Mycobacterium flavescens Infection - An Unusual Case of Prosthetic Joint Infection.

INTRODUCTION: The onset of prosthetic joint infections (PJIs) is characterized by early onset defined as within 90 days of the procedure, delayed onset defined as within 3 to 12 months, and late onset defined as over 12 months. In only a scant number of case reports, Mycobacterium flavescens associated infections are typically found in sputum cultures and associated with various forms of penetrating joint traumas, particularly post-surgical interventions. Due to its rarity in presentation among cases of PJIs, we have presented a case of PJI caused by Mycobacterium flavescens. CASE PRESENTATION: We have, herein, reported a case of a 70-year-old male presenting with stabbing left knee pain over the past several months along with accompanying erythema and swelling with the presence of purulent discharge. Outpatient cultures have shown the growth of Mycobacterium flavescent; subsequently, the patient underwent a 2-stage revision arthroplasty and was treated with a three-drug regimen and implant 5 months later. Although being an atypical cause of PJIs, we emphasize the importance of considering NTM as a differential for immunocompromised patients, especially those with prior surgical intervention. DISCUSSION: Mycobacterium spp. related PJIs manifest clinical features similar to other bacteriacausing PJIs, such as warm, indurated edema at the surgical site resulting in wound dehiscence and joint effusion. Diagnosis of Mycobacterium spp. related PJIs includes history and physical examination findings, serum inflammatory markers, synovial fluid analysis, and culture. Concurrently with surgical interventions, utilization of antimicrobial agents provides additional control in Mycobacterium- related PJI. Mycobacterium flavescens should be included among other NTMs as a possible cause of PJIs.

Erratum to: Acute abdomen in a 54-year-old COVID-19 patient: a case report.

[This corrects the article DOI: 10.1093/jscr/rjab198.].

Acute abdomen in a 54-year-old COVID-19 patient: a case teport.

Although primarily a respiratory virus, coronavirus-19 acts on the gastrointestinal tract to cause symptoms such as anorexia, nausea, vomiting and diarrhea. One possible mechanism involves the ACE2 receptor, which serves as the primary receptor for virus entry into the gastrointestinal epithelium. We describe the case of a 54-year-old-male with recent coronavirus disease 2019 (COVID-19) infection, who later presented with nausea, vomiting, diarrhea and progressively worsening diffuse abdominal pain for 1 week. He was diagnosed to have a small bowel obstruction; however, continued to have progressively worsening pain and failed conservative management. No cause for the obstruction was found in the operating room. Gastrointestinal involvement occurs in at least two-thirds of patients with coronavirus infection. Viral entry into the small bowel, triggering an inflammatory response, and virus-induced microthrombosis of the microcirculation have been postulated as a possible mechanism for paralytic ileus/small bowel obstruction.

Tics and shorter stature: should we be looking for an association?

BACKGROUND: Tic disorders have commonly occurring and well recognized comorbidities including obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). Shorter stature is not generally appreciated as an associated feature. METHODS: Case reports and a literature review. RESULTS: We describe four recently encountered patients with tics and shorter stature. The literature suggests that in addition to OCD and ADHD, shorter stature may also commonly accompany tic disorders. A variety of neuroendocrine mechanisms have been proposed. DISCUSSION: The potential associations between shorter stature and tic disorders and the common comorbidities OCD and ADHD deserve more attention. More research is needed to establish the strength of these associations and the underlying neurobiological mechanisms.