Infectious Diseases

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• Recurrent sepsis in a patient with biliary hamartomas Maria Beatriz Santos, Magda Ponta Garça, Bárbara Vieira, Paulo Ávila, Alexandra Freitas Views: 220 HTML: 82 PDF: 263

  Biliary hamartomas or von Meyenburg complexes (VMCs) are hepatic tumour-like lesions related to congenital malformation of the ductal plate, and are part of the ciliopathy spectrum of disorders. The exact pathogenesis of VMCs is unclear and it remains controversial whether they have the potential for malignant transformation. Patients are often asymptomatic and VMCs are usually encountered as an incidental finding on imaging.
  We report a case of recurrent sepsis with an unidentified focus. It was later confirmed that biliary hamartomas were acting as a sanctuary for the persistent pathogenic agent. The authors hope to draw attention to the existence of this unusual focus of recurrent sepsis.

• EBUS-TBNA-induced Purulent Pericarditis: A Rare Complication of a Common Procedure Joana Alfaiate, Andreia Brito, Ana Matos Views: 398 HTML: 42 PDF: 245

  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic tool used to investigate mediastinal lesions. It has a good safety profile, but there are rare accounts of potentially deadly complications. The present article describes one such complication: pericardial empyema.
  A 70-year-old man underwent EBUS-TBNA for the differential diagnosis of a pulmonary mass with multiple mediastinal adenopathies. Two weeks after the procedure he developed chest pain, shortness of breath and fever, with rapid progression to hypotension, tachycardia and low peripheral saturation. He was diagnosed with purulent pericarditis with cardiac tamponade. Pericardial drainage and antibiotic therapy were employed with successful recovery from obstructive disease and septic shock.

• Cryptic presentation of cryptococcal osteomyelitis in an apparently immunocompetent individual Hariharan Subramony, Balagurunathan Raghavan, Eswer Subbaiyan, Manjunatha Gajanana Hegde, Kartik Ramanathan Views: 332 HTML: 46 PDF: 323

  Cryptococcosis is an opportunistic fungal infection seen in immunocompromised individuals. It is caused by the yeast-like fungus Cryptococcus and predominantly affects the lungs and central nervous system. Immunocompetent individuals very rarely develop bone involvement and only a few cases of cryptococcal osteomyelitis in patients without other comorbid conditions have been described. Only one other case of pelvic involvement, which was accompanied by lymphopaenia, has been reported. We describe the case of a 42-year-old immunocompetent man with cryptococcal hip osteomyelitis.

• Cardiogenic shock associated with acute norovirus gastroenteritis: what is needed to prove causality? Abbie Evans, Juthipong Benjanuwattra , Barbara Mora, Mahmoud Abdelnabi Views: 1234 HTML: 227 PDF: 479

  Acute myocarditis is a well-recognized condition attributable to a variety of viral illnesses. Common viral aetiologies include enteroviruses including coxsackie, adenovirus, influenza, echovirus, parvovirus B19 and herpesvirus. A high index of suspicion, early diagnosis, and prompt management with supportive anti-failure measures, and in selected cases immunosuppressive therapies including high-dose steroids, might be considered for better outcomes. The authors report a case of sudden onset of acute heart failure complicated by cardiogenic shock caused by viral myocarditis in a patient who initially presented with norovirus gastroenteritis. She had no previous cardiac history or significant cardiovascular risk factors. Prompt medical management for cardiogenic shock for norovirus-induced myocarditis was started, her symptoms gradually improved, and she was discharged safely on regular follow-up.

• Abiotrophia defectiva Endocarditis: A Rare Cause with Aggressive Systemic Embolisation and Need of Valve Replacement Ana Cochicho Ramalho, Sofia Marques Santos, João Abecasis, Rui Rodrigues , Francisco Araujo , Helena Cantante Views: 354 PDF: 385 HTML: 62

  Infective endocarditis (IE) is a well-described infectious disease, one with increased morbidity and mortality being the third or fourth most common life-threatening infection syndrome.
  Abiotrophia defectiva is a non-motile, catalase negative, Gram-positive coccus in a chain, which can be isolated from the oral cavity, intestinal, and genitourinary tracts. IE due to this agent is rare and associated with heart valve destruction, congestive heart failure, and high embolisation rates, these being the major mortality causes.
  We present a case of IE due to this agent, complicated with a stroke, and splenic and renal infarction, with the need for aortic valve replacement. 
  This article highlights the gaps of knowledge left by the rarity of this disease, which range from its diagnosis to its treatment, and what we need to mitigate such gaps, supported with a case description of a successful treatment of this infection.

• Extraintestinal Clostridioides difficile Infection (CDI): A Recurrent Battle with Resilient Abdominal Wall Abscess Justine Chinnappan, Murtaza Hussain, Dominic Awuah, Ekwevugbe Ogbon, Ghassan Bachuwa, Philip McDonald Views: 605 HTML: 100 PDF: 476

  Clostridioides (formerly Clostridium) difficile infection is a common and costly healthcare-associated infection. Extraintestinal C. difficile infection is rarely encountered, especially in isolation. We present a unique case of abdominal wall abscess presenting six months following gastrointestinal (GI) surgery. The patient was managed with computed tomography (CT) guided drainage of the abscess, placement of a drainage catheter, and aggressive broad-spectrum antibiotic treatment for a prolonged duration over multiple admissions. 

• Malignant Syphilis: A Rare Case of Early Secondary Syphilis in an Immunocompetent Patient Ramiro Sá Lopes, Ana Sara Monteiro, Rosário Saez, Carlos Candeias, Catarina Mendonça Views: 670 HTML: 920 PDF: 404

  Early malignant syphilis is an uncommon form of secondary syphilis and characterized by pleomorphic multiple round-to-oval papules, some with necrosis, and associated with systemic signs and symptoms. Usually seen in immunosuppressed patients, mainly those infected with HIV, it can also be observed in immunocompetent patients.
  We report a case in a young healthy woman with the characteristic features of the disease and with favourable skin lesion evolution after appropriate treatment with penicillin.

• A Human Case of an Infection by the Pathogenic Streptococci that Causes “Strangles” in Horses Falgun Gosai, Neha Gosai Views: 284 HTML: 256 PDF: 244

  Strangles is a contagious upper respiratory tract infection primarily affecting equines. It is rare disease with zoonotic transmission. It is caused by the bacterium, Streptococcus equi. We present the rare case of strangles in an elderly patient complicated by bacteraemia, osteomyelitis and native valve endocarditis. The patient was treated successfully with appropriate antibiotics and no surgical intervention was needed. In an age of accelerated emerging zoonosis, this is an important entity clinicians should be aware of to prevent delay in diagnosis and poor outcome.

• Dalbavancin for Successful Treatment of Infective Endocarditis Caused by Enterococcus faecalis Francisco Javier Teigell Muñoz, María Mateos-González, Elsa Bernal-Hertfelder, Ana Sánchez de Torre, María García-Ferrón, Carmen de Cáceres Velasco, Coralia Bueno Muiño Views: 577 HTML: 79 PDF: 396

  Infective endocarditis is a relatively uncommon infection that requires a high index of suspicion, which can sometimes delay its diagnosis. It requires several weeks of intravenous antibiotics, which traditionally requires long hospital stays. Dalbavancin is a novel antibiotic with high activity against several Gram-positive pathogens. Its weekly administration allows the outpatient management of complicated infections requiring parenteral treatment, but only a few cases of Enterococcus faecalis endocarditis treated with dalbavancin have been reported in the literature. We here report a case of successful treatment with dalbavancin of an infectious endocarditis caused by E. faecalis.