Pandemic of COVID-19 has brought a pletho-ra of challenges throughout the world and has opened exposed gaps in already overburdened stressful health system [...]
Co-infections or consecutive infections of mucormycosis and aspergillosis are very rare. Additionally, distinguishing between these two infections is also difficult as both these conditions have similar clinical features. We report two similar cases from Tamilnadu, who presented to a tertiary care centre in Puducherry, India in 2017 (first case) and 2019 (second case).The first case was a 70-year-old, non-diabetic male patient who presented with haemoptysis with a prior history of pulmonary tuberculosis. Computed tomography bronchial angiography revealed an air-crescent sign and the histopathological examination showed a fungal ball (aspergillus and mucor) in the upper lobe and foci of fungal infection in the middle lobe. The second case was a 65-year-old diabetic male patient who presented with blackish expectoration and haemoptysis. A high-resolution computed tomography scan showed a reverse-halo sign in the right upper lobe. The results of the bronchoscopy-guided biopsy were consistent with a diagnosis of mixed mucormycosis and aspergillosis with angioinvasion. Both patients responded to amphotericin B with surgical excision of the affected lobe in the first case.A high degree of clinical suspicion, early surgical intervention and antifungal therapy are essential in the treatment of this rare co-infection. Keywords:Aspergillosis; Mucormycosis; Bronchoscopy; Coinfection; Amphotericin B; Case Report; India.
Introduction: Metallic mercury poisoning through intravenous injection is rare, especially as part of a suicide attempt. Diagnosis and treatment of the disease are challenging as clinical features are not specific. Material and metods: A 41-year-old male presented with dyspnea, fatigue, loss of weight, and loss of appetite over two months. Routine radiological examination by chest X-ray and CT showed randomly distributed high density opacities with Hounsfield units (HU) around 500 HU all over the body. The diagnosis was then confirmed with a urinary mercury concentration of > 1000 mcg/24 h. Results: The patient’s clinical condition was getting worse in spite of chelation therapy and hemodialysis. The patient eventually died because of respiratory failure. Conclusion: Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning especially because there are no specific signs or symptoms. There should be a high level of suspicion in drug abusers. Treatment should involve the combined use of chelating agents and other treatments such as hemodialysis and plasma exchange in advanced clinical settings.
Background Progressive acute respiratory failure with Mycobacterium tuberculosis (TB) in immunocompetent individuals is rare, and if detected early, diagnosis and treatment dilemmas can be limited. We report here a unique case of respiratory failure due to tubercular spontaneous pneumomediastinum complicated by acute respiratory distress syndrome (ARDS). Case presentation A 24-year-old male of low socioeconomic background presented with shortness of breath, dry cough, and fever for 7 days, which was accompanied by weight loss and a reduced appetite. The patient had tachypnea and hypoxemia (SpO2 = 86%). The patient’s condition deteriorated (SpO2 = 72% with 12 L min−1of O2 delivered using a non-rebreather mask), and he was intubated using a lung-protective approach with a tidal volume of 350 mL (6 mL kg−1), positive end-expiratory pressure (PEEP) of 5 cm H2O, RR of 20 cycles/min, a flow rate of 35 L min−1, and FiO2 of 0.6. High-resolution computer tomography of the thorax showed multilobar consolidation, pneumomediastinum, and extensive subcutaneous emphysema with left-sided pneumothorax. Subsequently, a left-sided tube thoracostomy was carried out. The PaO2/FiO2 (P/F) ratio immediately after intubation was 130 and rose to 170 post-thoracostomy, which was suggestive of moderate ARDS. Bacterial and fungal colonies detected from the blood and endotracheal aspirate were normal. However, for the endotracheal aspirate, the cartridge-based nucleic acid amplification test (CBNAAT) detected TB with no rifampicin resistance. The patient was started on anti-tubercular therapy (ATT). Despite ATT, the patient developed circulatory shock and died after 4 days. Conclusions In young patients with acute spontaneous pneumomediastinum and ARDS, TB infection should be considered during initial diagnostics. This consideration may lead to timely treatments and improved patient survival.
Subcutaneous emphysema (SE) occurs when air enters the tissues under the skin and passes into the soft tissues. We demonstrated a simple, minimally invasive technique for treating extensive SE, using a readily available infant nasogastric tube, in a mechanically ventilated patient.
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