Hypoxemic Respiratory Failure Secondary to Zika Virus Infection.

An 80-year-old man experienced general weakness, myalgias, arthralgias, fever, chills, and diarrhea for one week. He had hypotension and tachycardia. He also had leukocytosis, thrombocytopenia, increased creatinine levels, elevated liver enzymes, elevated creatine phosphokinase (CPK) levels, and metabolic acidosis with hypoxemia, for which he was admitted to the Intensive Care Unit (ICU). His chest x-ray showed decreased lung volumes. Ceftriaxone and levofloxacin were empirically started to cover leptospirosis and community acquired pneumonia, respectively. The patient continued with clinical deterioration and the antibiotic therapy was changed to linezolid, cefepime, and doxycycline. He required endotracheal intubation and mechanical ventilation support due to progressive hypoxemic respiratory failure. A bronchoscopy showed no evidence of bacterial infectious process. The patient developed clinical improvement with successful extubation afterwards (4 days after initial intubation). He was later discharged home with physical therapies. A serum specimen was tested with real-time polymerase chain reaction (RT-PCR) technique, producing a positive result only for Zika virus. Confirmatory molecular diagnostic testing was performed at the Center for Disease Control (CDC).

Chronic cough and uncontrolled asthma: Ending a three year clinical course with successful foreign body removal.

Acute foreign body aspiration can cause severe damage to the respiratory system, leading to laceration and even death due to asphyxia. However, a foreign body that has been aspirated could go unnoticed acutely and lead to persistent shortness of breath symptoms. Most of the patients will be able to recall the acute aspiration event, but others do not. On the latter, a more meticulous approach will lead to the diagnosis and subsequent effective management. We hereby present the case of a 52-year-old male with history of partly controlled severe asthma and chronic persistent cough with bloody sputum. Upon evaluation, he was found with a right-sided pneumonia and pertinent history remarkable for several episodes of bronchitis in the past 3 years. There circumstances and subsequent images led to the successful finding and removal of a chronic foreign body aspirated 3 years prior to evaluation. A procedure led to almost complete resolution of symptoms of cough and asthma.

An Unexpected Cause of Sepsis: Keep Pursuing the Source of Infection.

An 86-year-old man was found with altered mental status, fever and aphasia. His physical exam revealed nuchal rigidity but no other meningeal signs. Because the patient's mental status was declining, he was intubated and placed in mechanical ventilation. His head CT scan was unremarkable, without evidence of mass effect. A lumbar puncture yielded cerebrospinal fluid that was remarkable for the presence of gram-positive cocci in pairs. His blood cultures showed gram-negative bacilli. Given the presence of these organisms, a polymicrobial infection was suspected. An abdomino pelvic CT scan showed a multi-septated abscess within the right hepatic lobe. CT-guided percutaneous drainage was performed and a specimen for culture obtained, which grew Klebsiella pneumoniae. After receiving intravenous antibiotics and supportive care, the patient showed clinical improvement. In this patient, there was a central nervous system infection secondary to bacteremia in the setting of an intrabdominal infection. The inquiring clinician should take note that whenever a polymicrobial infection is evidenced, more than one site of infection should be considered in the differential diagnosis.