Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Neurosyphilis: An Unresolved Case of Meningitis Thu, 14 May 2015 12:15:12 +0000 Neurosyphilis can cause both symptomatic and asymptomatic meningitis. However the epidemiology of modern neurosyphilis is not well defined because of the paucity of population-based data. The majority of neurosyphilis cases have been reported in HIV-infected patients. Here we present a case of early neurosyphilis/symptomatic syphilitic meningitis in a non-HIV patient who presented with rash but was mistakenly treated for early latent or secondary syphilis. Syphilis presenting with a skin rash and an extremely high RPR titer could indicate CNS infection rather than simply secondary syphilis because rash is a nonspecific manifestation of disseminated infection. Given the effectiveness of penicillin therapy, why is the rate of syphilis continuing to increase? Is it due to a failure of prevention or could it be also because of failure to diagnose and treat syphilis adequately, as in this case? Shagufta Ahsan and Joesph Burrascano Copyright © 2015 Shagufta Ahsan and Joesph Burrascano. All rights reserved. Kytococcus schroeteri Bacteremia in a Patient with Hairy Cell Leukemia: A Case Report and Review of the Literature Thu, 07 May 2015 11:08:01 +0000 The Kytococcus genus formerly belonged to Micrococcus. The first report of a Kytococcus schroeteri infection was in 2002 in a patient diagnosed with endocarditis. We report a case of central line associated Kytococcus schroeteri bacteremia in a patient with underlying Hairy Cell Leukemia. Kytococcus schroeteri is an emerging infection in the neutropenic population and in patients with implanted artificial tissue. It is thought to be a commensal bacterium of the skin; however, attempts to culture the bacteria remain unsuccessful. There have been a total of 5 cases (including ours) of K. schroeteri bacteremia in patients with hematologic malignancies and neutropenia and only 18 documented cases in any population. Four of the cases of bacteria in neutropenic patients have been fatal, but early detection and treatment could make a difference in clinical outcomes. Akshay Amaraneni, Devin Malik, Sakshi Jasra, Sreenivasa R. Chandana, and Deepak Garg Copyright © 2015 Akshay Amaraneni et al. All rights reserved. Presentation of AIDS with Disseminated Cutaneous and Visceral Leishmaniasis in Iran Tue, 05 May 2015 07:27:12 +0000 Leishmaniasis is an infectious disease in form of visceral (VL), cutaneous (CL), and mucocutaneous (MCL) leishmaniasis. Immunocompromised patients have increased risk of Leishmania infection, especially in endemic areas for visceral leishmaniasis, where in the world HIV/VL coinfection has become endemic. The case here suffers from both AIDS and visceral-cutaneous leishmaniasis. We report an Iranian woman with disseminated cutaneous and visceral leishmaniasis who became positive for HIV test. Mohammadali Davarpanah, Masumeh Rassaei, and Fatemeh Sari aslani Copyright © 2015 Mohammadali Davarpanah et al. All rights reserved. Exophiala Pneumonia Presenting with a Cough Productive of Black Sputum Tue, 05 May 2015 07:00:14 +0000 Exophiala species are black, yeast-like molds that can cause subcutaneous cysts as well as disseminated disease. Isolated pneumonia due to Exophiala species is extremely uncommon. We report a case of isolated Exophiala pneumonia in a patient with bronchiectasis who presented with worsening dyspnea and a cough productive of black sputum. The production of black sputum, known as melanoptysis, is an uncommon physical finding with a limited differential diagnosis. To our knowledge, this is the first reported case of Exophiala pneumonia presenting with a cough productive of black sputum. Yehuda Z. Cohen and Wendy Stead Copyright © 2015 Yehuda Z. Cohen and Wendy Stead. All rights reserved. Multifocal Tubercular Osteomyelitis with Tubercular Breast Abscess: An Atypical Presentation of Tuberculosis Mon, 04 May 2015 12:01:23 +0000 Tuberculosis of spine is common in a developing country like India. However, involvement of spine at multiple levels along with involvement of rib and tubercular breast abscess in an immunocompetent patient without any pulmonary involvement is extremely rare. Here we report a case of 53-year-old immunocompetent lady who presented with quadriparesis and MRI (magnetic resonance imaging) of spine revealed multiple lesions involving cervical, thoracic, lumbar, and sacral region without any involvement of intervertebral disc. On detailed examination she was found to have a lump in right breast. Fine needle aspiration cytology of both paravertebral collection and breast lump revealed presence of acid fast bacilli. She was put on antitubercular drug for one year and she responded well to therapy. Mita Bar, Tuhin Santra, Pradipta Guha, Neha Agrawal, Apu Adhikary, Anirban Das, and Chanchal Mahapatra Copyright © 2015 Mita Bar et al. All rights reserved. Differences in Method-Specific Vancomycin MICs and Induced Daptomycin Resistance in an Infective Endocarditis Patient Sun, 03 May 2015 13:00:37 +0000 Methicillin-resistant Staphylococcus aureus (MRSA) is a common nosocomial infection that has a high burden of morbidity and mortality. Vancomycin is the often-used antibiotic of choice when MRSA is suspected as a causative infectious agent. Recent studies have called into question the reliability of vancomycin as empiric therapy, especially in instances of bacteremia. The isolate’s minimum inhibitory concentration (MIC), the source of infection, modality of susceptibility testing, and antibiotic resistance are all issues that should be taken into consideration when formulating a care plan for a patient. We present a case that illustrates some of these issues clinicians are facing. David Benjamin Lash, Jeremiah Joson, and Arash Heidari Copyright © 2015 David Benjamin Lash et al. All rights reserved. Cutaneous and Skeletal Simultaneous Locations as a Rare Clinical Presentation of Tuberculosis Thu, 30 Apr 2015 17:24:10 +0000 Tuberculosis is a resurgent disease in most regions of the world, infecting one-third of the world’s population and having a multisystemic involvement. Incidence of extra-pulmonary tuberculosis has increased in the last few decades as a result of the Human Immunodeficiency Virus (HIV) infection. The authors report a clinical case of the rare concomitant cutaneous and skeletal tuberculosis in an immunocompetent patient transferred from endemic area. Aida Pereira, Ana Miranda, Frederico E. Santo, and Pedro Fernandes Copyright © 2015 Aida Pereira et al. All rights reserved. Anaerobic Spondylodiscitis due to Fusobacterium Species: A Case Report Review of the Literature Mon, 27 Apr 2015 13:46:11 +0000 Spondylodiscitis caused by Fusobacterium species is rare. Most cases of spontaneous spondylodiscitis are caused by Staphylococcus aureus and most postoperative cases are caused by Staphylococcus aureus or coagulase-negative staphylococci. Escherichia coli is the most common Gram-negative organism causing spondylodiscitis. Fusobacterium species are unusual causes for anaerobic spondylodiscitis. We report the case of a patient with spontaneous L2-L3 spondylodiscitis, vertebral osteomyelitis, and epidural abscess caused by Fusobacterium species and review the literature for patients with Fusobacterium spondylodiscitis. Tiffany N. Latta, Aimee L. Mandapat, and Joseph P. Myers Copyright © 2015 Tiffany N. Latta et al. All rights reserved. Group D Salmonella Urinary Tract Infection in an Immunocompetent Male Thu, 23 Apr 2015 12:44:20 +0000 A 62-year-old male with past medical history of benign prostatic hyperplasia presented to the emergency department with complaints of decreased urinary flow, inability to fully empty his bladder, and gross hematuria. Physical examination was unremarkable. Urinalysis revealed large amount of blood and more than 700 white blood cells suggesting a urinary tract infection. Urine culture grew group D Salmonella greater than 100,000 colony-forming units per mL. He was prescribed 6 weeks of trimethoprim/sulfamethoxazole and had resolution of symptoms. Retrospectively, he reported a 3-day history of watery diarrhea about a week prior to onset of urinary symptoms that was presumed to be the hematogenous source in this case. Urinary tract infection from nontyphoidal Salmonella (NTS) is rare and is usually associated with immunosuppression, chronic diseases, such as diabetes or structural abnormalities of the genitourinary tract. Genitourinary tract abnormalities previously reported in the literature that predispose to nontyphoidal Salmonella urinary tract infection include nephrolithiasis, chronic pyelonephritis, retrovesicular fistula, urethrorectal fistula, hydrocele, and post-TURP. We present an exceedingly uncommon case of 62-year-old male with group D Salmonella urinary tract infection predisposed by his history of benign prostatic hyperplasia. Asad Jehangir, Dilli Poudel, Shoaib Bilal Fareedy, Ahmed Salman, Anam Qureshi, Qasim Jehangir, and Richard Alweis Copyright © 2015 Asad Jehangir et al. All rights reserved. Neuroinvasive Cryptococcosis in an Immunocompetent Patient with a Negative Spinal Fluid Cryptococcus Antigen Tue, 14 Apr 2015 06:35:14 +0000 58-year-old man presented with headache, nausea, vomiting, and gait disturbance. Brain MRI showed meningeal enhancement and herniation. Serum Cryptococcus antigen was positive but spinal fluid antigen and cultures were negative. A cerebellar biopsy revealed nonencapsulated Cryptococcus. He completed antifungal therapy. Serum Cryptococcus antigen titer decreased. He had a full neurological recovery. Rocio C. Garcia-Santibanez, Veenu Gill, Stanley Yancovitz, and DeWitt Pyburn Copyright © 2015 Rocio C. Garcia-Santibanez et al. All rights reserved. How an Opportunistic Infection Can Mess with Your Brain and Take Your Breath Away: A Rare Case of Simultaneous Lung and Brain Abscess due to Streptococcus anginosus Wed, 01 Apr 2015 10:33:28 +0000 Streptococcus anginosus (S. anginosus) is considered a friendly bug and is a one of many different bacteria that constitute the normal flora of the oral cavity. Nevertheless, it has been infrequently associated with more invasive infections, like lung abscess. It is extremely rare to have multisystemic involvement with S. anginosus group. We present a unique case of pulmonary and brain abscess due to S. anginosus in an immunocompetent patient. Farah Al-Saffar, Daisy Torres-Miranda, Saif Ibrahim, and Adil Shujaat Copyright © 2015 Farah Al-Saffar et al. All rights reserved. A Case of Fatal Gastrointestinal Anthrax in North Eastern Iran Tue, 31 Mar 2015 08:33:46 +0000 Background. Bacillus species are aerobic or facultative anaerobic, gram-positive, or gram-variable spore-forming rods. They are ubiquitous in the environmental sources. Bacillus anthracis may usually cause three forms of anthrax: inhalation, gastrointestinal, and cutaneous. The gastrointestinal (GI) anthrax develops after eating contaminated meat. In this paper we report septic intestinal anthrax. Case Presentation. We report an isolation of Bacillus anthracis from blood culture of patient with intestinal anthrax. Bacillus anthracis was isolated from a blood culture of a 34-year-old man who had a history of severe abdominal pain, bloody diarrhea, nausea, vomiting, fever, sweating, and lethargy within 4 to 5 days after eating the meat of domestic goat. He had evidence of severe infection and septic shock and did not respond to treatments and subsequently expired 9 hours after hospitalization. Conclusion. Gastrointestinal anthrax is characterized by rapid onset, fever, and septicemia. Rapid diagnosis and prompt initiation of antibiotic therapy can help in survival. Most of previous cases of septicemic anthrax were related to injection drug users but, in our case, septicemia occurred after gastrointestinal anthrax. Seyed Ahmad Hashemi, Amir Azimian, Sara Nojumi, Tahereh Garivani, Saghar Safamanesh, and Majid Ghafouri Copyright © 2015 Seyed Ahmad Hashemi et al. All rights reserved. Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling Sun, 29 Mar 2015 13:59:29 +0000 Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM) occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal liposuction, and gluteal lipofilling in Mexico. Three months postoperatively, implants were removed for NTM-infection in Switzerland. Adequate antibiotic treatment was stopped after seven days for drug-related hepatitis. At entrance, gluteal puncture for bacterial analysis was performed. MRI showed large subcutaneous collection. Debridement under general anaesthesia was followed by open wound management. Total antibiotic treatment was 20 weeks. Methods. Bacterial analysis of periprosthetic and gluteal liquids included Gram-stain plus acid-fast stain, and aerobic, anaerobic and mycobacterial cultures.  Results. In periprosthetic fluid, Mycobacterium abscessus, Propionibacterium, and Staphylococcus epidermidis were identified. The same M. abscessus strain was found gluteally. The gluteal wound healed within six weeks. At ten months’ follow-up, gluteal asymmetry persists for deep scarring. Conclusion. This case presents major complications of multisite aesthetic surgery. Surgical-site infections in context of medical tourism need appropriate bacteriological investigations, considering potential NTM-infections. Eva Rüegg, Alexandre Cheretakis, Ali Modarressi, Stephan Harbarth, and Brigitte Pittet-Cuénod Copyright © 2015 Eva Rüegg et al. All rights reserved.