Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Deep Neck Infection and Descending Mediastinitis as a Complication of Propionibacterium acnes Odontogenic Infection Sun, 29 Nov 2015 12:28:30 +0000 Propionibacterium acnes is an anaerobic, Gram-positive bacterium which causes numerous types of infections. Isolated Propionibacterium acnes deep neck infections are very rare. We present an interesting case of deep neck infection complicated by descending mediastinitis of isolated Propionibacterium acnes infection. Evgeni Brotfain, Leonid Koyfman, Lisa Saidel-Odes, Abraham Borer, Yael Refaely, and Moti Klein Copyright © 2015 Evgeni Brotfain et al. All rights reserved. Babesia in a Nonsplenectomized Patient Requiring Exchange Transfusion Sun, 29 Nov 2015 11:48:11 +0000 Babesiosis is a tick born zoonosis caused by red blood cell parasites of the genus Babesia. It is caused predominantly by B. microti and B. divergens, microti being more common in the US. The parasites are transmitted by Ixodes tick to their host but infection can also spread by blood transfusion and perinatally. Clinical manifestations vary from subclinical infection to fulminating disease depending upon the immune status of the patient. About half of patients, hospitalized with babesiosis, develop complication with fatality rates of 6 to 9% which increase up to 21% among those with immunosuppression. A case of 58-year-old previously healthy man, infected by B. microti, was reported on 2000 who presented with severe disease characterized by severe anemia, DIC, and renal and respiratory failure. First case of overwhelming septic shock without respiratory involvement due to babesiosis in a healthy patient with an intact spleen was published in a case report on 2011. Since our patient here is an immunocompetent healthy male with intact spleen presenting with severe babesiosis requiring exchange transfusion, this presentation of Babesia is rare and warrants further study. Dikshya Sharma, Bindu Mudduluru, Elias Moussaly, Neville Mobarakai, and Matthew Hurford Copyright © 2015 Dikshya Sharma et al. All rights reserved. Right Gaze Palsy and Hoarseness: A Rare Presentation of Mediastinal Tuberculosis with an Isolated Prepontine Cistern Tuberculoma Sun, 29 Nov 2015 07:29:36 +0000 We describe a previously healthy young man who presented with headaches, diplopia with right lateral gaze palsy, dysphagia, and hoarseness over a 2-month period. Magnetic resonance imaging of the brain revealed a small enhancing mass at the prepontine cistern and chest CT showed a left mediastinal mass. Mediastinoscopy and lymph node biopsy were performed. DNA probe and culture of the biopsy specimen were confirmed to be Mycobacterium tuberculosis complex. Resolution of neurologic symptoms was noted after 6 weeks, in addition to regression of brain stem and mediastinal lesions after 12 weeks of antituberculous therapy. Chidozie Charles Agu, Olufemi Aina, Md Basunia, Bikash Bhattarai, Vikram Oke, Marie Frances Schmidt, Joseph Quist, Danilo Enriquez, and Vijay Gayam Copyright © 2015 Chidozie Charles Agu et al. All rights reserved. Enterococcus faecalis Septicemia and Vertebral Osteomyelitis after Transrectal Ultrasound Guided Biopsy of the Prostate Sun, 22 Nov 2015 08:59:24 +0000 Transrectal ultrasound guided prostate biopsy (TRUS) has rarely been associated with disseminated infection, yet the occurrence appears to be increasing. Resistance to fluoroquinolones, the most commonly used prophylaxis, is one of the likely causes, with Escherichia coli being the most commonly reported cause of these infections. Herein we present what is, to our knowledge, the first case of Enterococcus faecalis septicemia and vertebral osteomyelitis after TRUS. Previously reported cases of this condition are referenced also. Ayaz Virji, Lucio R. Minces, and Zargham Abbass Copyright © 2015 Ayaz Virji et al. All rights reserved. Severe Legionnaires’ Disease Complicated by Rhabdomyolysis and Clinically Resistant to Moxifloxacin in a Splenectomised Patient: Too Much of a Coincidence? Sun, 22 Nov 2015 07:09:16 +0000 We here report a case of Legionnaires’ disease in a splenectomised patient, complicated by rhabdomyolysis and acute renal failure and characterized by a poor clinical response to moxifloxacin. Splenectomy is not included among the factors, typically associated with higher risk or mortality in patients with Legionellosis. However, our report is consistent with previous case reports describing severe Legionella infections in asplenic subjects. The possibility that functional or anatomic asplenia may be a factor predisposing to severe clinical course or poor response to therapy in patients with Legionella infection cannot be excluded, deserving further investigation in the future. More studies are required in order to clarify the underlying pathophysiological mechanisms that connect asplenia, immunological response to Legionella, and pathogen’s resistance to antibiotics. Theocharis Koufakis, Ioannis Gabranis, Marianneta Chatzopoulou, Anastasios Margaritis, and Maria Tsiakalou Copyright © 2015 Theocharis Koufakis et al. All rights reserved. Atypical Kaposi Sarcoma of the Tongue in HIV Positive Tanzanian Female Tue, 17 Nov 2015 11:24:01 +0000 We report atypical case of Kaposi Sarcoma (KS) in a 32-year-old human immunodeficiency virus- (HIV-) infected female, involving only the tongue. Viral loads and CD4 T cells were measured and were 65,000 cps/mL and 10 cells/mL, respectively. This patient was newly diagnosed and had no history of antiretroviral therapy (ART), radiotherapy, or immunosuppressive drugs prior to this admission. Clinically, there were no dermatological features of KS lesions which are purple, red, or brown and which may be flat, raised (plaques), or bumpy (nodules) except for fungating and protruding enlarged tongue which was necrotic. Histologically, it was proven to be the most common type of KS “epidemic” or AIDS-related KS. Elichilia Shao, Flora Ruhangisa, Neema Minja, Kanankira Nnko, Denis Katundu, George Semango, Eva Mbwilo, Amos Mwasamwaja, Kajiru Kilonzo, and Isaack Lyaruu Copyright © 2015 Elichilia Shao et al. All rights reserved. Onychomycosis due to Cunninghamella bertholletiae in an Immunocompetent Male from Central India Thu, 12 Nov 2015 11:34:41 +0000 Onychomycosis is a fungal infection of nails seen frequently in immune competent and immune compromised patients due to dermatophytes, Candida spp., Fusarium spp., Scopulariopsis brevicaulis, Penicillium spp., and Aspergillus spp. We report a case of onychomycosis in a young immunocompetent male who presented onycholysis of a solitary nail without inflammation. The etiological agent was diagnosed to be Cunninghamella bertholletiae, a fungus pertaining to the order Mucorales (subdivision Mucoromycotina) and known for some of the invasive lesions among immunocompromised patients. This case demonstrates the association of onychomycosis with Cunninghamella bertholletiae in an immune competent individual, not reported so far. Karuna Tadepalli, Pradeep Kumar Gupta, Dinesh P. Asati, and Debasis Biswas Copyright © 2015 Karuna Tadepalli et al. All rights reserved. First Report of Ventriculoperitoneal Shunt Infection due to Cyberlindnera fabianii Wed, 04 Nov 2015 07:21:47 +0000 Fungal infections in the central nervous system (CNS) are associated with significant morbidity and death. Transient fungemia in immunocompetent patients without any other risk factors for fungemia has been suggested as a possible mechanism that may lead to serious fungal ventriculoperitoneal (VP) shunt infections, but evidence is lacking. The clinical spectrum, diagnosis, and optimal therapy of Cyberlindnera fabianii infections remain to be determined. We describe the first case of CNS infection due to C. fabianii that occurred in an immunocompetent adult with a VP shunt. Spontaneous translocation with yeast that is not part of the normal gastrointestinal flora in the setting of ingestion of multiple servings of a fermentation product was the likely source from which Cyberlindnera fabianii gained entrance into the VP shunt system, causing meningitis in this patient. The authors conclude that, in view of the high morbidity associated with yeast infection of the CNS, long-term antifungal therapy should be strongly considered in cases where the VP shunt cannot be completely removed. Transient fungemia may lead to invasive disease in an immunocompetent host with VP shunt, even in the absence of any other risk factors for fungemia and even after remote placement of the VP shunt. Jonathan Baghdadi, Peera Hemarajata, Romney Humphries, and Theodoros Kelesidis Copyright © 2015 Jonathan Baghdadi et al. All rights reserved. Case Report of Granulicatella adiacens as a Cause of Bacterascites Wed, 04 Nov 2015 07:15:31 +0000 Granulicatella adiacens is a Gram-positive coccus, formerly grouped with nutritionally variant Streptococcus, often found as commensal bacteria of the human oral cavity, urogenital tract, and gastrointestinal tract. Prior case reports have demonstrated Granulicatella spp. as a pathogen that can cause bacteremia and infective endocarditis particularly of prosthetic valves and pacemaker leads. Here, we report on a unique case of Granulicatella adiacens bacterascites in a 50-year-old male. Molly C. Cincotta, K. C. Coffey, Shannon N. Moonah, Dushant Uppal, and Molly A. Hughes Copyright © 2015 Molly C. Cincotta et al. All rights reserved. Vibrio alginolyticus Associated Chronic Myringitis Acquired in Mediterranean Waters of Turkey Thu, 29 Oct 2015 08:04:02 +0000 Vibrio alginolyticus was originally classified as biotype 2 of Vibrio parahaemolyticus. Most clinical isolates are recovered from superficial wounds or the external ear infections. V. alginolyticus is acknowledged to be nearly nonpathogenic in humans. The reason for presence of V. alginolyticus’s virulence is uncertain. We describe a chronic myringitis case in a 47-year-old female due to V. alginolyticus. According to her anamnesis, it was detected that she had sea bathing history in Mugla Coast in Turkey. Pure isolation of V. alginolyticus was obtained from external auditory canal’s culture. Investigation and antimicrobial susceptibility of the isolate were performed by the automatized BD Phoenix system and Kirby-Bauer disk diffusion method, respectively. The bacteria were sensitive to all antibiotics. This case was presented to pay attention to Vibrio alginolyticus infections. Burak Ekrem Citil, Serhan Derin, Funda Sankur, Murat Sahan, and Mahmut Ugur Citil Copyright © 2015 Burak Ekrem Citil et al. All rights reserved. Enterococcus faecium Mediastinitis Complicated by Disseminated Candida parapsilosis Infection after Congenital Heart Surgery in a 4-Week-Old Baby Wed, 28 Oct 2015 13:57:25 +0000 Background. Cardiac surgery offers multiple treatment options for children with congenital heart defects. However, infectious complications still remain a major cause of morbidity and mortality in these patients. Mediastinitis is a detrimental complication in children undergoing cardiac surgery. The risk of mediastinitis after delayed sternal closure is up to 10%. Case Presentation. We report a case of Enterococcus faecium mediastinitis in a 4-week-old female baby on extracorporeal membrane oxygenation after Norwood procedure. Although repeated antibiotic irrigation, debridement, and aggressive antibiotic treatment were started early, the pulmonary situation deteriorated. Candida parapsilosis was isolated from bronchoalveolar lavage after pulmonary hemorrhage. Disseminated C. parapsilosis infection with pulmonary involvement was treated with liposomal amphotericin B. Subsequently, inflammatory markers increased again and eventually C. parapsilosis was isolated from the central venous catheter. Conclusion. Children undergoing delayed sternal closure have a higher risk of mediastinitis. Therefore, antibiotic prophylaxis, for example, for soft tissue infection seems justified. However, long-term antibiotic treatment is a risk factor for fungal superinfection. Antifungal treatment of disseminated C. parapsilosis infection may fail in PICU patients with nonbiological material in place due to capacity of this species to form biofilms on medical devices. Immediate removal of central venous catheters and other nonbiological material is life-saving in these patients. Hanna Renk, Felix Neunhoeffer, Florian Hölzl, Michael Hofbeck, and Matthias Kumpf Copyright © 2015 Hanna Renk et al. All rights reserved. Hepatosplenic Abscesses and Osteomyelitis of the Spine in an Immunocompetent Adult with Cat Scratch Disease Wed, 21 Oct 2015 12:35:15 +0000 We present an 18-year-old, immunocompetent Austrian military conscript with cervical lymphadenopathy, fever, back-pain, and persistent inflammation markers despite two weeks of antimicrobial therapy with ampicillin/sulbactam. All specific laboratory investigations for identification of a specific etiology, including blood cultures and autoantibodies, were inconspicuous. Abdominal computed tomography showed multiple hypodense hepatosplenic lesions and osteomyelitis of the thoracic and lumbar spine with base plate fracture. Based on the patient’s history, clinical presentation, and radiological findings, serology for cat scratch disease (CSD) was performed and high B. henselae specific IgM and IgG antibodies were detected. Due to its variety of clinical presentations, diagnosis of CSD is challenging, especially in the absence of a history of specific exposure. This case report shall remind the physician that cat scratch disease is a common disease, mainly presenting with fever and lymphadenopathy in young patients. Nevertheless CSD has many different and rare forms of presentations, including hepatosplenic lesions and bone involvement as shown in this case. D. Knafl, F. Lötsch, H. Burgmann, G. Goliasch, W. Poeppl, M. Ramharter, F. Thalhammer, and C. Schuster Copyright © 2015 D. Knafl et al. All rights reserved. Listeria monocytogenes Meningitis in an Immunosuppressed Patient with Autoimmune Hepatitis and IgG4 Subclass Deficiency Mon, 19 Oct 2015 06:08:40 +0000 A 51-year-old Caucasian woman with Listeria monocytogenes meningitis was treated and discharged after an uncomplicated course. Her medical history included immunosuppressive treatment with prednisolone and azathioprine for autoimmune hepatitis. A diagnostic work-up after the meningitis episode revealed that she had low levels of the IgG4 subclass. To our knowledge, this is the first case report describing a possible association between autoimmune hepatitis and the occurrence of Listeria monocytogenes meningitis, describing a possible association between Listeria monocytogenes meningitis and deficiency of the IgG4 subclass and finally describing a possible association between Listeria monocytogenes meningitis and immunosuppressive therapy with prednisolone and azathioprine. Shahin Gaini Copyright © 2015 Shahin Gaini. All rights reserved. Mycobacterium sherrisii Lung Infection in a Brazilian Patient with Silicosis and a History of Pulmonary Tuberculosis Sun, 18 Oct 2015 17:01:40 +0000 Nontuberculous mycobacteria (NTM) diseases became relevant with the emergence and spread of HIV and are also related to lung infection in non-HIV individuals with structural lung diseases. Mycobacterium sherrisii is a NTM first characterized in 2004. Only a few cases have been reported. The aim of this case report is to describe the first detailed case of infection with M. sherrisii in a patient with silicosis and history of pulmonary tuberculosis. A 50-year-old HIV-negative white male, previous smoker, with silicosis and a history of treated pulmonary tuberculosis developed a worsening of cough and expectoration pattern, and two sputum samples were positive for acid-fast bacilli. Presumptive treatment for pulmonary tuberculosis was initiated with rifampin, isoniazid, pyrazinamide, and ethambutol, but, at month 5 of treatment, despite correct medication intake and slight improvement of symptoms, sputum bacilloscopy remained positive. Sputum cultures were positive Mycobacterium sherrisii. Treatment regimen was altered to streptomycin (for 2 months), ethambutol, clarithromycin, rifabutin, and trimethoprim-sulfamethoxazole. M. sherrisii should be considered a possible etiological agent of lung infections in patients with pneumoconiosis and history of tuberculosis. Carolina de Oliveira Abrão and João Alves de Araújo Filho Copyright © 2015 Carolina de Oliveira Abrão and João Alves de Araújo Filho. All rights reserved. Empedobacter brevis Bacteremia in a Patient Infected with HIV: Case Report and Review of Literature Thu, 15 Oct 2015 13:19:43 +0000 Clinical disease caused by Empedobacter brevis (E. brevis) is very rare. We report the first case of E. brevis bacteremia in a patient with HIV and review the current literature. A 69-year-old man with human immunodeficiency virus (HIV) and CD4 count of 319 presented with chief complaints of black tarry stools, nausea and vomiting for 2 days. Physical exam was significant for abdominal pain on palpation with no rebound or guarding. His total leukocyte count was 32,000 cells/μL with 82% neutrophils and 9% bands. Emergent colonoscopy and endoscopic esophagogastroduodenoscopy showed esophageal candidiasis, a nonbleeding gastric ulcer, and diverticulosis. Blood cultures drawn on days 1, 2, and 3 of hospitalization grew E. brevis. Patient improved with intravenous antibiotics. This case is unusual, raising the possibility of gastrointestinal colonization as a source of the patient’s bacteremia. In conclusion, E. brevis is an emerging pathogen that can cause serious health care associated infections. Syed Bokhari, Naeem Abbas, Manisha Singh, Richard B. Cindrich, and Cosmina Zeana Copyright © 2015 Syed Bokhari et al. All rights reserved. Recurrent Candida albicans Ventriculitis Treated with Intraventricular Liposomal Amphotericin B Thu, 08 Oct 2015 09:44:32 +0000 Central nervous system (CNS) infection with Candida is rare but significant because of its high morbidity and mortality. When present, it is commonly seen among immunocompromised and hospitalized patients. Herein, we describe a case of a four-year-old boy with acute lymphoblastic leukemia (ALL) who experienced recurrent Candida albicans meningitis. The patient was treated successfully with intravenous liposomal amphotericin B at first attack, but 25 days after discharge he was readmitted to hospital with symptoms of meningitis. Candida albicans was grown in CFS culture again and cranial magnetic resonance imaging (MRI) showed ventriculitis. We administered liposomal amphotericin B both intravenously and intraventricularly and favorable result was achieved without any adverse effects. Intraventricular amphotericin B may be considered for the treatment of recurrent CNS Candida infections in addition to intravenous administration. Demet Toprak, Sevliya Öcal Demir, Eda Kepenekli Kadayifci, Özden Türel, Ahmet Soysal, and Mustafa Bakir Copyright © 2015 Demet Toprak et al. All rights reserved. Third Case of Streptococcus suis Infection in Greece Tue, 08 Sep 2015 10:26:33 +0000 Streptococcus suis is a facultative anaerobic, Gram-positive coccus that can cause severe disease to both pigs and humans. Its zoonotic potential was first recognized in 1968 when the first human case of meningitis was reported in Denmark. Since then, over 1600 human cases have been reported worldwide, the vast majority of which originated in Southeast Asia, and, thus, S. suis has been fairly characterized as an emerging pathogen. Infection in humans presents most commonly as bacteremia and/or meningitis while less common clinical manifestations such as endocarditis and septic arthritis can occur. S. suis infection is extremely uncommon in Greece and this is the third human case to be reported. Correct identification is of importance for optimization of antimicrobial treatment and epidemiological monitoring. Marianneta Chatzopoulou, Ioanna Voulgaridou, Dimitrios Papalas, Petros Vasiliou, and Maria Tsiakalou Copyright © 2015 Marianneta Chatzopoulou et al. All rights reserved. A Rare Case of Diffuse Alveolar Hemorrhage Secondary to Acute Pulmonary Histoplasmosis Tue, 08 Sep 2015 09:36:53 +0000 Diffuse alveolar hemorrhage (DAH) is a rare presentation of acute pulmonary histoplasmosis. While histoplasmosis has been reported to cause hemoptysis and alveolar hemorrhage in children, the English language literature lacks any adult case reports documenting this association. We report a case of pulmonary histoplasmosis where the initial presentation was pneumonia with a subsequent diagnosis of DAH. Kunal Grover, Hadeel Zainah, Shubhita Bhatnagar, and Tricia Stein Copyright © 2015 Kunal Grover et al. All rights reserved. Comment on “A Case of Healthcare Associated Pneumonia Caused by Chryseobacterium indologenes in an Immunocompetent Patient” Mon, 07 Sep 2015 13:30:29 +0000 Panagiotis Papastergiou Copyright © 2015 Panagiotis Papastergiou. All rights reserved. Miliary Tuberculosis Induced Acute Liver Failure Mon, 07 Sep 2015 09:13:58 +0000 Hepatobiliary tuberculosis is uncommon even in endemic countries. It is associated with a high mortality and is even diagnosed early in the disease course. Acute liver failure (ALF) caused by tuberculosis bacilli has been reported in only a few reports. All previous cases have been diagnosed by postmortem examination. Time to antituberculosis treatment is very critical. In case of suggestive findings on clinical and radiologic examination, antituberculosis treatment should be initiated immediately. Drug use can be a challenge in patients with ALF. However, as long as the other possible causes of ALF can be excluded and hepatotoxic drugs were avoided during the early course of treatment, such a highly fatal presentation of tuberculosis can be treated safely. Here, we report a case of acute liver failure as a presentation of miliary tuberculosis. He was treated successfully with antituberculosis treatment. Tayfur Toptas, Birkan Ilhan, Huseyin Bilgin, Elif Dincses, Osman Ozdogan, Isik Kaygusuz-Atagunduz, Zekaver Odabasi, Volkan Korten, and Tulin Firatli-Tuglular Copyright © 2015 Tayfur Toptas et al. All rights reserved. Enterococcus hirae Bacteremia Associated with Acute Pancreatitis and Septic Shock Mon, 31 Aug 2015 06:59:28 +0000 Infection with Enterococcus hirae has rarely been reported in humans but is not uncommon in mammals and birds. We describe a case of Enterococcus hirae bacteremia associated with acute pancreatitis, acute cholecystitis, and septic shock responsive to antibiotic therapy and supportive critical care management. Unique aspects of this case of Enterococcus hirae bacteremia are its association with acute pancreatitis and its geographical origin. To our knowledge, this is the first report of Enterococcus hirae bacteremia occurring in a patient in the United States. Although human infection with this organism appears to be rare, all cases reported to date describe bacteremia associated with severe and life-threatening illness. Thus, physicians need to be cognizant of the clinical significance of this heretofore little recognized pathogen. Peter V. Dicpinigaitis, Manuel De Aguirre, and Joseph Divito Copyright © 2015 Peter V. Dicpinigaitis et al. All rights reserved. Fatal Case of Probable Invasive Aspergillosis after Five Years of Heart Transplant: A Case Report and Review of the Literature Mon, 24 Aug 2015 08:29:48 +0000 Invasive fungal infections are very common in solid organ transplants and occur most frequently in the first three months after transplant. A 49-year-old female with a history of two remote heart transplants with the most recent one occurring 5 years ago was admitted for increasing shortness of breath, cough, and fever. Computerized tomography (CT) scan of the chest showed left lower lung ground-glass and tree-in-bud opacities. She was started on broad spectrum antibiotics along with ganciclovir and micafungin. Ganciclovir was added due to the patient’s past history of CMV infection and empiric fungal coverage with micafungin. Bronchoalveolar lavage (BAL) was performed as her respiratory status worsened and voriconazole was added for possible aspergillosis in combination therapy with micafungin. BAL galactomannan returned positive which was suggestive of aspergillosis. Patient worsened clinically and subsequently succumbed to cardiorespiratory arrest despite our best efforts. It is important to have a high degree of clinical suspicion for invasive aspergillosis in transplant patients even many years after transplant and initiate aggressive therapy due to poor outcomes. Toufik Mahfood Haddad, Mahesh Anantha Narayanan, Krista E. Shaw, and Renuga Vivekanandan Copyright © 2015 Toufik Mahfood Haddad et al. All rights reserved. Cepacia Syndrome in a Non-Cystic Fibrosis Patient Tue, 18 Aug 2015 16:11:34 +0000 Burkholderia (formerly Pseudomonas) cepacia complex is a known serious threat to patients with cystic fibrosis, in whom it has the potential to cause the fatal combination of necrotizing pneumonia, worsening respiratory failure, and bacteremia, known as Cepacia syndrome. The potential for this pathogen to infect non-cystic fibrosis patients is limited and its epidemiology is poorly understood. Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions. We present a case of a 64-year-old man with Streptococcus pneumoniae community-acquired pneumonia whose hospital course was complicated by developing cavitary lung lesions, bacteremia, and acute respiratory distress syndrome. Repeated tracheal aspirate and blood cultures grew Burkholderia cepacia. Our case appears to be the first report of Cepacia syndrome in a patient without cystic fibrosis. This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians’ suspicion for Cepacia syndrome. A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful. Naomi Hauser and Jose Orsini Copyright © 2015 Naomi Hauser and Jose Orsini. All rights reserved. Skin Abscess due to Serratia marcescens in an Immunocompetent Patient after Receiving a Tattoo Tue, 18 Aug 2015 10:14:01 +0000 The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression. J. Diranzo García, J. Villodre Jiménez, V. Zarzuela Sánchez, L. Castillo Ruiperez, and A. Bru Pomer Copyright © 2015 J. Diranzo García et al. All rights reserved. ESBL E. coli Urosepsis Resulting in Endogenous Panophthalmitis Requiring Evisceration of the Eye in a Diabetic Patient Mon, 17 Aug 2015 05:54:43 +0000 A primary infection in a remote site resulting in vision threatening complications like panophthalmitis in a person who is not immune-compromised is rare. We report a case of endogenous bilateral bacterial endophthalmitis progressing into panophthalmitis in one eye requiring evisceration of that eye. A patient admitted with severe ESBL E. coli urosepsis was effectively treated with source control (bilateral DJ stenting for hydroureteronephrosis) and antibiotics. She was found to have features suggestive of bilateral conjunctivitis which progressed to panophthalmitis possibly due to delay in appropriate diagnosis and treatment. Diagnosis requires a very high index of suspicion if eye involvement is noted in a patient with features of bacteraemia and early intervention could possibly produce better outcomes. To our knowledge, this is the first case of ESBL E. coli urosepsis complicated by microbiologically confirmed panophthalmitis. Tejaswini Arunachala Murthy, Pradeep Rangappa, Sangeetha Rao, and Karthik Rao Copyright © 2015 Tejaswini Arunachala Murthy et al. All rights reserved. Two Case Presentations Infected by Trichosporon asahii and Treated with Voriconazole Successfully Thu, 13 Aug 2015 12:14:01 +0000 Background. Trichosporon asahii is an opportunistic fungus that causes infections in immunosuppressed patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Case Report. We present two pediatric oncology cases successfully treated with voriconazole after T. asahii infection that is known to cause fatal sepsis and invasive fungal infection. Conclusion. There is no conclusive evidence that the antifungal agent voriconazole is effective in the neutropenic patients infected with Trichosporon asahii. Liposomal amphotericin B has also been reported to be inadequate for treatment. We believe that our patients were successfully treated and survived because the antifungal agents were started early and properly, although the infection can be fatal in up to 80% of cases despite treatment. Hikmet Gulsah Tanyildiz, Sule Yesil, Sule Toprak, Mehmet Onur Candir, and Gurses Sahin Copyright © 2015 Hikmet Gulsah Tanyildiz et al. All rights reserved. Treatment of Immunocompromised, Critically Ill Patients with Influenza A H1N1 Infection with a Combination of Oseltamivir, Amantadine, and Zanamivir Sun, 09 Aug 2015 07:13:25 +0000 Immunocompromised patients are at increased risk of complications of influenza virus infection. We report on two critically ill patients on immunosuppressive medication with influenza pneumonia. In both patients, oseltamivir monotherapy did not result in clearance of the virus after 18 and five days, respectively. After adding zanamivir and amantadine to the treatment, PCRs on pharyngeal and/or plasma specimens turned negative in both patients after four and three days, respectively. We suggest, that in critically ill patients with influenza A H1N1 infection, treatment efficacy should be monitored closely and treatment with a combination of antiviral drugs should be considered. Wouter J. Meijer, Wiete Kromdijk, Marcel P. H. van den Broek, Pieter-Jan A. Haas, Monique C. Minnema, Charles A. Boucher, Dylan W. de Lange, and Annemarie M. J. Wensing Copyright © 2015 Wouter J. Meijer et al. All rights reserved. Role of GeneXpert MTB/Rif Assay in Diagnosing Tuberculosis in Pregnancy and Puerperium Mon, 03 Aug 2015 10:47:54 +0000 Presentation of tuberculosis (TB) in pregnancy may be atypical with diagnostic challenges. Two patients with complicated pregnancy outcomes, foetal loss and live premature delivery at 5 and 7 months of gestation, respectively, and maternal loss, were diagnosed with pulmonary TB. Chest radiography and computed tomography showed widespread reticuloalveolar infiltrates and consolidation with cavitations, respectively. Both patients were Human Immunodeficiency Virus (HIV) seronegative and sputum smear negative for TB. Sputum GeneXpert MTB/Rif (Xpert MTB/RIF) was positive for Mycobacterium tuberculosis. To strengthen maternal and childhood TB control, screening with same-day point-of-care Xpert MTB/RIF is advocated among both HIV positive pregnant women and symptomatic HIV negative pregnant women during antenatal care in pregnancy and at puerperium. Zaiyad G. Habib, Farouq M. Dayyab, Abdallah Sanda, Sirajo H. Tambuwal, Mahmood M. Dalhat, Hamza Muhammad, Garba Iliyasu, Ibrahim Nashabaru, and Abdulrazaq G. Habib Copyright © 2015 Zaiyad G. Habib et al. All rights reserved. Pulmonary Thromboembolism Complicating Amebic Liver Abscess: First Reported Case in the United States—Case Report and Literature Review Thu, 30 Jul 2015 16:27:53 +0000 Even in the absence of Amebic colitis, Amebic liver abscess (ALA) is the most common extraintestinal complication of Entamoeba histolytica infection. In the USA, it is most prevalent in middle aged immigrant males from endemic countries such as Africa, Mexico, and India. One of the complications of ALA is inferior vena cava (IVC) thrombosis, which is believed to result from the mechanical compression of the IVC and the consequent thrombogenic nidus elicited from the resultant inflammatory response. There are very few reported cases and even fewer in which the thrombus became a harbinger to pulmonary thromboembolism. We present the case of a 43-year-old male from West Africa who presented with the chief complaint of right upper quadrant abdominal pain for one week associated with persistent nonproductive cough. He had a positive serum Entamoeba histolytica antibody with CT scan findings of a hepatic abscess with thrombosis of the hepatic vein and inferior vena cava and numerous bilateral pulmonary emboli. This amebic liver abscess was successfully treated with metronidazole and paromomycin, whereas the pulmonary thromboembolism was managed with medical anticoagulation. Based on current knowledge, this is the first reported case in the USA. Devon McKenzie, Michael Gale, Sunny Patel, and Grazyna Kaluta Copyright © 2015 Devon McKenzie et al. All rights reserved. A Case of Orf Disease Complicated with Erythema Multiforme and Bullous Pemphigoid-Like Eruptions Wed, 29 Jul 2015 10:25:44 +0000 Parapoxvirus infection in sheep and goats is usually referred to as contagious pustular dermatitis/ecthyma, or orf, and the corresponding human infection is referred to as orf. In humans, after a brief incubation period of 3 to 5 days, lesions begin as pruritic erythematous macules and then rise to form papules, often with a target appearance. Lesions become nodular or vesicular, and orf lesions often ulcerate after 14 to 21 days. Erythema multiforme and bullous pemphigoid have been associated with parapoxvirus infections and they are rare complications of orf disease. In this case report, we presented a 36-year-old woman with history of contact with sheep, developing a typical orf lesion that is complicated with erythema multiforme and bullous pemphigoid-like eruptions. Shahriar Alian, Fatemeh Ahangarkani, and Sara Arabsheybani Copyright © 2015 Shahriar Alian et al. All rights reserved.