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Mitra S, Hanumanthappa MK, Sarkar S, Bhalla A, Minz R, Ratho RK. Epstein Barr Virus-Related Acute Liver Failure and Hemophagocytosis in an Immunocompetent Individual: An Autopsy Report. Int J Surg Pathol 2024; 32:838-844. [PMID: 37723947 DOI: 10.1177/10668969231195068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Epstein-Barr virus (EBV) is a nonhepatotropic virus. It causes mild self-limiting illness characterized by fever, oral ulcer, diarrhea, lymphadenopathy, and hepatosplenomegaly. Rarely it causes acute liver failure (ALF). EBV-related ALF (EBV-ALF) accounts for 0.2% of all ALF cases. The prognosis of EBV-ALF is dismal, and it can affect both immunocompromised and immunocompetent individuals. We performed a partial autopsy on a 30-year-old immunocompetent individual with infectious mononucleosis and ALF. The autopsy showed characteristic histomorphology of EBV-ALF in the form of centrizonal confluent hepatocytic necrosis, portal mixed inflammatory infiltrate, sinusoidal lymphocytosis, numerous hemophagocytic figures, and tissue Epstein-Barr encoded RNA-in situ hybridization (EBER-ISH) positivity. Extensive hemophagocytosis was noted in the liver, spleen, lymph node, and bone marrow. Other features include T-zone expansion of lymph nodes and spleen, interstitial pneumonia pattern in the lungs, and exanthematous skin changes. EBV-DNA polymerase chain reaction from the postmortem blood sample yielded 70,200 copies/µL. The index case highlights the uncommon occurrence of EBV-ALF, its histomorphological features, and its putative pathogenesis.
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Affiliation(s)
| | | | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ranjana Minz
- Department of Immunopathology, PGIMER, Chandigarh, India
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Zaskey M, Burns B. Disseminated Histoplasmosis Causing Temporally and Spatially Discrete Gastrointestinal Perforations in an HIV-Negative Patient. Am Surg 2024; 90:1744-1747. [PMID: 38225921 DOI: 10.1177/00031348241227189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Histoplasma capsulatum is a dimorphic fungi endemic to the Ohio and Mississippi River valleys. Immunocompetent persons who become infected are generally asymptomatic or present with mild symptoms. Symptomatic disease is seen primarily in immunocompromised patients with pulmonary manifestations being the most common presentation. We present a case of a young HIV-negative male who required 4 exploratory laparotomies over the course of 4 months during 2 hospitalizations due to discrete perforations of the ileum and jejunum caused by biopsy-proven gastrointestinal histoplasmosis despite maximal medical therapy as well as a gastric perforation.
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Affiliation(s)
- Michael Zaskey
- Department of Surgery, East Tennessee State University, Johnson City, TN, USA
| | - Bracken Burns
- Department of Surgery, East Tennessee State University, Johnson City, TN, USA
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Tang M, Yao Z, Liu Y, Ma Z, Zhao D, Mao Z, Wang Y, Chen L, Zhou T. Host immunity involvement in the outcome of phage therapy against hypervirulent Klebsiella pneumoniae infections. Antimicrob Agents Chemother 2024:e0142923. [PMID: 38742895 DOI: 10.1128/aac.01429-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Highly encapsulated hypervirulent Klebsiella pneumoniae (hvKp) causes severe infections. Bacteriophage therapy, an antibiotic alternative, effectively treats bacterial infections. Phage φFK1979 encoding polysaccharide depolymerases can target and disarm the capsule of hvKp FK1979, showing promise against FK1979 infection. Resistant strains induced by φFK1979 are possibly eliminated by host immunity and new phage phiR3 targeting them. We constructed varied immunocompromised FK1979 infection mouse models to assess the therapy efficacy of φFK1979 alone or in combination with phiR3. Survival rates, bacterial loads, histopathology, inflammation, and immune cell distribution of mice were studied. Prompt and adequate administration of φFK1979, rather than phiR3, significantly improved survival rates in mice with different immune statuses. However, immunocompromised mice showed lower efficacy due to reduced tolerance to low-virulence φFK1979-resistant bacteria compared to immunocompetent mice. Adding phiR3 sequentially greatly enhanced therapy efficacy for them, leading to increased survival rates and notable improvements in pathology and inflammation. Immunocompetent mice exhibited the most favorable response to φFK1979 monotherapy, as their immune system cleared φFK1979-resistant bacteria while avoiding a robust response to phiR3 combating φFK1979-resistant bacteria. This study revealed host immunity involvement in the outcome of phage therapy against infections and introduced, for the first time, personalized phage therapy strategies for hvKp-infected mice with varying immune statuses.IMPORTANCEHypervirulent Klebsiella pneumoniae (hvKp), with high capsular polysaccharide production, can cause severe invasive infections. Capsule-targeting phage poses the potential to fight against hvKp. We previously elucidated that the capsule-targeting phage induces resistance in hvKp, while phage-resistant strains exhibit sensitivity to host innate immunity and new phages targeting them. This indicated that phage-resistant strains can be eliminated by the immune system in immunocompetent patients, whereas they may require treatment with phages targeting resistant bacteria in immunocompromised patients. HvKp can infect individuals with varying immune statuses, including both immunocompetent and immunocompromised/deficient patients. This study, for the first time, developed personalized phage therapy strategies for hvKp-infected mice with different immune statuses, optimizing phage therapy against hvKp infections. This research is expected to provide a theoretical foundation and novel insights for clinical phage therapy against hvKp infections, offering significant societal benefits and clinical value.
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Affiliation(s)
- Miran Tang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhuocheng Yao
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhexiao Ma
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Deyi Zhao
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenzhi Mao
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yue Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Ide R, Kubota T, Ohtomo A, Ohtomo M, Watanabe G, Tsukita K, Suzuki Y. Streptococcus agalactiae Meningitis in an Immunocompetent Adult: A Case Report and Literature Review. Intern Med 2024; 63:1301-1303. [PMID: 37779069 DOI: 10.2169/internalmedicine.2279-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Streptococcus agalactiae is a rare cause of meningitis in healthy adults. We herein report a case of culture-negative Streptococcus agalactiae meningitis in a healthy adult which was diagnosed using the FilmArray Meningitis and Encephalitis Panel. A healthy 22-year-old man presented with a fever, headache, and neck stiffness. Despite negative results from blood and cerebrospinal fluid cultures, the diagnosis was confirmed using the FilmArray Meningitis and Encephalitis Panel. The patient was treated with dexamethasone, vancomycin, and ceftriaxone, and thereafter recovered completely. This report highlights the importance of being aware that Streptococcus agalactiae meningitis can occur in healthy individuals, and summarizes these features.
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Affiliation(s)
- Ryunosuke Ide
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
| | - Takafumi Kubota
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | - Azusa Ohtomo
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
| | - Mizuki Ohtomo
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
| | - Genya Watanabe
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
| | - Kenichi Tsukita
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
| | - Yasushi Suzuki
- Department of Neurology, National Hospital Organization, Sendai Medical Center, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
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Jagdale N, Kondapalli MP, Reddy VKK, Adapa S, Sabharwal D. An Unusual Case of an Immunocompetent Adult Diagnosed With Cytomegalovirus Colitis. Cureus 2024; 16:e58595. [PMID: 38765379 PMCID: PMC11102762 DOI: 10.7759/cureus.58595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Cytomegalovirus (CMV) infections are typically considered opportunistic in individuals with immunosuppressive conditions such as human immunodeficiency virus/acquired immunodeficiency syndrome, underlying malignancies, organ or bone marrow transplantation, and those receiving chemotherapeutics or steroids. Nevertheless, there is a significant increase in reported instances of CMV infections globally, suggesting that even individuals with a healthy immune system might experience these infections. In such cases, the primary symptoms are typically related to the gastrointestinal system, such as ulcerative colitis, pseudopolyps, tumors, and ischemic and hemorrhagic enterocolitis. We present a unique instance of severe CMV colitis in a patient with a fully functioning immune system. The diagnosis of CMV colitis was determined through the histological analysis of biopsy tissues acquired during colonoscopy.
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Affiliation(s)
- Nilesh Jagdale
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Mohith Prakash Kondapalli
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Vutukuru Kalyan Kumar Reddy
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Saimounika Adapa
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Diksha Sabharwal
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Rocher M, Duchesne M, Andouard D, Beral L, Labriffe M, Chainier D, Gomes-Mayeras M, Hantz S, Alain S, Robert PY. Cytomegalovirus detected by qPCR in iris and ciliary body of immunocompetent corneal donors. J Clin Virol 2024; 171:105636. [PMID: 38219682 DOI: 10.1016/j.jcv.2023.105636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/25/2023] [Accepted: 12/30/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) can cause a wide panel of ocular infections. The involvement of CMV as a cause of anterior uveitis in the immunocompetent patient is recent and remains poorly understood. OBJECTIVE To investigate the presence of CMV in anterior uveal tissues of immunocompetent corneal donors. STUDY DESIGN We collected aqueous humor, iris, and ciliary body from both eyes of 25 donors died at the Limoges University Hospital between January 2020 and July 2021. CMV serology was determined for all patients from post-mortem blood sample. Ocular tissues were split in 2 fragments for qPCR and 2 for histological analysis. CMV genomes copies were quantified by Multiplex qPCR after DNA extraction. RESULTS 16 of 25 patients (64%) displayed positive CMV serology, with a median age of 67 years. Viremia was positive in 3 of 16 (19%) CMV-positive patients. No CMV DNA copies were found from the aqueous humor samples. CMV DNA was detected in iris and ciliary body of 28 of 32 eyes of seropositive donors, and 5 of 18 eyes of seronegative donors. The median viral copy number [IQR] was 2.41 × 102 [8.91 × 101 - 1.01 × 103] copies/1 × 106 cells in the CMV-positive group and 0.00 [0.00 - 3.54 × 102] copies/1 × 106 cells in the CMV-negative group (p<0.001). Histology and immunohistochemistry did not reveal any CMV lesions from any sample. CONCLUSION CMV DNA was found in iris and ciliary body of immunocompetent seropositive patients, but also, although less frequently, from seronegative donors. These results highlight mechanisms of infection, latency and reactivation of CMV in ocular tissues.
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Affiliation(s)
- Maxime Rocher
- Department of Ophthalmology, CHU Limoges, F-87000 Limoges, France; Univ. Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000 Limoges, France.
| | | | - Déborah Andouard
- Univ. Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000 Limoges, France; National Reference Center for Herpesviruses, Department of Bacteriology-Virology-Hygiene, CHU Limoges, F-87000 Limoges, France
| | - Laurence Beral
- Department of Ophthalmology, CHU Pointe-à-Pitre, F-97120 Guadeloupe, France
| | - Marc Labriffe
- Department of Pharmacology, CHU Limoges, F-87000 Limoges, France
| | - Delphine Chainier
- CRBioLim, Department of Bacteriology-Virology-Hygiene, CHU Limoges, F-87000 Limoges, France
| | - Mélissa Gomes-Mayeras
- Univ. Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000 Limoges, France; National Reference Center for Herpesviruses, Department of Bacteriology-Virology-Hygiene, CHU Limoges, F-87000 Limoges, France
| | - Sébastien Hantz
- Univ. Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000 Limoges, France; National Reference Center for Herpesviruses, Department of Bacteriology-Virology-Hygiene, CHU Limoges, F-87000 Limoges, France
| | - Sophie Alain
- Univ. Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000 Limoges, France; National Reference Center for Herpesviruses, Department of Bacteriology-Virology-Hygiene, CHU Limoges, F-87000 Limoges, France; CRBioLim, Department of Bacteriology-Virology-Hygiene, CHU Limoges, F-87000 Limoges, France
| | - Pierre-Yves Robert
- Department of Ophthalmology, CHU Limoges, F-87000 Limoges, France; Univ. Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000 Limoges, France
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Ghadery AH, Abbasian L, Jafari F, Yazdi NA, Ahmadinejad Z. Correlation of clinical, laboratory, and short-term outcomes of immunocompromised and immunocompetent COVID-19 patients with semi-quantitative chest CT score findings: A case-control study. Immun Inflamm Dis 2024; 12:e1239. [PMID: 38577996 PMCID: PMC10996371 DOI: 10.1002/iid3.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND As the effects of immunosuppression are not still clear on COVID-19 patients, we conducted this study to identify clinical and laboratory findings associated with pulmonary involvement in both immunocompromised and immunocompetent patients. METHODS A case-control of 107 immunocompromised and 107 immunocompetent COVID-19 patients matched for age and sex with either positive RT-PCR or clinical-radiological findings suggestive of COVID-19 enrolled in the study. Their initial clinical features, laboratory findings, chest CT scans, and short-term outcomes (hospitalization time and intensive care unit [ICU] admission) were recorded. In addition, pulmonary involvement was assessed with the semi-quantitative scoring system (0-25). RESULTS Pulmonary involvement was significantly lower in immunocompromised patients in contrast to immunocompetent patients, especially in RLL (p = 0.001), LUL (p = 0.023), and both central and peripheral (p = 0.002), and peribronchovascular (p = 0.004) sites of lungs. Patchy (p < 0.001), wedged (p = 0.002), confluent (p = 0.002) lesions, and ground glass with consolidation pattern (p < 0.001) were significantly higher among immunocompetent patients. Initial signs and symptoms of immunocompromised patients including dyspnea (p = 0.008) and hemoptysis (p = 0.036), respiratory rate of over 25 (p < 0.001), and spo2 of below 93% (p = 0.01) were associated with higher pulmonary involvement. Total chest CT score was also associated with longer hospitalization (p = 0.016) and ICU admission (p = 0.04) among immunocompromised patients. CONCLUSIONS Pulmonary involvement score was not significantly different among immunocompromised and immunocompetent patients. Initial clinical findings (dyspnea, hemoptysis, higher RR, and lower Spo2) of immunocompromised patients could better predict pulmonary involvement than laboratory findings.
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Affiliation(s)
- Abdolkarim Haji Ghadery
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center(ADIR)Tehran University of Medical SciencesTehranIran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of MedicineTehran University of Medical SciencesTehranIran
| | - Fatemeh Jafari
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of MedicineTehran University of Medical SciencesTehranIran
| | - Niloofar Ayoobi Yazdi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR)Tehran University of Medical SciencesTehranIran
| | - Zahra Ahmadinejad
- Department of Infectious Diseases, Liver Transplantation Research Center, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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Zhou R, Wu ST, Yazdanifar M, Williams C, Sanders A, Brouwer C, Maher J, Mukherjee P. Mucin-1-Targeted Chimeric Antigen Receptor T Cells Are Effective and Safe in Controlling Solid Tumors in Immunocompetent Host. J Immunother 2024; 47:77-88. [PMID: 38270462 PMCID: PMC10913860 DOI: 10.1097/cji.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
The chimeric antigen receptor (CAR) T-cell therapy in solid epithelial tumors has been explored, however, with limited success. As much of the preclinical work has relied on xenograft models in immunocompromised animals, the immune-related efficacies and toxicities may have been missed. In this study, we engineered syngeneic murine CAR T cells targeting the tumor form of human mucin-1 (tMUC1) and tested the MUC1 CAR T cells' efficacy and toxicity in the immunocompetent human MUC1-expressing mouse models. The MUC1 CAR T cells significantly eliminated murine pancreatic and breast cancer cell lines in vitro. In vivo, MUC1 CAR T cells significantly slowed the mammary gland tumor progression in the spontaneous PyVMT×MUC1.Tg (MMT) mice, prevented lung metastasis, and prolonged survival. Most importantly, there was minimal short or long-term toxicity with acceptable levels of transient liver toxicity but no kidney toxicity. In addition, the mice did not show any signs of weight loss or other behavioral changes with the treatment. We also report that a single dose of MUC1 CAR T-cell treatment modestly reduced the pancreatic tumor burden in a syngeneic orthotopic model of pancreatic ductal adenocarcinoma given at late stage of an established tumor. Taken together, these findings suggested the further development of tMUC1-targeted CAR T cells as an effective and relatively safe treatment modality for various tMUC1-expressing solid tumors.
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Affiliation(s)
- Ru Zhou
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
| | - Shu-ta Wu
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Medpace, Irving, TX
| | - Mahboubeh Yazdanifar
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Adaptive Biotechnologies, South San Francisco, CA
| | - Chandra Williams
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Pfizer, Cambridge, MA
| | - Alexa Sanders
- Department of Bioinformatics, University of North Carolina at Charlotte, Charlotte, NC
| | - Cory Brouwer
- Department of Bioinformatics, University of North Carolina at Charlotte, Charlotte, NC
| | - John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, London, UK
| | - Pinku Mukherjee
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
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Nguyen KN, Freeman LM, Ung TH, Ojemann S, Grassia F. Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23672. [PMID: 38531080 DOI: 10.3171/case23672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Isolated cerebral mucormycosis is rare in immunocompetent adults and is only sparsely reported to be associated with obstructive hydrocephalus. OBSERVATIONS Here, the authors report a case of obstructive hydrocephalus secondary to central nervous system mucormycosis without other systems or rhino-orbital involvement and its technical surgical management. A 23-year-old, incarcerated, immunocompetent patient with history of intravenous (IV) drug use presented with syncope. Although clinical and radiographic findings failed to elucidate an infectious pathology, endoscopy revealed an obstructive mass lesion at the level of the third ventricle, which, on microbiological testing, was confirmed to be Rhizopus fungal ventriculitis. Perioperative cerebrospinal fluid diversion, endoscopic third ventriculostomy, endoscopic biopsy technique, patient outcomes, and the literature are reviewed here. The patient received intrathecal and IV amphotericin B followed by a course of oral antifungal treatment and currently remains in remission. LESSONS The patient's unique presentation and diagnosis of isolated cerebral mucormycosis reveal this pathogen as a cause of ventriculitis and obstructive hydrocephalus in immunocompetent adult patients, even in the absence of infectious sequelae on neuroimaging.
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Affiliation(s)
- Khoa N Nguyen
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Lindsey M Freeman
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Timothy H Ung
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Steven Ojemann
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
| | - Fabio Grassia
- 1Department of Neurosurgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; and
- 2Division of Neurosurgery, Denver Health Medical Center, Denver, Colorado
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Takezawa T, Matsunaga N, Miki A, Arizumi T, Tanaka A, Ito F, Kawachi S. Vibrio fluvialis Bacteremia in an Immunocompetent Patient with Acute Cholangitis. Intern Med 2024:3078-23. [PMID: 38432963 DOI: 10.2169/internalmedicine.3078-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Vibrio fluvialis is a bacterium that can be found in both seawater and freshwater, and it is responsible for causing gastroenteritis and cholangitis. V. fluvialis bacteremia has rarely been reported. We report a case of V. fluvialis bacteremia due to cholangitis in an immunocompetent adult who was exposed to seawater regularly as a sushi chef. The increased risk of V. fluvialis entry into the body resulting from frequent consumption of raw fish and regular exposure to seawater, bile outflow impairment caused by transient inflammation of the bile duct, and the presence of multiple bile acid resistance-related genes in V. fluvialis may lead to the development of acute cholangitis and subsequent bacteremia in immunocompetent patients.
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Affiliation(s)
- Tomoko Takezawa
- Department of Infection Control and Prevention, Teikyo University Hospital, Japan
| | - Naohisa Matsunaga
- Department of Infection Control and Prevention, Teikyo University Hospital, Japan
| | - Atsushi Miki
- Department of Internal Medicine, Higashi Kawaguchi Hospital, Japan
| | | | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Japan
| | - Fuyu Ito
- Asia International Institute of Infectious Disease Control (ADC), Teikyo University, Japan
| | - Shoji Kawachi
- Asia International Institute of Infectious Disease Control (ADC), Teikyo University, Japan
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Boudriiya T, Zouaoui I, Lachkar S, El Mamoune M, Aoufi S. A Rare Case of a Retroperitoneal Abscess Due to Trichosporon spp. in an Immunocompetent Patient. Cureus 2024; 16:e55656. [PMID: 38586770 PMCID: PMC10997153 DOI: 10.7759/cureus.55656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
This report discusses a rare case of retroperitoneal infection caused by Trichosporon spp. in a 68-year-old immunocompetent woman following a nephrectomy. Trichosporon spp. was identified through meticulous mycological examination. This case challenges the typical association of Trichosporon infections with immunocompromised patients, emphasizing its potential pathogenicity in immunocompetent individuals. The importance of accurate identification, especially in postoperative infections and broad-spectrum antibiotic contexts, is highlighted, emphasizing the need for a thorough diagnostic approach in such cases.
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Affiliation(s)
- Tamer Boudriiya
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Imane Zouaoui
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Salim Lachkar
- Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Mostaine El Mamoune
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Sarra Aoufi
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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Magalhães ARG, Santos MB, Almeida PH, Carvalho AMF, Exposito BT. Human Herpesvirus 8-Positive Multicentric Castleman Disease in an Immunocompetent Patient: A Diagnostic Challenge. Cureus 2024; 16:e56534. [PMID: 38646242 PMCID: PMC11027444 DOI: 10.7759/cureus.56534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
We present a clinical case of a 79-year-old male admitted to inpatient care for longstanding asthenia and respiratory symptoms. Associated features were polyserositis, multiple enlarged lymphatic nodules, acute kidney injury, and heart failure. The patient's recent medical history revealed SARS-CoV-2 vaccination a week prior and an upper respiratory tract infection. The laboratory results from thoracentesis were compatible with a transudate, with no immunological stain. Epstein-Barr virus polymerase chain reaction (PCR) was positive. The thoracic, abdominal, and pelvic CT scans revealed multiple enlarged lymphatic nodules, worsening the pre-existent polyserositis and hepatosplenomegaly. The patient began to show signs of neurologic symptoms and deterioration of the global health status. An enlarged lymphatic nodule was excised and the pathology showed human herpesvirus 8 multicentric Castleman disease. The disease evolved rapidly into hematological dysfunction and blood transfusions were necessary. Even though the patient was started on high-dose rituximab therapy combined with etoposide, the disease evolved into multiorgan dysfunction with a fatal outcome.
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Affiliation(s)
- Ana Rita G Magalhães
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Marta B Santos
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Pedro H Almeida
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Ana Maria F Carvalho
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
| | - Beatriz T Exposito
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Chaves, PRT
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13
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Kedar AK, Ghewade B, Jadhav U, Wagh P, Alone VD. Invasive Pulmonary Aspergillosis in an Immunocompetent Patient: An Atypical Presentation. Cureus 2024; 16:e55469. [PMID: 38571820 PMCID: PMC10988542 DOI: 10.7759/cureus.55469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a severe fungal infection primarily affecting immunocompromised individuals. However, rare cases of IPA in immunocompetent patients have been reported, presenting diagnostic and therapeutic challenges. Here, we present a case of a 41-year-old immunocompetent male who presented with fever, cough with mucoid expectoration, and breathlessness. Despite the absence of traditional risk factors, imaging and laboratory findings led to the diagnosis of IPA. Prompt initiation of antifungal therapy resulted in clinical improvement. This case highlights the importance of considering IPA in the differential diagnosis of respiratory symptoms, even in immunocompetent individuals.
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Affiliation(s)
- Aishwarya K Kedar
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ulhas Jadhav
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Wagh
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek D Alone
- Pulmonary Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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14
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Shoji MK, Sengillo JD, Shetty A, Uhr J, Sridhar J. Cytomegalovirus Retinitis Associated With Intravitreal Dexamethasone Implant Injection. J Vitreoretin Dis 2024; 8:215-219. [PMID: 38465355 PMCID: PMC10924599 DOI: 10.1177/24741264231221325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To describe an immunocompetent patient with cytomegalovirus (CMV) retinitis after dexamethasone implant injection and review previously documented cases. Methods: A review of case reports and literature was performed. Results: A 75-year-old man presented with acute decreased vision in the left eye. He had a vitrectomy and membrane peeling for an epiretinal membrane with recurrent cystoid macular edema and was receiving intravitreal dexamethasone implant injections at an outside hospital. The visual acuity in the left eye was hand motions, and an examination found patchy retinal whitening with hemorrhages. Aqueous polymerase chain reaction was positive for CMV. The laboratory evaluation was negative for immunodeficiencies. He was treated successfully with intravitreal and oral antivirals; however, his vision remained poor at most recent follow-up. A literature review found 8 previous cases of CMV retinitis after dexamethasone implant injection, although most had underlying immune dysregulation. Conclusions: CMV retinitis after intravitreal dexamethasone implant injection is rare. Awareness of this complication is essential because of the risk for devastating blindness.
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Affiliation(s)
- Marissa K. Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jesse D. Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Akaanksh Shetty
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Uhr
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Retina and Ophthalmic Consultants, PC, Northfield, NJ, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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15
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Yadav S. Tuberculosis of the Iliac Bone and Acetabulum With Iliopsoas, Obturator Internus, and Obturator Externus Abscesses in an Immunocompetent Indian Female: An Extremely Rare Case. Cureus 2024; 16:e55727. [PMID: 38586629 PMCID: PMC10998663 DOI: 10.7759/cureus.55727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Skeletal tuberculosis is a rare form of extrapulmonary tuberculosis. Due to non-specific clinical features, these cases are often diagnosed very late, ultimately affecting treatment outcomes. The present case is a very rare case of tuberculosis of the iliac bone and acetabulum with iliopsoas, obturator internus, and obturator externus abscesses in an Indian female. She reported pain in her right hip and a limp. It was a difficult diagnosis, especially due to the rare involvement of bones and muscles in the absence of any lesions in the lungs. Nevertheless, the diagnosis was achieved by a detailed radiometric and laboratory workup. She was initiated on antituberculous treatment per her weight for 12 months.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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16
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Zhang D, Bahrami AS, Ricketts WD. All Eyes and Ears: A Case of Neurosyphilis Presenting With Simultaneous Ocular and Otic Involvement. Cureus 2024; 16:e56492. [PMID: 38638741 PMCID: PMC11026103 DOI: 10.7759/cureus.56492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
This report details a case of neurosyphilis manifesting as concurrent ocular and otosyphilis, an uncommon presentation of the disease. Here, we describe the diagnosis and treatment of a 27-year-old immunocompetent Caucasian male who presented with uveitis and tinnitus. Physical exam was consistent with uveitis and audiometric testing revealed bilateral sensorineural hearing loss. Serum rapid plasma reagin (RPR) was reactive at 1:512 with a follow-up cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test likewise reactive at 1:2, confirming neurosyphilis. The patient was treated with intravenous penicillin G with improvement of symptoms and with subsequent improvement of serum and CSF RPR. However, he ultimately represented with recurrent symptoms and fluctuating serum RPR levels, necessitating repeat treatment and ongoing clinical monitoring. Neurosyphilis can occur at any point during the course of a syphilis infection and may present with a variety of nonspecific findings. This case documents a particularly uncommon instance of simultaneous ocular and otosyphilis, a presentation of neurosyphilis that has only been described a handful of times.
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Affiliation(s)
- Derek Zhang
- Internal Medicine-Pediatrics, University of California Los Angeles, Los Angeles, USA
| | - Asma Safa Bahrami
- Internal Medicine-Pediatrics, University of California Los Angeles, Los Angeles, USA
| | - Wilson D Ricketts
- Internal Medicine-Pediatrics, University of California Los Angeles, Los Angeles, USA
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17
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Murkar R, von Heckel C, Walles H, Moch TB, Arens C, Davaris N, Weber A, Zuschratter W, Baumann S, Reinhardt J, Kopp S. Establishment of a Human Immunocompetent 3D Tissue Model to Enable the Long-Term Examination of Biofilm-Tissue Interactions. Bioengineering (Basel) 2024; 11:187. [PMID: 38391673 PMCID: PMC10885984 DOI: 10.3390/bioengineering11020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Different studies suggest an impact of biofilms on carcinogenic lesion formation in varying human tissues. However, the mechanisms of cancer formation are difficult to examine in vivo as well as in vitro. Cell culture approaches, in most cases, are unable to keep a bacterial steady state without any overgrowth. In our approach, we aimed to develop an immunocompetent 3D tissue model which can mitigate bacterial outgrowth. We established a three-dimensional (3D) co-culture of human primary fibroblasts with pre-differentiated THP-1-derived macrophages on an SIS-muc scaffold which was derived by decellularisation of a porcine intestine. After establishment, we exposed the tissue models to define the biofilms of the Pseudomonas spec. and Staphylococcus spec. cultivated on implant mesh material. After 3 days of incubation, the cell culture medium in models with M0 and M2 pre-differentiated macrophages presented a noticeable turbidity, while models with M1 macrophages presented no noticeable bacterial growth. These results were validated by optical density measurements and a streak test. Immunohistology and immunofluorescent staining of the tissue presented a positive impact of the M1 macrophages on the structural integrity of the tissue model. Furthermore, multiplex ELISA highlighted the increased release of inflammatory cytokines for all the three model types, suggesting the immunocompetence of the developed model. Overall, in this proof-of-principle study, we were able to mitigate bacterial overgrowth and prepared a first step for the development of more complex 3D tissue models to understand the impact of biofilms on carcinogenic lesion formation.
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Affiliation(s)
- Rasika Murkar
- Core Facility Tissue Engineering, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Charlotte von Heckel
- Core Facility Tissue Engineering, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Heike Walles
- Core Facility Tissue Engineering, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Theresia Barbara Moch
- Core Facility Tissue Engineering, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Giessen, 35392 Giessen, Germany
| | - Nikolaos Davaris
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Giessen, 35392 Giessen, Germany
| | - André Weber
- Photonscore GmbH, Brenneckestr. 20, 39118 Magdeburg, Germany
| | | | - Sönke Baumann
- Omicron-Laserage® Laserprodukte GmbH, Raiffeisenstr. 5e, 63110 Rodgau, Germany
| | - Jörg Reinhardt
- MedFact Engineering GmbH, Hammerstrasse 3, 79540 Lörrach, Germany
| | - Sascha Kopp
- Core Facility Tissue Engineering, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
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18
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Rodrigues AS, Correia de Azevedo A, Nobre S, Fonseca P. Multisystemic Disease in a Child and Successful Recovery With Antiviral Treatment. Cureus 2024; 16:e53893. [PMID: 38468986 PMCID: PMC10927160 DOI: 10.7759/cureus.53893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Cytomegalovirus (CMV), a member of the Herpesviridae family, typically causes asymptomatic infections or mild mononucleosis-like syndromes in immunocompetent individuals. However, severe manifestations are well-documented in immunocompromised populations. This case report presents a previously healthy seven-year-old girl with a rare and complex presentation of primary CMV infection leading to severe multiorgan involvement, hepatosplenomegaly, cholestasis, bicytopenia, and a prolonged disease course. The patient's condition prompted an exhaustive diagnostic investigation, ruling out other potential causes. The diagnosis was confirmed by positive CMV IgM and IgG antibodies and a significantly elevated CMV DNA viral load. Treatment with intravenous ganciclovir resulted in a remarkable recovery. The case underscores the importance of considering CMV as a potential etiology of hepatitis, even in immunocompetent children, and the challenges of diagnosing complicated CMV infections. While guidelines for treating CMV in immunocompetent individuals are lacking, this report suggests that antiviral therapy may be beneficial in severe cases. Further research is needed to establish clear treatment protocols for such instances. This report contributes to the limited body of literature on severe CMV-induced hepatitis in immunocompetent children, emphasizing the need for heightened clinical awareness and timely interventions to prevent progression to acute liver failure.
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Affiliation(s)
| | | | - Susana Nobre
- Paediatric Hepatology and Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Paula Fonseca
- Pediatrics, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
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19
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He S, Lin Y. Primary cutaneous nocardiosis in an immunocompetent host. Clin Case Rep 2024; 12:e8516. [PMID: 38374880 PMCID: PMC10875629 DOI: 10.1002/ccr3.8516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Nocardiosis is a rare opportunistic infection that is classically observed in immunocompromised patients but can also affect immunocompetent individuals. It tends to involve the lung, central nervous system, and skin and is often misdiagnosed.
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Affiliation(s)
- Shihuan He
- Department of Dermatology and VenereologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Youkun Lin
- Department of Dermatology and VenereologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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20
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Ono R, Kitagawa I. Staphylococcus aureus Bacteremia With Disseminated Multiple Foci and Pyomyositis in an Immunocompetent Patient: A Case Report. Cureus 2024; 16:e53483. [PMID: 38440020 PMCID: PMC10910248 DOI: 10.7759/cureus.53483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Pyomyositis is an uncommon primary infection of skeletal muscle resulting in muscle inflammation followed by pus formation. Pyomyositis is typically caused by Staphylococcus aureus (S. aureus), and most cases are associated with skin penetration and/or immunosuppressive conditions in tropical or even temperate climates. We report a previously healthy, immunocompetent 44-year-old man who presented with fever and right lower back pain. He had received an analgesic injection for his back pain 12 days prior to this visit. His clinical course was further complicated by the coexistence of multiple muscular abscesses, renal infarction, and septic arthritis of the right shoulder. He underwent computed tomography-guided drainage of the abscess. The abscess and blood cultures were positive for methicillin-susceptible S. aureus. The patient responded well to prolonged treatment with cefazolin and cephalexin and was discharged 12 weeks after initial admission.
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Affiliation(s)
- Ryohei Ono
- General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Izumi Kitagawa
- General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
- General Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Kanagawa, JPN
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21
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Nakata JA, Arif A, Chai LF, Su S. First report of a post-pneumonectomy nocardia empyema. J Surg Case Rep 2024; 2024:rjae002. [PMID: 38304314 PMCID: PMC10832585 DOI: 10.1093/jscr/rjae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Post-pneumonectomy empyema (PPE) is an uncommon but serious complication that carries significant therapeutic challenges. We present a late-onset PPE due to Nocardia nova in an immunocompetent individual. Nine years after a right pneumonectomy for non-small cell lung cancer, surveillance scans revealed new right pleural thickening and FDG avidity concerning for recurrence. Thoracoscopic pleural biopsies were negative for malignancy, but tissue cultures grew N. nova. Nocardia empyema is rare with few reported cases. Most occur in immunocompromised hosts, and all were associated with pulmonary or disseminated nocardiosis. Our case describes the first report of a PPE secondary to Nocardia.
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Affiliation(s)
- Jonathan A Nakata
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Azzan Arif
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Louis F Chai
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA 19140, United States
| | - Stacey Su
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA 19140, United States
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22
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Salehi M, Shafiee N, Moradi M. Cytomegalovirus colitis in immunocompetent hosts: A case report and literature review. Clin Case Rep 2024; 12:e8435. [PMID: 38197061 PMCID: PMC10774537 DOI: 10.1002/ccr3.8435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
Key Clinical Message Rectal bleeding can manifest cytomegalovirus (CMV) colitis even in immunocompetent patients, which can be cured with ganciclovir treatment. Abstract Cytomegalovirus (CMV) is an opportunistic virus widely affecting immunocompromised patients. Different manifestations varied from asymptomatic in immunocompetent individuals to end organ involvement, such as colitis in those with immunodeficiency. Despite the rarity of CMV colitis in immunocompetent hosts, we should consider it when the other conditions have been excluded. In this article, we have described a case of CMV colitis in an immunocompetent host and have performed a literature review on this entity. An immunocompetent 70-year-old female was admitted to the hospital with recurrent rectal bleeding. After various evaluations including laboratory analysis, stool examination, and colonoscopy, we have detected superficial lesions. Pathology and polymerase chain reaction reports favored CMV involvement. Her condition continues to improve after intravenous ganciclovir infusion. Rectal bleeding can manifest CMV colitis even in immunocompetent patients, which can be cured with ganciclovir treatment.
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Affiliation(s)
- Mohammadreza Salehi
- Department of Infectious DiseasesImam Khomeini Hospital, Tehran University of Medical SciencesTehranIran
| | - Nahid Shafiee
- Department of Infectious DiseasesImam Khomeini Hospital, Tehran University of Medical SciencesTehranIran
| | - Maryam Moradi
- Eye Research Center, The Five Senses Health InstituteRassoul Akram Hospital, Iran University of Medical SciencesTehranIran
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23
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Ranjan R, Gunasekaran J, Bir R, Kumar U, Gupta RM. First Case of Nocardia wallacei From India: A Case Report and Literature Review. Cureus 2024; 16:e53035. [PMID: 38410293 PMCID: PMC10896460 DOI: 10.7759/cureus.53035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Nocardia is a type of bacteria that can cause infections in both immunocompromised and immunocompetent hosts. It is an obligate aerobe and is commonly found in the environment. Pulmonary nocardiosis may present as pneumonia, endobronchial inflammatory masses, lung abscess, and cavitary disease with contiguous extension, leading to effusion and empyema. We present a case of pulmonary nocardiosis in a 75-year-old male patient with type 2 diabetes mellitus. The patient presented with bilateral pneumonia and hypoxia with an oxygen saturation of 85%. Sputum samples were sent to the microbiology laboratory for testing. Acid-fast staining with 1% H2SO4 showed acid-fast branching filamentous rods, but Nocardia could not be isolated in culture. The sample was subjected to 16S rRNA gene sequencing, which identified the pathogen as Nocardia wallacei. The culture of the sputum did not grow any pathogenic organisms, and the blood culture was sterile. Unfortunately, the patient left the hospital against medical advice as he was advised for intubation. The patient could not survive and died the next day after leaving the hospital. N. wallacei can be fatal and cause disseminated infection in both immunosuppressed and immunocompetent patients. Only eight case reports of N. wallacei have been reported in the literature from various parts of the world. Our case is the first case report of N. wallacei from India.
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Affiliation(s)
- Rahul Ranjan
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, IND
| | | | - Raunak Bir
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, IND
| | - Umesh Kumar
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, IND
| | - Rajiv M Gupta
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, IND
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24
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Romano J, Godinho G, Chaves J, Oliveira N, Sousa JP. Cytomegalovirus-Induced Hypertensive Anterior Uveitis: Diagnostic Challenge in an Immunocompetent Patient. Cureus 2024; 16:e52826. [PMID: 38406050 PMCID: PMC10884362 DOI: 10.7759/cureus.52826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertensive anterior uveitis poses diagnostic challenges owing to its multiple potential etiologies. Cytomegalovirus (CMV) infection is an under-recognized cause that exhibits diverse clinical presentations. This case report focuses on the intricate diagnostic challenge encountered in a 66-year-old immunocompetent patient with CMV-induced hypertensive anterior uveitis. The patient's history, encompassing angle closure glaucoma and topiramate use, contributed to the hypertensive crisis. Initial management included intraocular pressure (IOP)-lowering medication, topiramate discontinuation, and bilateral phacoemulsification, successfully normalizing IOP. However, a subsequent recurrence prompted a detailed investigation. The identification of keratic precipitates and a synechial closed angle led to aqueous humor sampling and polymerase chain reaction (PCR) testing, unveiling the presence of CMV-DNA. Treatment led to a favorable response, resolving ocular inflammation and effectively controlling IOP. This case underscores the complexity of diagnosing and managing CMV-induced hypertensive anterior uveitis, emphasizing the critical role of a comprehensive approach in achieving successful outcomes.
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Affiliation(s)
- João Romano
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
| | | | - João Chaves
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
| | - Nuno Oliveira
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
| | - João P Sousa
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
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25
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Al Harbi A, Saeedi J, Almowalad E, Alahmari R, Alzuabi HA, Almanea L, AlAbdulhadi A. A Rare Case of Varicella-Zoster Virus Meningitis With High Intracranial Pressure in an Immunocompetent Adult. Cureus 2024; 16:e52437. [PMID: 38370997 PMCID: PMC10870954 DOI: 10.7759/cureus.52437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Varicella-zoster virus (VZV) is an alphaherpesvirus causing varicella (chickenpox) and herpes zoster. While varicella typically presents with a vesicular rash, latent VZV may reactivate within the sensory ganglia causing shingles, characterized by painful vesicular rash, which may lead to neurologic complications such as aseptic meningitis. This case explores an atypical presentation in an immunocompetent young man with VZV meningitis lacking the characteristic skin rash but featuring elevated intracranial pressure. A literature review revealed rare instances of VZV-related neurologic disease without typical skin manifestations, suggesting the virus's potential to affect the central nervous system directly. Treatment with intravenous acyclovir is recommended, with ganciclovir as an alternative treatment option. This case emphasizes the importance of considering VZV meningitis in the differential diagnosis of patients presenting with viral meningitis symptoms, with or without dermatomal rash or immunocompromised conditions.
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Affiliation(s)
- Awad Al Harbi
- Neurosciences, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Jameelah Saeedi
- Neurology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, SAU
| | - Enas Almowalad
- Neurology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, SAU
| | - Razan Alahmari
- College of Medicine, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Hana A Alzuabi
- Medicine and Surgery, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Leenah Almanea
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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Farouji A, Haddad AW, Khan NY, Battah A, Ahmad AS, Slim J. Haemophilus Influenzae Epididymo-Orchitis and Bacteraemia in an Immunocompetent Patient. Eur J Case Rep Intern Med 2023; 11:004205. [PMID: 38223271 PMCID: PMC10783462 DOI: 10.12890/2023_004205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024] Open
Abstract
Background Epididymitis is a common cause of scrotal pain in adults, with coliform bacteria being the most common isolated organisms in patients older than 35. Case presentation A 51-year-old healthy patient presented with scrotal pain and swelling, and was found to have epididymo-orchitis and bacteraemia caused by Haemophilus influenzae, which has not previously been reported as a cause of epididymo-orchitis and bacteraemia in immunocompetent patients. Discussion Diagnostic studies can help confirm the diagnosis and detect the causative pathogen. In all suspected cases, a urinalysis, urine culture and a urine or urethral swab for nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae and Chlamydia trachomatis should be performed. Colour Doppler ultrasonography often shows an enlarged thickened epididymis with increased Doppler wave pulsation in epididymitis. H. influenzae are pleomorphic gram-negative rods that commonly colonise the human respiratory tract and are associated with a number of clinical conditions. H. influenzae has been reported as a cause of epididymo-orchitis in prepubertal boys, and in few cases were associated with positive blood cultures. In adults, H. influenzae has been isolated before from urine samples or urethral swabs in patients with epididymitis or epididymo-orchitis. Conclusion This case highlights the possibility of H. influenzae causing epididymo-orchitis and bacteraemia in immunocompetent patients. Healthcare providers should consider H. influenzae in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompetent and immunocompromised patients. LEARNING POINTS H. influenzae can cause epididymo-orchitis and bacteraemia in immunocompetent patients. This has not been previously reported.H. influenzae should be considered in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompromised and immunocompetent patients.Healthcare providers should be aware of the increasing incidence of epididymitis and epididymo-orchitis caused by non-coliform bacteria in patients older than 35 years, especially in immunocompromised patients.
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Affiliation(s)
- Abdelhadi Farouji
- Department of Internal Medicine, Saint Michael’s Medical Center, New York Medical College, Newark, USA
| | - Ahmad W. Haddad
- Department of Internal Medicine, Saint Michael’s Medical Center, New York Medical College, Newark, USA
| | - Nibras Yar Khan
- Department of Internal Medicine, Saint Michael’s Medical Center, New York Medical College, Newark, USA
| | - Arwa Battah
- Department of Internal Medicine, Saint Michael’s Medical Center, New York Medical College, Newark, USA
| | - Amaar S. Ahmad
- Department of Internal Medicine, Saint Michael’s Medical Center, New York Medical College, Newark, USA
| | - Jihad Slim
- Department of Infectious Diseases, Saint Michael’s Medical Center, New York Medical College, Newark, USA
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Lubis IND, Farah S, Pasaribu AP, Evalina R, Daulay RS, Wijaya H. A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting. Narra J 2023; 3:e426. [PMID: 38450345 PMCID: PMC10914060 DOI: 10.52225/narra.v3i3.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/15/2023] [Indexed: 03/08/2024]
Abstract
Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.
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Affiliation(s)
- Inke ND. Lubis
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- University of Oxford, Oxford, United Kingdom
- Menzies School of Health Research, Darwin, Australia
| | - Sara Farah
- University of Oxford, Oxford, United Kingdom
| | - Ayodhia P. Pasaribu
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rita Evalina
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rini S. Daulay
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Hendri Wijaya
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Solito S, Vadalá di Prampero SF, Bulajic M, Battista S, Tomassini G, Panic N, Jankovic K, Marino M. Cytomegalovirus-Related Gastritis in an Immunocompetent Host Presenting With Infectious Gastroparesis. ACG Case Rep J 2023; 10:e01231. [PMID: 38107606 PMCID: PMC10723881 DOI: 10.14309/crj.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Cytomegalovirus (CMV) infection is usually asymptomatic or causes a mild mononucleosis-like syndrome, whereas severe symptoms are rarely reported. We report a case of a 70-year-old woman who was admitted to our center because of severe clinical presentation with anorexia, epigastric pain, nausea, postprandial vomiting, and significant weight loss. Esophagogastroduodenoscopy with biopsies showed ulcerative chronic gastritis with scattered large cells with inclusion bodies. Immunohistochemistry and polymerase chain reaction for CMV-DNA resulted positive. A gastric emptying of solid scintigraphy showed severe gastroparesis. The patient was discharged after 2 months of antiviral therapy completely asymptomatic. To the best of our knowledge, this is the first case of CMV-related gastroparesis in an immunocompetent patient, successfully treated with antiviral therapy.
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Affiliation(s)
- Sonia Solito
- Gastroenterology and GI Endoscopy Unit, Academic Medical Center of Udine, Udine, Italy
| | - Salvatore Francesco Vadalá di Prampero
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
- Department for Digestive Endoscopy, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Milutin Bulajic
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
- Department for Digestive Endoscopy, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Serena Battista
- Department of Pathology, Academic Medical Center of Udine, Udine, Italy
| | - Giulia Tomassini
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
| | - Nikola Panic
- GI Endoscopy Unit, University Clinic "Dr Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Katarina Jankovic
- Clinic for Gastroenterohepatology, University Clinical Centre of Belgrade, Belgrade, Serbia
| | - Marco Marino
- Gastroenterology and GI Endoscopy Unit, Academic Medical Center of Udine, Udine, Italy
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Yogi TN, Bhusal A, Subedi S, Katwal S, Acharya K. Multidermatomal herpes zoster triggered by psychological stress in an immunocompetent young adult: a rare case report and clinical insights. Ann Med Surg (Lond) 2023; 85:6231-6236. [PMID: 38098591 PMCID: PMC10718367 DOI: 10.1097/ms9.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and Importance Herpes zoster (HZ), a reactivated varicella zoster virus infection arising from dormant viral latency after initial chickenpox, manifests as localized skin rashes along dermatomes. Multidermatomal involvement, especially in immunocompetent individuals, is rare. The potential link between psychological stress and HZ reactivation remains underexplored. The authors present a case of multidermatomal HZ triggered by psychological stress in a young immunocompetent adult. Case presentation A 26-year-old male presented with vesicular lesions spanning C5, C8, T1, and T2 dermatomes, triggered by psychological stress. The disease exhibited a unique midline-crossing presentation. The Varicella zoster virus IgM test result was positive. Treatment included acyclovir, pain management, and stress reduction strategies, yielding complete resolution within 3 weeks. Clinical discussions The case highlights a distinctive multidermatomal HZ presentation, defying conventional dermatomal restrictions. Psychological stress potentially influenced viral reactivation. Immunocompetence and stress interplay merit further exploration. Multidermatomal HZ necessitates prompt clinical recognition and comprehensive evaluation. Antiviral therapy and integrated stress management may contribute to successful outcomes. Conclusion This case underscores the rare occurrence of multidermatomal HZ in an immunocompetent young adult triggered by psychological stress. The atypical presentation and potential role of stress in viral reactivation emphasize the complex interaction between the nervous and immune systems. Integrated clinical management, stress reduction strategies, and antiviral therapy were effective in resolving the condition. Further research is warranted to elucidate the mechanisms underlying stress-induced viral reactivation and its clinical implications.
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Affiliation(s)
| | - Amrit Bhusal
- Department of Dermatology and Venerology, BP Koirala Institute of Health Sciences (BPKIHS)
| | - Suman Subedi
- Department of Dermatology and Venerology, BP Koirala Institute of Health Sciences (BPKIHS)
| | | | - Kshitiz Acharya
- Department of Dermatology and Venereology, Tribhuvan University Institute of Medicine
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30
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Hasbi A, Shatriah I, A Rahim H, Zamli AH, Tai E. Staphylococcus aureus Orbital Abscess With Impending Compressive Optic Neuropathy in an Immunocompetent Individual With Subclinical Bacteriuria: A Case Report. Cureus 2023; 15:e50693. [PMID: 38229775 PMCID: PMC10791544 DOI: 10.7759/cureus.50693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
This is a case of an orbital abscess evidenced radiologically in a 41-year-old female with no comorbidities. She was healthy and had no history of trauma or infection of the adjacent structures. She denied having symptoms of upper or lower respiratory and urinary tract infections. The decision for surgical drainage was made following a slow response to antimicrobial agents after 24 hours, a progressive painful erythematous eyelid swelling, and further deterioration of vision. Her clinical condition and visual acuity improved following cutaneous incision and drainage. Culture and sensitivity results for urine and orbital abscess were positive for Staphylococcus (S.) aureus. The patient regained full visual recovery without any sequelae. In conclusion, an orbital abscess is a blinding and life-threatening condition that rarely occurs in immunocompetent individuals and uncommonly arises from distant sources. A high index of suspicion, early institution of appropriate diagnostic imaging, and aggressive medical and surgical treatment are necessary for a favorable visual outcome in orbital abscess cases.
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Affiliation(s)
- Amirul Hasbi
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Ismail Shatriah
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Haslinda A Rahim
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, MYS
| | | | - Evelyn Tai
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences Universiti Sains Malaysia, Kubang Kerian, MYS
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31
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Auyeung AB, Rayan MN, Tang X, Thomas S. Radiation proctitis with recurrent gastrointestinal bleeding complicated by cytomegalovirus. J R Coll Physicians Edinb 2023; 53:265-268. [PMID: 37905373 DOI: 10.1177/14782715231205916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Cytomegalovirus (CMV) usually causes infections with mild symptoms in immunocompetent individuals. However, in immunocompromised patients, these infections can be serious or life-threatening. Following initial infection, CMV typically becomes dormant but remains lifelong in the host. Reactivation of the latent virus can occur in many organ systems, including the gastrointestinal (GI) tract. Radiation proctitis is a known risk factor associated with prostate radiation, with complicating ulceration and GI bleeding. We present the first case report of an immunocompetent 81-year-old male with multiple episodes of life-threatening GI bleeding, secondary to a non-healing CMV-positive rectal ulcer and CMV colitis following radiation for prostate cancer. Multiple insults including prostate radiation, repeated blood transfusions and CMV infection likely contributed to the recurrent bleeding episodes.
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Affiliation(s)
- Austin B Auyeung
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Melanie N Rayan
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Xiaolan Tang
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Sanil Thomas
- Infectious Diseases Department, HCA Florida North Florida Hospital, Gainesville, FL, USA
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32
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Allena N, Kolli M, Tale S, Soibam P, Layek A. Pulmonary Cryptococcosis Mimicking Lung Cancer: A Diagnostic Challenge. Cureus 2023; 15:e47597. [PMID: 38022362 PMCID: PMC10665769 DOI: 10.7759/cureus.47597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary cryptococcosis, although rare, maybe seen in both immunocompromised and immunocompetent patients. Cryptococcosis presenting as a lung mass mimicking lung cancer is very rare. Here, we report our experience with pulmonary cryptococcosis presenting as a lung mass mimicking malignancy in an immunocompetent patient. In this case, the patient presented to us with left-sided pleural effusion and lung mass on computed tomography (CT) of the chest. Bronchoscopy and endobronchial ultrasound (EBUS)-guided fine needle aspiration cytology (FNAC) was performed, which showed cryptococcal organisms. He responded well to oral anti-fungal therapy without any need for surgical interventions.
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Affiliation(s)
- Nishant Allena
- Department of Internal Medicine, BronxCare Health System, New York, USA
| | - Mrudula Kolli
- Department of Internal Medicine, Gayatri Vidya Parishad Medical College, Visakhapatnam, IND
| | - Sudheer Tale
- Department of Internal Medicine, Maharajah's Institute of Medical Sciences, Visakhapatnam, IND
- Department of Pulmonary and Critical Care Medicine, Medicover Hospitals, Visakhapatnam, IND
| | - Pahel Soibam
- Department of Pulmonary and Critical Care Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, IND
| | - Avishek Layek
- Department of Chest Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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33
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Noor N, Hossain HT, Urmee IJ, Akter S, Khandakar MAK, Islam QT. Adrenal histoplasmosis in an immunocompetent host. Trop Doct 2023; 53:531-532. [PMID: 37641234 DOI: 10.1177/00494755231193179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Nawsabah Noor
- Assistant Professor, Department of Medicine, Popular Medical College, Dhaka, Bangladesh
| | | | - Ishrat Jahan Urmee
- Assistant Registrar, Department of Medicine, Popular Medical College, Dhaka, Bangladesh
| | - Sharmin Akter
- Assistant Registrar, Department of Medicine, Popular Medical College, Dhaka, Bangladesh
| | | | - Quazi Tarikul Islam
- Professor of Medicine, Department of Medicine, Popular Medical College, Dhaka, Bangladesh
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34
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Lin CH, Henderson SO. Not a Rare Disease Anymore? A Case of Ocular Syphilis at the Correctional Facility. J Correct Health Care 2023; 29:311-313. [PMID: 37646626 DOI: 10.1089/jchc.22.04.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Los Angeles County has been facing a syphilis crisis since 2018. Cases of ocular syphilis have become increasingly identified and reported in the past few years, predominantly in HIV-positive men. Here we report a case of ocular syphilis in an otherwise healthy 49-year-old male in the Los Angeles County jail. This case study emphasizes the importance of increasing awareness of ocular syphilis so that it can be diagnosed promptly to prevent irreversible vision loss. Health care providers who work in the correctional facility setting need to be aware of this disease entity given that they serve a population with high risk of sexually transmitted diseases (STDs). This case study further stresses the importance of initial screening for sexual history and/or history of STDs within this population.
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Affiliation(s)
- Cindy H Lin
- Los Angeles County Department of Health Services, Correctional Health Services, Los Angeles, California, USA
| | - Sean O Henderson
- Los Angeles County Department of Health Services, Correctional Health Services, Los Angeles, California, USA
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35
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Kreidieh M, Gurala D, Amarnath S, Philipose J, Colef R, Yassine AA, Gumaste V. The Unmasking of Cytomegalovirus as an Accomplice to Helicobacter pylori-Induced Severe Acute Gastroenteritis in a Healthy Host. ACG Case Rep J 2023; 10:e01181. [PMID: 37899956 PMCID: PMC10602490 DOI: 10.14309/crj.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Cytomegalovirus (CMV) belongs to the Herpesviridae family, and it is considered the largest virus to infect humans. Primary CMV infection frequently targets immunodeficient patients and is often symptomatic. However, it may remain latent or clinically unapparent for years in immunocompetent individuals. CMV infection rarely presents as an invasive disease in the latter group of individuals, in which case, the most common site of involvement in the gastrointestinal tract. When CMV affects the gastrointestinal tract, the colon and stomach are the 2 frequently involved sites. This case report describes a unique case of an immunocompetent patient who presented with acute excruciating periumbilical pain and was diagnosed with acute gastritis secondary to CMV infection and possible Helicobacter pylori-associated chronic active gastritis. Symptoms resolved entirely soon after treatment with antimicrobials that cover for both infections. The diagnosis was based on histopathologic findings from biopsies taken from the stomach during the endoscopic evaluation combined with positive CMV serology and positive CMV-deoxyribonucleic acid.
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Affiliation(s)
- Malek Kreidieh
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Dhineshreddy Gurala
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Shivantha Amarnath
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Jobin Philipose
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Robert Colef
- Department of Pathology, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Ahmad Abou Yassine
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Vivek Gumaste
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
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Peterson CJ, Abel WF, Reddy V, Pfaff K. Furry, Fomite, and Facultative Anaerobe: A Unique Case of Capnocytophaga canimorsus. Cureus 2023; 15:e47747. [PMID: 38021979 PMCID: PMC10676269 DOI: 10.7759/cureus.47747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Capnocytophaga canimorsus infection is frequently associated with dog and cat bites or scratches in patients who have risk factors such as immunosuppression, asplenia, and alcohol abuse. However, rare instances of C. canimorsus infection in patients without typical risk factors have been reported. Here, we present such a rare and unusual case of C. canimorsus bacteremia in a patient without animal wounds or risk factors. Chronic sinusitis may have contributed to mucosal disruption and served as an entry point for C. canimorsus. Prompt initiation of antibiotics resulted in rapid resolution of symptoms and clearance of bacteremia.
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Affiliation(s)
| | - William F Abel
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Varsha Reddy
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kyle Pfaff
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
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37
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Rajabi MB, Sadeghi R, Soltani Shahgoli S, Mohsenzadeh Kermani N, Mohsen Rafizadeh S, Aghajani AH, Asadi Amoli F, Ashourizadeh H, Rajabi MT. Unusual orbital mucormycosis due to pecking injury: clinical characteristics and outcomes of four immunocompetent pediatric patients. Orbit 2023:1-7. [PMID: 37698843 DOI: 10.1080/01676830.2023.2252054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Mucormycosis is a serious fungal infection caused by fungi in the order of Mucorales. Orbital mucormycosis occurs more frequently in rhino-orbital, sino-orbital, and rhino-orbito-cerebral forms of the disease, while isolated orbital mucormycosis is much less common. Herein, we present four cases of immunocompetent children who developed primary cutaneous mucormycosis, which subsequently invaded and progressed to orbital mucormycosis following direct traumatic injury caused by pecking from Acridotheres tristis (Common Myna). Given the low prevalence of orbital mucormycosis in healthy children, an unknown source of infection and delayed diagnosis followed by late therapeutic interventions could result in life-threatening conditions and serious sequelae.
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Affiliation(s)
- Mohammad Bagher Rajabi
- Department of Ophthalmology, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran
| | - Reza Sadeghi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahel Soltani Shahgoli
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Mohsenzadeh Kermani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Aghajani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Asadi Amoli
- Department of Pathology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Helia Ashourizadeh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taher Rajabi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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38
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Truong RD, Vadlapatla VK, Avgeropoulos NG. Progressive Multifocal Leukoencephalopathy Presenting as Primary CNS Malignancy in an Immunocompetent Patient. Cureus 2023; 15:e45815. [PMID: 37876409 PMCID: PMC10591460 DOI: 10.7759/cureus.45815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is an infection caused by the John Cunningham virus (JCV), usually in an immunocompromised host. We present the case of a 74-year-old male who presented with a six-week history of progressive memory loss, episodic confusion, and aphasia. Cranial nerve, motor, sensory, and coordination testing were unremarkable. Magnetic resonance imaging (MRI) of the brain and spectroscopy were concerning for primary CNS lymphoma vs. diffuse glioma. Microscopic examination after the patient underwent left frontal stereotactic brain biopsy was suggestive of a viral infection, and further testing with JCV DNA in-situ hybridization (ISH) confirmed the diagnosis of PML. The patient's condition started resolving without treatment. This case demonstrates, to our knowledge, the first known case of primary PML masquerading as CNS lymphoma in modern literature.
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Affiliation(s)
- Rachel D Truong
- Department of Internal Medicine, Orlando Regional Medical Center, Orlando, USA
| | - Vamshi K Vadlapatla
- Department of Hematology and Medical Oncology, Orlando Regional Medical Center, Orlando, USA
| | - Nicholas G Avgeropoulos
- Department of Hematology and Medical Oncology, Orlando Regional Medical Center, Orlando, USA
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39
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Shukla R, Mishra AK, Verma A, Garg P, Lnu S. A Rare Case of Cytomegalovirus Retinitis in a Young Immunocompetent Patient. Cureus 2023; 15:e44948. [PMID: 37818518 PMCID: PMC10561789 DOI: 10.7759/cureus.44948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
Cytomegalovirus (CMV) is known to be the most common opportunistic infection in immunocompromised cases, and CMV retinitis is the most common ocular manifestation. Severe retinitis with involvement of the macula or retinal necrosis can lead to vision loss. Prompt diagnosis and treatment can restrict the disease's progression. We describe the case of a 30-year-old man who presented with the chief complaint of progressive diminution of vision in both eyes for 15 days. Diminution of vision was associated with fever and skin rashes. The patient had no history of diabetes, hypertension, tuberculosis, ocular trauma, ocular surgery, organ transplant history, history of immunosuppression, or previous drug history except paracetamol tablets for fever. On ocular examination on the day of presentation, the patient's best corrected visual acuity on Snellen's visual acuity chart was 6/12 and 6/24 in the right and left eyes, respectively. Fundus examination revealed a well-defined optic disc with peripapillary flame-shaped hemorrhages with exudates and an epiretinal membrane. On spectral domain optical coherence tomography (SD-OCT), macular edema was 469 µm and 421 µm in the right and left eyes, respectively. On serological examination, only cytomegalovirus IgG came out positive (1196.65 AU/ml). Based on the clinical findings, fundus examination, and lab investigations, the patient was diagnosed as having a systemic CMV infection with CMV retinitis, and treatment was started with intravenous ganciclovir. With timely diagnosis and management, the patient's vision was recovered. This is a rare case report regarding the development of CMV retinitis in a completely immunocompetent individual.
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Affiliation(s)
- Ruchi Shukla
- Department of Ophthalmology, All India Institute of Medical Sciences, Rae Bareli, Rae Bareli, IND
| | - Ashutosh K Mishra
- Department of Neurology, All India Institute of Medical Sciences, Rae Bareli, Rae Bareli, IND
| | - Archana Verma
- Department of Neurology, All India Institute of Medical Sciences, Rae Bareli, Rae Bareli, IND
| | - Pragati Garg
- Department of Ophthalmology, All India Institute of Medical Sciences, Rae Bareli, Rae Bareli, IND
| | - Shrinkhal Lnu
- Department of Ophthalmology, All India Institute of Medical Sciences, Rae Bareli, Rae Bareli, IND
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Yaghi M, Gamret AC, Elman S, Romanelli P, Keri JE. Paracoccidioidomycosis: An atypical presentation in an immunocompetent woman. JAAD Case Rep 2023; 39:40-43. [PMID: 37588801 PMCID: PMC10425778 DOI: 10.1016/j.jdcr.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Marita Yaghi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexandra C. Gamret
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Scott Elman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Paolo Romanelli
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonette E. Keri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Dermatology Service, Miami VA Hospital, Miami, Florida
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41
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Shah R, Patel S, Henriquez R, Parikh J, Mandalia A. Herpes Simplex Virus Esophagitis in an Immunocompetent Patient. Cureus 2023; 15:e44668. [PMID: 37799253 PMCID: PMC10550305 DOI: 10.7759/cureus.44668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Esophagitis due to herpes simplex virus (HSV) infection is a rare entity in the immunocompetent population. It is usually seen in immunocompromised hosts, those with human immunodeficiency virus (HIV) infection, malignancies, and patients on immunosuppressive medications. We present a case of a young immunocompetent man with anabolic steroid use who presented with esophagitis symptoms found to be from HSV infection. So far, the use of corticosteroids has been reported as a predisposing factor for HSV esophagitis in immunocompetent hosts in multiple case reports. However, our case suspects that transient immunosuppression with similar medication can cause HSV esophagitis in otherwise immunocompetent hosts.
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Affiliation(s)
- Raj Shah
- Internal Medicine, University of Central Florida College of Medicine / Hospital Corporation of America Healthcare Graduate Medical Education, Orlando, USA
| | - Stuti Patel
- Internal Medicine, Western Reserve Health Education, Trumbull Regional Medical Center, Warren, USA
| | - Richard Henriquez
- Internal Medicine, University of Central Florida College of Medicine / Hospital Corporation of America Healthcare Graduate Medical Education, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Amar Mandalia
- Gastroenterology, Orlando Veterans Affairs Medical Center, Orlando, USA
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Kang HM, Kang KR, Kim YJ, Kang JH, Lee SY. A booster administration of the OKA/SK strain causes fatal disseminated varicella in an immunocompetent child. J Med Virol 2023; 95:e29108. [PMID: 37715715 DOI: 10.1002/jmv.29108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
Live varicella vaccines are known to provide robust immunity against varicella zoster virus (VZV) infections. However, problems with viral attenuation have led to pathogenic VZV vaccine strains causing varicella-like rash and herpes zoster in immunocompetent children after immunization. We report the first fatal case of VZV infection caused by OKA/SK strain contained in the vaccine administrated as a booster shot in an immunocompetent child, which has been independently developed from any currently available varicella vaccines that are OKA strain or MAV/06 strain based. The patient died due to sudden pulmonary alveolar hemorrhage as a secondary complication of VZV pneumonitis. Sequencing of the four SNPs unique to the OKA/SK strain (SNP loci 14 035T; 32 626C; 58 777G; 70 319G) enabled discrimination of the strain responsible for the disseminated infection. OKA/SK strain does not have any SNPs in ORF62 postulated to be responsible for the attenuation of varicella vaccines which have been safely and effectively used world-wide or locally, and exclusively enriches a virulent factor in ORF31 identified in parental OKA strain, thus possibly resulting in disseminated VZV infection leading to mortality. Therefore, actions need to be taken to prevent vaccine related morbidity and mortality in children.
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Affiliation(s)
- Hyun Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Ri Kang
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ye Ji Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Subramanian M, Mehta A, Jha P. Unusual Presentation of Disseminated Histoplasmosis in an Immunocompetent Host. Cureus 2023; 15:e44170. [PMID: 37753008 PMCID: PMC10519440 DOI: 10.7759/cureus.44170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Histoplasmosis, a fungal infection caused by the inhalation of Histoplasma capsulatum conidia spores, has been shown to cause disseminated disease in immunocompromised individuals. Disseminated histoplasmosis manifests as multi-system involvement including pulmonary and/or neurological disease. Imaging findings, such as pulmonary focal infiltrates, cavitary nodules, mediastinal, and hilar lymphadenopathy, are common. Here, we report a rare case of disseminated histoplasmosis in a 58-year-old immunocompetent male with no occupational exposure. This patient presented with primary adrenal insufficiency, and a subsequent CT-guided biopsy of the adrenal gland was performed and revealed numerous spores containing Histoplasma capsulatum. This patient also suffered from numerous pulmonary and neurological derangements, which are likely sequelae of the disseminated fungal infection. Ultimately, the patient succumbed to their illness and died. Preventing such outcomes relies on early detection and prompt management, which are crucial in treating disseminated histoplasmosis. Increased awareness of atypical presentations can enhance patient outcomes and alleviate the impact of this severe fungal infection. This case not only underscores the importance of considering disseminated histoplasmosis in an immunocompetent patient presenting with unexplained weight loss and adrenal insufficiency but also contributes to the limited literature on disseminated histoplasmosis in immunocompetent individuals.
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Affiliation(s)
| | - Ashin Mehta
- Medicine, Medical College of Wisconsin, Wauwatosa, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
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Martinez-Ortega JI, Perez-Hernandez FDJ, Rodriguez-Castellanos MA, Martinez-Jaramillo E, Guillermo-Herrera JC. Disseminated Cutaneous Mycobacterium chelonae Infection in an Immunocompetent Patient. Cureus 2023; 15:e43170. [PMID: 37692700 PMCID: PMC10484636 DOI: 10.7759/cureus.43170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
We present a case report on disseminated cutaneous Mycobacterium chelonae infection with a sporotrichoid pattern in an immunocompetent patient. The aim of this report is to contribute to the existing knowledge on the clinical presentation and management of this uncommon presentation.
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Affiliation(s)
| | | | | | - Elvis Martinez-Jaramillo
- Department of Pathology, Faculty of Medicine and Health Science, McGill University, Montreal, CAN
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Haseeb Ul Rasool M, Swaminathan G, Hosna AU, Ishfaq S, Trandafirescu T. Candida lusitaniae, an Emerging Opportunistic Pathogen in Immunocompetent Populations: A Case Report. Cureus 2023; 15:e43211. [PMID: 37692725 PMCID: PMC10492586 DOI: 10.7759/cureus.43211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Candida lusitaniae is an emerging opportunistic pathogen in immunocompromised hosts and hospitalized patients. However, the incidence is low in immunocompetent hosts. Because of their characteristic similarities, C. lusitaniae may be confused with other fungal species, such as Candida tropicalis, Candida parapsilosis, and even Saccharomyces cerevisiae. Recently reported cases of serious infections caused by C. lusitaniae have proven detrimental, and some cases reported amphotericin resistance. Here, we present a case report of empyema caused by C. lusitaniae in an immunocompetent patient who was admitted to the intensive care unit and intubated for acute hypoxic respiratory failure. This case demonstrates the importance of recognizing this organism and initiating early treatment for the prevention of fatal complications.
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Affiliation(s)
| | - Gowri Swaminathan
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Asma U Hosna
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Salman Ishfaq
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Theo Trandafirescu
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Li W, Chen G, Lin F, Yang H, Cui Y, Lu R, Song C, Li H, Li Y, Pan P. A score for predicting invasive pulmonary aspergillosis in immunocompetent critically ill patients. Eur J Clin Invest 2023; 53:e13985. [PMID: 36920323 DOI: 10.1111/eci.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Delayed treatment leads to increased mortality in critically ill patients with invasive pulmonary aspergillosis (IPA). We aimed to develop and validate a prediction score based on novel biomarkers and clinical risk factors to identify IPA in immunocompetent patients in the intensive care unit (ICU). METHODS A retrospective study was conducted to collect medical information and novel biomarkers upon ICU admission. Risk factors adopted for the final prediction score were identified using multivariate logistic regression analysis. RESULTS We retrospectively collected 1841 critical ill patients between January 2018 and August 2022. Patients with IPA had higher C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio, systemic immune-inflammation index and lower prognostic nutritional index (PNI). Chronic obstructive pulmonary disease (COPD), continuous renal replacement therapy (CRRT), high dose of corticosteroids, broad-spectrum antibiotics, blood galactomannan (GM) positivity and high CAR were independent risk factors for IPA and were entered into the final prediction score. The score had good discrimination, with the area under receiver operating characteristic curve of 0.816 and 0.780 for the training and validation cohorts, respectively, and good calibration. CONCLUSION A score based on six clinical and novel immunological biomarkers showed promising predictive value for antifungal treatment in immunocompetent ICU patients.
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Affiliation(s)
- Wen Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Gang Chen
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Fengyu Lin
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Hang Yang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Yanhui Cui
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Rongli Lu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Chao Song
- Nosocomial Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
| | - Haitao Li
- First Department of Thoracic Medicine, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Pinhua Pan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
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Reihani AR, Ponce F, Spivak R. Pyogenic Liver Abscess: A Case of a Fussy Bug Seeking Unlikely Host. Cureus 2023; 15:e42263. [PMID: 37489179 PMCID: PMC10363015 DOI: 10.7759/cureus.42263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 07/26/2023] Open
Abstract
Pyogenic liver abscesses (PLAs) represent a rare yet life-threatening condition, and Fusobacterium species are an atypical etiology typically associated with immunocompromised patients or those with recent dental procedures or oro-gingival disease. Nonetheless, it is crucial to maintain a high level of suspicion for Fusobacterium infection in all cases, including immunocompetent individuals without known risk factors. In this case report, we present the clinical scenario of a young male with a history of COVID-19 pneumonia who exhibited subacute fever, abdominal pain, and pleuritic chest pain, leading to sepsis attributed to intraabdominal pathology. Subsequent imaging confirmed the presence of possible liver abscesses, prompting interventional radiology-guided drainage. Cultures obtained from the drained abscesses yielded Fusobacterium species, and significant clinical improvement was observed following the initiation of appropriate antibiotic therapy. This case report underscores the potential for disseminated Fusobacterium infections to occur in immunocompetent individuals without a history of oropharyngeal disease, highlighting the importance of early diagnosis and management to mitigate mortality risk.
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Affiliation(s)
- Amir R Reihani
- Medical Education, Griffin Hospital/Yale-Affiliated Hospital, Derby, USA
- Pulmonary and Critical Care Medicine, Eisenhower Hospital, Rancho Mirage, USA
| | - Fernanda Ponce
- Medical Education, Griffin Hospital/Yale-Affiliated Hospital, Derby, USA
| | - Roman Spivak
- Pulmonary and Critical Care Medicine, Griffin Hospital/Yale-Affiliated Hospital, Derby, USA
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Jagadisan B, Verma A, Deheragoda M, Deep A, Grammatikopoulos T, Sudhanva M, Bansal S, Hadzic N, Vimalesvaran S, Heaton N, Dhawan A. Outbreak of indeterminate acute liver failure in children with adenoviraemia - Not a new disease. J Hepatol 2023; 79:43-49. [PMID: 36822480 DOI: 10.1016/j.jhep.2023.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND & AIMS In the year 2022, an outbreak of indeterminate acute hepatitis and indeterminate paediatric acute liver failure (ID-PALF) in association with adenoviraemia in immunocompetent children was reported in the UK. We postulate that this association is not a new disease in immunocompetent children. METHODS Children with acute hepatitis during the outbreak who were referred to King's College Hospital, London for advice and management were included in the study. Data on the frequency of ID-PALF in 2022, as well as transplantation rates and the association with adenovirus infection, were obtained from electronic health records. The clinical presentation, histology and outcomes of children with ID-PALF and adenoviraemia in 2017-2021 were compared with those in 2022. RESULTS From January to June 2022, 65 patients with acute hepatitis were referred. Ten children were admitted with ID-PALF. ID-PALF constituted 26% of all PALF cases in 2017-2021, in contrast to 58.8% during the 2022 outbreak. During the outbreak, adenoviraemia was present in 52% of children with acute hepatitis without liver failure (in whom adenoviraemia test results were available) and in 100% of ID-PALF cases. Adenoviraemia was seen in immunocompetent children in 6/13 (46%) of all ID-PALF cases between 2017-2019, with a clear absence of adenoviraemia in the 6 ID-PALF cases during 2020-2021. Compared to ID-PALF with adenoviraemia in 2017-2019 (n = 6), ID-PALF with adenoviraemia during the outbreak (n = 10) was associated with more frequent hepatic encephalopathy, hypotension requiring vasoactive medications and higher plasma ammonia levels (admission and peak), with similar native liver survival. CONCLUSIONS The recent outbreak of ID-PALF with adenoviraemia in immunocompetent children does not appear to be a new disease, contrary to perception and other reports. The frequency of such cases over the years could be linked to background rates of adenovirus infections. IMPACT AND IMPLICATIONS Indeterminate paediatric acute liver failure (ID-PALF) associated with adenoviraemia in immunocompetent children is not a new disease specific to 2022. The exclusive role of human adenovirus infection in the causation of this outbreak of acute hepatitis seems unlikely. Indeed, we provide histological data from explants in transplanted patients that do not support direct viral cytotoxicity. The disease is probably mediated by immunological injury directed towards adenovirus infection and/or adeno-associated virus-2.
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Affiliation(s)
- Barath Jagadisan
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Anita Verma
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Maesha Deheragoda
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Akash Deep
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Tassos Grammatikopoulos
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Malur Sudhanva
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Sanjay Bansal
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Nedim Hadzic
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Sunitha Vimalesvaran
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Nigel Heaton
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK
| | - Anil Dhawan
- Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital NHS Foundation Trust, London, UK.
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Gupta RK, Agrawal M, Keche A, Ganguly S. Morphological Diagnosis of Blastomycosis Clinically Presenting as Mycetoma in a Young Immunocompetent Indian Patient; A Diagnostic Dilemma. Indian J Dermatol 2023; 68:446-449. [PMID: 37822386 PMCID: PMC10564219 DOI: 10.4103/ijd.ijd_100_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Primary cutaneous blastomycosis is very rare in non-endemic regions like India. Only few cases have been reported from India. Herein, we are reporting a rare case of chronic cutaneous blastomycosis in a young immunocompetent male presenting as mycetoma with multiple discharging sinuses in the anterior abdominal wall with no significant travel history.
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Affiliation(s)
- Rakesh K. Gupta
- From the Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mousmi Agrawal
- From the Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Archana Keche
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyaki Ganguly
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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50
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Ying D, Niu W, Chen Y, Wang Y, Tian W, Zhang X, Liu C, Wang S, Chen Z, Lin Y, Guo S, Yu Z, Chen X, Fang M, Qiang H, Yin Y, Tang Z, Zheng Z, Fu L, Xia N. Case Report: Chronic hepatitis E virus Infection in an individual without evidence for immune deficiency. Front Immunol 2023; 14:1183859. [PMID: 37404820 PMCID: PMC10315653 DOI: 10.3389/fimmu.2023.1183859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/03/2023] [Indexed: 07/06/2023] Open
Abstract
Chronic hepatitis E virus (HEV) infection occurs mainly in immunosuppressed populations. We describe an investigation of chronic HEV infection of genotype 3a in an individual without evidence for immune deficiency who presented hepatitis with significant HEV viremia and viral shedding. We monitored HEV RNA in plasma and stools, and assessed anti-HEV specific immune responses. The patient was without apparent immunodeficiency based on quantified results of white blood cell, lymphocyte, neutrophilic granulocyte, CD3+ T cell, CD4+ T cell, and CD8+ T cell counts and CD4/CD8 ratio, as well as total serum IgG, IgM, and IgA, which were in the normal range. Despite HEV specific cellular response and strong humoral immunity being observed, viral shedding persisted up to 109 IU/mL. After treatment with ribavirin combined with interferon, the indicators of liver function in the patient returned to normal, accompanied by complete suppression and clearance of HEV. These results indicate that HEV chronicity can also occur in individuals without evidence of immunodeficiency.
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Affiliation(s)
- Dong Ying
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Wenxia Niu
- Department of Infectious Disease, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Yanling Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Yingbin Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Weikun Tian
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Xiaoping Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Chang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Siling Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Zihao Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Yajie Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Shaoqi Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Zihao Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Xiuting Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Mujin Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, School of Public Health, Xiamen University, Xiamen, China
| | - Hongsheng Qiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Yifan Yin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Zimin Tang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, School of Public Health, Xiamen University, Xiamen, China
| | - Zizheng Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
| | - Lijuan Fu
- Department of Infectious Disease, Xiang’an Hospital of Xiamen University, Xiamen, China
- Xiamen Quality Control Center of Infectious Diseases, Xiamen, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, School of Life Sciences, Xiamen University, Xiamen, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, School of Public Health, Xiamen University, Xiamen, China
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