RESUMEN
We present a case of fever, brain abscesses, and Gemella morbillorum bacteremia after anti-tumor necrosis factor alpha (TNF-α) therapy in a 21-year-old acne inversa patient currently taking long-term dapsone. To the best of our knowledge, this is the first report describing such a case. During antimicrobial therapy, the patient developed systemic varicella infection with severe thrombocytopenia.
Asunto(s)
Anticuerpos/efectos adversos , Bacteriemia/diagnóstico , Gemella/aislamiento & purificación , Infecciones por Bacterias Grampositivas/diagnóstico , Hidradenitis Supurativa/tratamiento farmacológico , Factores Inmunológicos/efectos adversos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Antiinfecciosos/administración & dosificación , Anticuerpos/administración & dosificación , Bacteriemia/complicaciones , Bacteriemia/microbiología , Absceso Encefálico/diagnóstico , Absceso Encefálico/microbiología , Dapsona/administración & dosificación , Infecciones por Bacterias Grampositivas/microbiología , Hidradenitis Supurativa/complicaciones , Humanos , Factores Inmunológicos/administración & dosificación , Masculino , Adulto JovenRESUMEN
Septic-embolic diseases are life threatening; survival critically depends on rapid diagnosis. Clinically, cutaneous manifestations like Janeway lesions are infrequently occurring but highly characteristic. In contrast, histological features are not clearly defined. We report the case of a 59-year-old male patient in deteriorating general condition and fever of unknown origin with lesions suggestive for Janeway lesions. Histology showed dilated blood vessels and extravasated erythrocytes throughout the dermis. Only serial sections revealed single, deep dermal vessels occluded by fibrin thrombi. Computed tomography scan identified multiple pulmonary round masses. Blood cultures showed growth of Staphylococcus aureus and Enterococcus faecalis. The knowledge of the described subtle histological features and a clinical-pathological correlation is essential for the diagnosis of certain cases of septic-embolic conditions.