Corynebacterium striatum thrombophlebitis: a nosocomial multidrug-resistant disease?

Introduction. Corynebacterium striatum is a non-Diphteriae commensal bacterium with a wide range of pathogenicity. The identification of multidrug-resistant (MDR) C. striatum is concerning because drug susceptibility testing is not usually performed in microbiology laboratories. There is no consensus yet on the treatment of septic thrombophlebitis in this situation. Case report. We report here the first case of a quinquagenarian patient with a history of AIDS and fungic endocarditis, who was diagnosed with a nosocomial thrombophlebitis in the right jugular vein caused by C. striatum . Bitherapy with daptomycin for 12 days and linezolid for 23 days was combined with a therapeutic anticoagulant. The follow-up included weekly cervical ultrasound controls. The efficiency of the treatment and the stability of the lesions allowed us to alleviate the medication with a prophylactic dose of anticoagulant. The patient was discharged from hospital and showed no signs of recurrence after 12 months. Conclusion. The lack of consensus relative to the management of septic thrombophlebitis precludes the validation of a specific treatment for the condition. Our results suggest that a combination that includes removal of the medical device is needed. A total of 6 weeks of antibiotherapy should be applied, starting with 2 weeks of vancomycin or a combination of antibiotitherapy with daptomycin in order to reduce the bacterial load and avoid resistance. Six weeks of anticoagulation therapy is effective.

HEMATOGENOUS PULMONARY NODULES

Septic pulmonary embolism is an uncommon disorder that is most often seen in patients with predisposing situations (intravenous drug use, endocarditis, septic thrombophlebitis, central venous catheter infections…). The clinical signs are non-specific. CT scan is useful for diagnosis showing bilateral pulmonary nodules with some orienting signs. We report a case of a 43-year-old woman, with a history of hemodialysis via a tunneled jugular catheter, who presented with acute respiratory distress and fever, chest CT showed multiple bilateral nodules, some of which are excavated. Blood cultures showed a staphylococcus aureusbacteremia. The diagnosis of septic emboli was made in view of all the clinical, biological, and radiological elements.

THYROID ABSCESS: A CASE SERIES

Thyroid abscess is a rare surgical pathology, accounting for less than 0.7% of surgical pathologies involving the thyroid 1,2 gland. This is due to its rich blood supply and lymphatic drainage, high concentration oodine that inhibits bacterial growth, protective brous capsule, and fascial planes 2–4 separating it from other neck structures. It may lead to complications like septicaemia, paralysis of the vocal cords, retropharyngeal abscess and suppurative media stinitis and 2 may occasionally lead to osteomyelitis or septic thrombophlebitis. It 5 may also lead to tracheal and oesophageal perforation. The 6 left lobe is commonly affected. If left untreated, thyroid abscess can be life threatening resulting in a mortality of 12% 6 or more

Lemierre’s Syndrome: A Complication of Cervicofacial Cellulitis in a Child

Introduction: Lemierre’s syndrome complicates oropharyngeal infection and associates septic thrombophlebitis of the internal jugular vein with sepsis and distant septic emboli (especially pulmonary). We report a pediatric case with thrombophlebitis of the jugular vein in the context of cervicofacial cellulitis. Summary of the Clinical Case: A 2-year-old girl consulted in the emergency room for angina complicated by right cervicofacial cellulitis with thrombosis of the right jugular vein. The diagnosis of atypical Lemierre syndrome was made and the patient received first medical treatment (antibiotic therapy, anticoagulation) allowing a cure without sequelae. And secondary surgical treatment (adenoidectomy and tonsillectomy). Discussion: The presence of a cervical venous thrombosis complicating an oropharyngeal infection should lead to a search for Lemierre’s syndrome (blood cultures and chest CT) rare but serious and require immediate treatment

Ultrasound-guided cyanoacrylate injection for the treatment of incompetent perforator veins

Objective The use of cyanoacrylate products (CA) in incompetent perforator vein (IPV) treatment has not been thoroughly examined. The primary objective of this study is to describe the technique of ultra sound guided direct injection of IPV with CA, and secondarily to determine early closure rates and safety of this technique. Methods A retrospective analysis of patients undergoing IPV injection at two centres between 2015-2018 was conducted. Demographics, CEAP classification and IPV location were collected. Outcomes were assessed at two follow-up appointments. Results A total of 83 perforator vein injections were completed. CEAP classifications include C2 – C6 classes. Location of perforators were posteromedial (6%), femoral canal (9%), paratibial (14%), and posterior-tibial (71%). IPV closure rates were 96.3% at initial follow-up (16 ± 2 days). Closure rates decreased to 86.5% at second follow-up (72 ± 9 days). There were no deep vein thromboses during follow-up. One patient developed septic thrombophlebitis that was successfully managed with antibiotics. Conclusion Ultrasound-guided CA glue injection is a simple and low risk procedure that effectively closes incompetent perforator veins.