Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Ultrasonografía , Articulación Cigapofisaria , Humanos , COVID-19/prevención & control , Articulación Cigapofisaria/diagnóstico por imagen , Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/administración & dosificación , SARS-CoV-2/inmunología , Vértebras Lumbares/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Vacunación/efectos adversos , Artritis/diagnósticoRESUMEN
We report a case of a woman in her early 80s with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presented as myalgia mimicking polymyalgia rheumatica (PMR). She had positive results for the Neer and Hawkins-Kennedy impingement tests, and a normal serum creatine kinase (CK) concentration. At first, we suspected PMR; however, the patient did not strictly meet the classification criteria. Electromyography revealed an abnormal myogenic pattern, and muscle MRI revealed intramuscular and fascial hyperintensity. Moreover, chest CT revealed interstitial lung disease, and test results for ANCAs were positive. We diagnosed the patient with ANCA-associated vasculitis based on the criteria and treated her with corticosteroids and rituximab. Thus, ANCA-associated vasculitis can cause muscle involvement without elevation of the CK concentration and mimic PMR.
Asunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos , Polimialgia Reumática , Humanos , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamiento farmacológico , Femenino , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/diagnóstico , Diagnóstico Diferencial , Anciano de 80 o más Años , Rituximab/uso terapéutico , Imagen por Resonancia Magnética , Electromiografía , Mialgia/etiologíaRESUMEN
Nocardiosis in patients after allogeneic hematopoietic stem cell transplantation (HSCT) is rare, but is associated with a significant mortality risk. Although trimethoprim-sulfamethoxazole (TMP/SMX) remains the cornerstone of nocardiosis treatment, optimal alternative therapies for patients intolerant to TMP/SMX are not well-established. Herein, we report a case of disseminated nocardiosis with bacteremia and multiple lesions in the lungs and brain caused by Nocardia farcinica, in a 60-year-old man who had previously undergone allogeneic HSCT and was receiving immunosuppressants for severe chronic graft-versus-host disease. The patient received atovaquone for the prophylaxis of Pneumocystis pneumonia because of a previous serious allergic reaction to TMP/SMX. The patient was initially treated with imipenem/cilastatin and amikacin, which were later switched to ceftriaxone and amikacin based on the results of antimicrobial susceptibility testing. After switching to oral levofloxacin and a standard dose of minocycline, the patient experienced a single recurrence of brain abscesses. However, after switching to oral moxifloxacin and high-dose minocycline, the patient did not experience any relapses during the subsequent two years and seven months of treatment. In treating nocardiosis with brain abscesses, it is crucial to select oral antibiotics based on the antimicrobial susceptibility test results and pharmacokinetics, especially when TMP/SMX is contraindicated. A combination of oral moxifloxacin and high-dose minocycline could be a promising alternative therapy.
RESUMEN
Japanese spotted fever is an emerging rickettsiosis caused by Rickettsia japonica and is characterized by high fever, rash, and eschar formation. Other symptoms are often vague and nonspecific and include headaches, nausea, vomiting, and myalgia. We present a case of a 46-year-old woman with Japanese spotted fever, complicated by transient bilateral sensorineural hearing loss and presenting cutaneous IgM/IgG immune complex vasculitis. The patient was admitted with a history of several days of high fever, generalized skin erythema, and hearing impairment. Laboratory findings revealed thrombocytopenia and elevated liver enzyme and C-reactive protein levels. Pure-tone audiometry revealed bilateral sensorineural hearing loss, and a skin biopsy revealed leukocytoclastic vasculitis with deposition of C3 and IgM on the vessel walls. Under the tentative diagnosis of rickettsiosis, scrub typhus, or Japanese spotted fever, the patient was treated with minocycline, and her symptoms improved within approximately 10 days. A definitive diagnosis was made on the basis of a serological test showing increased antibody levels against Rickettsia japonica. Japanese spotted fever can cause transient sensorineural hearing loss, a rare complication that presents with cutaneous IgM/IgG immune complex vasculitis.
RESUMEN
Toxocariasis is a prevalent zoonosis caused by infection with the larvae of Toxocara canis or Toxocara cati. It ranges in severity from mundane to life-threatening, depending on organ involvement. The lungs are often affected, manifesting as coughing, wheezing, and chest pain. However, pleural effusions rarely occur in patients with pulmonary toxocariasis. We report the case of a 74-year-old man with highly suspected toxocariasis who presented with an eosinophilic pleural effusion and eosinophilia. He developed dyspnea and a right-sided pleural effusion. Thoracentesis revealed an exudative effusion containing numerous eosinophils. The pleural effusion continued to increase, and the eosinophilia rapidly progressed. Although the patient had not recently had contact with animals or known exposure to contaminated food, water, or soil, toxocariasis was confirmed by positive serological test results for anti-Toxocara antibodies in the serum and pleural effusion. The patient was cured with albendazole treatment for 28 days. The pleural effusion and eosinophilia resolved and did not recur. Clinicians should consider toxocariasis in the differential diagnosis of patients presenting with eosinophilic pleural effusions.
Asunto(s)
Eosinofilia , Derrame Pleural , Toxocariasis , Masculino , Animales , Humanos , Anciano , Toxocariasis/complicaciones , Toxocariasis/diagnóstico , Toxocariasis/tratamiento farmacológico , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Toxocara , Albendazol/uso terapéutico , Eosinofilia/diagnóstico , Eosinofilia/tratamiento farmacológicoRESUMEN
Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory disorder without a clear etiology that primarily affects young adults. New-onset disease at > 80 years of age is uncommon. We present the case of an 82-year-old woman with AOSD which developed after receiving a messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccine. COVID-19 vaccines are known to cause overproduction of cytokines, systemic inflammation, and some immune-mediated adverse events, such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, vasculitis, and polymyalgia rheumatica after the vaccination has been reported. A handful of cases of AOSD after the vaccination have also been reported and the median age was 40s. However, AOSD related to COVID-19 vaccination can develop even in older individuals.
RESUMEN
Streptococcus dysgalactiae subsp. equisimilis (SDSE) commonly causes a variety of infections in older individuals. However, respiratory infections are uncommon. We present the case of an older man with empyema due to SDSE subsequently to bacteraemia. He presented with a 1-day history of fever and laboratory findings revealed an increased white blood cell count and C- reactive protein (CRP) level. Chest CT revealed no infiltration and no pleural effusion. SDSE was detected in the blood cultures. Primary bacteraemia was suspected and antibiotic administration was initiated; however, 2 days later, his right breath sound diminished, and chest radiography revealed right pleural effusion. Thoracentesis yielded cloudy fluid with frank pus; thus, he was diagnosed with empyema due to SDSE, and a drainage tube was placed. Thereafter, his fever improved, and his CRP level decreased. Thus, SDSE can cause empyema probably by haemotological spread of SDSE to the pleura.
Asunto(s)
Bacteriemia , Empiema , Derrame Pleural , Infecciones Estreptocócicas , Masculino , Humanos , Anciano , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus , Empiema/diagnóstico , Bacteriemia/complicaciones , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiologíaRESUMEN
Negative myoclonus may present in the early stages of cefepime neurotoxicity. Cefepime neurotoxicity typically presents as reduced consciousness, myoclonus, and seizures; however, negative myoclonus is uncommon. This video shows an older woman with cefepime neurotoxicity that presented as a negative myoclonus of the upper limbs.
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Granulomatosis con Poliangitis , Trastornos Leucocíticos , Síndromes Mielodisplásicos , Enfermedades Cutáneas Genéticas , Humanos , Infliximab/uso terapéutico , Metotrexato/uso terapéutico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , CausalidadRESUMEN
Corynebacterium striatum occasionally causes nosocomial infections, such as catheter-related bloodstream infection and pneumonia; however, C. striatum-related infective endocarditis or septic arthritis is uncommon. We present the case of an 85-year-old woman with infective endocarditis at the native valve and septic arthritis at the native shoulder joint caused by C. striatum. The patient was admitted for a 10-day history of fever and right shoulder pain. She had no history of artificial device implantation, injury, arthrocentesis, or hospitalization. A physical examination revealed conjunctival petechiae, a systolic heart murmur, and right shoulder joint swelling. C. striatum was observed in two blood culture sets. Transesophageal echocardiography revealed vegetation in the right aortic coronary cusp. Arthrocentesis at the right shoulder aspirated pyogenic fluid and C. striatum was detected in the culture. The patient was diagnosed with infective endocarditis and septic arthritis caused by C. striatum, and ampicillin was administered based on antimicrobial susceptibility test results. The patient's condition was initially stable; however, she developed pulmonary congestion on day 56 and eventually died. An autopsy demonstrated perforation of the aortic left coronary cusp with vegetation. C. striatum may cause native valve endocarditis and native joint septic arthritis.
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Artritis Infecciosa , Infecciones por Corynebacterium , Corynebacterium , Endocarditis Bacteriana , Humanos , Femenino , Artritis Infecciosa/microbiología , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Corynebacterium/aislamiento & purificación , Anciano de 80 o más Años , Infecciones por Corynebacterium/microbiología , Infecciones por Corynebacterium/diagnóstico , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/complicaciones , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/complicaciones , Resultado Fatal , Antibacterianos/uso terapéutico , Ecocardiografía Transesofágica , Válvula Aórtica/microbiología , Válvula Aórtica/patología , Válvula Aórtica/diagnóstico por imagenRESUMEN
Generalized subcutaneous edema is rare in dermatomyositis. We herein report an 82-year-old woman with dermatomyositis who presented with generalized subcutaneous edema. Three weeks before admission, she first noticed facial edema, and the symptoms exacerbated, with limb edema occurring. On admission, muscle weakness in the limbs and skin rash were noted. Her muscle enzyme levels were elevated, and serum anti-transcriptional intermediary factor 1-γ antibody was detected. She was diagnosed with dermatomyositis and treated with corticosteroids and tacrolimus, which improved her muscle weakness, muscle enzymes, and edema. Thus, generalized subcutaneous edema can occur during dermatomyositis, with facial edema as the initial symptom.