A Conservative Approach to a Large Mycotic Pulmonary Pseudoaneurysm

Pulmonary mycotic pseudoaneurysm is a rare complication of bacteremia with high associated mortality. We present a case of a large proximal pulmonary artery pseudoaneurysm as a result of methicillin-sensitive Staphylococcus aureus bacteremia, originating from a tunneled dialysis catheter infection. This case was ultimately managed conservatively with surveillance imaging and a prolonged intravenous antibiotic course, rather than with surgical or interventional management. To our knowledge, this is the first reported case of a mycotic pulmonary pseudoaneurysm due to septic embolization of an infected superior vena cava thrombus.

A CASE OF INFECTIVE ENDOCARDITIS COMPLICATED BY ACUTE ISCHEMIC STROKE

Infective endocarditis is an infectious and inammatory process involving endothelial lining of heart structures and valves. Cerebrovascular complications (CVCs) frequently occur in patients who are in the active stage of infective endocarditis (IE), and result from cerebral septic embolization of an endocardial vegetation. Acute stroke due to septic emboli is a particularly dreaded complication , with a frequency of 25-35%. Here we present a case of 32 year old male patient, who comes to the ER with high grade fever and palpitations since 9 days. On examination we found hyperdynamic impulse with decrescendo type systolic murmur at mitral area and we decided to do a blood workup and also requested a 2D ECHO. Blood culture and 2D ECHO showed different species of streptococci and mitral regurgitation respectively. Based on the investigations we started the patient on antibiotics, However, on the day 7 of treatment, patient developed slurring of speech and hemiparesis followed by motor aphasia. We sent the patient for brain MRI that showed acute infarct in left central semioval, left corona radiata and left perisylvian region. Acute ischemic stroke is the complication of the infective endocarditis and we started tpAalong with intravenous antibiotics after which he experienced signicant clinical improvement in few days.

Streptococcus anginosus bacteremia: a septic IVC thrombus and a large empyema requiring decortication

A previously healthy 39 year old male presented with complaints of cough, fever, abdominal pain and chills. The patient was found to be in active sepsis with hypotension on presentation so was resuscitated while a full septic work-up was ordered. Initial chest X-ray showed only increased broncho-alveolar markings and no consolidations, but blood cultures eventually revealed Streptococcus anginosus bacteremia. Intravenous antibiotics were started and infective endocarditis was ruled out. Computerized tomography scan of the abdomen with contrast revealed findings suggestive of a septic hepatic inferior vena cava thrombus and right lower lung findings suggestive of septic embolization and an empyema. Later on during admission, CT scan of the chest with contrast revealed a moderate-sized empyema of the right lung which eventually required decortication. Discovering such findings concurrently in a single patient is extremely rare, particularly an embolizing septic IVC thrombus with confirmed bacteremia. For this reason it is described in the following case presentation

Subacute infective endocarditis presenting as upper abdominal pain

Splenic abscess develops in 3-5% of patients with infective endocarditis. In more protracted subacute cases of infective endocarditis, symptoms and signs such as anorexia, weight loss, weakness, arthralgia and abdominal pain may occur in 5-30% of patients and thereby misleading the clinician to pursue incorrect diagnosis such as malignancy, connective tissue disease, or other chronic infection or systemic inflammatory disorders. Left upper quadrant pain can be a presenting symptom in a patient with IE, if it is complicated by septic embolization to spleen. Here reported a case of subacute infective endocarditis complicated with splenic embolization in a 34-year-old male with diabetic nephropathy and ischemic dilated cardiomyopathy, presented as acute abdominal pain.

Lifesaving Treatment of Aortic Valve Staphylococcus aureus Endocarditis: Daptomycin and Early Surgical Therapy

Infective endocarditis (IE) is an uncommon infection in children. The recommended treatment for native valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus infection is antistaphylococcal penicillins such as nafcillin or oxacillin. If the initial therapy fails in IE, it can lead to catastrophic results. Nowadays, daptomycin is the best alternative antimicrobial agent to treat children with severe infections, when standard antimicrobial therapy does not yield a result. Herein, we describe a case of a 16-year-old boy who had aortic valve S. aureus endocarditis with septic embolization and stroke. The patient was successfully treated only with daptomycin as well as surgical therapy in the early phase of the infection.

An Unusual Case (Metastatic-Like Lesion) of Septic Cerebral Embolus Caused by Corynebacterium mucifaciens in a Diabetic Patient

Septic cerebral emboli can be a challenging diagnosis to give, especially if atypical bacterial infections are the cause of it. Correct diagnosis of this condition can change the management route of the patient and result in a nonsurgical treatment. To our best knowledge, this is the first case of septic cerebral embolus caused by Corynebacterium mucifaciens reported. In this study, a 65-year-old diabetic patient who have developed ketoacidosis and went into coma was investigated for a case of septic cerebral embolization. The patient developed a sudden right-sided hemiparesis, and the radiological findings showed a tumor-like lesion on the left hemisphere at the level of the internal capsule. At first glance, presence of a metastatic tumor could not be excluded; therefore, further laboratory tests and examinations were done to rule out metastatic lesions. The blood culture of the patient revealed a case of bacteremia caused by Corynebacterium mucifaciens and then a septic cerebral embolus was suspected, but due to the rarity of this pathogen causing such complications as well as the similarity of the lesion to a metastatic brain tumor, a biopsy was performed and the histopathological findings confirmed the diagnosis of a septic cerebral embolus. Corynebacterium mucifaciens should be considered a human pathogen in immunocompromised patients and it can cause cerebral septic embolization. Metastatic brain tumors and tuberculomas should be excluded; if the uncertainty of a metastatic tumor remains, biopsy can be performed and histological findings can amplify the diagnosis of septic cerebral embolus.