Red Man syndrome (RMS) occurs with the rapid infusion of intravenous (IV) vancomycin. RMS induced by oral vancomycin has been the focus of a limited number of case reports. We present a case of a 75-year-old female admitted with severe Clostridium difficile colitis who received oral vancomycin and by the second day of therapy, she developed flushing, erythema, and pruritus involving the face, neck and upper torso. Oral vancomycin was immediately withheld, and diphenhydramine was initiated. Clinical improvement was apparent 24 hours after discontinuation of oral vancomycin. Our case adds to the published literature on this rare clinical entity that should be considered when severe colitis patients prescribed oral vancomycin, as part of the standard of care, develop the typical signs and symptoms of RMS.
Mycobacterium tuberculosis is the bacterium that as a single agent is known to cause the infection with the most morbidity and mortality around the world. It is known to cause pulmonary infection in immunocompetent patient, but its dissemination outside the lungs has been linked to a high degree of cellular immunosuppression as seen in the advance stages of human immunodeficiency virus infection, and after chemotherapy. Despite extensive research, screening, education, and continuous efforts to try to eradicate and control the infection, tuberculosis is still one of the most prevalent infections throughout the world. Even the cases of extra pulmonary dissemination are seen to have increased. Extra pulmonary tuberculous dissemination has a very variable presentation that depends on the organ involved. The diagnosis is difficult and many times a long time passes between diagnosis and initial presentation. In this chapter, we will review how tuberculosis infection presents when the bacilli invades any tissue outside the pulmonary parenchyma, what the literature recommends for the proper work up and diagnosis, and general treatment for major organ system infection.
Actinomycosis is a filamentous bacterium that forms part of the normal human flora of the gastrointestinal, oropharynx and female genitalia. This indolent infection is characterized by abscess formation, widespread granulomatous disease, fibrosis, cavitary lung lesions and mass-like consolidations, simulating an active malignancy or systemic inflammatory diseases. It is subacute, chronic and variable presentation may delay diagnosis due to its capability to simulate other conditions. An accurate diagnostic timeline is relevant. Early diagnosis of pulmonary actinomycosis decreases the risk of indolent complications. Proper treatment reduces the need for invasive surgical methods. Actinomycosis can virtually involve any organ system, the infection spread without respecting anatomical variables as metastatic disease does, making malignancy an important part of the differential diagnosis. As it is normal gastrointestinal florae, it is difficult to cultivate, and share similar morphology to other organisms such as Nocardia and fungus. It is often difficult to be identified as the culprit of disease. Its true imitator capability makes this infectious agent a remarkable organism within the spectra of localized and disseminated disease. In this chapter, we will discuss different peculiarities of actinomycosis as an infectious agent, most common presentation in different organ systems, and challenging scenarios.
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