A Presentation of Disseminated Nocardia Paucivorans Infection: A Case Report.

Nocardia paucivorans is a rarely cultured bacteria most commonly found in immunocompromised hosts, and rarely, may result in dissemination across multiple organ systems. Infection and subsequent clinical manifestations are often vague and nonspecific, making timely diagnosis difficult. Due to the infrequency of N. paucivorans infection, no consensus treatment has yet been established. We report a case of an immunocompromised patient with disseminated nocardiosis with infective endocarditis and other extrapulmonary involvement.

Mediastinal Presentation of Testicular Embryonal Carcinoma.

Testicular embryonal carcinoma is a type of nonseminomatous germ cell tumor (NSGCT) that commonly presents with scrotal swelling due to testicular mass. About half of patients with NSGCTs will present with metastases at initial diagnosis. Rarely, testicular embryonal carcinoma can present primarily in the mediastinum. Treatment is well-studied and effective: chemotherapy with bleomycin, etoposide, and cisplatin. Post-chemotherapy retroperitoneal lymph node dissection (RPLND) is common adjuvant therapy. In this report we present a case of testicular embryonal carcinoma in a 32-year-old Caucasian man. The rarity of the case resides in its presentation: supraclavicular lymphadenopathy and no testicular mass on palpation or scrotal ultrasound.

A Case Presentation of Metastatic Hepatic Epithelioid Hemangioendothelioma: A Rare Vascular Tumor.

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor that can present in various organs, including the liver. Hepatic EHE (HEHE) may showcase with metastases at initial presentation, as patients have vague symptoms such as right upper quadrant pain leading to the risk of delayed diagnosis. There is no standard treatment. Fortunately, prognosis is good. This remains true for some patients with metastatic disease who are not being actively treated. In this report, we present a unique case of metastatic HEHE in a 65-year-old Caucasian male who has not received treatment and continues to remain in stable condition after his initial diagnosis three years ago.

A Case of Metastatic Uveal Melanoma: From Diagnosis to Survival Four Years Later.

Uveal melanoma includes melanoma of the choroid, ciliary body or the iris of the eye and is a rare malignancy that accounts for about 1,500 new cases in the U.S. every year. Of the choroid, ciliary body or the iris, the choroid is most often affected. Local treatment is well-studied; however, this cancer tends to metastasize in nearly 50% of patients, even if the primary melanoma is treated appropriately. There are limited approved treatments for metastatic uveal melanoma and thus, survival rates are low. However, emerging clinical trials demonstrate promising results and play a prominent role in survival of patients with uveal melanoma.

Gallstone Pancreatitis Post-Cesarean Section: A Case Report.

Acute gallstone pancreatitis is a rare occurrence in pregnancy and the postpartum period. However, gallstone pancreatitis should be considered in a differential diagnosis for right upper quadrant (RUQ) pain in this population, as the risk of biliary stasis and gallstone formation increases in pregnancy due to high levels of circulating estrogen causing increased cholesterol formation and delayed gallbladder emptying. Although gallstones are the most common cause of acute pancreatitis in pregnancy, alcohol use and hypertriglyceridemia may also be considered. In this case report, we present a G1P0 female pregnant with monochorionic diamniotic twins who developed postpartum acute gallstone pancreatitis status post Cesarean section.

Combinatorial liposomal peptide vaccine induces IgA and confers protection against influenza virus and bacterial super-infection.

OBJECTIVES: The upper respiratory tract is the major entry site for Streptococcus pyogenes and influenza virus. Vaccine strategies that activate mucosal immunity could significantly reduce morbidity and mortality because of these pathogens. The severity of influenza is significantly greater if a streptococcal infection occurs during the viraemic period and generally viral infections complicated by a subsequent bacterial infection are known as super-infections. We describe an innovative vaccine strategy against influenza virus:S. pyogenes super-infection. Moreover, we provide the first description of a liposomal multi-pathogen-based platform that enables the incorporation of both viral and bacterial antigens into a vaccine and constitutes a transformative development. METHODS: Specifically, we have explored a vaccination strategy with biocompatible liposomes that express conserved streptococcal and influenza A virus B-cell epitopes on their surface and contain encapsulated diphtheria toxoid as a source of T-cell help. The vaccine is adjuvanted by inclusion of the synthetic analogue of monophosphoryl lipid A, 3D-PHAD. RESULTS: We observe that this vaccine construct induces an Immunoglobulin A (IgA) response in both mice and ferrets. Vaccination reduces viral load in ferrets from influenza challenge and protects mice from both pathogens. Notably, vaccination significantly reduces both mortality and morbidity associated with a super-infection. CONCLUSION: The vaccine design is modular and could be adapted to include B-cell epitopes from other mucosal pathogens where an IgA response is required for protection.