Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. A Case of Septic Arthritis of the Wrist due to Finegoldia magna Sun, 13 Apr 2014 13:24:13 +0000 Finegoldia magna (F. magna) has been described as one of the most frequent pathogens in the etiology of postoperative and prosthetic implant associated septic arthritis. In this report, we document our first experience with septic arthritis of the wrist caused by F. magna occurring in a joint with primary disease from prior trauma. Camelia Arsene, Abhijit Saste, Manya Somiah, Janee Mestrovich, and Gregory Berger Copyright © 2014 Camelia Arsene et al. All rights reserved. Mixed Fungal Infection (Aspergillus, Mucor, and Candida) of Severe Hand Injury Thu, 13 Mar 2014 17:19:07 +0000 Severe hand injuries are almost always heavily contaminated and hence wound infections in those patients are frequent. Fungal wound infections are rare in immunocompetent patients. A case of mixed fungal infection (Aspergillus, Mucor, and Candida) was documented in a young male patient, with a severe hand injury caused by a corn picker. The diagnosis of fungal infection was confirmed microbiologically and histopathologically. The treatment was conducted with repeated surgical necrectomy and administration of antifungal drugs according to the antimycogram. After ten weeks the patient was successfully cured. The aggressive nature of Mucor and Aspergillus skin infection was described. A high degree of suspicion and a multidisciplinary approach are necessary for an early diagnosis and the initiation of the adequate treatment. Early detection, surgical intervention, and appropriate antifungal therapy are essential in the treatment of this rare infection that could potentially lead to loss of limbs or even death. Milana Obradovic-Tomasev, Aleksandra Popovic, Nada Vuckovic, and Mladen Jovanovic Copyright © 2014 Milana Obradovic-Tomasev et al. All rights reserved. Herpetic Esophagitis in Immunocompetent Medical Student Tue, 04 Mar 2014 08:47:02 +0000 Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient. Andréia Vidica Marinho, Vinícius Mendes Bonfim, Luciana Rodrigues de Alencar, Sebastião Alves Pinto, and João Alves de Araújo Filho Copyright © 2014 Andréia Vidica Marinho et al. All rights reserved. Simultaneous Occurrence of Ocular, Disseminated Mucocutaneous, and Multivisceral Involvement of Leishmaniasis Tue, 18 Feb 2014 12:20:17 +0000 Leishmaniasis is a tropical infection caused by the protozoan, belonging to the group of Leishmania which causes Old World and New World disease. These are typically divided into cutaneous, mucocutaneous, visceral, viscerotropic, and disseminated disease. Cutaneous leishmaniasis in the presence of visceral disease is a rarity. Isolated case reports have documented this occurrence, in the immunocompromised setting, and few otherwise. The concurrent presence of visceral leishmaniasis (bone marrow involvement) with solitary cutaneous and ocular disease and also solitary cutaneous and visceral disease (bone marrow involvement) has been reported before. Here, we present an immunocompetent patient who was diagnosed to have visceral leishmaniasis (liver and bone marrow involvement) along with simultaneous disseminated mucocutaneous and ocular involvement, a combination that has never been reported before. Cyriac Abby Philips, Chetan Ramesh Kalal, K. N. Chandan Kumar, Chhagan Bihari, and Shiv Kumar Sarin Copyright © 2014 Cyriac Abby Philips et al. All rights reserved. Pyogenic Liver Abscess, Bacteremia, and Meningitis with Hypermucoviscous Klebsiella pneumoniae: An Unusual Case Report in a Human T-Cell Lymphotropic Virus Positive Patient of Caribbean Origin in the United States Mon, 30 Dec 2013 10:54:11 +0000 Pyogenic liver abscess (PLA) is a potentially fatal disease. Klebsiella pneumoniae (K. pneumoniae) has replaced Escherichia coli (E. coli) as the predominant causative organism for pyogenic liver abscess. Over the years a unique form of community-acquired invasive K. pneumoniae infection of the liver has been well described in Southeast Asia. This has recently been linked to a virulent hypermucoviscous K. pneumoniae phenotype and to a specific genotype, rmpA positive. To our knowledge, we report the first case of PLA with bacteremia and meningitis in a Guyanese patient with the presence of rmpA-positive K. pneumoniae with laboratory evidence in North America. Gargi Patel, Neha Shah, and Roopali Sharma Copyright © 2013 Gargi Patel et al. All rights reserved. Unusual Presentation of Vivax Malaria with Anaemia, Thrombocytopenia, Jaundice, Renal Disturbance, and Melena: A Report from Malang, a Nonendemic Area in Indonesia Sun, 29 Dec 2013 14:35:33 +0000 Most of the complications of malaria such as anaemia, thrombocytopenia, jaundice, and renal failure are commonly found in Plasmodium falciparum malaria, but the incidence of severe and complicated vivax malaria tends to be increasing. We report two cases of severe Plasmodium vivax malaria from Malang, a nonendemic area in Indonesia. Patients exhibited anaemia, thrombocytopenia, jaundice, renal disturbance, and melena. Microscopic peripheral blood examination and amplification of parasite 18s rRNA by polymerase chain reaction showed the presence of P. vivax and absence of P. falciparum. All patients responded well to antimalarial drugs. Loeki Enggar Fitri, Teguh Wahju Sardjono, Bagus Hermansyah, Didi Candradikusuma, and Nicole Berens-Riha Copyright © 2013 Loeki Enggar Fitri et al. All rights reserved. A Rare Presentation of Community Acquired Methicillin Resistant Staphylococcus aureus Sat, 28 Dec 2013 18:55:11 +0000 Prostatic abscess is a rarely described condition and is commonly caused by gram-negative organisms such as enterobacteria. However, as the prevalence of methicillin resistant Staphylococcus aureus (MRSA) increases in the community, unusual infections due to this organism have been recently published. In this report, we describe a patient with diabetes mellitus type 2, who presents with diabetic ketoacidosis—later found to be due to a prostatic abscess from which MRSA was cultured. J. Docekal, J. Hall, B. Reese, J. Jones, and T. Ferguson Copyright © 2013 J. Docekal et al. All rights reserved. Recurrent Mitral Valve Endocarditis Caused by Streptococcus pneumoniae in a Splenectomized Host Sat, 28 Dec 2013 12:32:48 +0000 A 72-year-old male with a remote history of splenectomy and two previous episodes of pneumococcal endocarditis of mitral valve presented with high-grade fever and confusion for 3 days. Nine months priorly, patient underwent mitral valve repair when he had the first episode of pneumococcal mitral valve endocarditis. He received pneumococcal vaccination two years ago. On examination during this admission, he was found to be febrile (104.3 F) and confused and had a grade 2/6 systolic murmur at the apex without any radiation. Laboratory data was significant for a white blood cell count of 22,000/mm3 (normal: 4000–11000/mm3). Blood cultures (4/4 bottles) grew penicillin-sensitive Streptococcus pneumoniae. Transesophageal echocardiogram revealed small vegetation on the posterior mitral leaflet without any evidence of abscess and severe mitral regurgitation. Patient clinically responded to intravenous ceftriaxone. However, due to recurrent pneumococcal mitral valve endocarditis and severe mitral regurgitation, the patient underwent mitral valve replacement. Patient had an uneventful recovery and was discharged home. Pneumococcal endocarditis itself is being uncommon in this current, penicillin, era; our case highlights the recurrent nature of pneumococcal endocarditis in a splenectomized host and the importance of pursuing aggressive treatment options in this clinical scenario. Shikha Shrestha, JayaKrishna Chintanaboina, and Samir Pancholy Copyright © 2013 Shikha Shrestha et al. All rights reserved. Small Intestinal Obstruction Caused by Anisakiasis Thu, 26 Dec 2013 11:22:18 +0000 Small intestinal anisakiasis is a rare disease that is very difficult to diagnose, and its initial diagnosis is often surgical. However, it is typically a benign disease that resolves with conservative treatment, and unnecessary surgery can be avoided if it is appropriately diagnosed. This case report is an example of small intestinal obstruction caused by anisakiasis that resolved with conservative treatment. A 63-year-old man admitted to our department with acute abdominal pain. A history of raw fish (sushi) ingestion was recorded. Abdominal CT demonstrated small intestinal dilatation with wall thickening and contrast enhancement. Ascitic fluid was found on the liver surface and in the Douglas pouch. His IgE (RIST) was elevated, and he tested positive for the anti-Anisakis antibodies IgG and IgA. Small intestinal obstruction by anisakiasis was highly suspected and conservative treatment was performed, ileus tube, fasting, and fluid replacement. Symptoms quickly resolved, and he was discharged on the seventh day of admission. Small intestinal anisakiasis is a relatively uncommon disease, the diagnosis of which may be difficult. Because it is a self-limiting disease that usually resolves in 1-2 weeks, a conservative approach is advisable to avoid unnecessary surgery. Yuichi Takano, Kuniyo Gomi, Toshiyuki Endo, Reika Suzuki, Masashi Hayashi, Toru Nakanishi, Ayumi Tateno, Eiichi Yamamura, Kunio Asonuma, Satoshi Ino, Yuichiro Kuroki, Masatsugu Nagahama, Kazuaki Inoue, and Hiroshi Takahashi Copyright © 2013 Yuichi Takano et al. All rights reserved. Methicillin Resistant Staphylococcus aureus Prostatic Abscess with Bacteremia Tue, 24 Dec 2013 09:50:05 +0000 Prostatic abscess is traditionally considered a rare disease that is caused by Gram-negative bacteria. Methicillin resistant Staphylococcus aureus (MRSA) has recently emerged as an important cause of prostatic abscesses. Symptoms are nonspecific and include dysuria, urinary frequency, fever, chills, and perineal and low back pain. Morbidity and mortality increase with delays in identification and proper treatment. We present two cases of community acquired MRSA prostatic abscesses with bacteremia. One of these cases may be the first reported septic shock fatality resulting from a prostatic abscess source in an immunocompetent patient. As the number of community acquired MRSA bacteremia cases increases, this potential site of infection should be recognized. Daniel J. Lachant, Michael Apostolakos, and Anthony Pietropaoli Copyright © 2013 Daniel J. Lachant et al. All rights reserved. Vibrio parahaemolyticus Induced Necrotizing Fasciitis: An Atypical Organism Causing an Unusual Presentation Tue, 17 Dec 2013 18:24:03 +0000 Background necrotizing fasciitis (NF) represents a life-threatening bacterial infection characterized by a rapid necrosis of deep subcutaneous tissue and facia underlying the skin. Despite its lethal nature, NF occurs infrequently, leaving many physicians unfamiliar with the disease process, common pathogens, and treatment strategies. Here we present a case of NF caused by an unlikely organism, Vibrio parahaemolyticus. We highlight the innocuous nature of initial presentation and the potentially devastating sequela. Asim Ahmad, Lisa Brumble, and Michael Maniaci Copyright © 2013 Asim Ahmad et al. All rights reserved. From Incidentaloma to Suspicion of Malignancy: The Diverse Clinical Presentation of Gonadal Schistosomiasis mansoni Tue, 10 Dec 2013 11:29:38 +0000 Schistosomiasis is the second most widespread parasitic disease in the world, second only to malaria. The usual places the Schistosoma mansoni can be found in are the rectal and sigmoidal venules, as well as other segments of the large intestine of men. It may also be present in other ectopic topographies. Gonadal schistosomiasis is an unusual presentation of Schistosomiasis mansoni and its different clinical signs and symptoms disrupt correct diagnosis and culminate in surgical treatment that is, in most cases, unnecessary. In this study, we report four cases of gonadal Schistosomiasis mansoni, two in the ovary and two in the testicles. These cases were clinically investigated as a bacterial infection, a benign neoplasm, and a suspected cancer, whilst one of them was an incidentaloma. Laiana do Carmo Almeida, Marbele Guimarães de Oliveira, Fábio Meira Castro Pereira, and José de Bessa Júnior Copyright © 2013 Laiana do Carmo Almeida et al. All rights reserved. The Utility of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Infectious Diseases—Report of Three Cases Tue, 10 Dec 2013 10:57:57 +0000 Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a fast and minimally invasive methodology with a crucial impact on patients’ management. It has an important and established role in the diagnosis and staging of mediastinal and abdominal malignancies, but little is discussed in the literature on the usefulness of this technique in the diagnosis of infectious diseases. In the current report, we present three different cases where EUS was essential for reaching the diagnosis of tuberculosis and paracoccidiodomicosis in cases otherwise seen as malignant. In conclusion, EUS was successful not only in obtaining enough cells for morphological analysis, but also for the production of cell blocks and assessment of the presence of the microorganisms by special stains. EUS allied to fine needle biopsy was an important tool in determining diagnoses of enlarged lymph nodes, revealing the diagnosis of infectious diseases in cases otherwise seen as malignant. The wide use of this methodology in cases such as those reported here cannot only rule out malignancy, but also aid critically ill patients by installing early proper therapy without the need for aggressive interventions. Mauro Ajaj Saieg, Felipe Yazawa, Manuela Horta, Lucio G. Rossini, Mabel Tatty Medeiros Fracassi, and Fabíola Del Carlo Bernardi Copyright © 2013 Mauro Ajaj Saieg et al. All rights reserved. Syphilis, Hepatitis, and Pancreatitis: Is the Uncommon Becoming Common in the HIV+ Patient? Mon, 09 Dec 2013 10:59:38 +0000 Background. Coinfection with human immunodeficiency virus (HIV) and syphilis has been occurring at increasing rates, with the greatest increases being seen among men who have sex with men. Secondary syphilis rarely presents with liver disease, and the diagnosis may be overlooked in favor of more common causes of liver injury in this setting, such as viral hepatitis, antiretroviral therapy, alcohol use, and opportunistic infections. Case Presentation. We describe a 43-year-old patient with HIV who presented with symptoms suggesting acute pancreatitis. Investigation led to a diagnosis of hepatitis and pancreatitis, both attributed to syphilis. Conclusion. Syphilis should be included as part of the initial diagnosis among patients with HIV presenting with abnormal liver and pancreatic enzymes. B. A. da Silva, T. S. Soi, D. Cameron, A. C. Karikkineth, and R. B. Williams Copyright © 2013 B. A. da Silva et al. All rights reserved. An Unexpected Cause of Eye Irritation: A Case of Zoonotic Ocular Onchocerciasis Tue, 03 Dec 2013 15:25:09 +0000 A 19-year-old male residing in Pittsburgh presented with irritation and watering from his right eye and was diagnosed to have a right subconjunctival nodule. Surgical excision revealed both dead and living worms and histopathological staining of the worms confirmed these to be zoonotic species of Onchocerca. The morphologic characteristics of the worm suggest it to be either O. lupi or O. lienalis which were first detected in wolves and cattle, respectively. Mystery remains as to the mode of transmission and the hosts for this parasite in this part of the United States. This case adds to the growing number of cases of zoonotic ocular onchocerciasis reported from all over the world. Abhishek Biswas and Mohamed H. Yassin Copyright © 2013 Abhishek Biswas and Mohamed H. Yassin. All rights reserved. Primary Tuberculous Pyomyositis of Quadriceps Femoris in an Immunocompetent Individual Tue, 03 Dec 2013 15:19:32 +0000 Primary tuberculous pyomyositis is a rare manifestation of musculoskeletal tuberculosis especially in immunocompetent individuals without a focus of tuberculosis in the body and the underlying bone disease. It can cause a diagnostic dilemma for a physician and surgeon because of its similar presentation to soft tissue sarcomas, hematomas, and myopathies. We present a case of a 45-year-old immunocompetant gentleman with a thigh swelling with sepsis due to pyomyositis of the quadriceps requiring a multimodal management of drainage of abscess, debridement of devitalized muscle, antitubercular drugs, and physiotherapy. In a tubercular endemic country, a high index of suspicion is required to diagnose this disease which can be cured completely. M. A. Modi, A. D. Mate, A. M. Nasta, and A. K. Gvalani Copyright © 2013 M. A. Modi et al. All rights reserved. A Severe Case of Arthrographis kalrae Keratomycosis Wed, 27 Nov 2013 14:12:00 +0000 A 52-year-old man with diabetes developed a unilateral central corneal ulcer after accidental foreign body inoculation. He complained of pain and loss of visual acuity in the injured eye, which displayed redness and edema and eventually discharged pus. A corneal scraping from the left eye orbit revealed fungal elements, and cultures of the material grew a fungus. The isolate was identified as Arthrographis kalrae based on gross and microscopic morphologies. The patient received amphotericin B intravenously and itraconazole orally. The wound healed following surgical intervention, but the patient lost the use of his left eye. Siti Roszilawati Ramli, Alex Lourdes Francis, Yushaniza Yusof, and Tzar Mohd Nizam Khaithir Copyright © 2013 Siti Roszilawati Ramli et al. All rights reserved. Recreational Vehicle Water Tanks as a Possible Source for Legionella Infections Tue, 26 Nov 2013 09:07:37 +0000 We investigated recreational vehicle (RV) water reservoirs in response to a case of pneumonia in which Legionella pneumophila was cultured both from the patient and a RV reservoir in which he travelled. Water samples processed and cultured at the CDC according to standard protocol were positive for Legionella spp. in 4/17 (24%) faucets, 1/11 (9%) water tanks from 4/20 (20%) RVs from three different campsites. Legionella spp. that were isolated included L. pneumophila (serogroups 1 and 6), L. anisa, L. feeleii, and L. quateriensis. Environmental controls from the potable water of the three campsites were culture-negative. A survey of maintenance practices by the RV users at the campsites revealed that chlorine disinfection of the water tanks was rarely performed. To prevent the possibility of Legionella infections, RV owners should implement regular chlorine disinfection of their water tanks and follow the recommended maintenance guidelines according to their owner's manuals. Christine M. Litwin, Bankole Asebiomo, Katherine Wilson, Michael Hafez, Valerie Stevens, Carl B. Fliermans, Barry S. Fields, and John F. Fisher Copyright © 2013 Christine M. Litwin et al. All rights reserved. Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis Mon, 25 Nov 2013 08:17:21 +0000 Daptomycin has been used with success for the treatment of right-sided methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. However, its efficacy has not been completely assessed for the treatment of MRSA endocarditis when it is associated with pulmonary septic emboli. Hereby, we present a case of MRSA mitral and tricuspid native valve endocarditis with pulmonary septic emboli, which was treated with daptomycin as a sole agent, resulting in worsening pulmonary infiltrates and treatment failure. Hadeel Zainah, Marcus Zervos, Wassim Stephane, Sara Chamas Alhelo, Ghattas Alkhoury, and Allison Weinmann Copyright © 2013 Hadeel Zainah et al. All rights reserved. The Sinus That Breeds Fungus: Subcutaneous Zygomycosis Caused by Basidiobolus ranarum at the Injection Site Tue, 19 Nov 2013 13:03:18 +0000 Subcutaneous zygomycosis is caused by Basidiobolus ranarum which is endemic in India. We report a case of a housewife who presented with a persistent discharging sinus from the right gluteal region subsequent to an intramuscular injection which was refractory to empirical antituberculous therapy. She underwent an excision of the sinus tract, the culture of which yielded B. ranarum. The wound improved with oral potassium iodide. S. T. Jayanth, P. Gaikwad, M. Promila, and J. C. Muthusami Copyright © 2013 S. T. Jayanth et al. All rights reserved. E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis Wed, 13 Nov 2013 11:23:04 +0000 Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β-lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis. Juliana B. Gomez, Yvan Maque, Manuel A. Moquillaza, and William E. Anicama Copyright © 2013 Juliana B. Gomez et al. All rights reserved. Salmonella Neck Abscess as an Opportunistic Infection in Diabetes Mellitus Tue, 05 Nov 2013 09:39:30 +0000 Salmonella neck infections represent an uncommon cause of focal salmonellosis. While the incidence of nontyphoid salmonellosis is estimated at over 2 million cases annually, extraintestinal manifestations account for less than 1% of cases. This paper describes two patients with Salmonella neck abscesses as the initial presentation of diabetes mellitus. The first patient was diagnosed as having Salmonella enterica serotype Enteritidis sternocleidomastoid pyomyositis and the second patient Salmonella enterica serotype Typhimurium parapharyngeal abscess. Both patients had elevated hemoglobin A1c levels and had not been previously diagnosed with diabetes mellitus. Salmonella spp. should be on the differential as a causative pathogen in patients presenting with neck abscesses and poorly controlled glucose levels. Diabetes may be a risk factor for salmonellosis due to decreased gastric acidity and prolonged gastric transit time. Prompt incision and drainage accompanied by antibiotics remains the treatment of choice for infected neck abscesses. Mina Pastagia and Stephen G. Jenkins Copyright © 2013 Mina Pastagia and Stephen G. Jenkins. All rights reserved. A Case Report of Mycobacterium Avium Complex Peritonitis in an AIDS Patient Sat, 02 Nov 2013 08:54:48 +0000 Peritonitis due to Mycobacterium avium complex (MAC) infection is uncommon. The risk for MAC in AIDS patients is greatest in those with severely depressed CD4 count. The organs most commonly involved in disseminated MAC infection include spleen, mesenteric lymph nodes, liver, and intestines. The involvement of peritoneum by MAC infection is rare. This is a case of MAC peritonitis in a 26-year-old female AIDS patient who is noncompliant to highly active antiretroviral therapy (HAART). This patient presented with abdominal pain and distension, anorexia, diarrhea, and cough. She was treated with rifabutin, clarithromycin, and ethambutol along with atovaquone for Pneumocystis jiroveci pneumonia prophylaxis and so the patient’s condition improved. MAC peritonitis should be considered in a patient presenting with nonspecific abdominal symptoms in the setting of AIDS and low CD4 count. Yihenew Negatu and Eyasu Mekonen Copyright © 2013 Yihenew Negatu and Eyasu Mekonen. All rights reserved. Salmonella enteridis Septic Arthritis: A Report of Two Cases Tue, 22 Oct 2013 17:58:17 +0000 Introduction. Nontyphoidal salmonellosis causes significant morbidity, is transmitted via fecal-oral route, and is a worldwide cause of gastroenteritis, bacteremia, and local infections. Salmonella is a less common etiologic factor for septic arthritis compared with other gram-negative bacteria. Cases. We present two septic arthritis cases with Salmonella enteridis as a confirmed pathogen and also discuss the predisposing factors and treatment. Discussion. Septic arthritis is an orthopedic emergency. The gold standard treatment of septic arthritis is joint debridement, antibiotic therapy according to the culture results, and physiotherapy, which should start in the early postoperative period to prevent limitation of motion. Salmonella is an atypical agent for septic arthritis. It must be particularly kept in mind as an etiologic factor for the acute arthritis of a patient with sickle cell anemia and systemic lupus erythematosus. Clinicians should be cautious that the white blood cell count in synovial fluid can be under 50.000/mm3 in immune compromised individuals with septic arthritis. The inflammatory response can be deficient, or the microorganism may be atypical. Conclusion. Atypical bacteria such as Salmonella species in immune compromised patients can cause joint infections. Therefore, Salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting. Esat Uygur, Krishna Reddy, Feyza Ünlü Özkan, Salih Söylemez, Özlem Aydin, and Serkan Şenol Copyright © 2013 Esat Uygur et al. All rights reserved. Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature Tue, 22 Oct 2013 10:43:54 +0000 Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms. Doniel Drazin, George Hanna, Faris Shweikeh, Sunil Jeswani, Leah Lovely, Richard Sokolov, and John C. Liu Copyright © 2013 Doniel Drazin et al. All rights reserved. Cutaneous Leishmaniasis of the Eyelid: A Case Report Thu, 10 Oct 2013 11:57:27 +0000 Cutaneous leishmaniasis is endemic in certain areas of Iran, and in recent years, there has been an increase in the number of reports for rare and new forms of cutaneous leishmaniasis. We describe one unusual clinical form of cutaneous leishmaniasis. In a 27-year-old man, who noted a pimple on the upper eyelid 4 months before. The lesion was nodular and measured 1 cm × 1 cm in diameter. A diagnosis of eyelid cutaneous leishmaniasis was made, and treatment was started with intramuscular meglumine antimonate. He showed a dramatic response, and the lesion almost completely disappeared. Jamshid Ayatollahi, Ali Ayatollahi, and Seyed Hossein Shahcheraghi Copyright © 2013 Jamshid Ayatollahi et al. All rights reserved. Candida albicans Fungaemia following Traumatic Urethral Catheterisation in a Paraplegic Patient with Diabetes Mellitus and Candiduria Treated by Caspofungin Tue, 08 Oct 2013 07:57:14 +0000 A 58-year-old paraplegic male, with long-term indwelling urethral catheter, developed catheter block. The catheter was changed, but blood-stained urine was drained intermittently. A long segment of the catheter was seen lying outside his penis, which indicated that the balloon of Foley catheter had been inflated in urethra. The misplaced catheter was removed and a new catheter was inserted correctly. Gentamicin 160 mg was given intravenously; meropenem 1 gram every eight hours was prescribed; antifungals were not given. Twenty hours later, this patient developed distension of abdomen, tachycardia, and hypotension; he was not arousable. Computed tomography of abdomen revealed inflamed uroepithelium of right renal pelvis and ureter, 4 mm lower ureteric calculus with gas in right ureter proximally, and vesical calculus containing gas in its matrix. Urine and blood culture yielded Candida albicans. Identical sensitivity pattern of both isolates suggested that the source of the bloodstream infection was most likely urine. Both isolates formed consistently high levels of biofilm formation in vitro as assessed using a biofilm biomass stain, and high levels of resistance to voriconazole were observed. Both amphotericin B and caspofungin showed good activity against the biofilms. HbA1c was 111 mmol/mol. This patient was prescribed human soluble insulin and caspofungin 70 mg followed by 50 mg daily intravenously. He recovered fully from candidemia. Subramanian Vaidyanathan, Bakul Soni, Peter Hughes, Gordon Ramage, Leighann Sherry, Gurpreet Singh, and Paul Mansour Copyright © 2013 Subramanian Vaidyanathan et al. All rights reserved. Unusual Case of Osteomyelitis and Discitis in a Drug User with a Background of Chronic Back Pain: Do Not Miss the Serious Etiologies Wed, 02 Oct 2013 10:19:03 +0000 Chronic back pain is a common presenting complaint that is frequently encountered by clinicians. The challenge for clinicians is identifying the relatively few patients with a significant probability of a more serious problem that requires further evaluation. Such individuals require further evaluation for possible occult malignancy, infection, or fracture. We present a case of a 50-year-old male with a past medical history of chronic back pain and IV drug abuse who presented with acute back pain and in whom a diagnosis of vertebral osteomyelitis was missed during multiple visits to the emergency room. Alaa M. Ali, Moona Khan, Shawn G. Kwatra, Aram Barbaryan, Nasir Hussain, Raya Saba, and Aibek E. Mirrakhimov Copyright © 2013 Alaa M. Ali et al. All rights reserved. Acute Acalculous Cholecystitis due to Viral Hepatitis A Tue, 10 Sep 2013 10:31:16 +0000 Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with gangrene, perforation, and empyema. Due to these associated complications, AAC can be associated with high morbidity and mortality. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Particularly in acute acalculous cholecystitis cases, early diagnosis and early medical treatment have a positive effect on the patient and protect them from surgical trauma. ACC is a rare complication of acute viral hepatitis A. Herein, we present an adult patient of acalculous cholecystitis due to acute viral hepatitis A. She responded to the conservative management. Safak Kaya, Ahmet Emre Eskazan, Nurettin Ay, Birol Baysal, Mehmet Veysi Bahadir, Arzu Onur, and Recai Duymus Copyright © 2013 Safak Kaya et al. All rights reserved. Indigenous Infection with Francisella tularensis holarctica in The Netherlands Mon, 02 Sep 2013 13:24:14 +0000 We report here the first case of indigenous tularemia detected in The Netherlands, a nonendemic country, since 1953. Whole genome DNA sequence analysis assigned the isolate BD11-00177 to the genomic group B.FTNF002-00, which previously has been exclusively reported from Spain, France, Italy, Switzerland, and Germany. The patient had not been abroad for years, which implies that this is an indigenous infection. The current case might predict an upcoming distribution of Francisella tularensis holarctica genomic group B.FTNF002-00 in Europe. Boulos Maraha, Gerhard Hajer, Andreas Sjödin, Mats Forsman, Armand Paauw, Guus Roeselers, Ellen Verspui, Ine Frenay, Daan Notermans, Maaike de Vries, and Frans Reubsaet Copyright © 2013 Boulos Maraha et al. All rights reserved.