Emphysematous aortitis is a rare but lethal form of infectious vasculitis. This condition was found incidentally on computed tomography of the chest during the evaluation of a patient presenting with pneumonia coincident with adynamic ileus. The patient did not have a history of malignancy. While colon cancer could not be ruled out, it is possible that ileus may have contributed to or resulted in bacterial translocation in this case. Appropriate investigations and empirical therapy against Clostridium septicum should be initiated in the presence of clinical and radiological findings suggestive of emphysematous aortitis.
Non-mucinous lepidic adenocarcinoma with pneumonic presentation is a rare form of lung cancer. Its ability to mimic infectious and inflammatory diseases in both patient presentation and diagnostic imaging can result in a delayed diagnosis. This case follows the workup of a 60-year-old non-smoker female who immigrated from Ecuador twenty years prior and worked at a shore repair shop for the past two years who presented with worsening shortness of breath and 15lbs weight loss over a two-month period. A unique aspect of this patient's presentation was that the typical imaging and bronchoscopy findings often seen to distinguish this type of lung adenocarcinoma from other disease processes were absent. No nodular masses were observed on Computed Tomography (CT), and no lesions or airway abnormalities were seen on bronchoscopy. It was not until biopsy and bronchoalveolar lavage (BAL) that the diagnosis of adenocarcinoma was recognized. Our case aims to increase awareness among clinicians of the unpredictable presentation of nonmucinous lepidic adenocarcinoma. Furthermore, we want to highlight the relevance of including adenocarcinoma of the lung in the differential diagnosis even when infectious or occupational etiologies appear more likely.
The concomitant use of two distinct sampling methods can enhance the diagnostic yield of esophageal candidiasis during upper endoscopy. Furthermore, when initial staining is inconclusive, the use of additional stains can help establish the diagnosis.
Background The Streptococcus Anginosus Group (SAG) formerly Streptococcus Milleri Group is a subgroup of viridans streptococci including S. anginosus, intermedius, and constellatus. SAG are microaerophilic digestive tract commensals. They are associated with empyema and deep organ abscesses. We present 2 unusual cases: necrotizing fasciitis and aortic valve endocarditis with aortic root abscess, resulting in septic emboli causing renal infarction. Methods Review of the literature and reported cases of SAG. Results Case1) 48 year-old-male with history of HTN, T2DM, presented with swelling and erythema of the right arm of 2-day evolution. Exam: tender, erythematous indurated right deltoid. Significant labs: WBC 25k/uL and lactate of 2.5. CT of the RUE showed an extensive fluid collection. Vancomycin, levofloxacin and clindamycin were initiated, surgical debridement revealed extensive necrotizing fasciitis Wound cultures grew S. constellatus. Required multiple debridement and prolonged course of penicillin G. Case 2) 53-year-old male with history of COPD, Prior Splenectomy for a large splenic infarct, heterozygous factor V Leiden mutation, HCV infection, cirrhosis, presented with right flank pain, hematuria over 5 days. Labs: WBC 16.8 k/uL, CT abdomen with contrast: right renal infarct. Heparin drip, Vancomycin and Ceftriaxone were initiated. Blood cultures grew S. anginosus. TEE revealed new aortic valve vegetations with severe aortic regurgitation. His condition deteriorated, requiring aortic valve surgery, found to have aortic root abscess requiring aortic root replacement. Necrotizing Fascitis - Soft Tissue Air Post-Surgical Debridement Right Renal Infarct Conclusion SAG infections infections are unique from other S viridans, causing severe deep organ abscesses requiring combined surgical and antibiotic therapy. Isolation in clinical specimens should alert the possibility of severe life threatening infections. Here we highlight 2 unusual manifestations of necrotizing fasciitis and aortic valve endocarditis with aortic root abscess and possible large septic renal embolism. One patient had a splenectomy. We are not sure if this contributed to a severe SAG infection Disclosures All Authors: No reported disclosures
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