Polymicrobial Purulent Pericarditis From a Pancreatico-Pericardial Fistula

A 54-year-old male with chronic pancreatitis presented with dyspnea. Computed tomography scans demonstrated a subdiaphragmatic fluid collection with pericardial fistulization. Pericardial fluid cultures were polymicrobial in nature. Purulent pericarditis is rare but carries a high mortality rate. We present the first documented case of pancreatico-pericardial fistulization causing purulent pericarditis.

Clostridium paraputrificum bacteremia in a patient with presumptive complicated appendicitis: A case report

Here we present a rare case of Clostridium paraputrificum bacteremia in the setting of presumptive complicated appendicitis. The patient was an elderly male who presented in respiratory failure secondary to a suspected aspiration pneumonia. A blood culture result for C. paraputrificum guided the investigation toward an abdominal source of infection as this uncommon isolate has been reported as a gastrointestinal species. He was treated with ampicillin-sulbactam while in the hospital and discharged with metronidazole along with a planned appendectomy as an outpatient. There is no tissue histopathology to date to confirm the presumptive likely diagnosis of complicated appendicitis found on abdominal imaging.

HIV transmission through living donor kidney transplant: An 11-year follow-up on the recipient and donor

HIV transmission via solid organ transplant is a rare but serious complication. Here, we describe long-term outcomes in a case of living donor-derived transmission of HIV in a kidney transplant recipient. After 11 years since transplant surgery, the donor shows no evidence of abnormal renal function, while the recipient continues to have a functioning graft. HIV is well controlled in both individuals. This single case report highlights the possibility of acceptable long-term outcomes in living kidney donors with HIV as well as in donor-derived HIV transmission to kidney transplant recipients.

Successful Treatment of Brevibacterium Bacteremia Solely With Antimicrobial Therapy

Brevibacterium is a large genus that is not often involved in pathogenesis, however, since 1991 there have been several case reports of Brevibacterium-associated illness, most often due to bacteremia in the setting of an immunocompromised patient with a central venous catheter (CVC). Here we detail the case of an elderly woman with many comorbidities and a peripherally inserted central catheter (PICC) line for over four years, who presented with septic shock and Brevibacterium bacteremia. In nearly all previous cases of Brevibacterium bacteremia it was thought to be due to a CVC which was removed as part of the treatment in conjunction with antibiotics. In this case, the patient was treated with empiric antibiotics and her blood cultures cleared within 48 hours without catheter removal or antibiotic-lock therapy. The clinical outcome was favorable at 50 days follow-up.

Protein biochip array technology to monitor rituximab in rheumatoid arthritis

In rheumatoid arthritis (RA) there are currently no good indicators to predict a clinical response to rituximab. The purpose of this study was to monitor and determine the role of peripheral blood cytokine profiling in differentiating between a good versus poor response to rituximab in RA. Blood samples were collected at baseline and at 3 months from 46 RA patients who were treated with rituximab. Responders are defined by the presence of three of four American College of Rheumatology criteria: >or=20% decrease in C-reactive protein, visual analogical score of disease activity, erythrocyte sedimentation rate and improvement of the disease activity score (28) (four values) by >or=1.2 obtained at 3 months. Twelve cytokines were measured from serum collected on days 0 and 90 by proteomic array, including interleukin-6 (IL-6), tumour necrosis factor-alpha, IL-1a, IL-1b, IL-2, IL-8, interferon-gamma, IL-4, IL-10, monocyte chemoattractant protein-1, epidermal growth factor and vascular growth factor. We showed that C-reactive protein and IL-6 levels decrease significantly at 3 months in the responder group compared with baseline. At day 90 we identified a cytokine profile which differentiates responders and non-responders. High serum levels of two proinflammatory cytokines, monocyte chemoattractant protein-1 and epidermal growth factor, were significantly higher in the responder group at day 90 compared with non-responders. However, we were not able to identify a baseline cytokine profile predictive of a good response at 3 months. These findings suggest that cytokine profiling by proteomic analysis may be a promising tool for monitoring rituximab and may help in the future to identify responder RA patients.

Expression of matrix-degrading enzymes in pulmonary vascular remodeling in the rat

Exposure of rats to hypoxia causes pulmonary arterial remodeling, which is partly reversible after return to air. We hypothesized that degradation of excess collagen in remodeled pulmonary arteries in the posthypoxic period is mediated by endogenous matrix metalloproteinases (MMPs). Total proteolytic, collagenolytic, and gelatinolytic activities, levels of stromelysin-1 and tissue inhibitor of metalloprotease-1 (TIMP-1), and immunolocalization of stromelysin-1 in main pulmonary arteries were determined after exposure of rats to 10% O2 for 10 days followed by normoxia. We observed transient increases in total proteolytic, collagenolytic, and gelatinolytic activities and expression of approximately 72-, 68-, and 60-kDa gelatinases by zymography within 3 days of cessation of hypoxic exposure. The level of TIMP-1 increased as the stromelysin-1 level increased. Immunoreactive stromelysin-1 was localized predominantly in the luminal region of normal and hypertensive pulmonary arteries. These results are consistent with the notion that endogenous MMPs may mediate the breakdown of excess collagen in remodeled pulmonary arteries during the early posthypoxic period.