ABSTRACT
A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD 14, endoscopy and histologic examination revealed exfoliative rejection that was not controlled after 14 days of therapy with thymoglobulin. On POD 95, the patient underwent surgery again because of intestinal obstruction. The graft was removed 6 months after transplantation because of continuous severe abdominal pain with weight loss. After enterectomy, the patient developed multiple-organ failure and died on POD day 8. This case underlines the severity of exfoliative rejection and suggests that early enterectomy be performed when the diagnosis is made, before deterioration of clinical status and development of infectious and nutritional complications.
Subject(s)
Intestine, Small/transplantation , Short Bowel Syndrome/surgery , Adult , Antilymphocyte Serum/therapeutic use , Biopsy , Fatal Outcome , Graft Rejection/pathology , Humans , Intestinal Obstruction/surgery , Male , Multiple Organ Failure , Postoperative Complications/surgery , ReoperationABSTRACT
OBJECTIVE: Lemierre's syndrome is a rare but severe condition combining pyrexia, cervical pain and pulmonary signs following a pharyngeal infection, usually tonsillitis. This infectious disease is still present in our country despite wide use of antibiotic therapy in pharyngeal infections. METHODS: In a retrospective study conducted between 1995 and 2000 in two departments (infectious diseases and critical care unit) of Nice university hospital (Nice, France), we collected and analysed six cases of Lemierre's syndrome. RESULTS: We describe a serie of 6 cases, all of them female patients of mean age 27. We enrolled healthy patients whose initial symptom was tonsillitis. Most of these patients showed signs of severe sepsis and one died of septic shock. All the others recovered with treatment. The mean time between tonsillitis and first sign of sepsis was seven days. In four cases, patients received a beta- lactam antimicrobial agent with metronidazole. In two cases, patients were treated with amoxicillin-clavulanate. All patients were investigated for the presence of internal jugular vein thrombosis and were treated by anticoagulants when research was positive. CONCLUSIONS: A strong presumptive diagnosis can be made on the basis of clinical presentation, secondarily confirmed by para-clinical data. The prognosis depends on the speed and quality of management. We therefore wished to raise awareness of this condition among our colleagues by reporting our personal experience.
Subject(s)
Neck Pain/etiology , Sepsis/etiology , Tonsillitis/complications , Adult , Anti-Bacterial Agents/therapeutic use , Female , Fever/etiology , Humans , Prognosis , Respiratory Function Tests , Retrospective Studies , Sepsis/pathology , SyndromeABSTRACT
INTRODUCTION: Neurocysticercosis is the most frequently encountered cerebral parasitic infection worldwide. It is due to infection of the central nervous system by Taenia solium larval form. According to the location of the cysts, parenchymal and extra-parenchymal forms may be identified, with different clinical expressions. EXEGESIS: We report two cases of neurocysticercosis, one with typical parenchymal involvement and the second with extra-parenchymal involvement revealed by increased intra-cranial pressure. In both cases, the diagnosis was established over 10 years after the onset of symptoms. CONCLUSION: Neurocysticercosis is very frequent in non-Islamic developing countries, and its incidence is increasing in industrialized nations in relation to tourism and immigration from highly endemic areas. Symptoms usually appear several years after infection and this accounts for the frequent delays before the diagnosis is established.
Subject(s)
Neurocysticercosis/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Intracranial Pressure , Male , Time Factors , Tomography, X-Ray ComputedSubject(s)
Agranulocytosis/chemically induced , Ceftriaxone/adverse effects , Cephalosporins/adverse effects , Epilepsy, Tonic-Clonic/chemically induced , Aged , Drug Administration Schedule , Endocarditis, Bacterial/drug therapy , Humans , Male , Streptococcal Infections/drug therapy , Streptococcus bovis , Time FactorsABSTRACT
Propionibacterium acnes is a weakly pathogenic commensal of the skin. When isolated from blood cultures it is often considered a contaminant. However, P. acnes may be responsible for severe infections and its role in certain cases of infectious endocarditis has now been definitely established.(1) We report a case of endocarditis due to P. acnes stemming from a ventricular patch and revealed by a gallium 67 scan.
Subject(s)
Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/microbiology , Gram-Positive Bacterial Infections/diagnostic imaging , Gram-Positive Bacterial Infections/microbiology , Propionibacterium acnes/isolation & purification , Gallium Radioisotopes , Humans , Male , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Severity of Illness IndexSubject(s)
Aspergillosis/complications , Influenza, Human/complications , Lung Diseases, Fungal/complications , Aged , Aged, 80 and over , Aspergillosis/diagnosis , Aspergillosis/physiopathology , Female , Humans , Influenza, Human/diagnosis , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/physiopathologyABSTRACT
Visceral leishmaniasis is an anthropozoonosis endemic in the south of France. Its occurrence among patients infected with human immunodeficiency virus (HIV), in whom it presents with uncommon clinical, biological, and evolutionary signs, is being reported more and more often. We describe a case of leishmaniasis in an HIV-seropositive man that we believe is unique with respect to the cutaneous and then visceral location of the disease and the discovery at necropsy of an adrenal and myocardial leishmanial infiltrate.
