A 27-Year-Old Man With Intermittent Chest Pain During the Last 4 Years.

CASE PRESENTATION: A 27-year-old man from Eritrea presented to the ED complaining about a progressively worse blunt chest pain in the anterior right hemithorax. Chest pain started 4 years ago and was intermittent. During the last 6 months, symptoms got worse, and the patient experienced shortness of breath in mild exercise. For this purpose, he visited another institution, where a chest radiograph was performed (Fig 1). He was advised to visit a pulmonologist for further evaluation, with the diagnosis of a loculated pleural effusion in the right upper hemithorax.

Lymphocutaneous nocardiosis in a kidney transplant patient successfully treated with tigecycline.

Cutaneous nocardiosis is an infrequent infection which has been increasingly reported in immunocompromised patients. Although trimethoprim-sulfamethoxazole is considered to be the agent of choice for treatment of nocardiosis, newer antimicrobials such as tigecycline have been proven to be effective in vitro, as well. We report the first case of primary cutaneous nocardiosis in a renal transplant recipient having corresponded well to treatment with tigecycline.

An unusual case of aggregatibacter aphrophilus liver abscess.

Liver abscess of oropharyngeal origin in an immunocompetent patient is a rare condition. Furthermore, microbiologic diagnosis of liver abscess can be challenging due to the tremendous diversity of the microorganisms implicated and culture difficulties under laboratory conditions. We report a case of a previously healthy 23-year-old male, who presented multiple liver abscesses, attributed to aggregatibacter aphrophilus, an obligatory oral gram-negative microorganism, that normally is a component of the commensal oral microbiota and non-virulent. The etiopathogenic microorganism was identified after needle aspiration of a liver abscess cavity. Treatment with broad-spectrum antimicrobials and percutaneous catheter drainage under computed tomography guidance of both abscesses, resulted in full recovery. A. aphrophilus represents a rare entity of liver abscess in healthy individuals and suggests that a pathogen of oropharyngeal origin should be suspected when an overt source of infection cannot be documented.

Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review.

A 51 year old woman without significant past medical history or risk factors for Nocardia infection developed primary Nocardia nova sternal osteomyelitis with mediastinal abscess, diagnosed with open biopsy. She required prolonged antibiotic therapy and had a favorable outcome. Primary sternal osteomyelitis develops in the absence of a contiguous focus of infection, as opposed to secondary sternal osteomyelitis, which is usually a complication of sternotomy. Staphylococcus aureus probably still is the most common cause of both forms of sternal osteomyelitis. Nocardia species invade humans usually through the respiratory tract and can cause a variety of localized infections through the hematogenous route. Pulmonary involvement may or may not coexist. Immunosuppressed patients are more prone to infection by Nocardia species, although cases involving seemingly immunocompetent patients are not rare. This is the first reported case in the English literature of primary sternal osteomyelitis due to Nocardia nova or any other Nocardia species.

Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review

A 51 year old woman without significant past medical history or risk factors for Nocardia infection developed primary Nocardia nova sternal osteomyelitis with mediastinal abscess, diagnosed with open biopsy. She required prolonged antibiotic therapy and had a favorable outcome. Primary sternal osteomyelitis develops in the absence of a contiguous focus of infection, as opposed to secondary sternal osteomyelitis, which is usually a complication of sternotomy. Staphylococcus aureus probably still is the most common cause of both forms of sternal osteomyelitis. Nocardia species invade humans usually through the respiratory tract and can cause a variety of localized infections through the hematogenous route. Pulmonary involvement may or may not coexist. Immunosuppressed patients are more prone to infection by Nocardia species, although cases involving seemingly immunocompetent patients are not rare. This is the first reported case in the English literature of primary sternal osteomyelitis due to Nocardia nova or any other Nocardia species.

In vitro biocompatibility between mitomycin-C (MMC) and bacillus Calmette-Guerin (BCG).

BACKGROUND: Mitomycin-C (MMC) and bacillus Calmette-Guerin (BCG) intravesical instillations are widely and effectively used as adjuvant treatment for superficial bladder cancer. In an attempt to improve the efficacy of intravesical therapy, MMC and BCG have also been used in a sequential or an alternating mode. The aim of this study was to assess the in vitro biocompatibility between these agents. MATERIALS AND METHODS: The effect of MMC on BCG clumping tendency was assessed by estimating the number of colony forming units (CFU) of BCG in suspension, during incubation at 37 degrees C for 3 h, with repeated recordings of the suspension optical density (OD). Preparations containing either BCG plus MMC or BCG plus an equivalent amount of sterile water were cultivated using the non-radiometric system BACTEC MGIT 960. The final concentrations of the agents, following transfer of the preparations into the tubes of the system, were 1.25 mg/ml for BCG and 1 mg/ml for MMC. During the cultivation process, the tubes of the system were automatically checked every 60 min for fluorescence emission, which is an indication of mycobacteria growth. A comparative cultivation of the same preparations on Lowenstein-Jensen solid medium was also performed. RESULTS: The OD of the BCG preparation remained almost unaffected for 3 h and was minimally altered by inclusion of MMC. After 34-38 h of cultivation in the BACTEC MGIT 960 system, all 7 cultures of the BCG+sterile water preparations became positive. In contrast, no BCG+MMC specimen became positive after an incubation period of 42 days. Following re-cultivation of the 7 negative BCG+MMC specimens, 6 remained negative, whereas 1 specimen became positive after an incubation period of 22 days. On Löwenstein-Jensen medium, growth of mycobacteria was noted only in the BCG+sterile water specimens and not in the BCG+MMC specimens. CONCLUSION: The results of this study indicate that, although MMC has no apparent effect on BCG tendency to form clumps in suspension, it may inhibit its growth in vitro. However, this does not necessarily compromise BCG anti-tumour activity. As the in vivo interaction of the drugs may be different, the efficacy of the combined BCG+MMC treatment should be defined in clinical trials.