Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.

Masato Kimura

Eichiro Kawai

Hisao Yaoita

Natsuko Ichinoi

Osamu Sakamoto

Shigeo Kure

Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.

Zuhal Yesilbag

Asli Karadeniz

Fatih Oner Kaya

Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults&#x2014;Case Report and Review of the Literature

In the absence of coexisting immunocompromised state and lack of specific symptoms a reactivation of treated mycobacterial tuberculosis (MTB) infection is generally not considered in the differential diagnosis of leg pain. We present a unique case of disseminated tuberculosis presenting as an infected Baker&#x2019;s cyst in a 73-year-old immunocompetent male.

Najwa Pervin

Sami Akram

Tamer Hudali

Mukul Bhattarai

Sana Waqar

Disseminated Tuberculosis Presenting as Baker&#x2019;s Cyst Infection

One of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid progression phenotype, who started ART with TCD4+ of 53&#x2009;cells/mm3 (3,3&#x25;) and HIV RNA = 890000&#x2009;copies/mL (6&#x2009;log). Four weeks later he was admitted to the intensive care unit with severe sepsis. The diagnostic pathway identified progressive multifocal leukoencephalopathy, digestive Kaposi sarcoma, and P. aeruginosa bacteraemia. Five weeks after starting ART, TCD4+ cell count was 259&#x2009;cells/mm3 (15&#x25;) and HIV RNA = 3500&#x2009;copies/mL (4&#x2009;log). He developed respiratory failure and progressed to septic shock and death. Those complications might justify the outcome but its autopsy opened Pandora&#x2019;s box: cerebral and cardiac toxoplasmosis was identified, as well as hemophagocytic syndrome, systemic candidiasis, and Mycobacterium avium complex infection. IRIS remains a concern and eventually a barrier to ART. Male gender, young age, low TCD4 cell count, and high viral load are risk factors. The high prevalence of subclinical opportunistic diseases highlights the need for new strategies to reduce IRIS incidence.

Mariana Meireles

Concei&#xe7;&#xe3;o Souto Moura

Margarida Fran&#xe7;a

Immune Reconstitution Inflammatory Syndrome: Opening Pandora&#x2019;s Box

Diverticulitis primarily affects the sigmoid colon and is often complicated by intra-abdominal abscesses and fistulas. Rarely, however, mesenteric venous thrombosis has been known to occur. Optimal management is still unclear. We report the first case of polymicrobial sepsis resulting from diverticular pylephlebitis, managed successfully with bowel rest, antibiotics, and anticoagulation.

Pradhum Ram

Kamolyut Lapumnuaypol

Chitra Punjabi

Diverticular Pylephlebitis and Polymicrobial Septicemia

Brucellosis is still endemic and a significant public health problem in many Mediterranean countries, including Greece. It is a multisystemic disease with a broad spectrum of clinical manifestations including hematological disorders, such as anemia, pancytopenia, leucopenia, and thrombocytopenia. Thrombocytopenia is usually moderate and attributed to bone marrow suppression or hypersplenism. Rarely, autoimmune stimulation can cause severe thrombocytopenia with clinically significant hemorrhagic manifestations. We present the case of a girl with severe thrombocytopenic purpura as one of the presenting symptoms of Brucella melitensis infection. Treatment with intravenous immunoglobulin and the appropriate antimicrobial agents promptly resolved the thrombocyte counts. A review of similar published cases is also presented.

Alexandros Makis

Aikaterini Perogiannaki

Nikolaos Chaliasos

Severe Thrombocytopenic Purpura in a Child with Brucellosis: Case Presentation and Review of the Literature

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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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Case Reports in Infectious Diseases - Table of contents 2017

Case Reports in Infectious Diseases | Hindawi

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Case Reports in Infectious Diseases publishes case reports and case series related to infectious diseases of bacterial, viral and parasitic origin.

Case Reports in Infectious Diseases