A case of SFTS coinfected with E. coli bacteremia

Abstract Background Severe fever thrombocytopenia syndrome virus (SFTSV) is the causative agent of severe fever thrombocytopenia syndrome (SFTS). SFTS is an emerging infectious disease, characterized by high fever, gastrointestinal symptoms, leukopenia, thrombocytopenia, and a high mortality rate. Until now, little importance has been given to the association of SFTS with leukocytosis and bacterial co-infection. Case presentation A 51-year old man visited our hospital with fever and low blood pressure. He was a farmer by occupation and often worked outdoors. He had a Foley catheter inserted due to severe BPH. Laboratory tests revealed thrombocytopenia, elevated liver function, and elevated CRP levels. He had marked leukocytosis, proteinuria, hematuria, and conjunctival hemorrhage. Initially, we thought that the patient was suffering from hemorrhagic fever with renal syndrome (HFRS). However, we confirmed SFTS through PCR and increasing antibody titer. However, his blood culture also indicated E. coli infection. Conclusion SFTS displays characteristics of fever, thrombocytopenia, elevated liver function, and leukocytopenia. We described a case of SFTS with leukocytosis due to coinfection with E. coli. Since patients with SFTS usually have leukocytopenia, SFTS patients with leukocytosis are necessarily evaluated for other causes of leukocytosis. Here, we report the first case of an SFTS with concurrent E. coli bacteremia.

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Patient with severe fever with thrombocytopenia syndrome virus infection and central nervous system disturbance in Dongyang, Zhejiang Province, China, 2017

Virology Journal ◽

10.1186/s12985-019-1230-9 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Yi Sun ◽

Bin Guo ◽

Hao Yan ◽

Ai Lan Wu ◽

Wen Wu Yao ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Laboratory Tests ◽

Hemorrhagic Fever ◽

Activated Partial Thromboplastin Time ◽

Zhejiang Province ◽

Case Presentation ◽

First Case ◽

Severe Fever ◽

Elevated Lactate

Abstract Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever that was first described in China in 2011. We report a patient who died of Severe fever with thrombocytopenia syndrome virus (SFTSV) infection, with a rapidly progressive central nervous system (CNS) disturbance, in Dongyang, Zhejiang Province, China, in 2017. Case presentation A 64-year-old man was admitted to hospital after 4 days of fever. SFTSV was detected 1 day after the patient was admitted to hospital. The patient presented with CNS disturbance and died 4 days after admission. Detailed clinical and epidemiological investigations and laboratory tests were conducted. Reduced platelet, white blood cell, lymphocyte, and neutrophil counts, elevated lactate dehydrogenase, creatine kinase, aspartate aminotransferaseand alanine aminotransferase concentrations, and an increased activated partial thromboplastin time were observed. In a phylogenetic analysis, the isolate clustered close to a strain derived from South Korea. Conclusions: This is the first case of SFTSV infection with CNS disturbance in Dongyang, Zhejiang Province, China. The surveillance of suspected cases of SFTS is important in SFTSV endemic regions.

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Impact of C-Reactive Protein Levels on Differentiating of Severe Fever With Thrombocytopenia Syndrome From Japanese Spotted Fever

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa473 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Takeshi Kawaguchi ◽

Kunihiko Umekita ◽

Atsushi Yamanaka ◽

Seiichiro Hara ◽

Tetsuro Yamaguchi ◽

...

Keyword(s):

Spotted Fever ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Positive Likelihood Ratio ◽

Hemorrhagic Fever ◽

Spotted Fever Group ◽

C Reactive Protein ◽

Reactive Protein ◽

Severe Fever

Abstract Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever in China, Korea, and Japan. Japanese spotted fever (JSF), which belongs to spotted fever group rickettsioses, is also endemic to Western Japan. Patients with SFTS and those with JSF display many of the same clinical manifestations. Sudden fever, rash, tick bite, and neurological and gastrointestinal symptoms may be seen in both infections, but the frequency and severity of each disease have not been compared and studied. Because laboratory confirmation of pathogens takes time, it is important to predict diagnosis of SFTS vs JSF based on the features of the clinical characteristics at the initial presentation, particularly in primary care settings. Methods We conducted a case series review at 4 medical facilities in Miyazaki, Japan. Based on the medical records, clinical and laboratory characteristics were compared between patients with SFTS and those with JSF. Results Eighty-one patients were enrolled in this study, including 41 with SFTS and 40 with JSF. The absence of rash (P < .001), leukopenia (P < .001), and normal C-reactive protein (CRP) levels (P < .001) were the variables distinguishing SFTS from JSF. Normal CRP levels (≤1.0 mg/dL) had a 95% sensitivity (84%–99%) and 97% specificity (87%–100%) for SFTS, with a positive likelihood ratio of 37.1 (5.35–257). Conclusions Normal serum CRP levels were shown to differentiate SFTS from JSF with a very high probability.

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Acute Pancreatitis Associated with Ixazomib in a Multiple Myeloma Patient

Acta Haematologica ◽

10.1159/000484655 ◽

2018 ◽

Vol 139 (1) ◽

pp. 67-70 ◽

Cited By ~ 5

Author(s):

Raphael E. Steiner ◽

Robert Z. Orlowski ◽

Hans C. Lee

Keyword(s):

Multiple Myeloma ◽

Acute Pancreatitis ◽

Proteasome Inhibitor ◽

Gastrointestinal Symptoms ◽

Multiple Myeloma Patient ◽

Case Presentation ◽

Severe Diarrhea ◽

First Case ◽

To Receive ◽

Uncommon Complication

Background: Acute pancreatitis is an uncommon complication of anti-myeloma agents. Ixazomib is a first-in-class oral proteasome inhibitor to receive regulatory approval for the treatment of multiple myeloma. This case report describes the first case of ixazomib-associated pancreatitis. Case Presentation: An 80-year-old female with relapsed multiple myeloma presented with severe diarrhea, nausea, vomiting, abdominal pain, and acute renal failure 3 weeks after starting ixazomib and dexamethasone for disease progression. An extensive workup revealed acute pancreatitis without a definitive cause. Her condition improved with supportive measures and the discontinutation of ixazomib. The latter was suspected as the probable etiology of the patient's acute pancreatitis, given no clear alternative causes and the temporal relationship between initiating ixazomib and the development of her symptoms. Conclusions: Practitioners should include acute pancreatitis as part of their differential diagnosis in patients on ixazomib treatment who present with gastrointestinal symptoms.

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E. coliMeningitis Presenting in a Patient with DisseminatedStrongyloides stercoralis

Case Reports in Infectious Diseases ◽

10.1155/2013/424362 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Juliana B. Gomez ◽

Yvan Maque ◽

Manuel A. Moquillaza ◽

William E. Anicama

Keyword(s):

Gastrointestinal Symptoms ◽

Abdominal Distension ◽

Strongyloides Stercoralis ◽

The Body ◽

Case Presentation ◽

E Coli ◽

History Of ◽

Disseminated Strongyloidiasis ◽

Proper Diagnosis ◽

Cerebrospinal Fluid Culture

Introduction. SpontaneousEscherichia colimeningitis is an infrequent condition in adults and is associated with some predisposing factors, including severeStrongyloides stercoralis(SS) infections.Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrumβ-lactamase producingE. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multipleStrongyloideslarvae throughout the body.Conclusion.Strongyloides stercoralisinfection should be excluded in adults with spontaneousE. colimeningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

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Gastrointestinal disturbance and effect of fecal microbiota transplantation in discharged COVID-19 patients

Journal of Medical Case Reports ◽

10.1186/s13256-020-02583-7 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Fengqiong Liu ◽

Shanliang Ye ◽

Xin Zhu ◽

Xuesong He ◽

Shengzhou Wang ◽

...

Keyword(s):

B Cells ◽

Fecal Microbiota Transplantation ◽

Gastrointestinal Symptoms ◽

Fecal Microbiota ◽

Case Presentation ◽

Microbiome Composition ◽

Operational Taxonomic Units ◽

Gut Dysbiosis ◽

Rehabilitative Intervention ◽

Oral Capsule

Abstract Background To investigate the potential beneficial effect of fecal microbiota transplantation (FMT) on gastrointestinal symptoms, gut dysbiosis and immune status in discharged COVID-19 patients. Case presentation A total of 11 COVID-19 patients were recruited in April, 2020, about one month on average after they were discharged from the hospital. All subjects received FMT for 4 consecutive days by oral capsule administrations with 10 capsules for each day. In total, 5 out of 11 patients reported to be suffered from gastrointestinal symptoms, which were improved after FMT. After FMT, alterations of B cells were observed, which was characterized as decreased naive B cell (P = 0.012) and increased memory B cells (P = 0.001) and non-switched B cells (P = 0.012).The microbial community richness indicated by operational taxonomic units number, observed species and Chao1 estimator was marginally increased after FMT. Gut microbiome composition of discharged COVID-19 patients differed from that of the general population at both phylum and genera level, which was characterized with a lower proportion of Firmicutes (41.0%) and Actinobacteria (4.0%), higher proportion of Bacteroidetes (42.9%) and Proteobacteria (9.2%). FMT can partially restore the gut dysbiosis by increasing the relative abundance of Actinobacteria (15.0%) and reducing Proteobacteria (2.8%) at the phylum level. At the genera level, Bifidobacterium and Faecalibacterium had significantly increased after FMT. Conclusions After FMT, altered peripheral lymphocyte subset, restored gut microbiota and alleviated gastrointestinal disorders were observe, suggesting that FMT may serve as a potential therapeutic and rehabilitative intervention for the COVID-19.

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Immediate post partum macular subretinal bleeding in a highly myopic patient: a case report

BMC Ophthalmology ◽

10.1186/s12886-021-01814-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Karen Bitton ◽

J.-L. Bacquet ◽

F. Amoroso ◽

S. Mrejen ◽

M. Paques ◽

...

Keyword(s):

Valsalva Maneuver ◽

Post Partum ◽

Pathologic Myopia ◽

Pathological Myopia ◽

Case Presentation ◽

Sudden Loss ◽

Corrected Visual Acuity ◽

First Case ◽

History Of ◽

Macular Hemorrhage

Abstract Background Pathologic myopia is a major cause of visual impairment and blindness. Case presentation We report a case of an immediate post partum macular subretinal bleeding observed in a highly myopic patient. A 30-years-old woman presented two days after childbirth for sudden loss of vision in her right eye. Multimodal imaging showed macular hemorrhage masking a subtle yellowish linear lesion corresponding to lacker crack. Due to the lack of evidence for choroidal neovascularization, a simple clinical and imaging monitoring was recommended. Six weeks later, we noted an improvement in her best-corrected visual acuity and a decreased in size of the macular hemorrhage. Conclusions This is the first case reporting a macular subretinal bleeding on macular lacquer cracks in a highly myopic patient in immediate post partum. Valsalva maneuver associated with vaginal delivery could explain the occurrence of the hemorrhage associated with lacquer crack. However, natural history of pathological myopia could not be excluded.

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Emphysematous pyelonephritis with air bubble in the inferior vena cava

African Journal of Urology ◽

10.1186/s12301-020-00081-2 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Tiffany A. Perkins ◽

Alberic Rogman ◽

Murali K. Ankem

Keyword(s):

Septic Shock ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Rare Presentation ◽

Emphysematous Pyelonephritis ◽

Case Presentation ◽

Air Bubble ◽

First Case ◽

The Right

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

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Robotic-assisted proximal gastrectomy using the double-flap technique for early gastric cancer with situs inversus totalis: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01262-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Takeno ◽

Toru Masuzawa ◽

Shinsuke Katsuyama ◽

Kohei Murakami ◽

Kenji Kawai ◽

...

Keyword(s):

Gastric Cancer ◽

Situs Inversus ◽

Autosomal Recessive ◽

Intraoperative Complications ◽

Proximal Gastrectomy ◽

Situs Inversus Totalis ◽

Upper Body ◽

Robot Assisted ◽

Case Presentation ◽

First Case

Abstract Background The robotic system has been applied in the treatment of gastric cancer (GC), and the procedure has been found to be safe and feasible. Situs inversus totalis (SIT) is a relatively rare autosomal recessive congenital anomaly. We successfully performed robot-assisted proximal gastrectomy (RAPG) and handsewn double-flap esophagogastrostomy for GC in a patient with SIT. Case presentation A 71-year-old woman was referred to us with an asymptomatic ulcerative lesion in the upper body of the stomach. Computed tomography revealed that she had SIT. She was diagnosed with cT1bN0M0, cStageIA gastric cancer. RAPG with lymph node dissection and handsewn double-flap esophagogastrostomy was performed. Robotic surgery enabled the surgeon to perform the surgery without changing his position and experiencing any confusion resulting from the patient’s reversed anatomy. It took 448 min, and no intraoperative complications occurred. Her postoperative course was uneventful; she was discharged on postoperative day 10. The final pathologic report showed pT1b1N0M0, pStage IA. Conclusions This is the first case describing RAPG with handsewn double-flap esophagogastrostomy for a SIT patient with early GC.

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369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.564 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S254-S254

Author(s):

Victoria Bengualid ◽

Maria Martinez ◽

Zhenisa Hysenaj ◽

Debra M Willner ◽

Judith Berger

Keyword(s):

Oxygen Saturation ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Altered Mental Status ◽

Channel Blockers ◽

First Case ◽

Overall Mortality

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

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Fetal pulmonary choristoma: report of first case and literature review

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2020-0072 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Anupam Nanda ◽

Rajinder Nanda ◽

Seema Thakur ◽

Tej Prakash Gupta ◽

Sudhir Jain ◽

...

Keyword(s):

Literature Review ◽

Exome Sequencing ◽

Posterior Fossa ◽

Spinal Column ◽

Fetal Autopsy ◽

Case Presentation ◽

Antenatal Ultrasound ◽

Clinical Exome Sequencing ◽

First Case ◽

Pathologic Findings

AbstractObjectivesLung tissue choristoma is a very rare disorder where mature lung tissues develop in the site not normal to the lung.Case presentationWe hereby report a first case of fetal pulmonary choristoma in a 23–24 weeks fetus where antenatal ultrasound showed a mass in posterior fossa with severe ventriculomegaly. The mass extended inferiorly in cervical spinal column and thereafter extended in the skin over the back of fetus. Fetal autopsy confirmed these findings. Pathologic findings showed mature lung tissues with bronchi, bronchioles, and alveoli. Clinical exome sequencing showed normal results.ConclusionsWe describe the antenatal ultrasound, fetal autopsy and pathologic findings of an intracranial and cutaneous pulmonary choristoma.

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