Patient: Male, 32-year-old Final Diagnosis: Pneumonia due methicillin-resistant Staphylococcus aureus (MRSA) Symptoms: Hypoxemia • tonic-clonic seizures Medication: — Clinical Procedure: Bronchoalveolar lavage • lumbar puncture Specialty: Critical Care Medicine • Pulmonology Objective: Rare co-existance of disease or pathology Background: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia has well-defined characteristics. We present a case of cavitary pneumonia due to MRSA in a patient who had undergone a recent outpatient gastroscopic procedure. Case Report: A 32-year-old man presented at the Emergency Department with tonic-clonic seizures of 2 min durations. He had a history of seizures without current treatment or use of psychostimulant drugs. His personal history referred to hypothyroidism treated with levothyroxine, morbid type 3 obesity, gastritis with a gastric ulcer, penicillin allergies, and an ambulatory endoscopy with a biopsy (7 days ago) for erosive gastropathy. On the 3 rd day of admission to the Intensive Care Unit (ICU), a bronchoscopy was performed, which showed a reddened mucosa with hemorrhagic points and a cavitary area in the right main bronchus. Multiple polymerase chain reaction and mass spectrometry analyses of samples of bronchioalveolar lavage from the bronchus revealed MRSA with a mechanism of resistance to the mecA gene (1×10 5 colony-forming unit/mL). The laboratory results for the cerebrospinal fluid were negative for bacterial growth. After 6 days, he was discharged from the ICU, although he remained hospitalized for another 4 days. He was followed up through the Outpatient Department and 6 months later he remains in general good health. Conclusions: This is a rare case of cavitary pneumonia due to MRSA of clinical and epidemiological characteristics, which is unusual after an outpatient endoscopic procedure.
Subacute invasive aspergillosis is an infection that locally destroys lung parenchyma, and it affects patients with mild immunocompromise. The diagnosis is made by clinical symptoms, imaging, and laboratory results related to the infection. Early diagnosis and treatment is imperative for a favorable patient outcome. In this article, we present the case of a 19-year-old woman who was admitted to the intensive care unit for puerperal sepsis where a hysterectomy was performed. During her hospitalization, she presented atelectasis of the left lung and hemodynamic instability. Chest X-ray and chest computed tomography scan were performed and showed round opacities. It was decided to perform flexible bronchoscopy with bronchoalveolar lavage. An unusual subacute form of implementation of aspergillosis was confirmed by a bronchoalveolar lavage culture that showed the presence of Aspergillus. Images taken during bronchoscopy revealed Aspergillus implantation in the lung and serum galactomannan antigen test was positive. Voriconazole was introduced, 200 mg daily. The patient showed clinical improvement and was discharged from our hospital. We conclude that subacute invasive aspergillosis is a serious infection that can lead to high mortality. Bronchoscopy with bronchoalveolar lavage allows access and effective visualization of the airway as well as sampling for Aspergillus identification.
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