scholarly journals An Unusual Case (Metastatic-Like Lesion) of Septic Cerebral Embolus Caused by Corynebacterium mucifaciens in a Diabetic Patient

2020 ◽  
Vol 8 ◽  
pp. 232470962093093
Author(s):  
Seyed Arad Senaobar Tahaei ◽  
Zoltan Mencser ◽  
Zita Reisz ◽  
Pal Barzo
Keyword(s):  
Diabetic Patient ◽  
Bacterial Infections ◽  
Correct Diagnosis ◽  
Internal Capsule ◽  
Metastatic Tumor ◽  
Septic Embolization ◽  
Metastatic Lesions ◽  
First Case ◽  
Cerebral Embolization ◽  
Rule Out

Septic cerebral emboli can be a challenging diagnosis to give, especially if atypical bacterial infections are the cause of it. Correct diagnosis of this condition can change the management route of the patient and result in a nonsurgical treatment. To our best knowledge, this is the first case of septic cerebral embolus caused by Corynebacterium mucifaciens reported. In this study, a 65-year-old diabetic patient who have developed ketoacidosis and went into coma was investigated for a case of septic cerebral embolization. The patient developed a sudden right-sided hemiparesis, and the radiological findings showed a tumor-like lesion on the left hemisphere at the level of the internal capsule. At first glance, presence of a metastatic tumor could not be excluded; therefore, further laboratory tests and examinations were done to rule out metastatic lesions. The blood culture of the patient revealed a case of bacteremia caused by Corynebacterium mucifaciens and then a septic cerebral embolus was suspected, but due to the rarity of this pathogen causing such complications as well as the similarity of the lesion to a metastatic brain tumor, a biopsy was performed and the histopathological findings confirmed the diagnosis of a septic cerebral embolus. Corynebacterium mucifaciens should be considered a human pathogen in immunocompromised patients and it can cause cerebral septic embolization. Metastatic brain tumors and tuberculomas should be excluded; if the uncertainty of a metastatic tumor remains, biopsy can be performed and histological findings can amplify the diagnosis of septic cerebral embolus.

Clinicopathologic Features of Two Rare Cases of Dedifferentiated Adamantinomas, Including Diagnostic Implications

2018 ◽  
Vol 27 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Bharat Rekhi ◽  
Ayushi Sahay ◽  
Ajay Puri
Keyword(s):  
Microscopic Examination ◽  
Correct Diagnosis ◽  
Epithelial Differentiation ◽  
Resected Specimen ◽  
Intense Staining ◽  
Metastatic Lesions ◽  
First Case ◽  
Mitotic Figures ◽  
Aggressive Clinical Course

A dedifferentiated adamantinoma is a rare subtype of an adamantinoma, associated with a relatively aggressive clinical course, with less than 10 such cases reported so far. A 25-year-old-male presented with pain in his right leg of 1-year duration. Imaging disclosed a well-defined lytic, destructive lesion in his proximal tibia with a cortical break and a soft tissue component. Microscopic examination of the biopsy and resected specimen showed nests and clusters of atypical epithelial cells, along with significant areas showing markedly pleomorphic and spindly sarcomatous cells with interspersed mitotic figures and areas of stromal hyalinization. By immunohistochemistry, the areas of epithelial differentiation showed intense positivity for cytokeratin and p63, whereas the sarcomatous areas showed reduced to absent immunostaining. A 51-year-old lady presented with a recurrent tumor in her right tibia, which was initially diagnosed as an adamantinoma, along with metastatic lesions in her lung. Microscopic examination of the recurrent and metastatic tumors showed areas of epithelial differentiation along with spindly sarcomatous cells, arranged in fascicles. By immunohistochemistry, the areas of epithelial differentiation showed positivity for pan cytokeratin. Additionally, p63 was diffusely positive. p53 showed diffuse and intense staining pattern in the sarcomatous component (dedifferentiation). While the first case is disease-free, the second case is on follow-up. The 2 cases of dedifferentiated adamantinoma further confirm the rare occurrence of this tumor in our population. Its correct diagnosis has treatment implications. Differential diagnoses and literature review of similar reported cases are also presented in this article.

scholarly journals Epstein-Barr Virus Versus Novel Coronavirus-Induced Hemophagocytic Lymphohistocytosis: The Uncharted Waters

2020 ◽  
Vol 8 ◽  
pp. 232470962095010 ◽  
Author(s):  
Rawan Amir ◽  
Asim Kichloo ◽  
Jagmeet Singh ◽  
Ravinder Bhanot ◽  
Michael Aljadah ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Epstein Barr Virus ◽  
Genetic Mutations ◽  
High Grade ◽  
The Novel ◽  
Barr Virus ◽  
First Case ◽  
Epstein Barr ◽  
Virus Versus ◽  
Novel Coronavirus

Hemophagocytic lymphohistocytosis (HLH) is a hyperinflammatory syndrome characterized by fever, hepatosplenomegaly, and pancytopenia. It may be associated with genetic mutations or viral/bacterial infections, most commonly Epstein-Barr virus (EBV) and cytomegalovirus. As for the novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), also known as COVID-19 (coronavirus disease-2019), the cytokine storm it triggers can theoretically lead to syndromes similar to HLH. In this article, we report a case of a 28-year-old female who presented with high-grade fevers, found to have both SARS-CoV-2 and EBV infections, and eventually began to show signs of early HLH. To our knowledge, this is the first case reported in literature that raises the possibility of SARS-CoV-2–related HLH development.

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

BRAIN TUMORS IN INFANCY

PEDIATRICS ◽  
1948 ◽  
Vol 1 (3) ◽  
pp. 346-363
Author(s):  
I. WALLACE LEIBNER
Keyword(s):  
Nervous System ◽  
Differential Diagnosis ◽  
Brain Tumors ◽  
Correct Diagnosis ◽  
Full Recovery ◽  
The Other ◽  
Congenital Hydrocephalus ◽  
First Case ◽  
Clinical Patterns

Seven cases of brain tumors occurring in infants are presented. Six occurred in males and one was in a female. Three of them arose in the cerebellum while the other four were supratentorial. The tumors included two medulloblastomas, one [See Table II in Source Pdf] spongioblastoma polare, one ependymoma, one astrocytoma and one hemangioblastoma. The seventh case probably was also one of medulloblastoma. One of the proven medulloblastomas was supratentorial, which is unusual so faras location is concerned. The hemangioblastoma arose in the cerebrum. The location of this tumor is also a rare one and to my knowledge, it is the first case of its type reported in an infant in whom full recovery occurred following removal of the tumor. The diagnosis was unsuspected in four cases. Three of these infants were believed to be suffering from congenital hydrocephalus while the fourth was thought to be afflicted with encephalitis. The ways in which the correct diagnosis might have been made are discussed. Since bizarre clinical patterns are sometimes produced by brain tumors in infants and the diagnosis frequently overlooked, the possibility should be kept in mind by the pediatrician in considering the differential diagnosis of conditions producing signs referable to the nervous system.

scholarly journals An Unsual Site about Small Cells Osteosarcoma Parietal Region and Classique Osteosarcoma Occipital Region Mimicking Meningioma with Literature Review Management and Outcome

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Correct Diagnosis ◽  
Small Cell ◽  
Small Cells ◽  
Long Bones ◽  
Unusual Site ◽  
First Case ◽  
Review Management ◽  
Similar Materials ◽  
One Year ◽  
Age Range

Introduction: Primary osteosarcoma (OS) is the second most common primary bone malignancy, the first being multiple myeloma. OS occurs in the second decade, with a predilection for ends of long bones. Head and neck involvement is seen in 2-9% with extragnathic craniofacial bones in 1–2% of cases. Small Cell OS (SCO) constitutes 1.3-4% of all OS, skeletal distribution and age range being similar. Materials and Methods: We report two rare osteosarcoma and we done the review of the literature about the management and the outcome about intracranial osteosarcoma in our department of neurosurgery. Results: It is two osteosarcoma cases about a 72-year-old man and one 49-year-old man who both mimiking first meningioma. The first case is an unusual site parietal and the second case is occipital. The both benefited surgery with excision and exam of histology confirm diagnosis. But the first case died 15 days after surgery in intensive unit care and the second cases died after one year, he benefited surgery and chemotherapy. Conclusion: Small cell osteosarcoma (SCO) is an extremely uncommon entity that mainly involves the metaphysics of long bones and, rarely, the skull. Histopathology is the key to establishing the correct diagnosis, including sub typing for appropriate management and prognostication, as radiological features are not specific.

scholarly journals Fever without source as the first manifestation of SARS-CoV-2 infection in infants less than 90 days old.

2021 ◽  
Author(s):  
Daniel Blázquez-Gamero ◽  
Cristina Epalza ◽  
José Antonio Alonso Cadenas ◽  
Lourdes Calleja Gero ◽  
Cristina Calvo ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Urine Culture ◽  
Pediatric Intensive Care ◽  
Cross Sectional Study ◽  
Nasopharyngeal Swab ◽  
Sectional Study ◽  
Cross Sectional ◽  
Bacterial Coinfection ◽  
Growth Of Bacteria ◽  
Rule Out

Abstract Fever without source (FWS) in infants is a frequent cause of consultation at the emergency department and the emergence of SARS-CoV-2 could affect the approach to those infants. The aim of this study is to define the clinical characteristics and rates of bacterial coinfections of infants < 90 days with FWS as the first manifestation of SARS-CoV-2 infection. This is a cross-sectional study of infants under 90 days of age with FWS and positive SARS-CoV2 PCR in nasopharyngeal swab/aspirate, attended at the emergency departments of 49 Spanish hospitals (EPICO-AEP cohort) from March 1st to June 26th, 2020. Three hundred and thirty-three children with COVID-19 were included in EPICO-AEP. A total of 67/336 (20%) were infants less than 90 days old, and 27/67(40%) presented with FWS. Blood cultures were performed in 24/27(89%) and were negative in all but one (4%) who presented a Streptococcus mitis bacteremia. Urine culture was performed in 26/27(97%) children and was negative in all, except in two (7%) patients. Lumbar puncture was performed in 6/27(22%) cases, with no growth of bacteria. Two children had bacterial coinfections: 1 had UTI and bacteremia, and 1 had UTI. C-reactive was protein over 20 mg/L in two children (one with bacterial coinfection), and procalcitonin was normal in all. One child was admitted to the Pediatric Intensive Care Unit because of apnea episodes. No patients died. Conclusion: FWS was frequent in infants under 90 days of age with SARS-CoV-2 infection. Standardized markers to rule out bacterial infections remain useful in this population, and the outcome is generally good.

scholarly journals First case report of human myiasis with Sarcophaga species in Makkah city in the wound of a diabetic patient

2013 ◽  
Vol 4 (1) ◽  
pp. 225 ◽  
Author(s):  
MianUsman Usman ◽  
DinaAbdulla Muhammad Zaglool ◽  
Khaled Tayeb ◽  
YousifAbdul Wahid Khodari
Keyword(s):  
Case Report ◽  
Diabetic Patient ◽  
First Case ◽  
Makkah City

Procalcitonin measurement in West Nile virus neuroinvasive disease: a first case series

2021 ◽  
pp. e20200046
Author(s):  
Cheyanne Boehm ◽  
Christopher Doig ◽  
Justin Z Chen ◽  
Wendy I Sligl ◽  
Sean M Bagshaw ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Case Series ◽  
West Nile ◽  
Neuroinvasive Disease ◽  
First Case ◽  
Low Serum

West Nile virus neuroinvasive disease (WNV-NID) is challenging to diagnose. Procalcitonin (PCT) is a useful diagnostic test to identify bacterial infections. We present four cases of WNV-NID with serum PCT measurements. Methods: Daily (days 1–7) serum PCT (bioMérieux) was examined for critically ill patients with sepsis enrolled in a provincial sepsis study. Patients with identified WNV-NID are descriptively analyzed in this case series. PCT values of ≥0.5 ng/mL were suggestive of bacterial infection. Results: Four patients with WNV-NID were identified. Those with viral infections alone had consistently low PCT values ranging from 0.09 ng/mL to 0.34 ng/mL. Those with documented bacterial co-infections had initially elevated PCT levels that decreased by more than 50% with antimicrobial therapy. Conclusion: These cases are the first to report serial PCT measurements in confirmed cases of WNV-NID and support a low serum PCT in WNV-NID.

scholarly journals Salmonella enterica subspecies houtenae as an opportunistic pathogen in a case of meningoencephalomyelitis and bacteriuria in a dog

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Melissa N. Andruzzi ◽  
Mary L. Krath ◽  
Sara D. Lawhon ◽  
Beth Boudreau
Keyword(s):  
Salmonella Enterica ◽  
Bacterial Infections ◽  
Opportunistic Infections ◽  
Treatment Success ◽  
Immunosuppressive Treatment ◽  
Clinical Signs ◽  
Opportunistic Pathogen ◽  
First Case ◽  
Disease Diagnostics ◽  
Infectious Disease Diagnostics

Abstract Background We report the first case of canine Salmonella meningoencephalomyelitis and second case of canine Salmonella bacteriuria, as well as the first reported case of Salmonella enterica subspecies houtenae in a dog. Case presentation Immunosuppressive treatment in a dog for a relapse of steroid-responsive meningitis and arteritis (SRMA) allowed for the opportunistic establishment of a bacteremia with Salmonella enterica subsp. houtenae, ultimately causing meningoencephalomyelitis and subclinical bacteriuria. The bacterial infections were treated with a four-month course of amoxicillin; clinical treatment success was determined by serial negative urine cultures and lack of clinical signs correlated to the meningoencephalomyelitis. Conclusions Both the bacteriuria and meningoencephalomyelitis represented opportunistic infections in a dog immunosuppressed for SRMA. The clinical course of this infectious meningoencephalitis emphasizes the importance of differentiating relapse of initial disease from opportunistic infection occurring in a compromised central nervous system. The novel Salmonella species identified in this case acts as a reminder that infectious disease diagnostics should not be curbed by anecdotal prediction of routine pathogenic suspects.

Methylphenidate-associated Alice in Wonderland syndrome

2020 ◽  
pp. 112067212097888 ◽  
Author(s):  
Artémise Dugauquier ◽  
Sina Bidgoli
Keyword(s):  
Brain Mri ◽  
Ophthalmological Examination ◽  
Case Description ◽  
Single Center ◽  
Potential Side Effect ◽  
Hyperactivity Disorder ◽  
Alice In Wonderland ◽  
First Case ◽  
Life Threatening ◽  
Rule Out

Introduction: We describe the case of a child affected by typical symptoms of Alice in Wonderland syndrome (AIWS), related to the methylphenidate treatment he was taking for an attention deficit hyperactivity disorder (ADHD). To our knowledge, this is the first case of methylphenidate-associated AIWS. Methods: Retrospective single center observational case report. Case description: A 12-year-old boy was complaining of micropsias and macropsias. Except a disruptive ADHD treated by methylphenidate for 2 years, his medical history was banal. His symptoms coincided with a change in his treatment regimen and ceased with methylphenidate discontinuation. Unfortunately, they recurred when the medication was reimplemented by his psychiatrist. The ophthalmological examination was unremarkable. We concluded to an AIWS and prescribed ancillary testing (including blood work, electroencephalogram, and brain MRI) to rule out conditions known to be associated with this syndrome. In the meanwhile, the methylphenidate dosage was readapted, and the symptoms disappeared again. Seen this clear dechallenge and rechallenge effect and the fact that all additional tests returned normal results, we deduced that our patient’s symptoms were associated to methylphenidate. Conclusion: AIWS could be a potential side effect of methylphenidate. Given the frequency of methylphenidate prescription for ADHD and its widespread misuse, it is important to consider this peculiar adverse effect. Every physician should be aware of the condition to offer reassurance and to prescribe the appropriate additional examinations, as life-threatening disorders can cause this syndrome.

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