s):  
Rheumatoid Arthritis ◽  
Genetic Testing ◽  
Retinal Degeneration ◽  
High Index ◽  
Autoimmune Retinopathy ◽  
Negative Results ◽  
History Of ◽  
High Index Of Suspicion

A 74-year-old woman with a history of rheumatoid arthritis using hydroxychloroquine presented with gradually progressive decreased vision in both eyes and was found to have a bilateral maculopathy. Initial genetic testing was negative, and after discussing the low likelihood of her severe findings being secondary to her relatively low hydroxychloroquine exposure, the possibility of an autoimmune retinopathy was entertained. Updated data on the genetic testing reclassified one of her mutations in HGSNAT as pathogenic. This case highlights the value of genetic testing and the need to keep a high index of suspicion even after initial negative results, given the fact that our knowledge of mutations leading to retinal degeneration is constantly evolving.

Elizabethkingia anophelis infection in an infant: an unusual presentation

2021 ◽  
Vol 14 (5) ◽  
pp. e243078
Author(s):  
Mohsin Raj Mantoo ◽  
Jagat Jeevan Ghimire ◽  
Sarita Mahopatra ◽  
Jhuma Sankar
Keyword(s):  
Intensive Care ◽  
Clinical Presentation ◽  
Male Infant ◽  
Severe Anaemia ◽  
Blood Cultures ◽  
Lower Limbs ◽  
Emerging Pathogen ◽  
Non Accidental Trauma ◽  
History Of ◽  
Rule Out

A 7-month-old male infant presented with history of fever for 2 weeks, multiple ecchymotic patches over face, trunk and lower limbs, and one episode of seizure. The infant had shock, respiratory failure, severe anaemia, thrombocytopenia and temporoparietal haematoma on CT scan of the head. He was managed with supportive care and broad-spectrum empiric antibiotics. Two consecutive blood cultures grew Elizabethkingia anophelis, sensitive only to piperacillin–tazobactam. The infant responded to therapy and was discharged after 2 weeks of hospital stay. Repeated coagulation studies done to rule out an underlying bleeding disorder were negative. There was no clue in favour of non-accidental trauma. We report this case to highlight the unusual clinical presentation of this emerging pathogen. Mostly reported in outbreaks from surgical and post-operative intensive care units, it was worrisome to find this infant presenting with community-acquired E. anophelis infection.

scholarly journals Pasteurella multocidaBacteremia in an Immunocompromised Patient

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Shweta Kukrety ◽  
Jai Parekh ◽  
Theresa Townley
Keyword(s):  
Diabetes Mellitus ◽  
Pasteurella Multocida ◽  
Immunocompromised Patient ◽  
Altered Mental Status ◽  
Blood Cultures ◽  
Uneventful Recovery ◽  
Source Of Infection ◽  
Uncontrolled Diabetes ◽  
History Of ◽  
High Index Of Suspicion

We present the case of a 61-year-old Caucasian gentleman who presented with a one-day history of fever, chills, and altered mental status. His symptoms were initially thought to be secondary to cellulitis. Blood cultures grewPasteurella multocida, a rare pathogen to cause bacteremia. Our patient was treated with ciprofloxacin for two weeks and made a complete and uneventful recovery. Our patient’s uncontrolled diabetes mellitus and chronic kidney disease put him at a higher risk for developing seriousP. multocidainfection. The patient’s dog licking the wounds on his legs was considered as the possible source of infection. AsP. multicodabacteremia is rare, but severe with a high mortality rate, it is imperative to have a high index of suspicion for this infection especially in the vulnerable immunocompromised population.

scholarly journals 1423. Clinical Presentation Of Brucellosis: An Experience Of 29-Year Period

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S718-S718
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Fatma Smaoui ◽  
Amal Chakroun ◽  
Khaoula Rekik ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Close Contact ◽  
Public Health Problem ◽  
Blood Cultures ◽  
Disease Evolution ◽  
Therapy Regimen ◽  
Evolutionary Features ◽  
History Of ◽  
Acute Form ◽  
The Mean

Abstract Background Brucellosis is a multi-organ zoonotic disease which may present with a myriad manifestation. In our country, brucellosis remains endemic and represents a public health problem. We aimed to study the clinical, therapeutic and evolutionary features of brucellosis. Methods We conducted a retrospective study including all patients hospitalized for brucellosis in the infectious diseases department between 1990 and 2018. Positive blood cultures to Brucella spp and/or standard agglutination test (SAT) titer > 1/160 confirmed the diagnosis. Results During the study period, we encountered 216 cases of brucellosis, among whom 140 cases were males (64.8%). The mean age was 40±17 years. Patients came from rural areas (89.8%) and had a close contact with animals (70.8%). The consumption of unpasteurized milk was noted in 182 cases (84.2%). A family history of brucellosis was noted in 53 cases (24.5%). In total, 68 patients had a previous medical history of treated brucellosis (31.4%). There were 113 cases (52.3%) of acute brucellosis and 103 cases (47.7%) of sub-acute brucellosis. Spondylodiscitis (65 cases; 63.1%), neurobrucellosis (17 cases; 16.5%) and sacroiliitis (12 cases; 11.7%) were the most common forms of the sub-acute brucellosis. The revealing symptoms were fever (83.8%), night sweats (71.3%), arthralgia (55.1%) and back pain (53.2%). Laboratory investigations revealed leukopenia (14.4%), anemia (49%) and elevated C-reactive protein levels (42.1%). Blood cultures were positive to Brucella in 17.1% of the cases. Patients received a combination therapy based on doxycycline and rifampicin in 141 cases (65.2%). Triple therapy regimen including doxycycline, rifampicin and co-trimoxazole was prescribed in 51 cases (23.6%). The mean treatment duration was 52±20 days in the acute form and 6±3 months in the sub-acute form. The disease evolution was favourable in 94.4% of the cases. Sequelae were noted in 12% of the cases and relapse in 3.7% of the cases. Four patients were dead (1.9%). Conclusion Due to its various clinical presentation, the diagnosis of brucellosis might be delayed. High index of suspicion is required in order to promptly diagnose the disease. Control and eradication of brucellosis in animals are mandatory so as to eradicate brucellosis. Disclosures All Authors: No reported disclosures

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