Unusual presentation of Nocardia abscessus infection in an immunocompetent patient.

Introduction: Nocardia infections are being increasingly reported in both immunocompetent and immunocompromised patients. We describe a case of Nocardia abscessus infection with an atypical presentation in an immunocompetent patient. Case Presentation: A previously healthy 47-year-old gentleman presented with hiccups and paroxysmal spasms. Imaging revealed a pulmonary nodule, for which he underwent surgical resection. Pathologic evaluation demonstrated evidence of local inflammation, with growth of Nocardia abscessus on tissue cultures. Conclusion: Nocardia abscessus may have atypical presentations in immunocompetent patients. Further research is needed to understand the factors leading to Nocardia infections in immunocompetent patients.

An Unusual Case of Streptococcus anginosus Endocarditis in a Healthy Host With Bicuspid Aortic Valve.

Streptococcus anginosus group (SAG) is a subgroup of viridans streptococci and can be found ubiquitously in normal human flora. SAG is known to form invasive pyogenic infection when it becomes pathogenic. Yet, SAG is a very rare cause of endocarditis, and there is a dearth of case reports on this topic. We present a rare case of native bicuspid aortic valve endocarditis secondary to S. anginosus that caused aortic insufficiency and ascending aortic aneurysm. To our knowledge, this is the first well-documented case report of community-acquired S. anginosus endocarditis on a bicuspid aortic valve in an immunocompetent patient. The patient first presented with cough that was likely due to bronchus irritation from a 5.5 x 5.2 cm ascending aortic aneurysm. He underwent aortic valve replacement with bovine bioprosthesis and ascending aortic aneurysm repairment and was treated with a two-week regimen of IV ceftriaxone and gentamicin followed by another four weeks of IV ceftriaxone. He was eventually discharged to a rehabilitation facility. SAG is usually susceptible to beta-lactam antibiotics. The prognosis of SAG infection is usually good, but progression to bacteremia carries a poor outcome.

Epididymitis associated with bacteremic pneumococcal pneumonia.

We describe a case of a 56 year-old male who presented to the hospital with pneumonia and bacteremia secondary to Streptococcus pneumoniae. After admission and initiation of appropriate antibacterial therapy he began to complain of scrotal pain. Ultrasound of the testes confirmed findings of left-sided epididymitis. Urine culture, urine gonorrhea and chlamydia nucleic acid amplification and HIV testing were negative. Clinical picture suggested seeding of the epididymis with Streptococcus pneumoniae and resulting infection.

Salmonella Septic Arthritis and Bacteremia in a Patient With Poorly Controlled Diabetes.

Salmonella belongs to the Enterobacteriaceae family and is a frequent gastroenteritis pathogen when the food is not well handled. We present a case of indolent septic arthritis of the knee secondary to Salmonella bacteremia and uncontrolled diabetes. The knee effusion analysis showed a total nucleated cell count of 9206 cells/uL and no organism was seen under Gram stain. Both blood culture and synovial fluid culture later grew Salmonella enterica serovar Enteritidis. Meticulous workups revealed his previously undiagnosed and uncontrolled diabetes as the sole risk factor for developing severe salmonellosis. Serious non-typhoidal Salmonella infections often occur in immunocompromising states such as extreme age, HIV, malignancy, corticosteroid use, and rheumatologic disorders. Extraintestinal salmonellosis warrants surveillance for the aforementioned conditions. This case was unique in that septic arthritis and bacteremia due to Salmonella in a healthy man led to a diagnosis of uncontrolled diabetes. Like other bacterial septic arthritis, antimicrobial agents and proper drainage are the keys to treatment success. At least two weeks of antimicrobial therapy is needed for the treatment of Salmonella soft-tissue infection; however, therapy for four-six weeks might be necessary given the known persistence of Salmonella species at compromised sites.

Cytomegalovirus Viremia in Renal Transplant Recipients After Influenza Vaccination.

Vaccination with the inactivated influenza vaccine is routinely recommended for all patients before and after transplant, with reduction in complications noted in transplant recipients. The vaccine is relatively well tolerated with few mild side effects. Cytomegalovirus (CMV) infection can reactivate in both solid organ transplant and hematopoietic stem cell transplant recipients, with some patients progressing to disease. There are multiple factors known to contribute to reactivation and subsequent CMV disease, however vaccination has not been reported as a specific risk factor. We report on two renal transplant recipients who were seen to develop CMV viremia and CMV disease after receiving the Influenza vaccine. We review the literature regarding viremia occurring after vaccination in HIV patients (a similar group of immunocompromised patients).

Combination therapy with trimethoprim-sulfamethoxazole and caspofungin in a case of severe pneumocystis pneumonia.

Trimethoprim-sulfamethoxazole (TMP-SMX, co-trimoxazole, or bactrim) has been the standard first-line treatment against Pneumocystis jirovecii pneumonia (PCP) for decades. However, adverse effects and cases of treatment failure have led to a search for alternative agents. We present a case of a 50 year old immune compromised female whose course of PCP did not improve until Caspofungin was added to TMP-SMX.

A rare case of perineal abscess caused by aerococcus urinae.

Aerococcus urinae, a previously misidentified pathogen, has become increasingly recognized to cause severe and even fatal infections. Aerococcus-related perineal abscess infections have not previously been reported in the literature. Most reported cases of infections caused by Aerococcus are urinary tract infections, bacteremia, and even rare cases of endocarditis. We report an unusual case of a perineal abscess caused by Aerococcus urinae.

Postoperative testicular abscess with bacteremia due to Actinomyces neuii.

Bacteremia due to Actinomyces neuii has been reported in the literature 14 times. A. neuii is an endogenous organism that has been cultured in clinical specimens of the genitourinary tract; we are reporting a unique case of A. neuii postoperative testicular abscess with bacteremia which was successfully treated with surgery and a short course of parenteral antimicrobials.

Treatment of primary aspergilloma of the central nervous system in a diabetic immunocompetent patient with surgical resection and voriconazole: a case report and review of the literature.

Fungal infections of the central nervous system (CNS) are uncommon and occur mainly in immunocompromised patients. We describe a case of central nervous system aspergilloma without any evidence of systemic or paranasal foci in a diabetic but otherwise immunocompetent 71-year-old female treated successfully with surgical resection and medical therapy with voriconazole. Magnetic resonance imaging (MRI) after 6 months of voriconazole showed improvement and no evidence of residual or recurrent disease. Given its good CNS penetration, voriconazole along with surgical resection appears to be promising in treatment of these infections. Our case also demonstrates the importance of surgical intervention in the diagnosis and management of these atypical cases.