Case Reports in Infectious Diseases The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Strongyloides Hyperinfection in a Renal Transplant Patient: Always Be on the Lookout Mon, 20 Feb 2017 00:00:00 +0000 We present a case of a 71-year-old Vietnamese man with chronic kidney disease secondary to adult polycystic kidney disease. He had been a prisoner of war before undergoing a successful cadaveric renal transplant in the United States. He presented to clinic one year after the transplant with gross hematuria, productive cough, intermittent chills, and weight loss. Long standing peripheral eosinophilia of 600–1200/μL triggered further evaluation. A wet mount of stool revealed Strongyloides stercoralis larvae. A computed tomography (CT) of chest showed findings suggestive of extension of the infection to the lungs. The patient was treated with a three-week course of ivermectin with complete resolution of signs, symptoms, peripheral eosinophilia, and the positive IgG serology. Strongyloides infection in renal transplant patient is very rare and often presents with hyperinfection, associated with high mortality rates. The American Transplant Society recommends pretransplant screening with stool examination and Strongyloides stercoralis antibody in recipients and donors from endemic areas or with eosinophilia. It is imperative that healthcare professionals involved in the care of these individuals be cognizant of these recommendations as it is a very preventable and treatable entity. Murtaza Mazhar, Ijlal Akbar Ali, and Nelson Iván Agudelo Higuita Copyright © 2017 Murtaza Mazhar et al. All rights reserved. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease Sun, 19 Feb 2017 00:00:00 +0000 Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms. Ali Ridha, Njideka Oguejiofor, Sarah Al-Abayechi, and Emmanuel Njoku Copyright © 2017 Ali Ridha et al. All rights reserved. Successful Treatment of Necrotizing Fasciitis and Streptococcal Toxic Shock Syndrome with the Addition of Linezolid Sun, 19 Feb 2017 00:00:00 +0000 Necrotizing fasciitis is a deep-seated subcutaneous tissue infection that is commonly associated with streptococcal toxic shock syndrome (TSS). Surgical debridement plus penicillin and clindamycin are the current standard of care. We report a case of necrotizing fasciitis and streptococcal TSS where linezolid was added after a failure to improve with standard therapy. Briefly after isolation of Streptococcus pyogenes from tissue cultures, the patient underwent two surgical debridement procedures and was changed to standard of care therapy. While the patient was hemodynamically stable, the patient’s wounds, leukocytosis, and thrombocytopenia all progressively worsened. After initiation of linezolid, the patient slowly improved clinically. The present report is the first to highlight the role of linezolid in streptococcal necrotizing fasciitis and TSS not improving with standard therapy. Hana Rac, Karine D. Bojikian, Jose Lucar, and Katie E. Barber Copyright © 2017 Hana Rac et al. All rights reserved. Occupational Neurobrucellosis Mimicking a Brain Tumor: A Case Report and Review of the Literature Thu, 16 Feb 2017 00:00:00 +0000 Brucellosis is a zoonotic bacterial infection which is transmitted to humans from infected animals and is endemic in many parts of the world including Saudi Arabia. In this article, we report a case of occupational neurobrucellosis that presented with a space-occupying lesion mimicking a brain tumor. We stress on the importance of obtaining detailed social history including occupation to reach the diagnosis in several conditions including brucellosis. We also stress on taking universal precautions when handling any specimens. It may be advisable that manipulation of all unknown specimens arriving at the laboratory should occur in biological safety cabinet until a highly infectious organism is ruled out. Neurobrucellosis should be included in the differential diagnosis in patients presenting with solitary mass lesion mimicking brain tumor especially in endemic areas or high occupational risk group. Hussein Algahtani, Bader Shirah, Dina Abdulghani, Roiya Farhan, and Raghad Algahtani Copyright © 2017 Hussein Algahtani et al. All rights reserved. Granulomatous Lobular Mastitis Associated with Mycobacterium abscessus in South China: A Case Report and Review of the Literature Sun, 12 Feb 2017 00:00:00 +0000 Mycobacteria, which are known as rapidly growing bacteria, are pathogens that are responsible for cutaneous or subcutaneous infections that especially occur after injection, trauma, or surgery. In this report, we describe a species of Mycobacterium abscessus that was isolated from a breast abscess in a patient who was previously diagnosed with granulomatous lobular mastitis (GLM). This current case is the first ever presented case of GLM associated with M. abscessus documented in South China. The case presentation highlights the role of M. abscessus in GLM. The association of M. abscessus and GLM is discussed and a summary of breast infection due to Mycobacteria is given. Ye-sheng Wang, Qi-wei Li, Lin Zhou, Run-feng Guan, Xiang-ming Zhou, Ji-hong Wu, Nan-yan Rao, and Shuang Zhu Copyright © 2017 Ye-sheng Wang et al. All rights reserved. Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature Thu, 09 Feb 2017 00:00:00 +0000 Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed. Nicholas E. Ingraham, Brenton Schneider, and Jonathan D. Alpern Copyright © 2017 Nicholas E. Ingraham et al. All rights reserved. Actinomyces meyeri Popliteal Cyst Infection and Review of the Literature Tue, 31 Jan 2017 13:41:36 +0000 A 66-year-old, Caucasian male presented with pain and swelling involving the left knee of one-week duration. Arthrocentesis was negative for evidence of septic arthritis. Magnetic resonance imaging (MRI) study of the left knee showed degenerative arthritis, partial tear of medial meniscus, and a complex fluid collection along the posteromedial aspect of the left knee suggestive of popliteal cyst. He underwent arthroscopy with partial medial meniscectomy. Intraoperative joint fluid was noted to be cloudy but cultures were negative. Arthroscopic procedure provided him with temporary relief but the pain and swelling in the posterior aspect of the left knee recurred in 6 weeks. Repeat MRI showed complex fluid collection in the posterolateral aspect of left knee. Ultrasound guided aspiration of the fluid collection revealed purulent material and cultures grew Actinomyces meyeri. He was treated with 6 weeks of intravenous penicillin regimen followed by 18 months of oral penicillin. Bharath Raj Palraj and Ala S. Dababneh Copyright © 2017 Bharath Raj Palraj and Ala S. Dababneh. All rights reserved. A Dual Case of Peritonitis and Central Nervous System Infection Caused by Nutritionally Variant Streptococcal Species Mon, 23 Jan 2017 00:00:00 +0000 Nutritional variant streptococci (NVS) are difficult to identify bacteria that can cause invasive infections such as endocarditis and meningitis. NVS as a cause of peritonitis has not been routinely described. This case of NVS as the etiology of peritonitis associated with previous neurosurgery and ventriculoperitoneal (VP) shunt revision demonstrates its potential role as a significant pathogen in patients with peritonitis and VP shunts. Therapy consists of vancomycin plus a second agent but since there are no standards for susceptibility testing, clinical response remains the standard for determining the efficacy of treatment. When there is central nervous system (CNS) involvement it is important to include drugs with appropriate CNS penetration. Sussi Vivar, Jennifer E. Girotto, and Thomas S. Murray Copyright © 2017 Sussi Vivar et al. All rights reserved. Unusual Presentation of Cutaneous Leishmaniasis: Ocular Leishmaniasis Sun, 22 Jan 2017 00:00:00 +0000 The leishmaniases are parasitic diseases that are transmitted to humans by infected female sandflies. Cutaneous leishmaniasis (CL) is one of 3 main forms of the disease. CL is the most common form of the disease and is endemic in many urban and rural parts of Iran and usually caused by two species of Leishmania: L. major and L. tropica. We report a case of unusual leishmaniasis with 25 lesions on exposed parts of the body and right eyelid involvement (ocular leishmaniasis). The patient was a 75-year-old male farmer referred to health care center in Aran va Bidgol city. The disease was diagnosed by direct smear, culture, and PCR from the lesions. PCR was positive for Leishmania major. Masoud Doroodgar, Moein Doroodgar, and Abbas Doroodgar Copyright © 2017 Masoud Doroodgar et al. All rights reserved. Disseminated Mycobacterium interjectum Infection with Bacteremia, Hepatic and Pulmonary Involvement Associated with a Long-Term Catheter Infection Wed, 18 Jan 2017 09:45:30 +0000 We present a 49-year-old female with one year of intermittent fevers, chills, night sweats, and significant weight loss. Liver and lung biopsy showed evidence of a granulomatous process. Blood and liver biopsy cultures yielded growth of presumed Mycobacterium interjectum, thought to be related to a disseminated long-term central venous catheter infection. She successfully received one year of combined antimicrobial therapy after catheter removal without recurrence of disease. M. interjectum has been previously described as a cause of lymphadenitis in healthy children and associated with pulmonary disease in adults, although other localized infections have been reported. This is the first case described of a disseminated M. interjectum infection with bacteremia, hepatic and pulmonary involvement associated with a long-term catheter infection. David Sotello, D. Jane Hata, Mohammed Reza, Raj Satyanarayana, Vichaya Arunthari, and Wendelyn Bosch Copyright © 2017 David Sotello et al. All rights reserved. Corynebacterium striatum Bacteremia Associated with a Catheter-Related Blood Stream Infection Wed, 18 Jan 2017 08:08:15 +0000 A 49-year-old woman visited our emergency department because of exertional dyspnea due to severe left ventricular functional failure. It progressed to disseminated intravascular coagulation and disturbance of consciousness on day 67 of admission. Gram-positive bacilli were detected from two different blood culture samples on day 67 of admission. An API-Coryne test and sequencing (1~615 bp) of the 16S rRNA gene were performed, and the strain was identified as Corynebacterium striatum. The bacterium was detected from the removed central venous catheter tip too, and the patient was diagnosed with catheter-related bloodstream infection by C. striatum. However, treatment was not effective, and the patient died on day 73 of admission. Ueno Daisuke, Tomohiro Oishi, Kunikazu Yamane, and Kihei Terada Copyright © 2017 Ueno Daisuke et al. All rights reserved. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia Tue, 17 Jan 2017 05:52:34 +0000 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, and Shigeo Kure Copyright © 2017 Masato Kimura et al. All rights reserved. Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults—Case Report and Review of the Literature Tue, 17 Jan 2017 00:00:00 +0000 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, and Fatih Oner Kaya Copyright © 2017 Zuhal Yesilbag et al. All rights reserved. Disseminated Tuberculosis Presenting as Baker’s Cyst Infection Tue, 10 Jan 2017 00:00:00 +0000 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’s cyst in a 73-year-old immunocompetent male. Najwa Pervin, Sami Akram, Tamer Hudali, Mukul Bhattarai, and Sana Waqar Copyright © 2017 Najwa Pervin et al. All rights reserved. Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box Mon, 09 Jan 2017 13:00:50 +0000 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 cells/mm3 (3,3%) and HIV RNA = 890000 copies/mL (6 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 cells/mm3 (15%) and HIV RNA = 3500 copies/mL (4 log). He developed respiratory failure and progressed to septic shock and death. Those complications might justify the outcome but its autopsy opened Pandora’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, Conceição Souto Moura, and Margarida França Copyright © 2017 Mariana Meireles et al. All rights reserved. Diverticular Pylephlebitis and Polymicrobial Septicemia Mon, 09 Jan 2017 07:05:53 +0000 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, and Chitra Punjabi Copyright © 2017 Pradhum Ram et al. All rights reserved. Severe Thrombocytopenic Purpura in a Child with Brucellosis: Case Presentation and Review of the Literature Tue, 03 Jan 2017 08:52:44 +0000 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, and Nikolaos Chaliasos Copyright © 2017 Alexandros Makis et al. All rights reserved. Successful Treatment of Multiple Multidrug Resistant Intracranial Tuberculomata Thu, 29 Dec 2016 12:32:02 +0000 A 21-year-old Bangladesh-born man presented with a month history of evolving neurological symptoms in the context of a six-month history of fever, night sweats, and axillary lymphadenopathy. He was subsequently diagnosed with multiple multidrug resistant intracranial tuberculomata and was successfully treated over two years. Intracranial multidrug resistant tuberculosis has a high mortality and successful treatment is rarely reported. Management is complex and requires consideration of the penetration and likely effect of antituberculous agents within the central nervous system. We discuss the role of various antituberculous agents, the duration of therapy, the utility of corticosteroids, the value of intrathecal and systemic therapy, and the need for rapid diagnosis. Richard P. Sullivan, Hazel F. Goldberg, Ross S. Mellick, and Jeffrey J. Post Copyright © 2016 Richard P. Sullivan et al. All rights reserved. Spondylodiscitis Caused by Enterobacter agglomerans Thu, 29 Dec 2016 09:57:30 +0000 All over the globe, the incidence of vertebral infection is rising. Nowadays, compared to tuberculous variety, pyogenic spondylodiscitis incidence is high. The increase in the susceptible population and improved diagnostics summatively contributed to this. In clinical grounds, differentiation of pyogenic and tuberculous spondylodiscitis is well defined. Enterobacter agglomerans is a hospital contaminant and associated with infections in immunocompromised individuals and intravenous lines. It causes a wide array of infections. Enterobacter agglomerans spondylodiscitis is unusual and there are, around the globe, only less than 31 suspected cases that have been previously reported. Enterobacter agglomerans histology mimics tuberculous rather than pyogenic spondylodiscitis. A 65-year-old farming lady, while being in hospital, developed sudden onset spastic paraparesis with hyperreflexia. Later blood culture revealed Enterobacter agglomerans with 41-hour incubation in 99.9% probability from Ramel identification system. Her initial ESR was 120 mm/first hour. Isolate was susceptible to ciprofloxacin and intravenous followed with oral therapy shows a drastic ESR fall and improved clinical response. Differentiation of tuberculous and pyogenic spondylodiscitis is very much important in management point of view. Therefore, blood culture has a role in diagnosis of spondylodiscitis. ESR can be used as important inflammatory marker in monitoring the response to treatment. Retrospectively, ESR would aid in reaching a definitive diagnosis. Jayaweera Arachchige Asela Sampath Jayaweera, Mahen Kothalawala, Balachandran Devakanthan, Sinnappoo Arunan, Dinithi Galgamuwa, and Manori Rathnayake Copyright © 2016 Jayaweera Arachchige Asela Sampath Jayaweera et al. All rights reserved. Atypical Mycobacterial Infection after Abdominoplasty Overseas: A Case Report and Literature Review Tue, 27 Dec 2016 08:25:51 +0000 Increasing number of medical tourists travel internationally for cosmetic procedures. Lipotourism is a form of medical tourism becoming popular among patients of developed countries due to the cost efficiency of cosmetic procedures when performed in developing nations. There is a paucity of data on quality, safety, and risks involved with these surgeries. Many cases of infections have been documented in patients following cosmetic surgeries in developing countries. We present a case of a 34-year-old female who underwent abdominoplasty in Dominican Republic that was complicated with development of multiple abdominal wall abscesses due to infection from rapidly growing mycobacteria (RGM). In the absence of clear treatment guidelines, she was treated with a combination of intermittent surgical drainage and prolonged antibiotic course. This case is of interest as more than one species of RGM was isolated from the same patient. Our case highlights the fact that identification of these organisms can be difficult requiring referral of samples to specialized laboratories and treatment duration can last several months, which is determined by clinical and microbiological response. Prabin Sharma, Laia Jimena Vazquez Guillamet, and Goran Miljkovic Copyright © 2016 Prabin Sharma et al. All rights reserved. A Rare Case of Disseminated Pyogenic Gonococcal Infection in an Immunocompetent Woman Tue, 27 Dec 2016 07:44:12 +0000 We present a case of previously healthy, immunocompetent, 41-year-old woman who developed systemic inflammatory response syndrome secondary to Neisseria gonorrhoeae bacteremia. Clinical course was complicated by the simultaneous formation of multiple muscular abscesses, epidural abscess, and septic spondylodiscitis. The patient responded well to prolonged ceftriaxone treatment and was released 10 weeks after initial admission. Spinal lesions and/or pyomyositis individually constitute rare complications of disseminated gonococcal infection. This case, combining both manifestations, is to our knowledge unique. Apropos, diversity of the clinical presentation, and therapeutic challenges for this historical disease are discussed for the practicing physician. Iordanis Romiopoulos, Athina Pyrpasopoulou, Anna Varouktsi, Elisavet Simoulidou, Konstantina Kontopoulou, Ekaterini Karantani, Vivian Georgopoulou, Konstantinos Kitsios, Apostolos Mamopoulos, Charalampos Antachopoulos, Asterios Karagiannis, and Emmanuel Roilides Copyright © 2016 Iordanis Romiopoulos et al. All rights reserved. Human Nasal Myiasis Caused by Oestrus ovis in the Highlands of Cusco, Peru: Report of a Case and Review of the Literature Mon, 26 Dec 2016 08:37:09 +0000 Myiasis is the infestation by dipterous larvae. The larvae can infect intact or decaying tissue including the skin or epithelial surfaces of the orbits, nose, and genitourinary and gastrointestinal tracts. We report a case of primary obligatory nasal myiasis by Oestrus ovis in a 56-year-old man from Cusco in Peru. He presented with nasal pruritus, congestion, and sneezing white “cottony” material. The material was identified as O. ovis larvae. A literature review of publications reporting nasal myiasis caused by O. ovis is presented. P. Hoyer, R. R. Williams, M. Lopez, and M. M. Cabada Copyright © 2016 P. Hoyer et al. All rights reserved. Leprosy with Atypical Skin Lesions Masquerading as Relapsing Polychondritis Mon, 26 Dec 2016 07:23:14 +0000 Leprosy can present with a variety of clinical manifestations depending on the immune status of the individual. After dermatological and neurological involvement, rheumatic features specially various forms of arthritis are the third most common manifestation of the disease. We describe a unique case of a 22-year-old patient presenting with external ear involvement mimicking relapsing polychondritis along with inflammatory joint symptoms and skin lesions. Ear involvement in relapsing polychondritis characteristically is painful and spares the noncartilaginous ear lobules, in contrast to painless ear involvement in leprosy affecting the lobules as well. Histopathology confirmed the diagnosis, although the ear and skin lesions were not classical of leprosy. Such a presentation of leprosy closely mimicking relapsing polychondritis has not been described previously. Tissue diagnosis should always be attempted whenever possible in patients presenting with autoimmune features, so that inappropriate therapy with immunosuppressants is avoided. Punit Pruthi, Hariharan Munganda, Amit Bangia, Uma Rani, Rajesh Budhiraja, and Swapnil Brajpuriya Copyright © 2016 Punit Pruthi et al. All rights reserved. Kawasaki Shock Syndrome in a 12-Year-Old Girl Mimicking Septic Shock Thu, 22 Dec 2016 11:52:40 +0000 Kawasaki disease is diagnosed when fever lasts for more than 5 days with the presence of four out of five of the following clinical features: bilateral conjunctival congestion, changes in the lips and oral cavity, polymorphous exanthem, changes in peripheral extremities, and acute nonpurulent cervical lymphadenopathy (Nakamura et al., 2012). The average age of onset is 2 years and 90% of patients are below 5 years of age. Boys are more affected than girls (Cox and Sallis, 2009). This case report describes an adolescent female who was initially managed as having septic shock and subsequently found to have Kawasaki shock syndrome. Vindika Prasad Sinhabahu, Janani Suntharesan, and Dimuthu Saraji Wijesekara Copyright © 2016 Vindika Prasad Sinhabahu et al. All rights reserved. Identification of Dietzia spp. from Cardiac Tissue by 16S rRNA PCR in a Patient with Culture-Negative Device-Associated Endocarditis: A Case Report and Review of the Literature Thu, 22 Dec 2016 09:40:51 +0000 The genus Dietzia was recently distinguished from other actinomycetes such as Rhodococcus. While these organisms are known to be distributed widely in the environment, over the past decade several novel species have been described and isolated from human clinical specimens. Here we describe the identification of Dietzia natronolimnaea/D. cercidiphylli by PCR amplification and sequencing of the 16S rRNA encoding gene from cardiac tissue in a patient with culture-negative device-associated endocarditis. Praveen Sudhindra, Guiqing Wang, and Robert B. Nadelman Copyright © 2016 Praveen Sudhindra et al. All rights reserved. A Rare Manifestation of Tuberculosis Presenting in the United States Thu, 22 Dec 2016 09:40:42 +0000 A 64-year-old Bangladeshi female presented to her primary care physician with a tender right breast lump that had been present for 4-5 days along with subjective fevers and malaise. Initial biopsy revealed granulomas, but Ziehl-Neelsen and Gram stain were negative for TB so antibiotics were prescribed for abscess until culture came positive for tuberculosis. She was started on triple therapy for extrapulmonary tuberculosis, an exceedingly rare presentation that requires high clinical suspicion in the Western world. Osman Bhatty, David Waters, Nicholas Wilka, Shradha Samuel, John Horne, and Renuga Vivekanandan Copyright © 2016 Osman Bhatty et al. All rights reserved. Rapid Fatal Outcome of Cryptococcal Meningoencephalitis in a Non-HIV Immunocompromised Patient with a Low Fluconazole Susceptibility Isolate: A Case Report from Madagascar Sun, 18 Dec 2016 11:09:25 +0000 Cryptococcal meningoencephalitis is considered rare in HIV-negative individuals. In Madagascar, the epidemiology of cryptococcosis has not yet been well described, neither in immunocompetent nor in immunocompromised patients. We report here the first Malagasy detailed case of cryptococcal meningoencephalitis in a non-HIV immunocompromised adult patient carrying a low fluconazole susceptibility isolate. We emphasize the importance of early and accurate diagnosis to meet the challenges of managing cryptococcosis in developing countries. Mihaja Raberahona, Rivonirina A. Rakotoarivelo, Njary Randriamampionona, Angelot F. Rakotomalala, Tiana Razafinambinintsoa, Thomas Bénet, Philippe Vanhems, Mamy J. D. D. Randria, Muriel Cornet, and Mala Rakoto-Andrianarivelo Copyright © 2016 Mihaja Raberahona et al. All rights reserved. An Unusual Case of Cystic Fibrosis Associated Pneumocystis jiroveci Pneumonia in an Infant Tue, 13 Dec 2016 13:47:08 +0000 Pneumocystis jiroveci pneumonia (PJP) is one of the major infections in patients with impaired immunity. The entity is common in HIV-seropositive individuals but quite very rare in HIV-seronegative individuals especially children. We report here a case of 16-week-old HIV-seronegative infant with chief complaint of chronic cough of one month of evolution. Sweat chloride test for diagnosis of cystic fibrosis was positive. Bronchoalveolar lavage (BAL) fluid was collected and Pseudomonas aeruginosa was isolated on culture. Empirical antibiotic regimen comprising ceftriaxone and azithromycin was initiated that was switched to meropenem as per antimicrobial susceptibility report, but the patient did not improve. Subsequently, an immunofluorescence staining of BAL fluid was performed and P. jiroveci cysts were detected. Following a laboratory confirmation of Pneumocystis pneumonia, cotrimoxazole was added and the clinical condition of the patient significantly improved. This is an unusual case wherein unsuspected PJP occurred and since signs and symptoms of the patient persisted even after the initiation of antimicrobial therapy for Pseudomonas infection and resolved only after treatment for PJP was started, it suggests a causative role of P. jiroveci rather than colonization/contamination. Ravinder Kaur, Priyanka Katariya, Megh Singh Dhakad, Bhanu Mehra, Urmila Jhamb, and A. P. Dubey Copyright © 2016 Ravinder Kaur et al. All rights reserved. Spinal Tuberculosis and Cold Abscess without Known Primary Disease: Case Report and Review of the Literature Tue, 13 Dec 2016 13:35:23 +0000 Extrapulmonary tuberculosis (TB) is uncommon but not rare. Bone and joint involvement constitute about 10% of extrapulmonary TB cases, with the spine being the most frequently affected site. Spinal TB patients typically present with back pain but other constitutional or pulmonary symptoms may be absent, rendering the diagnosis difficult. This case explores challenges in the diagnosis of spinal TB. We report a case of a 39-year-old woman presenting with vague back swelling for many years. Imaging revealed osteomyelitis of the spine but initial studies and cultures were negative for Mycobacterium tuberculosis. The diagnosis was confirmed weeks later when cultures demonstrated Mycobacterium tuberculosis. Considering the severe complications of untreated spinal TB including paraplegia and need for surgical intervention, high suspicion is critical in early diagnosis. Rima Patel, Vedavyas Gannamani, Emily Shay, and David Alcid Copyright © 2016 Rima Patel et al. All rights reserved. Meningitis Caused by Salmonella Newport in a Five-Year-Old Child Mon, 12 Dec 2016 15:32:54 +0000 Salmonella Newport is a Gram-negative bacillus belonging to the Enterobacteria family and the nontyphi Salmonella (NTS), usually related to gastroenteritis. Main difference between NTS and Salmonella typhi is that the last one evolves to an invasive disease easier than NTS. These can progress to bacteremias in around 5% of cases and secondary focuses can appear occasionally, as in meningitis. An infection of the central nervous system is uncommon, considering its incidence in 0.6–8% of the cases; most of them are described in developing countries and mainly in childhood, especially neonates. Bacterial meningitis by NTS mostly affects immunosuppressed people in Europe. Prognosis is adverse, with a 50% mortality rate, mainly due to complications of infection: hydrocephalus, ventriculitis, abscesses, subdural empyema, or stroke. Choice antibiotic treatments are cefotaxime, ceftriaxone, or ceftazidime. The aim of this paper is to present a case of meningitis caused by Salmonella Newport diagnosed in a five-year-old girl living in a rural area of the province of Ourense (Spain), with favorable evolution and without neurological disorders. Ana De Malet, Sheila Ingerto, and Israel Gañán Copyright © 2016 Ana De Malet et al. All rights reserved.