ABSTRACT
Herpes Simplex Virus (HSV) esophagitis is a relatively rare form of infectious esophagitis. Typically, patients with viral esophagitis are immunocompromised. HSV esophagitis in an immunocompetent patient is uncommonly reported. The objective of this case report is to discuss symptoms, investigations, imaging, and treatment of HSV esophagitis in a healthy adolescent male. A previously healthy 17-year-old male presented to the ED of our facility with a 5-day history of fever, odynophagia, lethargy, and 2 episodes of emesis that failed to resolve with antibiotic treatment. Investigations revealed a low platelet count, mild hyponatremia, hypochloremia, and an elevated AST and ALT. A respiratory infection panel as well as CMV IgG, HIV, Rickettsia, and EBV tests were negative. HSV-1 PCR was positive and upper endoscopy revealed a friable mucosa, erythema, and exudates in the lower esophagus and erythematous duodenopathy. The patient received a diagnosis of HSV esophagitis and was treated with a 14-day course of IV to PO acyclovir. There was a rapid improvement of his symptoms with antiviral therapy.
ABSTRACT
This report describes a 15-year-old with an 11.1 × 8.2 × 8.4 cm multiloculated liver abscess caused by methicillin-sensitive Staphylococcus aureus who failed extensive catheter drainage and intravenous antibiotics. Daily intra-abscess oxacillin was instilled for 7 days with rapid clinical improvement and sterilization of the abscess. One month later, an ultrasound of the abdomen revealed a normal liver.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Liver Abscess, Pyogenic/drug therapy , Staphylococcal Infections/drug therapy , Adolescent , Female , Humans , Instillation, Drug , Liver/diagnostic imaging , Liver/pathology , Liver Abscess, Pyogenic/diagnostic imaging , Liver Abscess, Pyogenic/pathology , Methicillin-Resistant Staphylococcus aureus , Oxacillin/administration & dosage , Oxacillin/therapeutic use , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/pathologySubject(s)
Fractures, Bone/complications , Fractures, Closed/complications , Humeral Fractures/complications , Osteomyelitis/diagnostic imaging , Adult , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Humans , Liver Transplantation , Male , Osteomyelitis/drug therapy , Osteomyelitis/etiologySubject(s)
Autoimmune Diseases/psychology , Autoimmune Diseases/therapy , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Streptococcal Infections/psychology , Streptococcal Infections/therapy , Acute Disease , Anti-Bacterial Agents/therapeutic use , Autoimmune Diseases/drug therapy , Azithromycin/therapeutic use , Behavior Therapy/methods , Child , Diagnosis, Differential , Humans , Male , Obsessive-Compulsive Disorder/drug therapy , Penicillins/therapeutic use , Streptococcal Infections/drug therapySubject(s)
Edema/etiology , Gallbladder Diseases/etiology , Mucocutaneous Lymph Node Syndrome/complications , Aspirin/therapeutic use , Diagnosis, Differential , Diagnostic Imaging , Edema/diagnosis , Edema/drug therapy , Female , Gallbladder Diseases/diagnosis , Gallbladder Diseases/drug therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Young AdultABSTRACT
Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed "extensively resistant typhi," has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.
