Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Professional Acquisition of M. bovis in Calabria Region (Southern Italy): A Challenging Case of Osteomyelitis in a Migrant Patient from Bulgaria Tue, 14 Jul 2015 09:36:55 +0000 We report herein the first case of a coinfection with Brucella spp., M. bovis, and Enterobacter cloacae in a butcher who moved from Bulgaria to Italy. Molecular typing suggested professional acquisition of M. bovis in Italy. So, surveillance and preventive measures need to be implemented. Angela Quirino, Carlo Torti, Alessio Strazzulla, Salvatore Nisticò, Luisa Galati, Giorgio Settimo Barreca, Angelo Giuseppe Lamberti, Giuseppina Berardelli, Maria Pacciarini, Giorgio Gasparini, Vincenzo Pisani, Antonio Gambardella, Maria Carla Liberto, and Alfredo Focà Copyright © 2015 Angela Quirino et al. All rights reserved. A 28-Year-Old Woman with Fever, Weight Loss, Pancytopenia, and Multiple Hepatosplenic and Bone Lesions Mon, 13 Jul 2015 13:25:07 +0000 Brucellosis is a systemic zoonotic infection that can involve any organ or system in the body. It may present with a broad spectrum of clinical manifestations. Considering such myriad presentations, brucellosis should always be considered in the differential diagnosis of any febrile illness in a compatible epidemiological context. Here, we report a rare presentation of acute brucellosis with multifocal osteomyelitis and hepatosplenic lesions. Fereshte Sheybani, Bezat Amiri, HamidReza Naderi, and Mohammad Reza Sarvghad Copyright © 2015 Fereshte Sheybani et al. All rights reserved. Acute Brucellosis with Splenic Infarcts: A Case Report from a Tertiary Care Hospital in Saudi Arabia Mon, 13 Jul 2015 09:54:10 +0000 Splenic infarction is an extremely rare and unique presentation of brucellosis. Only few cases have been reported worldwide. We here report a case of a young man, presenting with acute onset of fever, left hypochondial pain, and vomiting. Further evaluation revealed multiple splenic infarcts and positive blood culture for brucellosis despite negative transesophageal echocardiography for endocarditis. Significant improvement in clinical symptoms and splenic lesions was achieved after six weeks of combination therapy against brucellosis. Mishal Alyousef, Mushira Enani, and Mohammad Elkhatim Copyright © 2015 Mishal Alyousef et al. All rights reserved. Acute Myopericarditis Likely Secondary to Disseminated Gonococcal Infection Sun, 12 Jul 2015 11:45:31 +0000 Disseminated gonococcal infection (DGI) is a rare complication of primary infection with Neisseria gonorrhoeae. Cardiac involvement in this condition is rare, and is usually limited to endocarditis. However, there are a number of older reports suggestive of direct myocardial involvement. We report a case of a 38-year-old male with HIV who presented with chest pain, pharyngitis, tenosynovitis, and purpuric skin lesions. Transthoracic echocardiogram showed acute biventricular dysfunction. Skin biopsy showed diplococci consistent with disseminated gonococcal infection, and treatment with ceftriaxone improved his symptoms and ejection fraction. Though gonococcal infection was never proven with culture or nucleic acid amplification testing, the clinical picture and histologic findings were highly suggestive of DGI. Clinicians should consider disseminated gonococcal infection when a patient presents with acute myocarditis, especially if there are concurrent skin and joint lesions. Daniel Bunker and Leslie Dubin Kerr Copyright © 2015 Daniel Bunker and Leslie Dubin Kerr. All rights reserved. Postpartum Ovarian Vein Thrombophlebitis with Staphylococcal Bacteremia Sun, 28 Jun 2015 10:52:49 +0000 A 34-year-old female patient presented with fever and right flank pain ten days after uncomplicated vaginal delivery. CT examination revealed right ovarian vein thrombosis and methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood cultures. No other source of bacteremia was found. Antibiotic therapy and anticoagulation with enoxaparin were instituted. Fourteen days after admission, she was discharged in good condition. Although a very uncommon complication after spontaneous vaginal delivery, septic ovarian vein thrombophlebitis should be suspected in cases of persistent puerperal fever when other diagnostic possibilities have been excluded. Eduardo Parino, Eric Mulinaris, Edgardo Saccomano, Juan Cruz Gallo, and Gabriel Kohan Copyright © 2015 Eduardo Parino et al. All rights reserved. Pulmonary Mucormycosis in a Patient with Systemic Lupus Erythematosus: A Diagnostic and Treatment Challenge Mon, 22 Jun 2015 10:48:04 +0000 Pulmonary mucormycosis is commonly encountered in patients with diabetic ketoacidosis, hematologic malignancies, neutropenia, organ or hematopoietic stem cell transplantation, and malignancy, but it rarely occurs in high-risk patients with systemic lupus erythematosus (SLE). We present the case of a 40-year-old SLE female with fulminant pneumonia after remission of nephritis treated with rituximab, who developed severe pulmonary mucormycosis that led to her rapid death from acute respiratory failure and acute respiratory distress syndrome. Pulmonary mucormycosis has a high mortality rate. However, with early diagnosis and antifungal therapy with lipid formulation-liposomal amphotericin B and surgical removal of the infected area, the outcome can be improved. Hung-Chang Hung, Gang-Yu Shen, Shiuan-Chih Chen, Kai-Jieh Yeo, Shih-Ming Tsao, Meng-Chih Lee, and Yuan-Ti Lee Copyright © 2015 Hung-Chang Hung et al. All rights reserved. Solitary Pyomyositis of the Left Rhomboideus Muscle Caused by Streptococcus anginosus and Streptococcus intermedius in an Immunocompetent Person Mon, 22 Jun 2015 10:13:20 +0000 Primary pyomyositis is a bacterial infection of the skeletal muscle commonly affecting children with Staphylococcus aureus most often isolated as a pathogen. However, pyomyositis caused by anaerobic bacteria is rare in adults. Here, we report a case of solitary Pyomyositis of the left rhomboideus muscle in an immunocompetent person. A 70-year-old Japanese male presented with high fever and left shoulder pain. His muscle below the lower edge of the left scapula was tender and swollen. His laboratory examinations revealed severe inflammation. Computed tomography showed a solitary low-density area around a contrast enhancement in the left rhomboideus muscle. He was diagnosed as having solitary pyomyositis. Although his symptoms did not improve despite empiric intravenous administration of antibiotics, an incision was performed. Streptococcus anginosus and Streptococcus intermedius were isolated from the culture of drainage fluid. His symptoms gradually disappeared after the incisional drainage and continuous administration of antibiotics. Pyomyositis did not recur after his discharge. To the best of our knowledge, this is the first report on anaerobic pyomyositis of the shoulder muscle. Yasuhiro Tanaka, Kenichi Takaya, Go Yamamoto, Isaku Shinzato, and Toshiro Takafuta Copyright © 2015 Yasuhiro Tanaka et al. All rights reserved. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy Wed, 17 Jun 2015 13:45:45 +0000 Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy. Lovekesh Kumar, Mahendra Singh, Ashish Saxena, Yuvraj Kolhe, Snehal K. Karande, Narendra Singh, P. Venkatesh, and Rambabu Meena Copyright © 2015 Lovekesh Kumar et al. All rights reserved. Severe Osteomyelitis and Septic Arthritis due to Serratia marcescens in an Immunocompetent Patient Mon, 15 Jun 2015 06:50:32 +0000 Septic arthritis and osteomyelitis due to Serratia marcescens in immunocompetent patients without risk factors are extremely rare. Here, we report a case of septic arthritis and severe adjacent osteomyelitis of the tibia due to Serratia marcescens in a diabetic community-dweller patient. The patient had no contact with healthcare workers or facilities and had no chronic disease except for poorly controlled diabetes. Without predisposing risk factors, this type of infection is extremely rare, even in diabetics. Hiba Hadid, Muhammad Usman, and Sudeep Thapa Copyright © 2015 Hiba Hadid et al. All rights reserved. Compartmentalized Histoplasma capsulatum Infection of the Central Nervous System Sun, 14 Jun 2015 11:27:44 +0000 Background. Histoplasmosis is a common fungal infection in the southeastern, mid-Atlantic, and central states; however, its presentation can be atypical. Case Presentation. We report a case of Histoplasma capsulatum infection presenting as slowly progressive weakness in the lower extremities, followed by the development of numbness below the midthoracic area, urinary incontinence, and slurred speech. Brain MRI showed leptomeningeal enhancement, predominantly linear, involving the basal cisterns, the brainstem, and spinal cord. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Discussion. CNS histoplasmosis is usually seen in patients with disseminated histoplasmosis. Isolated CNS histoplasmosis is rarely seen, especially in immunocompetent patients. Conclusions. Histoplasmosis should be considered in the differential diagnosis of patients experiencing slowly progressive neurological deficit. Albert J. Eid, John D. Leever, and Kathrin Husmann Copyright © 2015 Albert J. Eid et al. All rights reserved. Streptococcus constellatus Causing Septic Thrombophlebitis of the Right Ovarian Vein with Extension into the Inferior Vena Cava Thu, 11 Jun 2015 16:52:38 +0000 Introduction. Streptococcus constellatus collectively with Streptococcus anginosus and Streptococcus intermedius constitute the Streptococcus anginosus (formerly Streptococcus milleri) group. Though they are commonly associated with abscesses, bacteremia with subsequent septic thrombophlebitis is extremely rare, and resulting mortality is infrequent. Case Presentation. We report a case of a previously healthy 60-year-old African American female who presented with Streptococcus constellatus bacteremia associated with septic thrombophlebitis to the right ovarian vein extending into the inferior vena cava. She was urgently treated with antibiotics and anticoagulation. Conclusion. Septic thrombophlebitis has a clinical presentation that is often misleading. Therefore, a high clinical index of suspicion and the use of appropriate imaging modalities (computed tomography) are essential in recognizing and confirming this diagnosis. Prompt treatment is warranted. Surgical thrombectomies have been successfully replaced by a combination of antibiotics and anticoagulation therapy. Abdallah Haidar, Amy Haddad, Amir Naqvi, Ngozi U. Onyesoh, Rushdah Malik, and Michael Williams Copyright © 2015 Abdallah Haidar et al. All rights reserved. Native Pulmonic Valve Endocarditis due to Mycobacterium fortuitum: A Case Report and Literature Review Mon, 08 Jun 2015 13:21:01 +0000 Endocarditis secondary to Mycobacterium fortuitum is a rare entity often involving prosthetic valves and rarely native valves. Pulmonic valve endocarditis secondary to any organism is rare. We report the first case of native pulmonic valve endocarditis secondary to M. fortuitum and a literature review of native valve M. fortuitum endocarditis. Aaron M. Mulhall and Renee S. Hebbeler-Clark Copyright © 2015 Aaron M. Mulhall and Renee S. Hebbeler-Clark. All rights reserved. Primary Bronchopulmonary Actinomycosis Masquerading as Lung Cancer: Apropos of Two Cases and Literature Review Thu, 04 Jun 2015 10:05:28 +0000 Actinomycosis is a rare and slowly progressive infectious disease that can affect a variety of organ systems including the lung. It is caused by filamentous Gram-positive anaerobic bacteria of the genus Actinomyces. Despite its rarity, pulmonary actinomycosis can involve lung parenchyma, bronchial structures, and chest wall. The disease can mimic lung malignancy given its nonspecific clinical and radiological presentation, thus posing a diagnostic dilemma to the attending physician. In this paper, we describe two patients with pulmonary actinomycosis mimicking bronchogenic carcinoma; the former presented with peripheral infiltrate and associated hilar/mediastinal lymphadenopathy and the latter presented with a foreign body-induced endobronchial mass. Clinical, imaging, diagnostic, and therapeutical aspects of the disease are discussed, demonstrating the paramount importance of the histological examination of lung tissue specimens in the confirmation of the infection given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice. Stamatis Katsenos, Iosif Galinos, Panagiota Styliara, Nikoletta Galanopoulou, and Konstantinos Psathakis Copyright © 2015 Stamatis Katsenos et al. All rights reserved. Actinomyces meyeri Empyema: A Case Report and Review of the Literature Mon, 01 Jun 2015 11:45:21 +0000 Actinomyces meyeri is an uncommon cause of human actinomycosis. Here, we report a rare case of empyema caused by A. meyeri. A 49-year-old male presented with a history of 10 days of dyspnea and chest pain. A large amount of loculated pleural effusion was present on the right side and multiple lung nodules were documented on radiological studies. A chest tube was inserted and purulent pleural fluid was drained. A. meyeri was isolated in anaerobic cultures of the pleural fluid. The infection was alleviated in response to treatment with intravenous penicillin G (20 million IU daily) and oral amoxicillin (500 mg every 8 hours) for 4 months, demonstrating that short-term antibiotic treatment was effective. Hae Won Jung, Chong Rae Cho, Ji Yoon Ryoo, Hyun Kyo Lee, So Young Ha, Ji Hoon Choi, and Yee Gyung Kwak Copyright © 2015 Hae Won Jung et al. All rights reserved. Myocarditis and Rhabdomyolysis in a Healthy Young Man Caused by Salmonella Gastroenteritis Mon, 01 Jun 2015 11:19:13 +0000 Salmonella gastroenteritis is a common, self-limiting, foodborne disease and a rare cause of life-threatening complications especially in immunocompetent individuals. Moreover, bacterial infections of the GI tract have been rarely reported as a cause of serious complications like acute myocarditis and rhabdomyolysis. While viral infections are commonly associated with myocarditis, bacterial infections are infrequently seen with these conditions. Similarly, bacterial infections may lead to only 5% of adult rhabdomyolysis events whereas viral-induced myositis appears to be the commonest. A 28-year-old young male with no past medical problems presented with acute salmonella gastroenteritis that was complicated by myocardial injury (most likely myocarditis), rhabdomyolysis, acute renal failure, and shock. He made an uneventful complete recovery of all complications by early recognition of these rare complications and prompt institution of appropriate therapy. Warkaa Al Shamkhani, Yasmeen Ajaz, Nagham Saeed Jafar, and Sunil Roy Narayanan Copyright © 2015 Warkaa Al Shamkhani et al. All rights reserved. Three Cases of West Nile Encephalitis over an Eight-Day Period at a Downtown Los Angeles Community Hospital Thu, 28 May 2015 09:07:38 +0000 Since its introduction in New York City in 1999, the virus has spread throughout the entire North American continent and continues to spread into Central and Latin America. Our report discusses the signs and symptoms, diagnostics, and treatment of West Nile disease. It is important to recognize the disease quickly and initiate appropriate treatment. We present three cases of West Nile encephalitis at White Memorial Medical Center in East Los Angeles that occurred over the span of eight days. All three patients live within four to six miles from the hospital and do not live or work in an environment favorable to mosquitoes including shallow bodies of standing water, abandoned tires, or mud ruts. All the patients were Hispanic. Physicians and other health care providers should consider West Nile infection in the differential diagnosis of causes of aseptic meningitis and encephalitis, obtain appropriate laboratory studies, and promptly report cases to public health authorities. State governments should establish abatement programs that will eliminate sources that allow for mosquito reproduction and harboring. The public needs to be given resources that educate them on what entails the disease caused by the West Nile virus, what the symptoms are, and, most importantly, what they can do to prevent themselves from becoming infected. Adam Puchalski, Antonio K. Liu, and Byron Williams Copyright © 2015 Adam Puchalski et al. All rights reserved.