Mycoplasma hominis brain abscess presenting after a head trauma: a case report

ABSTRACT: INTRODUCTION: Mycoplasma hominis brain abscess is a rare occurrence, and treatment is not well defined.The mechanism by which M. hominis infects sites outside the genitourinary tract, includingthe central nervous system, is unclear. CASE PRESENTATION: We report the case of a 40-year-old Somali man who sustained a traumatic brain injury thatrequired initial neurosurgical hematoma evacuation and that subsequently was complicatedby a hospital-acquired M. hominis brain abscess. Our patient was successfully treated withneurosurgical debridement and an antibiotic course of intravenous doxycycline. CONCLUSIONS: Head trauma or neurosurgical procedures or both might be a predisposing factor for this typeof infection.     

Parotid abscess due to salmonella enteritidis: A case report

BACKGROUND: Salmonella infection of the parotid gland is rare. CASE: An instance in a 50-year-old man of Salmonella enteritidis parotiditis initially recognized by microbial culture of a fine needle aspiration cytology material is described. The identified predisposing factor was chronic alcoholic abuse. For the infection source, a carrier state of salmonella parotitis was postulated, which progressed to focal abscess and was subsequently complicated by bacteremia and hematogenous spread to the liver, spleen and lungs. CONCLUSION: Salmonella should be included in the differential consideration of head and neck abscesses in immunocompromised individuals and treated aggressively.     

我国首见斑替支孢瓶霉引起脑脓肿1例

目的报道1例斑替支孢瓶霉引起脑脓肿。方法抽取脑脓液作直接镜检和真菌培养,分离菌株行DNA序列分析、KOH耐受试验、温度试验和明胶液化试验。结果脑脓液直接镜检发现大量棕色、分隔或不规则膨胀菌丝,SDA培养出灰黑色、绒状、纽扣样菌落,微量培养可见棕色、单支或分支特长的孢子链结构,DNA序列分析属于斑替支孢瓶霉。菌株具有耐碱性,不能液化明胶,可在25-42℃环境下生长。脓肿穿刺术、两性霉素B脂质体静脉滴注和脓腔内注射等治疗无明显疗效,放弃治疗后死亡。结论根据其形态学特点和DNA序列分析,菌株被鉴定为斑替支孢瓶霉。该菌引起的脑脓肿为国内首例报道,脓肿穿刺术和单用两性霉素B治疗无明显疗效。     

扁舌蛭肛内脓肿区寄生一病例记述

蛭类动物种类繁多,分布广泛,与人民生产、生活、环保、医药等关系较为密切。在林区、沼泽、池塘及河川地带,能够迅速爬上人畜身体各部位吸血。但迄今为止,蛭类对人体直接危害的报道均为暂时性外寄生,尚未见其钻入人体腔道,并长期生活于其中的报道。本文首次报道一例...     

Pulmonary nocardiosis associated with cerebral abscess successfully treated by co-trimoxazole: a case report

Nocardiosis is an acute or chronic infectious disease caused by the soil-borne filamentous bacteria belonging to the genus Nocardia. The organisms opportunistically infect both immunocompromised and immunocompetent individuals. The lungs are the primary site of infection and brain abscess is, by far, the most common complication following nocardial metastasis from pulmonary lesions. Although surgical intervention must always be considered in the treatment of nocardial brain abscess, it can obviously be cured by antibiotic therapy alone. This report describes a case infected by Nocardia cyriacigeorgica. Identification of the infectious agent was achieved by conventional and semi-nested PCR techniques. A 55-year-old woman with fever was referred to the infect disclinic of Imam Khomeini hospital in Tehran and was hospitalized after clinical assessment. She was a kidney transplant recipient for 4 years and was taking immunosuppressive treatment including azathioprine and methylprednisolone. Follow-up of the patient by CT scan revealed pulmonary infection and cerebral lesions. Specimens of the brain lesions contained filamentous bacteria. The patient received a combination of co-trimoxazole and ceftriaxone and brain abscesses as well as lung inflammation disappeared gradually during the course of antibiotic therapy within 3 months. The patient was discharged from the hospital after 2 months of therapy.     

Confounding factors in diagnosing brain death: a case report

Background  

Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses.     

Age-related Epstein-Barr virus-positive cutaneous ulcer arising after a self-limited subcutaneous abscess: a case report

ABSTRACT: INTRODUCTION: Epstein-Barr virus-positive mucocutaneous ulcer is a newly recognized clinicopathologic entity in the spectrum of Epstein-Barr virus-positive lymphoproliferative disorders. This entity is characterized by a self-limited, indolent course. CASE PRESENTATION: We report the case of a 74-year-old, type 2 diabetic man who presented with an ulceroinfiltrative skin lesion on the left side of his neck. Histological examination showed that the lesion consisted of large atypical cells, some with Hodgkin-Reed-Sternberg-like morphology, in the midst of reactive lymphocytes, plasma cells, eosinophils and histiocytes. The atypical cells were partially positive for CD45, CD20, CD79a, CD30, B-cell lymphoma 2 and latent membrane protein 1 (CS.1-4), and negative for CD15, B-cell lymphoma 6 and CD10. In situ hybridization for Epstein-Barr virus-encoded ribonucleic acid was positive. Two years before, the patient had been diagnosed with a self-limited subcutaneous abscess in the same anatomic area that healed after antibiotic therapy. CONCLUSION: Older patients with positive Epstein-Barr virus serology may develop B-cell lymphoproliferations due to age-related immune suppression. Epstein-Barr virus-encoded ribonucleic acid testing and clonality analysis, eventually complemented with close clinical follow-up, should be performed for suspicious inflammatory lesions in older patients.     

Bilophila wadsworthia: a unique Gram-negative anaerobic rod

Although comprising less than 0.01% of the normal human gastrointestinal microbiota, Bilophila wadsworthia is the third most common anaerobe recovered from clinical material obtained from patients with perforated and gangrenous appendicitis. Since its discovery in 1988, B. wadsworthia has been recovered from clinical specimens associated with a variety of infections, including sepsis, liver abscesses, cholecystitis, Fournier's gangrene, soft tissue abscesses, empyema, osteomyelitis, Bartholinitis, and hidradenitis suppurativa. In addition, it has been found in the saliva and vaginal fluids of asymptomatic adults and even in the periodontal pockets of dogs. The organism is a saccharolytic, fastidious, and is easily recognized by its strong catalase reaction with 15% H2O2, production of hydrogen sulfide, and growth stimulation by bile (oxgall) and pyruvate. Approximately 75% of strains are urease positive. When grown on pyruvate-containing media, > 85% of strains demonstrate beta-lactamase production. Ribosomal RNA-based phylogenetic studies show Bilophila to be a homogeneous species, most closely related to Desulfovibrio species. Both adherence to human cells and endotoxin have been observed, and preliminary work suggests that environmental iron has a role in expression of outer membrane proteins. Penicillin-binding proteins appear to mediate the organism's susceptibility to at least some beta-lactam agents, which induce spheroplast formation that results in a haze of growth on agar dilution susceptibility test plates which is difficult to interpret.Bilophilastrains are inhibited in vitro by most antibiotics.     

Intraoperative cytodiagnosis of metastatic brain tumors confused clinically with brain abscess. A report of three cases

BACKGROUND: Cystic lesions of the brain may have diverse etiologies, ranging from true cysts to malignant tumors with cystic degeneration. Preoperative determination of the exact nature of them as well as intraoperative diagnosis may be sometimes difficult or even impossible. Sensitivity and specificity of diagnosis will be improved by introducing new methods or combining traditional procedures. CASES: Three metastatic brain carcinomas with primary sites of breast, pancreas and prostate presented as cystic lesions and were confused clinically with abscess. Intraoperative frozen section was not revealing. Cytologic study of sediments of aspirated fluid uncovered malignant cells. CONCLUSION: When combined with frozen section, intraoperative cytologic studies in the form of crush preparation, fine needle aspiration or evaluation of aspirated fluid in cystic lesions (as in our cases) can improve diagnostic accuracy by detecting important diagnostic features that otherwise may be missed.     

Primary excision of brain abscess.

Sixteen consecutive patients with brain abscess, including two with multilocular and two with infratentorial abscesses, were treated by primary total excision of the abscess. The patients were followed for six months to three years. Only one patient died and there were no recurrences. Immediate primary excision is therefore the treatment of choice in brain abscess.     

Widespread enlarged perivascular spaces associated with dementia and focal brain dysfunction: case report

Background

Enlarged perivascular spaces (PVS) are common magnetic resonance imaging (MRI) findings, whereas widespread enlarged PVS are extremely rare. Although most patients with widespread enlarged PVS remain asymptomatic, some develop neurological dysfunctions; however, it remains unclear whether these are the consequence of widespread enlarged PVS.

Case presentation

A 64-year-old female patient developed consciousness disturbance, cognitive dysfunctions, fluent aphasia, agraphia, acalculia, and left-right disorientation after suffering from bronchopneumonia. Brain MRI revealed unusually widespread enlarged PVS predominantly in the left cerebral hemisphere. Following bronchopneumonia treatment, her cognitive dysfunction, fluent aphasia, agraphia, acalculia, and left-right disorientation persisted despite improvement of her general condition. Furthermore, the hypoperfusion area on single photon emission computed tomography and slow wave sites on electroencephalography were consistent with the location of enlarged PVS, indicating that severe enlarged PVS impaired focal brain functions.

Conclusions

This case suggested that widespread enlarged PVS could be a potential cause of neurological deficits. We propose that impaired perivascular circulation due to enlarged PVS might lead to focal brain dysfunction.

     

Case report: Metaplastic carcinoma presenting as a breast abscess

Metaplastic breast carcinoma (MBC) is a rare neoplasm containing a mixture of epithelial and mesenchymal elements. The epithelial component is usually ductal carcinoma but may include other variants of breast carcinomas including squamous carcinoma and osteogenic sarcoma. There is a relative paucity of data regarding such tumours. Metaplastic carcinoma carries a prognosis not dissimilar to that of comparable ductal carcinoma. This is the case of a 57 year old patient with MBC presenting with a breast abscess. A thorough literature search has not revealed any previous reports of MBC presenting as a breast abscess.     

Melanosis intestini: case report

A transrectal needle biopsy from a 63-year-old man was decided because of a high prostatic spesific antigen in the blood, and a hard right lobe in rectal examination. 10 examples were taken from each lobe. In 1 of 4 of the examples from the left lobe, which contained a small focus of adenocarcinoma, numerous eosinophils were observed to surround the carcinomatous focus and attack the carcinoma cells. Uniquely, at the same focus Charcot-Leyden crystals could be seen in the intraluminal space and stromal area. A carcinoma oriented eosinophil accumulation, and Charcot-Leyden crystals in prostate was not described before.