Urinary tract infections (UTI) in the elderly are common. UTI ranges in severity from mild disease to severe sepsis. Many organisms can cause UTIs yet many UTIs are caused by the same few organisms. An organism that has been increasingly gaining notoriety for infections is Aerococcus urinae. Aerococcus infections are constantly misdiagnosed due to their difficulty to identify. Here we present a case of an elderly male who was found to have a urinary tract infection with Aerococcus urinae that progressed into bacteremia, severe sepsis and ultimately death.
A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization.CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.LEARNING POINTSMay–Thurner syndrome (MTS) should be suspected in patients in their second to fourth decade of life presenting with unprovoked deep venous thrombosis of the left leg.An iliac venogram is the diagnostic test of choice for MTS.MTS is treated only when it is symptomatic. The goal of treatment is to remove the clot to prevent post-thrombotic syndrome and to repair the anatomical defect.A stent was successfully deployed in the iliac vein of our patient and restoration of blood flow resulted in a dramatic improvement in the patient’s symptoms.
INTRODUCTION: Benign esophageal strictures can result from long-standing GERD, ablative or radiation therapy, corrosive substance ingestion etc. Management of strictures could be very challenging. We describe a case of esophageal strictures that was managed with an innovative approach. CASE DESCRIPTION/METHODS: A 36-year-old Indian female with a history of esophageal strictures secondary to caustic ingestion 9 years ago presented with complaints of dysphagia. Patient underwent multiple EGD with dilatations in the early years of her stricture formation. Subsequently she was taught to perform self dilations in India, every 2 weeks to relieve dysphagia. An esophagram revealed a narrow caliber mid and distal esophagus with 3 prominent stricture points. During endoscopy an 8.8 mm gastroscope could not traverse the most proximal stricture hence a bronchoscope was used to evaluate the number and size of strictures for optimal use of pneumatic balloon catheter for dilation. The bronchoscope evaluation revealed 3 esophageal strictures at 25 cm, 30 cm and 35 cm from incisors. Serial dilations were performed with a balloon dilator and triamcinolone was then injected at the stricture site post dilation. Following this intervention she was able to defer dilatation for 6 weeks. Using a Bronchoscope a second session of dilatation and triamcinolone injection was repeated 6 weeks later. Therapy was required for one of the three strictures with the others having healed well. Patient has not been performing self dilations since her first EGD and continues to be asymptomatic. DISCUSSION: Caustic ingestion and its gastrointestinal sequelae such as stricture formation have been an important public health concern for decades. Damage and complications depend on several aspects: substance concentration and pH, length of time of tissue contact and amount ingested. The primary treatment of a caustic esophageal stricture is endoscopic dilatation, however sometimes management could be challenging. Using a bronchoscope (thin caliber scope), the high grade strictures in our patient were traversed and evaluated optimally prior to execution of the treatment modality. In our extensive literature review, a bronchoscope has never been used before for managing high-grade strictures, which makes our case unique. We believe that this new technique of utilizing a bronchoscope for evaluation of high-grade strictures can provide more targeted therapeutic approach and superior management to the patient.
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