Osteoarticular infections caused by Erysipelothrix rhusiopathiae: a case report and literature review

We present a case of Erysipelothrix rhusiopathiae spondylodiscitis in an otherwise healthy man, occurring one year after exposure. The patient was cured after 6-weeks treatment with amoxicillin followed by ciprofloxacin without surgery. E. rhusiopathiae can cause severe osteoarticular infections with a delayed presentation following the exposure to the pathogen.

Rare manifestation of a large stenosing gastrointestinal tumor caused by Mycobacterium tuberculosis in a previously healthy man from Austria

Summary Background Gastrointestinal tuberculosis (TB) is a rare manifestation in low TB-incidence countries such as Austria. It is usually seen in immunocompromised patients or in migrants being more susceptible for extrapulmonary disease manifestations. Case description We report a very rare manifestation of severe gastrointestinal TB in a 49-year-old previously healthy man from Upper Austria. Endoscopy showed a large tumor mass obstructing about 2/3 of the lumen of the cecum. Positron emission tomography/computed tomography scan revealed not only a high metabolic activity in the tumor mass, but also active pulmonary lesions in both upper lung lobes. Bronchial secretion showed acid-fast bacilli in the microscopy and polymerase chain reaction was positive for M. tuberculosis complex. Phenotypic resistance testing showed no resistance for first-line anti-TB drugs. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was initiated. Based on therapeutic drug monitoring, the standard treatment regime was adapted to rifampicin high dose. TB treatment was well tolerated and the patient achieved relapse-free cure one year after the end of treatment. Conclusion Gastrointestinal involvement mimicking an intestinal tumor is a very rare TB manifestation in previously healthy Austrians. However, it should be kept in mind due to increasing migration from countries with higher rates of extrapulmonary TB and due to an increasing number of immunocompromised patients. TB telephone consultations can support medical professionals in the diagnosis and the management of complex TB patients. TB management is currently at a transitional stage from a programmatic to personalized management concept including therapeutic drug monitoring or biomarker-guided treatment duration to achieve relapse-free cure.

Emergence Delirium in a 29-Year-Old Man following an Uneventful Appendectomy

Emergence delirium (ED) is defined as the delirium that occurs during the transition from the sleep state to full consciousness. ED increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization and occurs in patients of any age but most often in children and elderly patients. However, ED in young adults is rarely reported. We presented a case of typical ED occurring in a young healthy man following an uneventful appendectomy. The causes of ED can be classified as either predisposing or precipitating factors. In this case, the unnoticeable mental stress may be the predisposing factor and the sevoflurane maintenance of anesthesia may be the precipitating factor. ED occurs at any age of patient and in any minor surgery, and anesthesiologists should do some work to prevent it from happening.

Adult-onset nephrotic syndrome following COVID-19 vaccination

A 22-year-old healthy man was admitted for edema 15 days after the first injection of the COVISHIELD COVID-19 vaccine (Oxford AstraZeneca) vaccine. Nephrotic syndrome was diagnosed and a kidney biopsy showed minimal change disease. Oral Prednisolone was started at 1mg/kg/day resulting in complete remission within one week.

Extensive cerebral venous thrombosis in a patient with previous COVID-19 infection

The coronavirus disease 2019 (COVID-19) has been associated with coagulopathy that can lead to thrombotic complications such as stroke. There are increasing reports of association between active COVID-19 infection and Cerebral Venous Thrombosis (CVT). However, the complication of coagulopathy, like CVT, has only been reported only in active ongoing infections. We report a 30-year-old healthy man who presented with extensive CVT due to previous asymptomatic COVID-19 infection.