Case Reports in Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. A Rare Case of Mediterranean Spotted Fever and Encephalitis Wed, 07 Dec 2016 10:11:07 +0000 Mediterranean spotted fever is a tick-borne zoonotic disease caused by Rickettsia conorii. It is transmitted by the dog tick Rhipicephalus sanguineus. It usually presents as a benign self-limited disease characterized by a skin rash, high fever, and, sometimes, a characteristic ulcer at the tick bite site called tache noir. The course of this disease is usually benign, although severe manifestations have been previously described, mainly in adults. Neurological manifestations are very unusual. We present a case of Mediterranean spotted fever with encephalitis to highlight the importance of clinical suspicion, mainly in endemic areas, the potential severity of this disease, and the need of early initiation of therapy in order to prevent severe complications. Raquel Sousa Almeida, Petra M. Pego, Maria João Pinto, and João Matos Costa Copyright © 2016 Raquel Sousa Almeida et al. All rights reserved. Forgotten but Not Gone! Syphilis Induced Tenosynovitis Tue, 06 Dec 2016 09:01:28 +0000 Objective. Tenosynovitis, inflammation of a tendon and its synovial sheath, is a rare manifestation of secondary syphilis and if diagnosed early is reversible. Background. A 52-year-old male with past medical history of untreated syphilis presented with gradual onset of swelling and pain of the right fourth metacarpophalangeal joint (MCP). He reported a history of painless penile lesions after having sexual intercourse with a new partner approximately five months ago which was treated with sulfamethoxazole/trimethoprim. An RPR done at that time came back positive with a high titer; however, patient was lost to follow-up. On examination, patient had an edematous, nonerythematous right fourth proximal interphalangeal (PIP) joint. Urgent irrigation, debridement, and exploration of the right hand into the tendon sheath were performed. With his history of syphillis, an RPR was done, which was reactive with a titer of 1 : 64. A confirmatory FTA-ABS test was completed, rendering a positive result. Based on his history of untreated syphilis, dormancy followed by clinical scenario of swelling of the right fourth finger, and a high RPR titer, he was diagnosed with secondary syphilis manifesting as tenosynovitis. Felicia Ratnaraj, David Brooks, Mollie Walton, Arun Nagabandi, and Mahmoud Abu Hazeem Copyright © 2016 Felicia Ratnaraj et al. All rights reserved. The Liver as Another Possible Target Organ for Bacillus cereus Infection Tue, 29 Nov 2016 06:26:58 +0000 A case of liver abscess due to Bacillus cereus infection in an immunocompetent 59-year-old man is reported. Percutaneous drainage and antimicrobial therapy, with vancomycin and levofloxacin afterwards, have been demonstrated to be an appropriate treatment, leading to clinical and radiological cure. Mario Alessandri-Bonetti, Umberto Vespasiani-Gentilucci, Giacomo Luppi, Silvia Angeletti, Giordano Dicuonzo, and Antonio Picardi Copyright © 2016 Mario Alessandri-Bonetti et al. All rights reserved. Fatal Dengue Myocarditis despite the Use of Extracorporeal Membrane Oxygenation Mon, 28 Nov 2016 13:43:05 +0000 Dengue is an important mosquitoes-borne viral disease which is endemic in tropics and subtropics region. Rapid spreading of disease to previously unaffected region was found in recent years. Atypical manifestations, such as myocarditis, were reported during large outbreak. There is a wide range of clinical manifestations of cardiac involvement in dengue, but rarely fatal. Here we reported a case of fulminant dengue myocarditis in fatal outcome despite cardiac mechanical support. Yee-Huang Ku and Wen-Liang Yu Copyright © 2016 Yee-Huang Ku and Wen-Liang Yu. All rights reserved. Nigerian Female with Skin Lesions in the Leg and Face: Herpetic Sycosis Folliculitis Sun, 27 Nov 2016 11:49:54 +0000 Nongenital HSV 1 presents outside the mucus membrane. Our patient had unusual presentation that caused diagnostic dilemma. 30-year-old native Nigerian female coming with fiancée to the United States presented to our service one day after arrival through ER with a lesion on her right ankle. She was diagnosed with cellulitis, started on antibiotics, and admitted to hospital. She had fever of 39.1°C. Head and neck exam showed multiple sized lesions over tongue and palate and inner aspect of lower lip. Abdomen and genital exam was normal. Skin exam showed lesions over the face and lesions over the lateral aspect of the right leg. There was ulcerated lesion over the right lateral malleolus with surrounding erythema and edema. Her tests showed elevated ESR of 98; HIV test was negative; CT scan of the ankle showed no abscess or osteomyelitis. TB quantiferon was indeterminate; AFB stain and culture were negative; HSV IgM was elevated at 1 : 16; RPR was negative; ANA was negative; malaria screen was negative, and blood cultures were negative for bacteria, fungus, and virus. Debrided wound had no growth of bacteria or fungus or virus. This case illustrates the unusual presentation of the HSV1 outside the mucus membrane and how it can be confused with other conditions that required extensive tests. Therapeutic trail with antiviral medications resolved lesions over the leg and face. Dominique Dilorenzo, Naganna Channaveeraiah, Patricia Gilford, and Bruce Deschere Copyright © 2016 Dominique Dilorenzo et al. All rights reserved. Multiple Renal Abscesses due to ESBL Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Causing Acute Pyelonephritis and Bacteremia: A Case Report with a Good Outcome (No Drainage Required) Sun, 27 Nov 2016 11:36:01 +0000 Extended-spectrum beta-lactamase-producing Enterobacteriaceae urinary tract infections are challenging infections with increased mortality, morbidity, and failure of therapy. A 44-year-old Saudi male diabetic patient was seen at the ER of IMC Hospital with features of acute pyelonephritis: fever, burning urine, and left flank pain for three days. He was treated for cystitis at the Endocrine Clinic two weeks prior to his ER visit with nitrofurantoin and levofloxacin orally according to urine culture and sensitivity result. The patient was admitted, received IV meropenem, and continued to be febrile for three days. His urine and blood culture at ER grew the same ESBL-producing E. coli as in his urine culture from the Endocrine Clinic. His abdomen CT scan showed two left renal abscesses at the upper and middle poles. His temperature resolved on the fourth day of IV therapy. Intravenous meropenem was continued for 4 weeks after inserting PICC line and the patient was followed up by home healthcare. He was feeling better with occasional left flank pain and repeated abdomen CT scan showed complete resolution of both renal abscesses. Abdalla Khalil, Musaad Qurash, Asem Saleh, Rasha Ali, and Mohamed Elwakil Copyright © 2016 Abdalla Khalil et al. All rights reserved. Cryptococcus gattii in an Immunocompetent Patient in the Southeastern United States Sun, 27 Nov 2016 08:08:06 +0000 Cryptococcal infections are seen throughout the United States in both immunocompromised and immunocompetent patients. The most common form is C. neoformans. In the Northwestern United States, C. gattii has received considerable attention secondary to increased virulence resulting in significant morbidity and mortality. There are no cases in the extant literature describing a patient with C. gattii requiring neurosurgical intervention in Alabama. A middle-aged immunocompetent male with no recent travel or identifiable exposure presented with meningitis secondary to C. gattii. The patient underwent 12 lumbar punctures and a ventriculoperitoneal shunt and required 83 days of inpatient therapy with 5-flucytosine and amphotericin B. The patient was found to have multiple intracranial lesions and a large intramedullary spinal cryptococcoma within his conus. Following an almost 3-month hospitalization the patient required treatment with oral voriconazole for one year. In the United States meningitis caused by C. gattii infection is not isolated to the Northwestern region. John W. Amburgy, Joseph H. Miller, Benjamin J. Ditty, Patrick Vande Lune, Shaaf Muhammad, and Winfield S. Fisher III Copyright © 2016 John W. Amburgy et al. All rights reserved. A Rare Case of Coexistence of Borderline Lepromatous Leprosy with Tuberculosis Verrucosa Cutis Thu, 24 Nov 2016 14:35:10 +0000 Occurrence of pulmonary tuberculosis with leprosy is known but association of cutaneous tuberculosis with leprosy is rare. We report a case of borderline lepromatous leprosy coexistent with tuberculosis verrucosa cutis in a 29-year-old male, who presented with multiple skin coloured nodules and hyperkeratotic scaly lesions of 3-month duration. Dual infections are associated with high mortality and morbidity. Therefore early diagnosis and management helps to reduce mortality and to mitigate the effects of morbidity. Biswajit Dey, Debasis Gochhait, Nagendran Prabhakaran, Laxmisha Chandrashekar, and Biswanath Behera Copyright © 2016 Biswajit Dey et al. All rights reserved. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter Tue, 22 Nov 2016 13:22:49 +0000 Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients. R. Zea-Vera, M. Sanchez, E. Castañeda, and L. Soto-Arquiñigo Copyright © 2016 R. Zea-Vera et al. All rights reserved. Rituximab-Associated Inflammatory Progressive Multifocal Leukoencephalopathy Mon, 14 Nov 2016 13:33:19 +0000 Progressive multifocal leukoencephalopathy (PML) is a rare disease of the immunosuppression that results from neurotropic invasion of the JC virus which leads to demyelination of oligodendrocytes. Immune reconstitution inflammatory syndrome (IRIS), on the other hand, is a condition of inflammation that develops as the immune system reconstitutes. This case report describes a case of a 35-year-old HIV-negative male who presented with three weeks of right lower extremity paresthesias as well as right upper extremity apraxia. He was diagnosed with PML complicated by IRIS secondary to Rituximab, which he had completed four months prior to presentation. Despite the condition’s poor prognosis, the patient recovered with only minor deficits. Chandra Punch, Christina Schofield, and Penelope Harris Copyright © 2016 Chandra Punch et al. All rights reserved. Mycoplasma hominis Induces Mediastinitis after a Tonsillar Abscess Thu, 10 Nov 2016 14:46:41 +0000 Mycoplasma hominis is commonly involved in genitourinary tract infections. We report a 59-year-old man who developed a M. hominis-associated mediastinitis following acute tonsillar infection. Anna Grancini, Manuela Colosimo, Antonella Restelli, Rosaria Colombo, Anna Maraschini, Cristina Pozzi, Giuseppe Breda, Alessandro Protti, Milena Arghittu, Luca Gallelli, and Rita Maiavacca Copyright © 2016 Anna Grancini et al. All rights reserved. Symptomatic Acute Hepatitis C Infection Following a Single Episode of Unprotected Sexual Intercourse Thu, 10 Nov 2016 06:02:45 +0000 A previously healthy 23-year-old MSM presented with jaundice, systemic upset, and rash 2 months after a single episode of unprotected sexual intercourse. Liver biochemistry was grossly deranged, with markedly elevated transaminases and hyperbilirubinaemia. Serology was positive for genotype 1a hepatitis C virus (HCV) and in the absence of other causes, acute HCV infection was suspected. He was subsequently successfully treated with pegylated interferon and ribavirin for 24 weeks and made a full clinical and biochemical recovery. Benjamin Butler, Bhaskar Narayan, Jonathan Potts, and Julian Emmanuel Copyright © 2016 Benjamin Butler et al. All rights reserved. Disseminated Cryptococcal Disease in Non-HIV, Nontransplant Patient Wed, 09 Nov 2016 13:20:50 +0000 Disseminated cryptococcal infection carries a high risk of morbidity and mortality. Typical patients include HIV individuals with advanced immunosuppression or solid organ or hematopoietic transplant recipients. We report a case of disseminated cryptococcal disease in a 72-year-old male who was immunocompromised with chronic lymphocytic leukemia and ongoing chemotherapy. The patient presented with a subacute history of constitutional symptoms and headache after he received five cycles of FCR chemotherapy (fludarabine/cyclophosphamide/rituximab). Diagnosis of disseminated cryptococcal disease was made based on fungemia in peripheral blood cultures with subsequent involvement of the brain, lungs, and eyes. Treatment was started with liposomal amphotericin, flucytosine, and fluconazole as induction. He was discharged after 4 weeks of hospitalization on high dose fluconazole for consolidation for 2 months, followed by maintenance therapy. F. AlMutawa, D. Leto, and Z. Chagla Copyright © 2016 F. AlMutawa et al. All rights reserved. Primary Cutaneous Actinomycosis along with the Surgical Scar on the Hand Wed, 09 Nov 2016 13:10:26 +0000 Primary cutaneous actinomycosis is a rare clinical form with variable presentation. The tumoral presentation of actinomycosis as pseudocarcinomatous or sarcomatous masses is completely rare. The management of cutaneous actinomycosis needs proper antibiotic treatment and surgical resection would not be adequate alone. Herein, we report a case of primary cutaneous actinomycosis on the dorsal surface of the hand as draining and infiltrated lesions along with the scar of previous tumor excision that had not received proper antibiotics after the surgery. Reza M. Robati, Nasim Niknezhad, Farahnaz Bidari-Zerehpoush, and Nakisa Niknezhad Copyright © 2016 Reza M. Robati et al. All rights reserved. Subacute Bacterial Endocarditis with Leptotrichia goodfellowii in a Patient with a Valvular Allograft: A Case Report and Review of the Literature Tue, 08 Nov 2016 13:30:24 +0000 Leptotrichia species are normal constituents of the oral cavity and the genitourinary tract microbiota that are known to provoke disease in immunocompromised patients and rarely in immunocompetent individuals. Following the description of Leptotrichia goodfellowii sp. nov., two cases of endocarditis by this species have been reported. Here, we report a case of Leptotrichia goodfellowii endocarditis in an immunocompetent patient with a valvular allograft. The isolation and identification of Leptotrichia can be challenging, and it is likely that infection with this pathogen is significantly underdiagnosed. A definitive identification, as in this case, most often requires 16S rRNA gene sequencing, highlighting the increasingly important role of this diagnostic modality among immunocompetent patients with undetermined anaerobic bacteremia. Wilfredo R. Matias, Daniel L. Bourque, Tomoko Niwano, Andrew B. Onderdonk, and Joel T. Katz Copyright © 2016 Wilfredo R. Matias et al. All rights reserved. A Case of False-Positive Mycobacterium tuberculosis Caused by Mycobacterium celatum Tue, 08 Nov 2016 09:24:55 +0000 Mycobacterium celatum is a nontuberculous mycobacterium shown to cause symptoms similar to pulmonary M. tuberculosis. Certain strains have been shown to cross-react with the probes used to detect M. tuberculosis, making this a diagnostic challenge. We present a 56-year-old gentleman who developed signs and symptoms of lung infection with computed tomography scan of the chest showing right lung apex cavitation. Serial sputum samples were positive for acid-fast bacilli and nucleic acid amplification testing identified M. tuberculosis ribosomal RNA, resulting in treatment initiation. Further testing with high performance liquid chromatography showed a pattern consistent with M. celatum. This case illustrates the potential for M. celatum to mimic M. tuberculosis in both its clinical history and laboratory testing due to the identical oligonucleotide sequence contained in both. An increasing number of case reports suggest that early reliable differentiation could reduce unnecessary treatment and public health intervention associated with misdiagnosed tuberculosis. Edward Gildeh, Zaid Abdel-Rahman, Ruchira Sengupta, and Laura Johnson Copyright © 2016 Edward Gildeh et al. All rights reserved. Candida glabrata Pneumonia in a Patient with Chronic Obstructive Pulmonary Disease Wed, 02 Nov 2016 11:11:26 +0000 Pneumonia remains an important cause of morbidity and mortality among infectious diseases. Streptococcus pneumoniae and viruses are the most common cause of pneumonia. Candidiasis in such patients has been associated with haemodialysis, fungal colonization, exposure to broad-spectrum antibiotics, intensive care unit (ICU) hospitalization, and immunocompromised patients. The most common cause of infection is C. albicans. The case presented here is of a 66-year-old male patient diagnosed with C. glabrata. The patient suffered from chronic obstructive pulmonary disease. Onur Yazici, Mustafa Cortuk, Hasan Casim, Erdogan Cetinkaya, Ali Mert, and Ali Ramazan Benli Copyright © 2016 Onur Yazici et al. All rights reserved. Nicolau Syndrome due to Penicillin Injection: A Report of 3 Cases without Long-Term Complication Tue, 01 Nov 2016 07:35:53 +0000 Nicolau syndrome (NS) or livedo-like dermatitis is a rare complication of injection of various medications such as penicillin. The pathophysiology of this events is not clear, but some hypotheses are suggested, such as sympathetic nerve stimulation, embolic occlusion, inflammation, or mechanical injury. In this paper we report 3 cases of NS following benzathine penicillin. Clinical symptoms improved in 2 cases during 2-month follow-up, but one of them had a residual necrosis in the distal phalanges of the toes. Sara Memarian, Behdad Gharib, Mohammd Gharagozlou, Hosein Alimadadi, Zahra Ahmadinejad, and Vahid Ziaee Copyright © 2016 Sara Memarian et al. All rights reserved. An Uncommon Feature of Chronic Granulomatous Disease in a Neonate Mon, 31 Oct 2016 11:41:33 +0000 Chronic Granulomatous Disease (CGD) represents recurrent life-threatening bacterial and fungal infections and granuloma formation with a high mortality rate. CGD’s sign and symptoms usually appear in infancy and children before the age of five; therefore, its presentation in neonatal period with some uncommon features may be easily overlooked. Here we describe a case of CGD in a 24-day-old boy, presenting with a diffuse purulent vesiculopustular rash and multiple osteomyelitis. Razieh Afrough, Sayyed Shahabeddin Mohseni, and Setareh Sagheb Copyright © 2016 Razieh Afrough et al. All rights reserved. Bacteremia Caused by Kocuria kristinae from Egypt: Are There More? A Case Report and Review of the Literature Mon, 31 Oct 2016 11:12:43 +0000 Kocuria kristinae is opportunistic Gram-positive cocci from the family Micrococcaceae. It is usually considered part of the normal flora that rarely is isolated from clinical specimens. Here, we report a case of Kocuria kristinae bacteremia; to the best of our knowledge, this is the first report from Egypt. Reem M. Hassan, Dina M. Bassiouny, and Yomna Matar Copyright © 2016 Reem M. Hassan et al. All rights reserved. Infrarenal Aorta Thrombosis Associated with H1N1 Influenza A Virus Infection Mon, 31 Oct 2016 09:41:10 +0000 Influenza viruses are members of the Orthomyxoviridae family, of which influenza A, B, and C viruses constitute three separate genera. Arterial thrombosis associated with H1N1 influenza A virus infection has rarely been reported. A Turkish man aged 28 years was admitted to our emergency department with dyspnea, bilateral lower extremity insensitivity, and cold. He reported symptoms of fever, myalgia, and cough, which he had had for fifteen days before being admitted to our hospital. The patient was tested for pandemic influenza A (H1N1) virus using polymerase chain reaction (PCR) tests, which were positive. Abdominal computerized tomography with contrast revealed a large occlusive thrombus within the infrarenal aorta. Can Hüzmeli, Mustafa Saglam, Ali Arıkan, Barıs Doner, Gulay Akıncı, and Ferhan Candan Copyright © 2016 Can Hüzmeli et al. All rights reserved. Pulmonary Kaposi Sarcoma: An Uncommon Cause of Respiratory Failure in the Era of Highly Active Antiretroviral Therapy—Case Report and Review of the Literature Sun, 30 Oct 2016 09:49:45 +0000 Kaposi Sarcoma (KS) is the most common malignancy associated with Acquired Immune Deficiency Syndrome (AIDS) and is caused by Human Herpesvirus 8 (HHV 8) or Kaposi Sarcoma Herpesvirus (KSHV). In about 90% of cases Kaposi Sarcoma is associated with cutaneous lesions; however visceral disease can occur in the absence of cutaneous involvement. In the era of Highly Active Antiretroviral Therapy (HAART), the incidence of KS has declined. Clinical features of pulmonary KS might be difficult to distinguish from pneumonia in the immunocompromised patients and could lead to diagnostic challenges. First-line treatment of KS is with HAART and the incidence has declined with its use. Systemic chemotherapy may play a role depending on the extent of the disease. We report the case of a young man who presented with pulmonary symptoms and was later found to have pulmonary KS. Interestingly this diagnosis was made in the absence of the classic skin lesions. His disease was complicated by progressive respiratory failure and he eventually died. Stanley M. Nwabudike, Stefan Hemmings, Yonette Paul, Yordanis Habtegebriel, Octavius Polk, and Alem Mehari Copyright © 2016 Stanley M. Nwabudike et al. All rights reserved. Direct Acting Antivirals in Patients with Chronic Hepatitis C and Down Syndrome Wed, 26 Oct 2016 07:09:15 +0000 Patients with Down syndrome who received blood transfusions, likely in conjunction with cardiothoracic surgery for congenital heart disease and prior to the implementation of blood-donor screening for hepatitis C virus infection, face a substantial risk of acquiring the infection. In the past, interferon-based therapy for chronic hepatitis C infection in patients with Down syndrome was noted to have lower efficacy and potentially higher risk of adverse effects. Recently, the treatment for chronic hepatitis C has been revolutionized with the introduction of interferon-free direct acting antivirals with favorable safety, tolerability, and efficacy profile. Based on our experiences, the newly approved sofosbuvir-based direct acting antiviral therapy is well tolerated and highly efficacious in this subpopulation of hepatitis C virus infected patients with Down syndrome. Eric R. Yoo, Ryan B. Perumpail, George Cholankeril, and Aijaz Ahmed Copyright © 2016 Eric R. Yoo et al. All rights reserved. A Rare Case of Glossitis due to Pasteurella multocida after a Cat Scratch Thu, 20 Oct 2016 14:36:23 +0000 Pasteurella is one of the zoonotic pathogens that can cause variety of serious infections in animals and humans such as bacteremia, septic shock, endocarditis, meningitis, prosthetic and native valve infections, osteomyelitis, skin and soft tissue infections, abscesses, and even pneumonia with empyema. However, there have been few reports of upper respiratory involvements like tonsillitis and epiglottitis in humans. We present a case of recurrent Pasteurella glossitis after a cat scratch which has not been reported in humans. Negin Niknam, Thien Doan, and Elizabeth Revere Copyright © 2016 Negin Niknam et al. All rights reserved. Chronic Leptomeningitis and Spinal Intradural Mass Secondary to Alternaria Infection in a Patient with Ventriculoperitoneal Shunt Thu, 20 Oct 2016 13:10:01 +0000 Fungal infection following placement of ventriculostomy or ventriculoperitoneal (VP) shunt is uncommon. We report the first case of Alternaria related central nervous system (CNS) shunt infection in a patient with CNS ependymoma manifesting as leptomeningitis and a spinal intradural mass. This case illustrates the diagnostic and management challenges. Sanjeet S. Dadwal, Russell Thompson, Rahul Jandial, Bernard Tegtmeier, and Mike Yue Chen Copyright © 2016 Sanjeet S. Dadwal et al. All rights reserved. Histoplasmosis-Induced Hemophagocytic Lymphohistiocytosis in an Adult Patient: A Case Report and Review of the Literature Tue, 18 Oct 2016 13:56:08 +0000 Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threating immune dysregulation syndrome characterized by persistent activation of the mononuclear phagocytic system leading to uncontrolled systemic hyperinflammatory response. The proliferation and activation of histiocytes and lymphocytes lead to production of large amounts of cytokines, also called cytokine storm. Hematopoietic and lymphoid tissues are directly involved while other organs are damaged by circulating cytokines. Primary HLH is attributed to genetic defects of the immune system and secondary HLH is usually seen in adults secondary to malignancy, infection, or autoimmune diseases. Zoonotic diseases including fungal infections are an important cause of HLH. Secondary HLH can delay the recognition of the underlying zoonoses. We report the case of a 61-year-old female with history of rheumatoid arthritis with histoplasmosis associated hemophagocytic lymphohistiocytosis. Ramona Vesna Untanu, Syed Akbar, Stephen Graziano, and Neerja Vajpayee Copyright © 2016 Ramona Vesna Untanu et al. All rights reserved. First Report of AIDS-Related Burkitt’s Lymphoma Presenting as Bilateral Orbital Masses Thu, 13 Oct 2016 13:40:13 +0000 Burkitt’s lymphoma (BL) is an aggressive B-cell non-Hodgkin’s lymphoma and one of the fastest growing tumors in humans. It is an acquired immunodeficiency syndrome- (AIDS-) defining disease and occurs with relatively preserved CD4 cell counts. It rarely affects the orbital region in the setting of AIDS. We report unusual presentation of a fatal case of AIDS-associated BL in a 42-year-old female patient with severe CD4 cell depletion who presented with dramatic fast growing (within days) bilateral orbital masses leading to striking facial deformities. To the best of our knowledge, this is the first report of bilateral orbital involvement in AIDS-associated BL. Monica Alves de Almeida, Juliana Nesi Cardoso Migliano Porto, Ana Carolina de Brito Lyra, Luiz Arthur Calheiros Leite, Rodrigo Panno Basilio-de-Oliveira, Rogério Neves-Motta, Andréa Ramos Correa, Fernando Raphael de Almeida Ferry, Walter de Araujo Eyer-Silva, and Ronaldo Grechi Pacheco Copyright © 2016 Monica Alves de Almeida et al. All rights reserved. Neurobrucellosis: A Case Report from Himachal Pradesh, India, and Review of the Literature Thu, 13 Oct 2016 07:42:40 +0000 Human brucellosis is a multisystem disease that commonly presents as a febrile illness along with variable spectrum of clinical manifestations. Neurological complications include encephalitis, meningoencephalitis, radiculitis, myelitis, peripheral and cranial neuropathies, subarachnoid hemorrhage, and psychiatric manifestations. We report a case diagnosed as neurobrucellosis who presented with fever and bilateral upper motor neuron symptoms and signs along with bilateral sensorineural deafness. Diagnosis was confirmed by Rose Bengal Test (RBT) and standard tube agglutination test (SAT). Sujeet Raina, Ashish Sharma, Rajesh Sharma, and Amit Bhardwaj Copyright © 2016 Sujeet Raina et al. All rights reserved. Persistent Bacteremia from Pseudomonas aeruginosa with In Vitro Resistance to the Novel Antibiotics Ceftolozane-Tazobactam and Ceftazidime-Avibactam Wed, 12 Oct 2016 13:06:22 +0000 Ceftazidime-avibactam and ceftolozane-tazobactam are new antimicrobials with activity against multidrug-resistant Pseudomonas aeruginosa. We present the first case of persistent P. aeruginosa bacteremia with in vitro resistance to these novel antimicrobials. A 68-year-old man with newly diagnosed follicular lymphoma was admitted to the medical intensive care unit for sepsis and right lower extremity cellulitis. The patient was placed empirically on vancomycin and piperacillin-tazobactam. Blood cultures from Day 1 of hospitalization grew P. aeruginosa susceptible to piperacillin-tazobactam and cefepime identified using VITEK 2 (Biomerieux, Lenexa, KS). Repeat blood cultures from Day 5 grew P. aeruginosa resistant to all cephalosporins, as well as to meropenem by Day 10. Susceptibility testing performed by measuring minimum inhibitory concentration by -test (Biomerieux, Lenexa, KS) revealed that blood cultures from Day 10 were resistant to ceftazidime-avibactam and ceftolozane-tazobactam. The Verigene Blood Culture-Gram-Negative (BC-GN) microarray-based assay (Nanosphere, Inc., Northbrook, IL) was used to investigate underlying resistance mechanism in the P. aeruginosa isolate but CTX-M, KPC, NDM, VIM, IMP, and OXA gene were not detected. This case report highlights the well-documented phenomenon of antimicrobial resistance development in P. aeruginosa even during the course of appropriate antibiotic therapy. In the era of increasing multidrug-resistant organisms, routine susceptibility testing of P. aeruginosa to ceftazidime-avibactam and ceftolozane-tazobactam is warranted. Emerging resistance mechanisms to these novel antibiotics need to be further investigated. Louie Mar Gangcuangco, Patricia Clark, Cynthia Stewart, Goran Miljkovic, and Zane K. Saul Copyright © 2016 Louie Mar Gangcuangco et al. All rights reserved. Familial Adenomatous Polyposis Manifesting as Lactococcus Endocarditis: A Case Report and Review of the Association of Lactococcus with Underlying Gastrointestinal Disease Wed, 12 Oct 2016 12:57:26 +0000 A 45-year-old male with a prosthetic aortic valve presented to the hospital with several months of generalized malaise. On admission, he was noted to have anemia of unclear etiology and subsequently became febrile with multiple blood cultures growing Lactococcus garvieae. Inpatient workup was concerning for infectious endocarditis (IE) secondary to Lactococcus. The patient was discharged home with appropriate antimicrobial therapy; however, he was readmitted for persistent, symptomatic anemia and underwent colonoscopy, which revealed innumerable colonic polyps consistent with Familial Adenomatous Polyposis (FAP) that was later confirmed with genetic testing. Surveillance computed tomography (CT) imaging of the aortic repair later demonstrated valve dehiscence with surrounding fluid collection; he underwent redo surgery and was found to have destruction of the aortic annulus and a large pseudoaneurysm. Histopathology of the valve prosthesis confirmed IE. It is suspected that the patient developed Lactococcus IE from enteric translocation. Review of the literature provides several reports of Lactococcus infections in association with underlying gastrointestinal disease, including colorectal cancer. Given this association, we raise the question of whether the diagnosis of Lactococcus IE should evoke suspicion and encourage evaluation for gastrointestinal pathology, as occurs with Streptococcus bovis. Taylor C. Bazemore, Stacey A. Maskarinec, Kahli Zietlow, Edward F. Hendershot, and John R. Perfect Copyright © 2016 Taylor C. Bazemore et al. All rights reserved.