Coagulase negative staphylococci are skin commensals and are generally disregarded as contaminants in clinical specimens. Repeated isolation of coagulase negative staphylococci in blood cultures should warrant a species identification to recognize unusually virulent organisms that demand aggressive treatment, such as Staphylococcus lugdunensis. Staphylococcus lugdunensis is known to cause a wide variety of infections, including a predominant left-sided endocarditis. We report a rare case of native tricuspid valve Staphylococcus lugdunensis endocarditis in a non-intravenous drug user and include a brief literature review.KEY WORDS: Staphylococcus lugdunensis; coagulase negative staphylococci; skin commensals; left-sided endocarditis.
Mycobacterium porcinum has been reported to cause a variety of illnesses including wound infections, respiratory tract infections, osteomyelitis and catheter-related bacteremias. We report the first case of M. porcinum peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old woman on CAPD presented with three weeks of constitutional symptoms and abdominal pain. Peritoneal fluid cultures on day three grew acid-fast rods. Nocardiosis was suspected and the patient was empirically treated with amikacin and trimethoprim-sulfamethoxazole. The dialysis catheter was removed. Two weeks later final culture results revealed M. porcinum. Ciprofloxacin and trimethoprim-sulfamethoxazole were initiated with good clinical response.
A 66-year-old male presented with visual hallucinations. He had chronically elevated serum creatine kinase (CK) levels without muscle weakness. His hospital course was complicated by hypercapnic respiratory failure requiring mechanical ventilation. His hallucinations completely subsided on mechanical ventilation. Elevated CK levels prompted a muscle biopsy, which showed myopathy consistent with acid maltase deficiency disorder (AMDD). This is the first reported case of adult onset AMDD presenting with psychiatric symptoms. Our objective in reporting this case is to encourage early recognition of neuromuscular respiratory failure in AMDD and to reinforce that respiratory failure may develop without associated extremity muscle weakness. CASE NARRATIVEA 66-year-old male presented to his primary care physician's office with a three-week history of visual hallucinations and nightmares. The hallucinations had all occurred at night while in bed. The patient had a two-year history of depression marked by decreased appetite, inability to concentrate and memory problems. He was diagnosed as having depression with psychotic features and was admitted to the inpatient psychiatry service for further evaluation.The patient had minimal past medical history, significant only for hypertension and chronic, mildly elevated CK levels. This elevation in CK levels had been present for at least five years, with values generally ranging between 250-500 international units per liter (IU/L). An extensive workup had been performed to evaluate the cause of his elevated CK levels. He was not on any lipid lowering agents and his thyroid function was normal. His rheumatologic work-up, including antinuclear antibody, rheumatoid factor, anti-double stranded DNA, anti-centromere antibodies and erythrocyte sedimentation rate were all normal. His only symptoms were chronic minimal shortness of breath and fatigue, but he was still physically active. In fact the day prior to admission he had exercised on his treadmill. He had a remote history of smoking. He smoked 1-2 cigarettes for about five years and had quit about thirty years ago. There was no family history of inherited muscular disorders. His medications on admission to the hospital were nifedipine, metoprolol succinate, venlafaxine and eszopiclone. The eszopiclone had been prescribed recently for insomnia, but the patient had not been taking it, as he believed it was worsening his nightmares. On physical examination he was awake and alert. His body mass index was 23.3. Neurological examination revealed normal cranial nerves. Sensory and cerebellar systems were normal. The patient did have slight shoulder and pelvic girdle weakness but the distal muscles had good strength. Deep tendon reflexes and the plantar response were normal. The remainder of the physical exam was normal.Mental status exam revealed a blunted affect but an appropriate thought process that was goal directed, logical and coherent without tangentiality or loosening of association. He admitted to visual hallucinations but den...
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