Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . 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. 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.