Pyoderma gangrenosum in a patient with chronic granulomatous disease: A case report.

RATIONALE: The simultaneous occurrence of pyoderma gangrenosum (PG) and chronic granulomatous disease (CGD) is uncommon and few cases have been reported worldwide. PATIENT CONCERNS: PG is a rare, chronic, ulcerative, neutrophilic skin disease of unknown etiology that requires immunosuppressive treatment. CGD belongs to Primary Immune Deficiencies in which the main defect lies in an inability of the phagocytic cells to generate superoxide making patients susceptible to serious, potentially life-threatening bacterial and fungal infections. DIAGNOSES: In this manuscript, we present a case of ulcerative pyoderma gangrenosum in a 28-year-old man with recent diagnosis of chronic granulomatous disease during hospitalization for resistant pulmonary tuberculosis complicated with Aspergillus infection. INTERVENTIONS: Second-line therapy with dapsone and intravenous immunoglobulin was initially administered but eventually corticosteroids were added to treatment because of disease progression and further ulceration. OUTCOMES: Patient's ulcers were gradually healed with no side effects. LESSONS: Corticosteroids could be used under close monitoring for the treatment of PG in a patient with CGD, despite the increased risk for infections.

Primary pyomyositis and disseminated septic pulmonary emboli: a reactivated staphylococcal infection?

Staphylococcal pyomyositis is a severe invasive soft tissue infection with high mortality rate that is increasingly being recognized even in temperate climates. In most cases predisposing factors are identified that include either source of skin penetration or/and impaired host immunocompetence. A case of primary, community-acquired pyomyositis of the left iliopsoas muscle in a 59-year-old immunecompetent woman, which was complicated with septic pulmonary emboli within 24 h after hospital admission, is presented. The patient was subjected to abscess drainage under computed tomography guidance. Both pus aspiration and blood cultures revealed methicillin-susceptible Staphylococcus aureus. Given the absolute absence of predisposing factors and a remote history of staphylococcal osteomyelitis in the same anatomical region 53 years ago, reactivation of a staphylococcal soft tissue infection was postulated. Systematic review of the literature revealed a few interesting cases of reactivated staphylococcal infection after decades of latency, although the exact pathophysiological mechanisms still need to be elucidated.

The adverse consequences of pyoderma gangrenosum in a 13 year old child.

INTRODUCTION: Pyoderma gangrenosum (PG) is an uncommon, but serious, non infectious, neutrophilic dermatosis that causes cutaneous necrosis with a characteristically rapid evolution. PRESENTATION OF CASE: A 13 year-old girl was admitted with a postoperative infected wound, which was surgically debrided. A new more aggressive lesion on the left upper extremity led the patient to the intensive care unit. Clinical diagnosis of pyoderma gangrenosum was introduced with a crucial delay. An immediate clinical improvement after immunosuppressive therapy with systemic corticosteroids and cyclosporine was observed. The extensive cutaneous deficits were covered with keratinocyte cultured cells with an aesthetically good outcome. DISCUSSION: Diagnosis of PG in young children is very difficult, especially without dermatological evaluation. This deforming ulcerative skin disease is probably a result of altered immunologic reactivity. Its early recognition may prevent unnecessary surgical treatment which leads to dangerous complications. CONCLUSION: To our knowledge this is the first case of PG with such a widespread distribution reported in a child, as a consequence of iatrogenic pathergy.

Penetration of moxifloxacin into sternal bone of patients undergoing routine cardiopulmonary bypass surgery.

This study investigated plasma and bone concentrations of moxifloxacin following a single intravenous dose of 400mg to consider its potential role in the treatment of osteomyelitis. Eight patients who underwent routine cardiopulmonary bypass surgery were enrolled in the study. Plasma and bone samples were collected 2h and 5h after the end of infusion. High performance liquid chromatography was used for the determination of moxifloxacin concentrations. Mean plasma concentrations were 3.36 microg/mL and 2.93 microg/mL at 2h and 5h after the end of infusion. The concentrations in the body and manubrium of the sternal bone were 1.65 microg/g and 1.64 microg/g at 2h and 1.4 microg/g and 1.45 microg/g at 5h, respectively. Moxifloxacin showed good penetration into bone and could be considered for the treatment of osteomyelitis.

Vancomycin-resistant enterococci, colonizing the intestinal tract of patients in a university hospital in greece

OBJECTIVE: Determine the prevalence of Vancomycin-resistant enterococci (VRE) colonizing the intestinal tract of hospitalized patients and define risk factors. MATERIAL AND METHODS: A point prevalence survey of VRE fecal carriage was carried out among patients who stayed at a 600-bed teaching hospital for at least two days. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factor analysis. RESULTS: A total of 128 patients hospitalized for at least two days were enrolled in this investigation. Thirty-nine patients (30.5 percent) were colonized with vancomycin-resistant enterococci. Twenty-three of the 39 strains were identified as Enterococcus faecium, 13 were identified as Enterococcus gallinarum and three strains as Enterococcus casseliflavus. The risk factors that were significantly associated with VRE colonization included length of hospital stay (13.2 days vs. 8.6 days), age (60.7 years vs. 47.7 years) and the presence of underlying malignancies (28.2 percent vs. 11.2 percent). An association was found between VRE colonization and the use of antimicrobials with anaerobic activity, such as metronidazole, piperacillin/tazobactam and imipenem. The use of vancomycin was associated with VRE colonization in the intensive care unit. CONCLUSIONS: VRE colonization must be monitored, and risk factors should be determined, because they are useful for screening hospitalized patients for VRE colonization in order to establish prevention and control measures.

Vancomycin-resistant enterococci, colonizing the intestinal tract of patients in a university hospital in Greece.

OBJECTIVE: Determine the prevalence of Vancomycin-resistant enterococci (VRE) colonizing the intestinal tract of hospitalized patients and define risk factors. MATERIAL AND METHODS: A point prevalence survey of VRE fecal carriage was carried out among patients who stayed at a 600-bed teaching hospital for at least two days. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factor analysis. RESULTS: A total of 128 patients hospitalized for at least two days were enrolled in this investigation. Thirty-nine patients (30.5%) were colonized with vancomycin-resistant enterococci. Twenty-three of the 39 strains were identified as Enterococcus faecium, 13 were identified as Enterococcus gallinarum and three strains as Enterococcus casseliflavus. The risk factors that were significantly associated with VRE colonization included length of hospital stay (13.2 days vs. 8.6 days), age (60.7 years vs. 47.7 years) and the presence of underlying malignancies (28.2% vs. 11.2%). An association was found between VRE colonization and the use of antimicrobials with anaerobic activity, such as metronidazole, piperacillin/tazobactam and imipenem. The use of vancomycin was associated with VRE colonization in the intensive care unit. CONCLUSIONS: VRE colonization must be monitored, and risk factors should be determined, because they are useful for screening hospitalized patients for VRE colonization in order to establish prevention and control measures.