Tissierella praeacuta Bacteremia Associated With Acute on Chronic Osteomyelitis: A Case Report.

Tissierella praeacuta is a rare gram-variable bacillus that naturally occurs in the environment and is pathogenic in humans with chronic infections. We report the case of a 45-year-old man with a history of chronic osteomyelitis of the left tibia and recurrent bacteremia secondary to intravenous drug use (IVDU). He had previously received multiple partially completed courses of antibiotics over the past one year. Blood cultures demonstrated polymicrobial infection, including T. praeacuta and methicillin-sensitive Staphylococcus aureus managed with parenteral beta-lactams, and the subsequent first surveillance cultures remained sterile. Medical literature on human infections with T. praeacuta is limited due to its rare occurrence. Most cases have reported sensitivity to beta-lactam antibiotics, making them an antibiotic of choice. T. praeacuta infections should prompt a search for additional underlying infectious foci and treatment of any additional co-infecting microbes.

Amiodarone-Induced Nystagmus and Ataxia: Case Report and Systematic Review of Case Reports.

Amiodarone is an antiarrhythmic drug with a significant adverse effect profile, including neurotoxicity. While ataxia, neuropathy, and tremors are more commonly seen forms of amiodarone neurotoxicity, very few cases of nystagmus are reported. We report the case of an 86-year-old man who presented with abrupt-onset ataxia, dizziness, and inability to ambulate, 10 days after initiating amiodarone for atrial fibrillation. His examination revealed gaze-evoked nystagmus along with features of cerebellar dysfunction. After excluding other etiologies, amiodarone was stopped. His nystagmus resolved, and his ataxia improved within 48 h of stopping amiodarone. Due to the rarity of this drug-induced adverse effect, we performed a systematic review of available case reports in the literature (PubMed and Scopus) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and presented our findings. Nystagmus is a rarely reported adverse effect of amiodarone, which can occur within days to months of starting the medication. Treatment includes stopping the drug and monitoring for resolution of nystagmus.

A Fatal Etiology of Splenic Infarction.

Hemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory disorder that is rapidly progressive and carries a poor prognosis. We present a case of HLH caused by undiagnosed B cell lymphoma, presenting initially with splenic infarction. Both HLH and splenic infarction are secondary conditions with a wide range of underlying etiologies. When either condition is identified, a prompt search for the underlying trigger is needed to prevent devastating consequences. We demonstrate the difficulties and barriers that can delay the diagnosis of HLH, and emphasize the importance of early treatment in improving survival rates.