scholarly journals Endobronchial Enigma: A Clinically Rare Presentation ofNocardia beijingensisin an Immunocompetent Patient

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Nader Abdel-Rahman ◽  
Shimon Izhakain ◽  
Walter G. Wasser ◽  
Oren Fruchter ◽  
Mordechai R. Kramer
Keyword(s):  
Present Report ◽  
Signs And Symptoms ◽  
Immunocompetent Patient ◽  
Clinical Findings ◽  
Community Acquired Pneumonia ◽  
Rare Presentation ◽  
Pulmonary Nocardiosis ◽  
Neoplastic Processes ◽  
Paratracheal Lymph Node ◽  
Aerobic Actinomycetes

Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonaryNocardia beijingensisas an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual.

scholarly journals An Unusual Case of Pulmonary Nocardiosis in Immunocompetent Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Zehra Yaşar ◽  
Murat Acat ◽  
Hilal Onaran ◽  
Mehmet Akif Özgül ◽  
Neslihan Fener ◽  
...  
Keyword(s):  
Microscopic Examination ◽  
Unusual Case ◽  
Immunocompetent Patient ◽  
Necrotizing Pneumonia ◽  
Gram Positive ◽  
Antituberculosis Drugs ◽  
Gram Positive Bacteria ◽  
Pulmonary Nocardiosis ◽  
Aerobic Actinomycetes

Pulmonary nocardiosis is a subacute or chronic necrotizing pneumonia caused by aerobic actinomycetes of the genusNocardiaand rare in immune-competent patients. A 35-year-old male, who had treated with antituberculosis drugs, presented with cough, dyspnea, and expectoration with episodes of hemoptysis with purulent sputum. The diagnosis of nocardiosis was made by microscopic examination of the surgically resected portion of the lung and revealed filamentous Gram-positive bacteria.

scholarly journals Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis

2019 ◽  
Author(s):  
Adeel Nasrullah ◽  
Anam Javed ◽  
Usman Tariq ◽  
Meilin Young ◽  
Zunera Moeen ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Purpura Fulminans ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Community Acquired Pneumonia ◽  
Rare Presentation ◽  
Disseminated Intravascular Coagulopathy ◽  
Intravascular Thrombosis ◽  
Pneumococcal Sepsis ◽  
Intravascular Coagulopathy

Infectious purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) due to diffuse intravascular thrombosis and haemorrhagic infarction of the skin. PF can present in infancy/childhood or adulthood and usually presents as ecchymotic skin lesions, fever and hypotension. It is most commonly a consequence of sepsis related to Neisseria meningitidis, Streptococcus pneumoniae or Haemophilus influenzae. Despite aggressive management of sepsis with intravenous fluids, antibiotics, and conventional and nonconventional therapies, the condition still carries a mortality rate of 43%[1]. Streptococcus pneumoniae mostly presents with community-acquired pneumonia. We present a case of PF secondary to DIC related to Pneumococcal sepsis in an otherwise healthy and immunocompetent patient.

scholarly journals A rare case of right-sided varicocele in right renal tumor in the absence of venous thrombosis and IVC compression

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Priyabrata Adhikari ◽  
Siddalingeshwar I. Neeli ◽  
Shyam Mohan
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Renal Vein ◽  
Renal Tumor ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Spermatic Vein ◽  
Careful Study ◽  
Rare Presentation ◽  
Grade 3

Abstract Background The presence of unilateral right-sided varicocele hints at a serious retroperitoneal disease such as renal cell neoplasm. Such tumors are usually associated with a thrombus in renal vein or spermatic vein. We report a rare presentation of right-sided renal tumor causing right-sided varicocele in the absence of thrombus in renal vein and spermatic vein but due to an anomalous vein draining from the tumor into the spermatic vein as demonstrated by computed tomography angiogram. Case presentation A 54-yr-old hypertensive male presented with unilateral grade 3 right-sided varicocele and no other signs and symptoms. Ultrasound examination of his abdomen showed the presence of a mass lesion in the lower pole of right kidney. Computed tomography confirmed the presence of right renal mass, absence of thrombus in right renal vein or inferior vena cava. The angiographic phase of CT scan showed an anomalous vein from the tumor draining into the pampiniform plexus causing varicocele. Conclusion The presence of right-sided varicocele should raise a suspicion hidden serious pathological retroperitoneal condition, renal malignancy in particular, and should prompt the treating physician to carry out imaging studies of the retroperitoneum and careful study of the angiographic phase of the CT scan can ascertain the pathogenesis of the varicocele.

scholarly journals Clinical Features and Outcomes of Community-Acquired Pneumonia Caused by Haemophilus Influenza

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Saeed Shoar ◽  
Fernando H Centeno ◽  
Daniel M Musher
Keyword(s):  
Clinical Features ◽  
Alcohol Use Disorder ◽  
Pneumococcal Pneumonia ◽  
Severe Infection ◽  
Clinical Findings ◽  
Community Acquired Pneumonia ◽  
Equal Frequency ◽  
Haemophilus Influenza ◽  
Radiologic Findings ◽  
Viral Coinfection

Abstract Background Long regarded as the second most common cause of community-acquired pneumonia (CAP), Haemophilus influenzae has recently been identified with almost equal frequency as pneumococcus in patients hospitalized for CAP. The literature lacks a detailed description of the presentation, clinical features, laboratory and radiologic findings, and outcomes in Haemophilus pneumonia. Methods During 2 prospective studies of patients hospitalized for CAP, we identified 33 patients with Haemophilus pneumonia. In order to provide context, we compared clinical findings in these patients with findings in 36 patients with pneumococcal pneumonia identified during the same period. We included and analyzed separately data from patients with viral coinfection. Patients with coinfection by other bacteria were excluded. Results Haemophilus pneumonia occurred in older adults who had underlying chronic lung disease, cardiac conditions, and alcohol use disorder, the same population at risk for pneumococcal pneumonia. However, in contrast to pneumococcal pneumonia, patients with Haemophilus pneumonia had less severe infection as shown by absence of septic shock on admission, less confusion, fewer cases of leukopenia or extreme leukocytosis, and no deaths at 30 days. Viral coinfection greatly increased the severity of Haemophilus, but not pneumococcal pneumonia. Conclusions We present the first thorough description of Haemophilus pneumonia, show that it is less severe than pneumococcal pneumonia, and document that viral coinfection greatly increases its severity. These distinctions are lost when the label CAP is liberally applied to all patients who come to the hospital from the community for pneumonia.

Gastric antral vascular ectasia in children, rare presentation

2020 ◽  
Vol 13 (11) ◽  
pp. e236896
Author(s):  
Matthew Pizzuto ◽  
Sarah Ellul ◽  
Mohamed Shoukry
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Abdominal Ultrasound ◽  
Clinical Findings ◽  
Evidence Based ◽  
Gastric Antral Vascular Ectasia ◽  
Perianal Area ◽  
Rare Presentation ◽  
Vascular Ectasia ◽  
Blood Tests ◽  
Abdominal Examination

A 14-year-old boy, a known case of perinatal hypoxic cerebral palsy, presented to paediatric emergency with acute melaena and blood staining around feeding gastrostomy site. Physical examination revealed pallor, but no signs of distress with an unremarkable abdominal examination. Routine blood tests revealed normochromic. Abdominal ultrasound scan and Meckel’s scan were unremarkable. The patient underwent examination under anaesthesia of the perianal area and joint upper and lower gastrointestinal endoscopy. Streak-like gastritis with no signs of active bleeding lesions were noted and patchy areas of colitis involving the descending and sigmoid colon and the rectum. All clinical findings and evidence-based diagnosis matched gastric antral vascular ectasia. He was successfully managed conservatively with elemental hydrolysed feeding formula.

scholarly journals Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Christina Walker ◽  
Vincent Peyko ◽  
Charles Farrell ◽  
Jeanine Awad-Spirtos ◽  
Matthew Adamo ◽  
...  
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Case Reports ◽  
Healthy Woman ◽  
Signs And Symptoms ◽  
Rare Presentation ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

Acute proptosis secondary to bilateral pansinus mucopyocele with orbital compartment syndrome: a rare presentation, its management and outcome

2021 ◽  
Vol 14 (7) ◽  
pp. e241972
Author(s):  
Khushboo Chauhan ◽  
Tanya Sharma ◽  
Bhavana Sharma ◽  
Samendra Karkhur
Keyword(s):  
Compartment Syndrome ◽  
Nasal Polyposis ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Guided Exploration ◽  
Rapid Relief ◽  
Maxillary Sinuses

A 37-year-old Indian female presented with forward protrusion of left eye for one week, associated with progressive diminution of vision. The patient had undergone sinus surgery for nasal polyposis a year ago. On examination, there was severe proptosis and limitation of extraocular movements in all gazes. CT-scan revealed a heterogeneous expansile mass, arising from left fronto-ethmoidal sinus, infiltrating left orbit. MRI showed T2-hyperintense, peripherally enhancing areas in bilateral nasal cavity (right >left), bilateral ethmoidal sinuses and frontal, sphenoidal and maxillary sinuses. Otorhinolaryngology consultation was sought and in view of vision threatening proptosis — with likely orbital compartment syndrome — emergent endoscopic guided exploration and orbital decompression was undertaken. Rapid relief of signs and symptoms was achieved, with normal vision, extraocular movements and resolution of proptosis. Cytology and microbiology ruled out infectious or malignant aetiology and helped in resolving a diagnostic dilemma. Histopathology confirmed the diagnosis of mucopyocele and follow-up period was uneventful.

scholarly journals Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care

2018 ◽  
Vol 68 (676) ◽  
pp. e765-e774 ◽  
Author(s):  
Mark H Ebell ◽  
Isabella Locatelli ◽  
Yolanda Mueller ◽  
Nicolas Senn ◽  
Kathryn Morgan
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Signs And Symptoms ◽  
Clinical Decision ◽  
Community Acquired Pneumonia ◽  
Multivariate Model ◽  
Clinical Decisions ◽  
Acute Cough ◽  
Treatment Thresholds ◽  
Rule Out

BackgroundTest and treatment thresholds have not yet been described for decision-making regarding the likelihood of pneumonia in patients with acute cough.AimTo determine decision thresholds in the management of patients with acute cough.Design and settingSet among primary care physicians attending meetings in the US and Switzerland, using data from a prospective cohort of primary care patients.MethodClinical vignettes were used to study the clinical decisions of physicians regarding eight patients with cough that varied by six signs and symptoms. The probability of community-acquired pneumonia (CAP) was determined for each vignette based on a multivariate model. A previously published approach based on logistic regression was used to determine test and treatment thresholds.ResultsIn total, 256 physicians made 764 clinical decisions. Initial physician estimates systematically overestimated the likelihood of CAP; 75% estimating a higher probability than that predicted by the multivariate model. Given the probability of CAP from a multivariate model, 16.7% (125 of 749) changed their decision from ‘treat’ to ‘test’ or ‘test’ to ‘rule out’, whereas only 3.5% (26/749) changed their decision from ‘rule out’ to ‘test’ or ‘test’ to ‘treat’. Test and treatment thresholds were 9.5% (95% confidence interval (CI) = 8.7 to 10.5) and 43.1% (95% CI = 40.1 to 46.4) and were updated to 12.7% (95% CI = 11.7 to 13.8) and 51.3% (95% CI = 48.3 to 54.9) once the true probability of CAP was given. Test thresholds were consistent between subgroups. Treatment thresholds were higher if radiography was available, for Swiss physicians, and for non-primary care physicians.ConclusionTest and treatment thresholds for CAP in patients with acute cough were 9.5% and 43.1%, respectively. Physicians tended to overestimate the likelihood of CAP, and providing information from a clinical decision rule (CDR) changed about 1 in 6 clinical decisions.

scholarly journals Pneumococcal pneumonia and invasive pneumococcal disease: immunopathogenesis and diagnosis

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 8-14
Author(s):  
Gina Amanda ◽  
Dianiati Kusumo Sutoyo ◽  
Erlina Burhan
Keyword(s):  
Immune System ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Pneumococcal Pneumonia ◽  
Bacterial Load ◽  
Adaptive Immune System ◽  
Signs And Symptoms ◽  
Community Acquired Pneumonia ◽  
High Bacterial Load ◽  
Droplet Nuclei

Abstract Streptococcus pneumoniae is the most common aetiology of community-acquired pneumonia (CAP). It has many virulence factors, the most important being a polysaccharide capsule (Cps). There are 97 different serotypes of pneumococcal based on Cps which include both colonization and invasive serotypes. Pneumococcal pneumonia may exist as a result of either aspiration of bacteria in the nasopharynx or inhalation of droplet nuclei which contains bacteria until they reach the lower respiratory tract. This condition will activate both innate and adaptive immune system. The diagnosis of pneumococcal pneumonia is established in a patient who has the signs and symptoms of pneumonia, accompanied by the detection of S. pneumoniae in microbiology examination. Pneumococcus may also penetrate into a normally sterile site such as bloodstream, meninges, and pleural cavity, and infection of pneumococcus in those sites are defined as an invasive pneumococcal disease (IPD). High bacterial load, dysfunction of the immune system, and co-colonization of another microorganism may also lead to IPD.

scholarly journals Case Report of Disseminated Pseudomonas Infection with Superadded Burkholderia Infection - A Battle Lost!

2021 ◽  
Vol 6 (06) ◽  
pp. 393-397
Author(s):  
Dr Sangita Kamath ◽  
Dr Murari Bharadwaj ◽  
Dr Manish Kumar ◽  
Dr Ashok Sunder
Keyword(s):  
Risk Factors ◽  
Burkholderia Cepacia ◽  
Case Reports ◽  
Immunocompetent Patient ◽  
Community Acquired Pneumonia ◽  
Healthy Individuals ◽  
Nosocomial Pathogen ◽  
Gram Negative ◽  
Pseudomonas Infection ◽  
Progressive Course

Pseudomonas aeruginosa is a gram-negative pathogen, that often causes nosocomial pneumonia in hospitalized patients. Most of these patients have risk factors for pseudomonas infection. Although uncommon, there have been case reports of previously healthy individuals who developed community-acquired pneumonia (CAP) caused by P. aeruginosa. Such cases have often rapidly progressive course and prove fatal. We, hereby, report a case of pseudomonas pneumonia in a 29-year old immunocompetent patient, who developed disseminated infection and superinfection with yet another nosocomial pathogen, Burkholderia cepacia, eventually leading to septic shock and death, despite appropriate antibiotic therapy.

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