Fusarium osteomyelitis: case report and review of the literature.

We present a case of Fusarium osteomyelitis attributed to innocuous trauma in a patient with significant peripheral vascular disease and diabetes mellitus type 2. Fusarium species have been reported to cause an increasing number of infections, particularly in severely immunocompromized patients. Colonization of normal skin has also been reported. To the best of the author's knowledge, there are 5 cases of Fusarium osteomyelitis described in English-language literature. There is also a report with little detail of Fusarium infection involving bone in 3 patients with hematologic malignancy. We tabulated the pertinent facts of the 5 detailed cases and compared them to ours. Early diagnosis requires some suspicion of invasive fungal infection. Tissue culture and pathologic examination are necessary for definitive diagnosis and to distinguish infection from colonization. Therapy includes antifungal drugs and aggressive surgical debridement, and even when these modalities are readily implemented the outcome may not be optimal because of the angioinvasive character of the organism.

Aspergillus flavus scleritis: successful treatment with voriconazole and caspofungin.

Aspergillus scleritis is a potentially devastating ocular infection difficult to treat because of poor scleral vascularity. Most Aspergillus cases occur following ocular surgery, but others have been associated with trauma or intravenous drug use. No anti-fungal agents are consistently efficacious in the treatment of scleral fungal infections. We report a case of Aspergillus scleritis successfully treated with a combination of voriconazole and caspofungin, as well as a review of the literature concerning treatment of Aspergillus scleritis.

Spectrum of pulmonary toxicity associated with the use of interferon therapy for hepatitis C: case report and review of the literature.

Hepatitis C is one of the leading causes of liver disease in the United States, and current recommendations for its treatment include the use of interferon (IFN). Pulmonary side effects, although uncommon, have been reported in association with the use of IFN. We report a case of interstitial granulomatous pneumonitis that occurred after therapy with IFN and ribavirin, and we review the literature concerning this entity and other forms of IFN-associated pulmonary toxicity in patients with hepatitis C. The purpose of the present study is to increase awareness of the unusually wide spectrum of pulmonary toxicities associated with the use of IFN and ribavirin, with the anticipation that IFN will be used more frequently in the future for the treatment of hepatitis C.

Disseminated Nocardia transvalensis infection with osteomyelitis and multiple brain abscesses.

A case of Nocardia transvalensis osteomyelitis and cerebral abscesses is described. To the authors' knowledge, the patient described here represents the first reported case of primary N. transvalensis leg abscess with contiguous osteomyelitis of the femur and secondary brain abscesses. The literature on nocardial osteomyelitis and cerebral nocardiosis is reviewed, and treatment of both conditions is discussed. The interactions between the immune system and nocardial organisms are described, as well as the host defense defects in diabetic patients as they relate to pathogenicity of the bacteria. Finally, the patient's paradoxical therapeutic response of resolving brain abscesses with concomitant unresolving osteomyelitis is discussed, as well as its implications for managing similar cases in the future.