Unusual presentation of a periurethral abscess following infection with Neisseria gonorrhoea

We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.

Bilateral extensive leg pyomyositis presenting with diabetic ketoacidosis

Pyomyositis is a rare and serious acute purulent bacterial infection of the skeletal muscle. Diabetes is the most important predisposing factor and, if left untreated, the infection has significant complications. We report the case of an adult male who presented acutely with a history of abdominal pain, nausea and vomiting and bilateral thigh pain. His abdominal examination was unremarkable, but a fluctuant swelling was identified in both thighs. Biochemical investigations revealed raised inflammatory markers and diagnostic chemistry of diabetic ketoacidosis. Pyomyositis was treated with intravenous antibiotics and surgical abscess drainage. MRI is the definitive investigation of choice to diagnose pyomyositis. Differential diagnoses include cellulitis, septic arthritis and deep vein thrombosis.

A Rare Case of Hepatic Abscess That Resolved after Drainage of Pleural Empyema

Empyema has rarely been associated with hepatic abscess. In patients with concurrent empyema and hepatic abscess, hepatic abscess drainage is usually required after drainage of the pleura. We present a rare case of a 91-year-old Caucasian man who presented with a 2-week history of productive cough, fever, shortness of breath, and generalized malaise. The patient was found to have concurrent streptococci empyema and hepatic abscess, and, interestingly, the hepatic abscess resolved after the drainage of the empyema and initiation of antibiotics.

Efficacy and Safety of Thalidomide in Crohn’s Disease Patients with Perianal Fistula and Abscess

Background Medical therapies of parianal Crohn’s disease (CD) are limited. Thalidomide is an effective medical therapy to alleviate disease activity of CD. However, the effects and safety of thalidomide in the treatment of perianal fistula and abscess was not evaluated. Methods This retrospective cohort study was performed at a tertiary referral centre and recruited 73 patients with perianal CD who received thalidomide (50–100 mg) daily for 1 year. Data collected included demographics, medications, and disease behaviour. Clinical assessment of CD was conducted using the Crohn’s Disease Activity Index (CDAI), and perianal lesions were evaluated using the Fistula Drainage Assessment index and Perianal Disease Activity Index (PDAI). At the same time, the occurrence of adverse effects was recorded during treatment. Wilcoxon's signed-rank test and Student’s t-test were used to analyse the data. Results The CDAI score and laboratory indices were significantly lower after thalidomide treatment than at baseline (all P < 0.01). The value of PDAI was significantly lower in patients with symptomatic perianal abscess after thalidomide treatment than at baseline (10 [6.25, 10] versus 2.5 [1, 3.75]; P = 0.05). PDAI was also significantly reduced in all patients treated with thalidomide whether with or without perianal abscess drainage (all P < 0.05). The rates of responsive patients were similar between the thalidomide group and thalidomide combined with azathioprine group (72.73% [8/11] and 84% [21/25], respectively; P = 0.65). In total, 31% (24/77) of patients experienced adverse events, and interventions were required in 15 patients to reduce or eliminate discomfort from adverse events. Four patients discontinued thalidomide due to adverse effects. Side effects (rash, diarrhoea, peripheral neuropathy, somnolence, constipation, and numbness) were mild and mostly transient. Conclusions Thalidomide is effective in inducing clinical remission and response in CD patients with perianal fistula and abscess with or without abscess drainage. Thalidomide in combination with azathioprine is also effective in these patients. Low-dose thalidomide is proven to be effective and safe in treating perianal CD patients.

Presentación atípica de celulitis orbitaria en recién nacido

Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended. Key word: Celullitis, orbital abcess, new born

Acquired localised lipoatrophy secondary to transgluteal drainage

Acquired localised lipoatrophy is a focal loss of subcutaneous fat, which is commonly secondary to trauma, injections of medications such as antibiotics or corticosteroids, pressure, previous surgery or panniculitis. We present a case of a patient who experienced focal fat loss in the left gluteal region from a previous left transgluteal drainage of a suspected abscess. There was no medical history of corticosteroid, antibiotic injection or use of highly active antiretroviral therapy. Lipoatrophy occurring as a consequence of a deep pelvic abscess drainage has not been reported in the literature; however, based on the lack of other aetiologies, the diagnosis of acquired localised lipoatrophy secondary to a transgluteal drainage was made in this patient. The aim of this report was to present this rare cause of lipoatrophy that has not previously been described and to acknowledge lipoatrophy as a potential side effect of a deep abscess drainage.