RESUMO
Arteriovenous (AV) fistulas are irregular connections between arteries and veins, and thoracic AV fistulas are rarely identified in clinical practice. We report a case of a 56-year-old female with a history of esophageal adenocarcinoma treated with radiation and resection who presented to the hospital due to hemoptysis. She underwent bronchoscopy revealing a tracheobronchial fistula, and esophagogastroduodenoscopy revealing active arterial bleed. Subsequent angiography uncovered an AV fistula between her right T8 intercostal artery and pulmonary vein with a pseudoaneurysm. She underwent coiling of her T8 and T9 intercostal arteries with resolution of her symptoms.
RESUMO
Acinetobacter species are Gram-negative coccobacilli found to cause a multitude of infections. However, they are a rare cause of bacteremia with Acinetobacter radioresistens accounting for less than 10 % of Acinetobacter infections. In this report, we describe a patient presenting with acute encephalopathy, fever, and hypoxia who was initially found to have bilateral perihilar and lower lobar peribronchial thickening on chest x-ray. Two sets of blood cultures obtained on admission were positive for Acinetobacter radioresistens and Enterococcus casseliflavus and one set of blood cultures returned positive for Leclercia adecarboxylata although believed to be a skin contaminant. Susceptibilities confirmed all bacteria were pan-sensitive. The patient was also found to have an aortic valve vegetation which was not amenable to surgical intervention. He was treated with 42 days of daptomycin and cefepime. At present, co-infection with Acinetobacter radioresistens and Enterococcus casseliflavus with manifestations of polymicrobial endocarditis has never been reported. Though this co-infection was pan-sensitive, there is an increasing rate of resistance to commonly used, broad-spectrum antibiotics such as ß-lactams, which will continue to pose a challenge between balancing treatment and antibiotic stewardship.