Saccharomyces cerevisiae has recently been used as an ingredient in probiotic supplements. Invasive Saccharomyces infection have been documented, and multiple predisposing risk factors have been identified including critical illness, ICU admission, antibiotics use, central venous catheters, probiotics use, and immunosuppression. We report a case of a 74-year-old man admitted for acute cholangitis taking a probiotic supplement containing the subtype Saccharomyces boulardii. He later developed S. cerevisiae fungemia that was successfully treated with Micafungin and Fluconazole.
Patient: Female, 44
Final Diagnosis: Varicella zoster meningitis
Symptoms: Headache
Medication: —
Clinical Procedure: —
Specialty: Infectious Diseases
Objective:
Unusual clinical course
Background:
Varicella zoster virus (VZV) is a common viral infection, with primary infection presenting as fevers and pruritic vesicular rash. After staying dormant in the dorsal root ganglia, reactivation can lead to secondary infection. Meningitis is a rare a complication of VZV infection.
Case Report:
We report a case of a 44-year-old woman with no past medical history, presenting with severe frontal headache without meningeal signs or fevers, found to have VZV meningitis. CSF analysis revealed hypoglycorrhachia and she was treated successfully with combination of intravenous acyclovir and oral valacyclovir.
Conclusions:
VZV meningitis can present with subtle clinical signs and symptoms and should be considered as a possible etiology for headaches without identifiable cause.
Patient: Female, 53Final Diagnosis: Muscular mucormycosisSymptoms: Arm pain • leg pain • swellingMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Unusual clinical courseBackground:Mucormycosis is a serious, potentially fatal fungal infection caused by species in the Mucorales order. Together with candidiasis and aspergillosis, it is one of the most significant fungal infection that carries a high rate of mortality. Early detection and initiation of antifungal therapy with adequate surgical debridement improves the clinical outcome.Case Report:We describe a case of mucormycosis in a patient with acute myeloid leukemia who developed disseminated lung disease with muscular involvement without any cutaneous manifestation. Successful treatment was achieved with surgical debridement, amphotericin B lipid-complex and posaconazole step-down therapy.Conclusions:Mucormycosis can present in various clinical scenarios. Key to diagnosis depends on tissues diagnosis from the affected system, as was done with lung and muscle biopsy in our patient. Clinicians should maintain high suspicion for early diagnosis and prompt treatment.
Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) is a life-threatening complication of type 2 diabetes mellitus with a wide range of presenting symptoms. Neurological symptoms, such as coma, can also be part of the manifestation of HHNS; however, focal seizures remain a rare but notable association.
A 85-year-old male patient with no history of diabetes presented to our emergency department complaining of a two-day history of twitching movements of his left wrist. Laboratory findings suggested HHNS and his hemoglobin A1c were found to be 10.2%. He was aggressively treated in the intensive care unit with fluids and insulin which also resolved his seizure episodes. He was ultimately discharged in stable condition without any seizure-like activity while having good glycemic control.
According to the American Diabetes Association, about 25% of all individuals 65 years and older have diabetes mellitus. With an increasing prevalence, the complications of uncontrolled diabetes are also becoming more notable. While the neurological deficits associated with HHNS are focal, the mechanism by which this occurs is still poorly understood and underreported warranting further studies.
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