RESUMO
Mycobacterium marinum is a ubiquitous and opportunist agent that may cause infections related to water activities in humans. It causes mainly skin and soft tissue infections, and other forms of presentation are uncommon. A 27-year-old man presented to the Emergency Department of a tertiary hospital due to a cervical foreign-body sensation that evolved into right cervical swelling and consumption symptoms. He was a waiter on a cruise in the Douro river. Weeks after the initial presentation, the diagnosis of Mycobacterium marinum infection was made by positive nucleic acid amplification tests (NAAT) in tissues obtained by excisional biopsy of cervical adenopathy. Treatment with rifampicin and clarithromycin was started. The symptoms improved, and there was a decrease in the adenopathy number and size. Although Mycobacterium marinum adenitis as initial presentation of the disease is rare, the identification of the agent by NAAT and favorable response to treatment supported the diagnosis.
RESUMO
Despite the undeniable complexity one may encounter while managing critically ill patients with human immunodeficiency virus infection (HIV), intensive care unit-related mortality has declined in recent years, not only because of more efficacious antiretroviral therapy (ART) but also due to the advances in critical support. However, the use of extracorporeal membrane oxygenation (ECMO) in these patients remains controversial. We report four cases of HIV-infected patients with Pneumocystis jirovecii pneumonia (PJP) and acute respiratory distress syndrome (ARDS) treated with ECMO support and discuss its indications and possible role in the prevention of barotrauma and ventilator- induced lung injury (VILI). The eventually favorable clinical course of the patients that we present suggests that although immune status is an important aspect in the decision to initiate ECMO support, this technology can provide real benefit in some patients with severe HIV-related refractory ARDS.