An unusual cause of fever and jaundice.

A 52 year old previously healthy woman from Mumbai presented with fever and jaundice of 10 days duration. At admission, she was jaundiced with tachycardia, tachypnea, hypoxia, hypotension, conjunctival congestion and mild erythematous flush over the skin. She had very high WBC counts and CRP's with direct hyperbilirubinemia and azotemia. Investigations for infectious causes of fever were negative. RT-PCR for SARS-CoV-2 in the nasopharynx was negative. However her SARS-CoV-2 antibodies were reactive. She also had echocardiographic and biochemical evidence of cardiac dysfunction. The diagnosis of Multisystem inflammatory syndrome-Adult (MIS-A) was thus established. She rapidly improved with intravenous immunoglobulin (2 gm/kg) and high dose steroids.

ACUTE CLINICAL LEPTOSPIROSIS (GRIPPOTYPHOSA SEROVAR) IN AN ADULT DROMEDARY CAMEL (CAMELUS DROMEDARIUS).

A 9-yr-old castrated male dromedary camel (Camelus dromedarius) presented with lethargy and partial anorexia. A diagnostic examination revealed fever, and further workup revealed a neutrophilia, hyperfibrinogenemia, renal azotemia, and a rapid onset of a high Leptospira antibody titer during the acute clinical period (Grippotyphosa serovar). The camel responded clinically to antimicrobial treatment with ceftiofur crystalline free acid injections, but renal azotemia persisted, presumably secondary to chronic renal damage. Subsequent Leptospira polymerase chain reaction testing on urine samples obtained over the following 4 mo revealed no evidence of urinary shedding, so a persistent infection was unlikely. Although often mentioned as a potential cause of reproductive loss, well-documented case reports of clinical leptospirosis in camelids are very rare. In this case, native wildlife contamination of a small watering hole is suspected to have been the source of infection. In response to this experience, the camel and two conspecifics were prescribed a vaccination regimen using an inactivated pentavalent Leptospira vaccine licensed for cattle.

Postrenal azotemia due to C. albicans pyocystitis and a Candidal plug.

BACKGROUND: There are many causes of acute renal failure, with cases often being classified as pre-renal, intrarenal or post-renal based on the etiology. A post-obstructive etiology is responsible in a minority of patients. Infectious causes of post-obstructive azotemia are even more rare, but as this case illustrates, should be considered as part of the differential. CASE REPORT: This case report describes a patient who developed acute renal failure (ARF) while hospitalized. Examination showed a candidal plug at his urethral meatus. Bladder washings removed a significant amount of purulent material. Treatment for C. albicans with fluconazole resolved his urinary retention and his bilateral hydronephrosis. His acute renal failure was due to an infectious, post-obstructive pyocystitis and formation of a candidal plug in his urethral meatus. CONCLUSIONS: Removal of the candidal plug and treatment of his infection with fluconazole resulted in return to baseline renal function. While not common, an infectious cause of post-renal azotemia should be considered in the appropriate clinical situation.