An Unusual Case of Campylobacter jejuni Gastroenteritis Presenting with Acute Reversible Encephalopathy in an Immunocompetent HostRead the full article
Case Reports in Infectious Diseases publishes case reports and case series related to infectious diseases of bacterial, viral and parasitic origin.
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Atypical Presentation of COVID-19 Leading to ARDS
A 60-year-old male was brought into the emergency department by EMS after he was found unresponsive by his neighbors. He was initially admitted to the hospital for chronic obstructive pulmonary disease exacerbation secondary to pneumonia. However, due to a sudden, rapidly progressing course of events, the patient was evaluated for COVID-19.
Secondary Subcutaneous Rhizopus Infection in a Posttransplant Recipient with Calcific Uremic Arteriolopathy
Calcific uremic arteriolopathy is a rare condition affecting chronic kidney disease (CKD) patients on long-term dialysis. The clinical manifestations include subcutaneous skin necrosis and ulcers secondary to calcification of the subcutaneous blood vessels. The necrotic tissue often becomes a nidus of infection. The prognosis is often poor. We present a case of a renal allograft recipient who developed a subcutaneous necrotic lesion which was subsequently infected by Rhizopus spp. The patient underwent surgical debridement and antifungal therapy. The infection resolved completely. Our case represents agrave underlying condition predisposing a rare and serious posttransplant infection. The outcome was favourable because of early identification and treatment of the infection.
Misidentification of Scedosporium boydii Infection as Aspergillosis in a Patient with Chronic Renal Failure
Aspergillosis is a commonly diagnosed fungal infection. Histopathologic examination alone can have diagnostic pitfalls due to the overlapping of fungal morphology. We report a case of Scedosporium boydii infection initially misdiagnosed as aspergillosis. The patient presented to the hospital with shortness of breath and chest and abdominal pain. Laboratory tests revealed leukocytosis and elevated serum liver enzymes, myoglobin and lipase. He died of hypotensive shock and brain abscesses despite antibiotic treatment. Autopsy revealed invasive fungal infection in the heart, thyroid, and brain with presence of 45-degree angled, branching hyphae. The initial diagnosis of aspergillosis was made; however, further molecular studies identified the organism as S. boydii. This report reveals the potential pitfalls of morphologic diagnosis alone; and the necessity of other testing modalities to render an accurate diagnosis which is crucial for appropriate.
Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review
Introduction. Blood culture-negative infective endocarditis (BCNIE) can present subtly and is associated with a diagnostic delay leading to increased morbidity and mortality. Case Report. We present the case of an 18-year-old male with a history of complex congenital heart disease and 3-year intermittent episodes of fever of unknown origin, who was referred to our hospital for upper and lower extremity focal seizures. Laboratory blood tests were normal, blood cultures were negative, and brain imaging revealed an abscess. Cardiology consultation was requested, and transthoracic echocardiography revealed an intracardiac vegetation. Empiric antibiotic treatment with sultamicillin, gentamycin, and meropenem was initiated. Serology testing was positive for Coxiella burnetii, and the diagnosis of BCNIE was established. The antibiotic course was changed to oral doxycycline for 36 months and led to resolution of IE, with no vegetation detected on TTE after 15 months. Conclusion. BCNIE is a life-threatening disease entity that can lead to severe complications, such as valve regurgitation, emboli, and death. Patients with congenital heart disease are particularly vulnerable to IE. Timely diagnosis and antibiotic management are of paramount importance in order to avoid the potentially fatal sequelae.
Listeria monocytogenes Meningoencephalitis and Cerebral Abscess in a Heart Transplant Recipient
A 54-year-old male, five months postorthotopic heart transplantation, presented with intermittent fevers, headaches, and “soupy” stools. Prior to presentation, he had low-level cytomegalovirus (CMV) viremia for two straight weeks. Given his immunosuppression, diarrhea, and low-level CMV viremia, he was presumed to have cytomegalovirus and/or C. difficile colitis and treated empirically for both on hospital day one. However, he developed neck pain/stiffness, diaphoresis, and worsening fevers on hospital day three. Blood cultures eventually grew Listeria monocytogenes; MRI of the brain with gadolinium showed left brain meningoencephalitis with early cerebral abscess formation. Lumbar puncture revealed elevated opening pressure, CSF neutrophilic pleocytosis, and elevated CSF protein and lactate but negative gram stain and cultures. First-line agent for Listeria meningoencephalitis is ampicillin. However, he reported amoxicillin allergy. Desensitization to ampicillin failed because ampicillin was too unstable per the allergist. He was therefore treated with penicillin monotherapy for eight weeks with complete resolution of his brain lesions and without any residual neurologic deficits.
Effects of Intravenous Immunoglobulin and Acyclovir in Preventing Neonatal Varicella
Neonatal varicella mostly results from maternal varicella. The disease can cause presentation ranging from mild symptoms to varicella pneumonia, hepatitis, meningoencephalitis, or fatality. If the mother develops symptoms implying varicella 4–5 days antepartum to 2 days postpartum, the mortality rate of the baby may reach 20%. We report a case of neonatal varicella from maternal varicella. The patient’s mother initially developed maculopapular rash over her trunk 1 day after giving birth; she had a family member in the same household diagnosed with herpes zoster recently, and another member with diagnosed varicella, whose rash disappeared before the patient's birth. On the baby's third day of life, discrete vesicular rashes on erythematous background and discrete erythematous maculopapular rashes were found over his trunk, arms, and legs. The baby was subsequently diagnosed with neonatal varicella and was treated by intravenous immunoglobulin (IVIG) because there was no varicella zoster immunoglobulin (VZIG) available in the hospital, and also, intravenous acyclovir was given for 7 days. The rash completely resolved by the baby's fifth day of life, without any complications. The combination of IVIG and acyclovir might not effectively prevent neonatal varicella, but the medication could prevent the baby from developing serious complications and shorten the clinical course.