Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Community Acquired Chronic Arthritis due to Pseudomonas aeruginosa in a Previously Healthy Pregnant Woman Sun, 12 Oct 2014 00:00:00 +0000 Septic arthritis caused by Pseudomonas aeruginosa is uncommon in the immunocompetent population, despite its occurrence in younger patients with open injuries and in intravenous drug abusers. Here we report a case of septic arthritis caused by P. aeruginosa. This case is unique for several reasons. First, it is a case of septic arthritis in a pregnant woman with no traditional risk factors reported in the literature including history of prior traumatic events, hospitalisation, or chronic underlying disease. She was suspected of having transient osteoporosis associated with pregnancy to involve both hip joints. Second, this is the first reported case of a community acquired chronic septic arthritis due to P. aeruginosa involving large joints of both upper and lower extremities. The patient was treated successfully with a combination of ceftazidime and amikacin for 4 weeks followed by oral ciprofloxacin 750 mg twice daily for 8 weeks. Mesut Yilmaz, Ferhat Arslan, and Ali Mert Copyright © 2014 Mesut Yilmaz et al. All rights reserved. A Fatal Case of Multidrug Resistant Acinetobacter Necrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection Thu, 02 Oct 2014 11:31:04 +0000 Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis. Nupur Sinha, Masooma Niazi, and Dmitry Lvovsky Copyright © 2014 Nupur Sinha et al. All rights reserved. On a Boat: A Case in Australia of Endophthalmitis and Pyogenic Liver, Prostatic, and Lung Abscesses in a Previously Well Patient due to Klebsiella pneumoniae Wed, 17 Sep 2014 06:17:42 +0000 This is a case report about a patient who arrived in our emergency department in Western Australia to the care of the urologists having just gotten off a ship with a bacterial infection that would result in a 44-day stay in hospital and have quite devastating lasting effects for the young male. His story was in fact reflective of an emerging global phenomenon. Once thought to generally be a bacterium of threat only to the elderly and alcoholics, causing pneumonia and urinary tract infections, this case report describes the potentially devastating consequences of what is now becoming recognized as a hypervirulent form of Klebsiella pneumoniae with the potential to spread throughout the system rapidly seeding abscesses and causing significant morbidity in nonimmunocompromised patients. Initially noticed in Asia increasingly case reports are emerging in Western countries suggesting a global spread. Alecia Vandevelde and Bojana Stepanovic Copyright © 2014 Alecia Vandevelde and Bojana Stepanovic. All rights reserved. Pediatric HIV Long-Term Nonprogressors Tue, 26 Aug 2014 12:59:55 +0000 Patients infected with HIV are best categorized along a continuum from rapid progressors to HIV long-term nonprogressors. Long-term nonprogressors (LTNPs) are those in which AIDS develop many years after being infected with HIV, often beyond the 10-year mark, and represent 15–20% of the HIV infected patients. Many of these patients are able to control their infection and maintain undetectable viral loads for long periods of time without antiretroviral therapy. After a comprehensive literature search, we found extensive data related to HIV LTNPs in the adult population; however, very limited data was available related to LTNPs within the pediatric population. We present a case of pediatric HIV LTNPs, perinatally infected patient with undetectable viral loads, despite never receiving ART. Although there are not many instances of LTNPs among children, this child may be one, though she had intermittent viremia. She has continued to manifest serologic evidence of infection, with yearly ELISA and western blot positive tests. Based on the viral fitness studies that were performed, this case exemplifies an adolescent LTNP. B. H. Rimawi, R. H. Rimawi, M. Micallef, L. Pinckney, S. L. Fowler, and T. C. Dixon Copyright © 2014 B. H. Rimawi et al. All rights reserved. Atypical Presentation of PKDL due to Leishmania infantum in an HIV-Infected Patient with Relapsing Visceral Leishmaniasis Thu, 14 Aug 2014 09:19:52 +0000 We describe the case of an Italian patient with HIV infection who developed an atypical rash resembling post-kala-azar dermal leishmaniasis (PKDL) when receiving liposomal Amphotericin B (L-AMB) for secondary prophylaxis of visceral leishmaniasis (VL). At the time of PKDL appearance, the patient was virologically suppressed but had failed to restore an adequate CD4+ T-cell count. Histology of skin lesions revealed the presence of a granulomatous infiltrate, with lymphocytes, plasma cells, and macrophages, most of which contained Leishmania amastigotes. Restriction fragment length polymorphism-polymerase chain reaction was positive for Leishmania infantum. Paradoxically, cutaneous lesions markedly improved when a new relapse of VL occurred. The patient received meglumine antimoniate, with a rapid clinical response and complete disappearance of cutaneous rash. Unfortunately, the patient had several relapses of VL over the following years, though the interval between them has become wider after restarting maintenance therapy with L-AMB 4 mg/kg/day once a month. Even if rare, PKDL due to Leishmania infantum may occur in Western countries and represents a diagnostic and therapeutic challenge for physicians. The therapeutic management of both PKDL and VL in HIV infection is challenging, because relapses are frequent and evidence is often limited to small case series and case reports. Benedetto Maurizio Celesia, Bruno Cacopardo, Daniela Massimino, Maria Gussio, Salvatore Tosto, Giuseppe Nunnari, and Marilia Rita Pinzone Copyright © 2014 Benedetto Maurizio Celesia et al. All rights reserved. Streptococcus intermedius Bacteremia and Liver Abscess following a Routine Dental Cleaning Wed, 13 Aug 2014 12:24:24 +0000 Streptococcus intermedius is a member of the Streptococcus anginosus group of bacteria. This group is part of the normal flora of the oropharynx, genitourinary, and gastrointestinal tracts; however, they have been known to cause a variety of purulent infections including meningitis, endocarditis, and abscesses, even in immunocompetent hosts. In particular, S. intermedius has been associated with the development of liver and brain abscesses. There have been several case reports of S. intermedius liver abscesses with active periodontal infection. To our knowledge, however, there has not been a case following a routine dental procedure. In fact, the development of liver abscesses secondary to dental procedures is very rare in general, and there are only a few case reports in the literature describing this in relation to any pathogen. We present a rare case of S. intermedius bacteremia and liver abscess following a dental cleaning. This case serves to further emphasize that even routine dental procedures can place a patient at risk of the development of bacteremia and liver abscesses. For this reason, the clinician must be sure to perform a detailed history and careful examination. Timely diagnosis of pyogenic liver abscesses is vital, as they are typically fatal if left untreated. Lachara V. Livingston and Elimarys Perez-Colon Copyright © 2014 Lachara V. Livingston and Elimarys Perez-Colon. All rights reserved. A Case of Ocular Syphilis in a 36-Year-Old HIV-Positive Male Mon, 11 Aug 2014 11:36:43 +0000 The incidence of syphilis in the United States has increased markedly over the last decade, particularly among men who have sex with men (MSM). Although uncommon, ocular involvement is a potentially devastating clinical manifestation of syphilis. Human immunodeficiency virus (HIV) infection appears to increase the risk of ocular syphilis. Because of the lack of pathognomonic features for ocular syphilis and its ability to occur in both immunocompetent and immunosuppressed individuals, prompt diagnosis requires a high index of suspicion. Ocular syphilis should therefore be considered in MSM and HIV-infected patients presenting with unexplained visual complaints. Herein, we present a case of ocular syphilis in a patient with newly diagnosed HIV. Amy Nguyen, Samuel Clark Berngard, Jay Patrick Lopez, and Timothy C. Jenkins Copyright © 2014 Amy Nguyen et al. All rights reserved. Visceral Leishmaniasis in a UK Toddler following a Short Trip to a Popular Holiday Destination in Spain Sun, 10 Aug 2014 13:19:05 +0000 We herein present the case of a 15-month-old with visceral leishmaniasis diagnosed in the UK following a short trip to a popular holiday destination in Spain. Four months after the initial symptoms, the diagnosis was made incidentally on microscopy of a bone marrow biopsy taken for suspected haematological malignancy after the child developed hepatosplenomegaly, pancytopaenia, and Klebsiella pneumoniae septicaemia. Neda Minakaran, Talha Soorma, and Shamez N. Ladhani Copyright © 2014 Neda Minakaran et al. All rights reserved. Elizabethkingia meningosepticum in a Patient with Six-Year Bilateral Perma-Catheters Tue, 05 Aug 2014 12:40:54 +0000 Elizabethkingia meningosepticum (EM) is a saprophyte which is ubiquitous in nature, but not normally present in the human flora. Instances of infection are rare in the USA, but EM may be an emerging pathogen among immune-compromised patients. EM can cause a variety of infections, but nosocomial pneumonia and bacteremia have been the most commonly reported among immune-compromised adults. EM has proven difficult to treat with a mortality rate of 23%–41% in adult bacteremia. This is likely due to its resistance to commonly used empiric antibiotics for Gram-negative infections. A review of the literature suggests that there has been a shift EM’s susceptibility profile over time along with a great variability in antibiotic susceptibilities reported. This signifies the importance of close monitoring of these changes. In this report we present a case of a 64-year-old male with end stage renal disease and bilateral subclavian perma-catheters, who was admitted with systemic inflammatory response syndrome. While initial peripheral blood cultures were negative, cultures later drawn from his perma-catheters revealed Corneybacterium species and EM. The patient was initially treated with empiric vancomycin and piperacillin-tazobactam. After antibiotics susceptibilities became available, he was treated with levofloxacin and ceftazidime. The patient improved, was culture negative, and later had perma-catheter removal. Konstantin Boroda and Li Li Copyright © 2014 Konstantin Boroda and Li Li. All rights reserved. A Case of Recurrent Cryptococcal Meningoencephalitis in an Immunocompetent Female Tue, 15 Jul 2014 09:34:06 +0000 Cryptococcus neoformans is commonly associated with meningoencephalitis in immunocompromised patients and occasionally in apparently healthy individuals. Duration and regimen of antifungal treatment vary depending on the nature of the host and extent of disease and CNS shunts are placed in persistently elevated intracranial pressures. Recurrence of infection after initial treatment is not uncommon in HIV positive patients, Kaya et al. (2012) and Illnait-zaragozí et al. (2010). We describe a 39-year-old immunocompetent female that presented with neurologic deficits and increased intracranial pressure (ICP) due to cryptococcal meningoencephalitis that had a complicated course with drug induced hepatitis and persistently increased ICP that ultimately required shunt placement and presented again with relapse of cryptococcal meningoencephalitis after completion of antifungal treatment. Our case shows that recurrent cryptococcal meningitis can be seen in immunocompetent patients due to prolonged placement of CNS shunt and suggests that shunts should be removed after resolution of meningitis. Negin Niknam, Negar Niknam, Kola Dushaj, and Erfidia Restrepo Copyright © 2014 Negin Niknam et al. All rights reserved. Chryseobacterium indologenes Septicemia in an Infant Thu, 10 Jul 2014 08:31:25 +0000 Chryseobacterium indologenes is a rare cause of infection in children. The organism causes infections mostly in hospitalised patients with severe underlying diseases. The choice of an effective drug for the treatment of infections due to C. indologenes is difficult as the organism has a limited spectrum of antimicrobial sensitivity. We present a case of nosocomial septicemia caused by C. indologenes in an infant with congenital heart disease who was successfully treated with trimethoprim sulfamethoxazole and also reviewed fourteen additional cases of C. indologenes infections reported in the English literature in this report. Turkan Aydin Teke, Fatma Nur Oz, Ozge Metin, Gulsum Iclal Bayhan, Zeynep Gökce Gayretli Aydin, Melek Oguz, and Gonul Tanir Copyright © 2014 Turkan Aydin Teke et al. All rights reserved. Disseminated Abdominal Hydatidosis: A Rare Presentation of Common Infectious Disease Tue, 08 Jul 2014 13:06:27 +0000 Hydatid disease is one of the most geographically widespread zoonoses with substantial disease burden. In this report we are discussing an unusual case of intra-abdominal HD that was ongoing for 22 years despite two surgical interventions. Significant symptomatic relief was achieved within the first two months of combination therapy with albendazole and praziquantel. HD is still of public health concern in the Middle East that needs optimized care. Abdulrahman Almalik, Aynaa Alsharidi, Mohammed Al-Sheef, and Mushirah Enani Copyright © 2014 Abdulrahman Almalik et al. All rights reserved. A Case Report of Typhoidal Acute Acalculous Cholecystitis Thu, 26 Jun 2014 09:19:37 +0000 Introduction. Acalculous cholecystitis in the setting of typhoid fever in adults is an infrequent clinical encounter, reported sparsely in the literature. In this case report we review the presentation and management of enteric fever involving the biliary system and consider the literature surrounding this topic. The aim of this case report is to alert clinicians to the potential diagnosis of extraintestinal complications in the setting of typhoid fever in the returned traveller, requiring surgical intervention. Presentation of Case. We report the case of a 23-year-old woman with acalculous cholecystitis secondary to Salmonella Typhi. Discussion. There is scarce evidence surrounding the optimal treatment and prognosis of typhoidal acalculous cholecystitis. In the current case, surgical invention was favoured due to failure of medical management. Conclusion. Clinical judgement dictated surgical intervention in this case of typhoidal acute acalculous cholecystitis, and cholecystectomy was safely performed. Neeha Rajan, Imeldah Motoroko, Dilshan Udayasiri, Jo-Lyn McKenzie, Jason S. C. Tan, and Adrian R. Tramontana Copyright © 2014 Neeha Rajan et al. All rights reserved. A Novel Case of Symptomatic BK Viraemia in a Patient Undergoing Treatment for Hodgkin Lymphoma Tue, 24 Jun 2014 12:12:01 +0000 Symptomatic BK viral infection in the immunocompromised host is well described, most commonly seen in renal transplant recipients, bone marrow transplant recipients, and HIV positive patients. The present case describes a novel clinical scenario of symptomatic urological BK virus infection in a patient receiving treatment for Hodgkin lymphoma. This case highlights the importance of casting a wide diagnostic net for adverse events encountered with novel therapeutic agents or regimens. Jacinta Perram and Jane Estell Copyright © 2014 Jacinta Perram and Jane Estell. All rights reserved. A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis Sun, 15 Jun 2014 06:19:02 +0000 Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy. Brijesh Patel, Anas Souqiyyeh, and Ammar Ali Copyright © 2014 Brijesh Patel et al. All rights reserved. Atypical Pyoderma Gangrenosum Mimicking an Infectious Process Thu, 12 Jun 2014 09:31:34 +0000 We present a patient with atypical pyoderma gangrenosum (APG), which involved the patient’s arm and hand. Hemorrhagic bullae and progressive ulcerations were initially thought to be secondary to an infectious process, but a biopsy revealed PG. Awareness of APG by infectious disease services may prevent unnecessary use of broad-spectrum antibiotics. Derek To, Aaron Wong, and Valentina Montessori Copyright © 2014 Derek To et al. All rights reserved. A Highly Rare Cause of Lumbar Spondylodiscitis with Epidural Abscess: Actinomyces israelii Thu, 12 Jun 2014 09:30:58 +0000 Actinomyces species may lead to slowly progressive infection of almost any site once mucosal breakdown exists; hence, it has the name “great pretender.” Its diagnosis may be unthinkable unless proper cultures/histologies are taken. We describe a patient with lumbar spondylodiscitis and epidural abscess. This is an exceptional another disease by actinomycosis. Mahir Kapmaz, İsmail Gülşen, Naciye Kış, Seniha Başaran, Lütfiye Öksüz, and Nezahat Gürler Copyright © 2014 Mahir Kapmaz et al. All rights reserved. Autoimmune Hemolytic Anemia Induced by Levofloxacin Thu, 12 Jun 2014 06:58:41 +0000 Drug-induced autoimmune hemolytic anemia is a rare condition. We report the case of a 32-year-old white female who presented to the emergency department with generalized fatigue, fever, and jaundice. The patient reported using levofloxacin few days prior to presentation for urinary tract infection. The patient had evidence of hemolytic anemia with a hemoglobin of 6.7 g/dL which dropped to 5 g/dL on day 2, the direct Coombs test was positive, indirect bilirubin was 5.5 mg/dL, and LDH was 1283 IU/L. Further testing ruled out autoimmune disease, lymphoma, and leukemia as etiologies for the patient’s hemolytic anemia. Levofloxacin was immediately stopped with a gradual hematologic recovery within few days. Marwan Sheikh-Taha and Pascale Frenn Copyright © 2014 Marwan Sheikh-Taha and Pascale Frenn. All rights reserved. Nonattenuated Polymyxin B Used for the Treatment of Extreme-Drug Resistant Acinetobacter baumannii-Related Infections in Patients with Preexisting End Stage Renal Failure Tue, 03 Jun 2014 12:26:53 +0000 Recent pharmacokinetic studies have suggested that nonrenal clearance predominates the elimination of polymyxin B. We present 2 patients with preexisting end stage renal failure, who were given nonattenuated doses of polymyxin B for the treatment of extreme-drug resistant organism. No evidence of adverse events occurred and microbiological clearance was documented. Yvonne Peijun Zhou, Nathalie Grace Sy Chua, Maciej Piotr Chlebicki, Winnie Hui Ling Lee, and Andrea Lay Hoon Kwa Copyright © 2014 Yvonne Peijun Zhou et al. All rights reserved. Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis Sun, 01 Jun 2014 11:16:25 +0000 Infective endocarditis (IE) is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC) joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic. Neda Hashemi-Sadraei, Rohan Gupta, Jorge D. Machicado, and Rukma Govindu Copyright © 2014 Neda Hashemi-Sadraei et al. All rights reserved. Acute Myeloid Leukemia Presenting with Pulmonary Tuberculosis Wed, 28 May 2014 05:52:01 +0000 We report the case of a 58-year-old immunocompetent man presenting with fever, cough, anorexia, weight loss, and cervical lymphadenopathy. Blood investigations revealed severe neutropenia with monocytosis. Chest imaging showed bilateral reticular infiltrates with mediastinal widening. Bronchoalveolar lavage culture and molecular test were positive for Mycobacterium tuberculosis and treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. Although pulmonary tuberculosis could explain this clinical presentation we suspected associated blood dyscrasias in view of significant monocytosis and mild splenomegaly. Bone marrow aspiration revealed acute myeloid leukemia. Thereafter the patient received induction chemotherapy and continued antituberculous treatment. After first induction of chemotherapy patient was in remission and successfully completed 6 months antituberculosis therapy without any complications. To our knowledge there has been no such case reported from the State of Qatar to date. Merlin Thomas and Mushtak AlGherbawe Copyright © 2014 Merlin Thomas and Mushtak AlGherbawe. All rights reserved. Necrotizing Fasciitis of the Nose Complicated with Cavernous Sinus Thrombosis Wed, 30 Apr 2014 13:23:51 +0000 Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative. D. Swaminath, R. Narayanan, M. A. Orellana-Barrios, and B. Temple Copyright © 2014 D. Swaminath et al. 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.