Rapidly Progressive Numbness and Weakness After Soft-Tissue Abscess

A previously healthy 45-year-old man had development of neck pain and swelling, followed 1 week later by fevers, chills, and night sweats. Cervical computed tomography showed a left-sided cervical soft-tissue abscess. The patient was treated with oral cephalexin for 10 days, without benefit. Fine-needle aspiration biopsy of the mass showed granulomatous inflammation and a heterogeneous lymphocyte population without evidence of malignancy. Meropenem and gentamicin were started. Ten days later, he had development of acute urinary retention, numbness and weakness in the lower extremities, and numbness in the upper extremities. At symptom nadir 2 days later, he required the aid of a walker to ambulate. Lhermitte sign and erectile dysfunction were also present. The patient was admitted to the hospital. Spinal cord magnetic resonance imaging showed a longitudinally extensive, nonenhancing, T2-hyperintense lesion predominantly affecting the ventral and lateral parenchyma of the cervical and thoracic spinal cord. Cerebrospinal fluid examination showed a white blood cell count of 581 cells/µL with 42% neutrophils, 35% lymphocytes, and 22% monocytes, increased protein concentration (109 mg/dL), and normal glucose concentration. A diagnosis of postinfectious idiopathic transverse myelitis was made. The patient was treated with intravenous immunoglobulin, intravenous methylprednisolone, and broad-spectrum antibiotics, with improvement of both the abscess and his neurologic symptoms. After discharge, he was able to walk unassisted. At follow-up evaluation 6 months after the initial evaluation, neurologic examination showed only mild weakness of the left iliopsoas muscle and brisk reflexes in the lower extremities. Acute transverse myelopathies are a heterogeneous group of spinal cord disorders characterized by acute or subacute signs and symptoms of spinal cord dysfunction, typically a combination of sensory, motor, and autonomic manifestations. Underlying causes include vascular, infectious, neoplastic, postirradiation, traumatic, and inherited/metabolic, and inflammatory processes.

886 Healing Hands and Thrifty Plans! A Prospective, Cost-Effective Trial in Abscess Management

Aim Cutaneous abscesses are ubiquitous presentations requiring surgical drainage in most cases. There is a wide variation across the UK in the surgical practice dealing with such common problem. The aim of this study was to reduce the costs incurred in surgical drainage of acute skin and soft tissue abscess. Method This was a prospective, cost-effective study of the expenses incurred in surgical drainage of acute cutaneous and subcutaneous abscesses treated under the general surgeons' care over one year. Results A consequential saving of £13,962 was achieved during the study period. Between October 2019 and October 2020, 322 patients with soft tissue abscesses were treated by incision and drainage in general surgery. We calculated a total cost of £55.26 per patient for this routine operation. These expenses were based on basic surgical drapes pack, standard surgical gowns, sterile gloves and obtaining and processing the microbiology specimens. We have designed and implemented a new theatre protocol specifically for this procedure, resulting in a substantial reduction of the costs to £11.90 per patient. The total savings of £13,962 do not include savings caused by abscess drainage under local anaesthesia and does not calculate the savings that occurred due to shorter inpatient stay. These extra savings will be calculated and added later. Conclusions Considering the increasing financial burden on the NHS, we could make significant savings of nearly 80% of the operative costs of surgical drainage of a cutaneous abscess. We could achieve that by implementing simple modifications in the current surgical pathways without compromising patients' safety.

Local complications and lymphadenitis after BCG–M vaccination in children – сhoosing the right tactics

Тhe aim: to analyze the cases of complications of BCGvaccination in children, potential risk factors, patient management tactics.Materials and methods: The statistical data on local complications of BCG-M vaccination in Saint Petersburg (Russia) from 2012 to 2019 was studied. To verify the diagnosis of post-vaccinal complication the Mantoux test, diaskintest or QuantiFERON-TB, X-ray examination, morphological and bacteriological examination were used in cases of indication. Observations of 22 children aged from 1,5 months to 1,5 years with complications after vaccination with BCG-M were analyzed.Results. Since 2010, the sparing BCG-M vaccine has been used in St. Petersburg for primary immunization. The incidence of local complications over the past 8 years was 0,002% – 0,012% of the number of vaccinated children. A cold abscess was diagnosed in 11 (50,0%), BCG-lymphadenitis in 9 (40,9%), an ulcer in 2 (9,1%) children. In 14 (63,6%) of 22 children complications of vaccination were detected in the phase of abscess formation. Fore children underwent surgery with diagnoses of nonspecific lymphadenitis (3), soft tissue abscess (1). In these cases, diagnoses of BCG-M complications was established only after morphological examination of the surgical material. In children with complications while the results of Mantoux test were positive, results of diaskintest and QuantiFERON-TB were negative. The detection of Mycobacterium bovis BCG was possible in 5 patients by culture and polymerase chain reaction methods. 2 clinical cases are given.Conclusion: It is necessary to increase the knowledge of pediatricians, pediatric surgeons, nurses of BCG vaccination techniques, diagnosis and treatment of post-vaccination complication, indications for dispensary observation.

Forgotten disease: an atypical case of Lemierre syndrome presenting as a soft tissue abscess

Lemierre syndrome (LS) is an acute oropharyngeal infection with secondary septic thrombophlebitis and distant septic embolisation. A 29-year-old woman with sore throat, dyspnoea and left shoulder pain, who was on levofloxacin for 3 days, presented with worsening symptoms. She was tachycardic, tachypneic and hypoxic on presentation. CT of neck and chest revealed multiple loculated abscesses on her left lower neck and shoulder, right peritonsillar abscess, thrombosis of the right external jugular vein and multiple bilateral septic emboli to the lungs. She was started on clindamycin and ampicillin sulbactam for LS. She developed septic shock and required intubation due to respiratory failure. Drainage of the left shoulder abscess grew Fusobacterium nucleatum. After 2 weeks of a complicated intensive care unit stay, her haemodynamic status improved and she was transferred to the floor. LS has variable presentations, but regardless of the presentation, it is a potentially fatal disease-requiring prompt diagnosis and management.

1557. First Report of Nocardia veterana Soft Tissue Abscess

Background Members of the genus Nocardia are filamentous, gram-positive, aerobic bacteria and exist ubiquitously in most environments. In 2001, the species Nocardia veterana was first isolated, and it predominantly causes pulmonary infections in immunocompromised hosts. Methods We present the first report of a soft tissue abscess caused by N. veterana in a 59-year-old woman being treated for chronic cutaneous graft-versus-host disease. Results After failing to improve with empiric treatment, two incision and drainage procedures were required. She subsequently completed a one-year course of oral antibiotic therapy consisting of trimethoprim-sulfamethoxazole then azithromycin. No relapse occurred. To better characterize N. veterana infections, we performed a systematic literature review and summarized all previously reported cases. Nocardia veterana abscess Conclusion The rising prevalence of immunocompromising conditions warrants increased vigilance for N. veterana infections and other atypical or opportunistic pathogens. Disclosures All Authors: No reported disclosures

Just the Facts: Methicillin-resistant Staphylococcus aureus and soft tissue abscess in the emergency department

Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incision and drainage (I + D) and discharge your patient. Times have changed. Methicillin-resistant Staphylococcus aureus (MRSA) is now a major cause of soft tissue abscess in ED patients. MRSA is, by definition, resistant to cloxacillin and cephalosporins. Almost all Canadian strains are susceptible to vancomycin and linezolid. MRSA strains are variably susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), tetra/doxycycline, and clindamycin, with pooled Canadian clindamycin resistance just over 40%.