Otitis with Aspergillus niger in a patient with SARS-CoV-2 and multiple comorbidities

Introduction. COVID-19 is associated with a significant incidence of bacterial and fungal superinfections and with the exacerbation of pre-existing infections, representing a diagnostic and therapeutic challenge. Case presentation. A 64-year-old woman, confirmed with COVID-19 by the SARS-CoV-2 antigen test, is hospitalized accusing fatigue, nausea, watery stools, cough and vertigo started 10 days ago, aggravated 4 days before the presentation. It also reports recurrent episodes of otalgia and otorrheic pluriantibiotic treatment in the last 2 months. From the personal pathological antecedents we remember: hypothyroidism, dyslipidemia, hypertension, ischemic heart disease, history of deep vein thrombosis (DVT) and secondary pulmonary thromboembolism, in chronic anticoagulant treatment. Pathological clinical signs at admission: bilateral basal crackling rales. Biologically, inflammatory syndrome is detected, and radiologically, interstitial-alveolar infiltrates in the lower lung fields. On day 3 of hospitalization, the patient shows purulent secretion in the right external auditory canal and the ENT consultation confirms chronic suppurative otitis media in acute onset. Bacteriological examination of otic secretion reveals Aspergillus niger. Antiviral treatment with Remdesivir is initiated, antibiotic therapy initiated at home with Azithromycin is continued for one day, then escalated to Ceftriaxone i.v. (in the context of clinical-paraclinical aggravation), systemic corticotherapy, anticoagulation with Dalteparin in the prophylactic regime of DVT, systemic treatment with Voriconazole p.o. (according to the antifungal program) and topical (local) with a slow favorable evolution. Conclusions. The association of COVID-19 with otitis with Aspergillus is a rare and particular clinical picture.

Download Full-text

Plantar vein thrombosis provoked by mechanical strain to the foot: a rare cause of plantar heel pain

BMJ Case Reports ◽

10.1136/bcr-2019-230054 ◽

2019 ◽

Vol 12 (11) ◽

pp. e230054 ◽

Cited By ~ 2

Author(s):

Herman Jan Christiaan Swellengrebel ◽

Thijs Backus ◽

Frank Marinus Zijta ◽

Peer van der Zwaal

Keyword(s):

Mechanical Strain ◽

Acute Onset ◽

Heel Pain ◽

Vein Thrombosis ◽

Plantar Heel Pain ◽

Plantar Aspect ◽

Fasciitis Plantaris ◽

History Of ◽

Inflammatory Drugs ◽

The Right

A 61-year-old mountain hiker presented with acute pain of the medial-plantar aspect of the right foot. As the location, intensity and acute onset of the pain were atypical for fasciitis plantaris, an ultrasound was performed. This demonstrated a segmental plantar vein thrombosis (PVT), which was confirmed on consequent MRI. Patient was a non-smoker, without a medical or family history of coagulopathies. Four months previously, he suffered from metatarsalgia of the left, thus contralateral, foot, which prompted treatment with bilateral orthoses. In addition to metatarsal padding, medial-arch support was prescribed due to the presence of flexible flatfeet. Following internal medicine consultation, treatment consisted of discontinuing the use of orthoses, rest and non-steroidal anti-inflammatory drugs (NSAIDs). At 2-week follow-up, the patient was pain-free. In this case report, PVT, a rare cause for plantar heel pain, is discussed. In addition, a summary of the diagnosis and treatment of PVT is outlined.

Download Full-text

Invasive Aspergillus niger Is the Sole Etiological Agent for CSOM : A Clinical Case from Nepal

Case Reports in Infectious Diseases ◽

10.1155/2021/5556679 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Ajay Kumar Chaurasiya ◽

Rabindra Bhakta Pradhananga ◽

Niranjan Prasad Sah ◽

Basista Prasad Rijal ◽

Bharat Mani Pokhrel ◽

...

Keyword(s):

Aspergillus Niger ◽

Fungal Spores ◽

Fungal Growth ◽

Opportunistic Pathogen ◽

Neck Surgery ◽

Suppurative Otitis Media ◽

Gram Staining ◽

History Of ◽

Etiological Agents ◽

The Right

Aspergillus causing chronic suppurative otitis media (CSOM) is rare in immunocompetent people; however, it can occur as a significant opportunistic pathogen in immunocompromised patients. Here, in our study, a 53-year-old diabetic patient having a history of CSOM visited the Department of Otorhinolaryngology-Head and Neck Surgery (ENT-HNS), Tribhuvan University and Teaching Hospital (TUTH), Nepal, in March 2016. Although he was on medication with an antibacterial ear drop from the last 10 days, his right ear was presented with otorrhea, pruritus, otalgia, aural fullness, hearing impairment, and tinnitus from the last 3-4 months. Preliminarily, otoscopy of the right ear revealed the presence of fungal mass. For further diagnosis, ear discharge was aseptically collected and sent to the laboratory to confirm the etiological agents. Findings of laboratory analysis indicated that Gram staining of aural discharge displayed pus cells with fungal spores but did not exhibit bacteria. Furthermore, potassium hydroxide (KOH) mount revealed the presence of fungal spores and septate hyphae with the characteristic of dichotomous branching. Culture in four different bacterial media (chocolate agar, blood agar, MacConkey agar, and Robertson’s cooked meat medium) has unveiled no bacterial growth. However, fungal growth was observed in both bacterial and fungal media. Thereafter, the fungal colony was investigated via a lactophenol cotton blue (LPCB) tease mount which displayed the structure of Aspergillus. Aspergillus niger was microbially conformed by specifically characterizing the specific phenotypic biseriate structure of phialides and the black-coloured conidia. For medication, the patient was treated with Candid Ear Drop with clotrimazole (1% w/v) plus lidocaine (2% w/v) for 4 weeks which successfully improved his condition.

Download Full-text

Clinical, MRI and histopathological findings in a dog with distemper meningomyelitis

Veterinary Record Case Reports ◽

10.1136/vetreccr-2020-001173 ◽

2020 ◽

Vol 8 (3) ◽

pp. e001173

Author(s):

Alessandra Destri ◽

Lluís Sánchez ◽

Jennifer Stewart ◽

Ruth Dennis

Keyword(s):

Spinal Cord ◽

Clinical Signs ◽

Acute Onset ◽

Mri Findings ◽

German Shepherd ◽

German Shepherd Dog ◽

History Of ◽

The Right ◽

Clinical Mri ◽

Severe Fever

A 14-month-old female entire German Shepherd dog presented with a five-day history of acute onset, progressive, non-ambulatory paraparesis, with lateralisation to the right. The neurolocalisation was to the L4-S1 spinal cord segments. MRI of the thoracic, lumbar and sacral spinal cord revealed multifocal, ill-defined, T2-weighted hyperintense, intramedullary lesions, which were moderately contrast-enhancing, becoming more defined and ovoid to nodular after injection of gadolinium-containing contrast medium. The lesions affected both white and grey matter and were lateralised mainly to the right side. PCR tests on blood and cerebrospinal fluid were positive for canine distemper virus (CDV). Despite intensive treatment, the dog developed myoclonus and severe fever and was humanely euthanased. Postmortem examination confirmed the presence of spinal cord lesions consistent with CDV. Distemper rarely presents with clinical signs of myelopathy exclusively and there is a scarcity of description of MRI findings of distemper meningomyelitis in the literature.

Download Full-text

Omental Infarction: A Case Treated with Laparoscopic Surgery

10.31487/j.ijscr.2019.02.03 ◽

2019 ◽

pp. 1-3

Author(s):

Bertrand Ng ◽

Arafat Yasser

Keyword(s):

Diabetes Mellitus ◽

Laparoscopic Surgery ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Inflammatory Markers ◽

Acute Onset ◽

Laparoscopy Surgery ◽

History Of ◽

Background History ◽

The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

Download Full-text

Immune-Mediated Neutropenia in a Miniature Poodle

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6832 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Benjamin Brunson

Keyword(s):

Bone Marrow ◽

Bone Marrow Aspirate ◽

Clinical Signs ◽

Response To Therapy ◽

Tertiary Referral Center ◽

Immune Mediated ◽

Specialized Equipment ◽

History Of ◽

Light Sedation ◽

The Right

ABSTRACT A 10 yr old spayed female toy poodle was presented to a tertiary referral center for a 10 day history of waxing and waning lethargy, vomiting, diarrhea, and anorexia. An immune-mediated neutropenia (IMN) was suspected to be the underlying cause of her clinical signs. A bone marrow aspirate was obtained from the chostochondral junction of the 11th and 12th ribs on the right side and provided a definitive diagnosis of IMN. A positive response to therapy and repeat blood work further confirmed the diagnosis. Obtaining bone marrow aspirates from the chostochondral junction is a safe, cheap, and reliable method of diagnosing IMN and can be performed in the private practice setting with light sedation and minimal need for specialized equipment.

Download Full-text

Cerebellar peduncle abscess secondary to disseminated strangles in a six-week-old miniature foal

Veterinary Science Development ◽

10.4081/vsd.2011.3516 ◽

2011 ◽

Vol 1 (1) ◽

pp. 12

Author(s):

Brianne Henderson

Keyword(s):

Animal Health ◽

Clinical Signs ◽

Acute Onset ◽

Abscess Formation ◽

Neurological Deficits ◽

Post Mortem ◽

Streptococcus Equi ◽

The Central Nervous System ◽

Cerebellar Peduncle ◽

The Right

During a strangles outbreak within a herd of minature horses, a six week old foal developed acute onset clinical signs of sepsis and neurological deficits. The foal was euthanized and submitted for post-mortem at the Animal Health Laboratories, Guelph Ontario. Gross post-mortem examination noted severe bronchopneumonia, hypopyon of the right eye and a singular cerebellar peduncle abscess. Culture of the lungs and cerebellum produced a pure growth of Streptococcus equi ssp. equi. Streptococcus equi ssp. equi, the causative agent of equine strangles, produces an acute pyrexia, purulent lymphadenopathy of submandibular and retropharyngeal lymph nodes. Commonly, lymph node abscesses rupture and resolve without complication. Rarely, complications may include: dissemination of the bacteria with diffuse abscess formation, immune mediated disease (purpura haemorrhagica), rarely abscess formation within the central nervous system (CNS) can occur. These can be managed medically with appropriate antibiotics and drugs to reduce intra-cranial pressure, however surgical drainage and debulking of the abscess has been attempted successfully in a few cases.

Download Full-text

Unusual coexistence of first and second branchial fistulas: clinical case and review of the literature

Journal of International Medical Research ◽

10.1177/0300060520944303 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094430

Author(s):

Danqing Liu ◽

Guangqi Li ◽

Jun Qiu ◽

Jianyan Wang ◽

Genwang Pei

Keyword(s):

Clinical Signs ◽

Preoperative Imaging ◽

Review Of The Literature ◽

False Positive Diagnosis ◽

Fistula Recurrence ◽

History Of ◽

Physical Examinations ◽

Missed Diagnosis ◽

The Right

Branchial fistulas are uncommon in the clinical setting. The coexistence of first and second branchial fistulas has not been previously reported. We herein describe a 12-year-old girl who presented with a 2-year history of repeated swelling and purulence behind the right earlobe and neck. According to the patient’s physical and auxiliary examination findings, she was diagnosed with coexisting first and second branchial fistulas, both of which were completely removed by surgery. No clinical signs of fistula recurrence were present at the patient’s 20-month postoperative follow-up. Ipsilateral coexisting first and second branchial fistulas are very rare; thus, a false-positive diagnosis can easily occur if the doctor does not carefully perform specialized physical examinations. Surgery is an effective method for treating this condition. Adequate preoperative imaging preparation is imperative to ensure the most effective course of treatment. The purpose of this article is to improve clinicians’ awareness of this disease, thereby effectively reducing the rates of missed diagnosis and recurrence.

Download Full-text

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) with painful erythematous nodules

BMJ Case Reports ◽

10.1136/bcr-2019-234197 ◽

2020 ◽

Vol 13 (4) ◽

pp. e234197

Author(s):

Nicholas Kevin Laidler ◽

Thomas Delaney

Keyword(s):

Tertiary Hospital ◽

Acute Onset ◽

General Malaise ◽

Metastatic Adenocarcinoma ◽

Cutaneous Manifestations ◽

Hands On ◽

History Of ◽

Recent Diagnosis ◽

The Right ◽

Pitting Edema

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) is an uncommon syndrome characterised by acute onset severe synovitis of the radiocarpal and small joints of the hands, with associated pitting edema. Discussed here is the case of a 69-year-old man who presented to the emergency department of a tertiary hospital with acute bilateral hand swelling. This was on a background of a recent diagnosis of metastatic adenocarcinoma of the caecum and subsequent hemicolectomy. There was a history of general malaise, fever and lethargy for 5 days prior to the swelling of the hands. On examination, the upper limbs were swollen to the elbow bilaterally. Painful erythematous nodules were noted on the dorsal and palmar aspects of the hands and violaceous periungual discolouration was observed on the right fourth and fifth fingers. Prednisolone was commenced resulting in a dramatic resolution of the articular and cutaneous manifestations within 3 weeks.

Download Full-text

A case of May-Thurner Syndrome: An old anomaly but, a new suggestion: A case report

Malawi Medical Journal ◽

10.4314/mmj.v31i3.12 ◽

2019 ◽

Vol 31 (3) ◽

pp. 230-232

Author(s):

Şule Gökçe

Keyword(s):

Case Report ◽

Sports Medicine ◽

Iliac Vein ◽

Common Iliac Vein ◽

Ultrasound Screening ◽

Vascular Abnormalities ◽

Vein Thrombosis ◽

History Of ◽

The Right ◽

Deep Vein

May-Thurner syndrome (MTS) is an anatomical condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine. MTS is rarely diagnosed because diagnostic workup is seldom continued once the diagnosis of a deep vein thrombosis (DVT) has been established. Furthermore, patients with DVT generally have several well-known confounding risk factors. We report a 16-year-old girl with a history of left leg swelling who was incidentally diagnosed with MTS. We hope that our case report will create awareness of vascular abnormalities in sports medicine and suggest that routine venous Doppler ultrasound screening may help to detect MTS or associated anatomical prior to the formation of early thrombosis.

Download Full-text

Internal Carotid Dissection as the Cause of Stroke in Childhood

Case Reports in Pediatrics ◽

10.1155/2021/5568827 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Giulia Cinelli ◽

Vitaliana Loizzo ◽

Lisa Montanari ◽

Ilaria Filareto ◽

Elisa Caramaschi ◽

...

Keyword(s):

Risk Factors ◽

Magnetic Resonance ◽

Internal Carotid ◽

Clinical Signs ◽

Cervical Pain ◽

Resonance Imaging ◽

Cervical Trauma ◽

History Of ◽

Associated Risk Factors ◽

The Right

Internal carotid artery (ICA) dissection is a cause of stroke, but it is often underdiagnosed in children. ICAs’ risk factors and pathogenic mechanisms are poorly understood, and the treatment is still empirical. We report the case of a previously healthy 9-year-old girl who presented with involuntary hypertonic closure of the right hand associated with transient difficulty for both fine movements of the right arm and speech. She had a history of minor cervical trauma occurring 20 days prior to our observation without other associated risk factors. Magnetic resonance imaging and magnetic resonance angiography showed ischemic lesions due to the left ICA dissection. Treatment with both acetylsalicylic acid and levetiracetam allowed recanalization of the ICA associated with the resolution of clinical signs. Our clinical case suggests that the ICA dissection must be suspected early whenever a child manifests mild neurologic deficits after a cervical trauma, especially if they are associated with headache and/or cervical pain. Moreover, the management of ICA dissection must be improved.

Download Full-text