Persistent Multispecies Actinomyces Mastitis Treated With Repeated Aspiration and Long-Term Oral Antibiotics

Actinomycosis is an infection characterized by abscess formation, draining sinuses, and tissue fibrosis. The causative bacterium is a Gram-positive facultative anaerobe from the genus Actinomyces. Infections classically affect the cervicofacial, thoracic, or pelvic region and often require prolonged antibiotic therapy. Actinomycosis of the breast is a rare condition that may present as a recurrent breast abscess. We present a 33-year-old female with a recurrent breast abscess which grew A. radingae and A. israeli on aspirated fluid cultures. Treatment with surgical aspiration and a 6-week course of oral amoxicillin/clavulanic acid 875 mg twice daily resulted in clinical improvement. Our case demonstrates how recurrent breast abscesses caused by Actinomyces can be difficult to manage. Long-term antibiotic therapy with surgical aspiration and regular follow-up offer the best chance of clinical resolution.

Piomiosite del cingolo scapolare con focolai polmonari multipli e sepsi da MRSA

The paper describes the case of a 14-year-old girl with intense right shoulder pain and severe signs of local and systemic inflammation. Magnetic resonance imaging revealed a pyomyositis of right shoulder girdle muscles. Blood culture was found positive for methicillin-resistant Staphylococcus aureus (MRSA) and the chest computed tomography scan revealed nodular infiltrates in both pulmonary fields resulting from septic embolism. A prolonged antibiotic therapy according to antibiogram allowed the complete recovery. Pyomyositis is a deep pyogenic infection of the skeletal muscle tissue and is most commonly caused by Staphylococcus aureus species. In the described case, repetitive trauma due to karate may have caused the initial muscle cell damage with subsequent haematoma, which subsequently becomes colonised by bacteria during a transient bacteraemia. There is an increasing prevalence of pyomyositis in temperate climates and in the last few years MRSA has emerged as a pathogen within the community (CA-MRSA) also in healthy people. An early diagnosis is important to avoid local and systemic complications.

Extended-spectrum β-lactamase-producing Escherichia coli rib osteomyelitis with debridement and vacuum-assisted closure

Rib osteomyelitis is a rare disease, comprising 1% or less of all osteomyelitis. Treatment of rib osteomyelitis includes prolonged antibiotic therapy and surgical intervention. Indications for surgical treatment of rib osteomyelitis remain unclear, however, because of few reported cases. We report the first known case of extended-spectrum β-lactamase-producing Escherichia coli rib osteomyelitis caused by urosepsis. The 69-year-old male patient remains free of recurrence and symptoms after rib resection and vacuum-assisted closure treatment with antibiotic therapy. Rib osteomyelitis should be considered as differential diagnosis when patients report chest pain after bacteraemic infection. We recommend surgical treatment for patients with drug-resistant bacterial rib osteomyelitis.

Acute appendicitis located within Amyand’s hernia—a complex case with concurrent acute cholecystitis

Amyand’s hernia is the presence of the vermiform appendix within an inguinal hernia sac. It is rare, and even rarer is the presence of acute appendicitis within the sac. It presents in a variety of different ways and often is only diagnosed intra-operatively. We present the case of a 90 year old male with extensive co-morbidities presenting with right upper quadrant pain, who on computed tomography scan of the abdomen, had acute cholecystitis alongside acute appendicitis within Amyand’s hernia. Ultimately given his co-morbidities, a conservative approach with prolonged antibiotic therapy was adopted, with a successful outcome. This case highlights that although classifications for treatment of Amyand’s hernia exist, careful clinical assessment is warranted in each case to ensure optimal outcome based upon individual circumstances.