RÉSUMÉ
The prognosis of tuberculous meningitis, a rare form of extrapulmonary tuberculosis, depends on the stage of treatment initiation. We report a fatal case of tuberculous meningitis. The patient had received successive tumor necrosis factor (TNF) antagonists and abatacept to treat juvenile idiopathic arthritis, with negative results for polymerase chain reaction and acid-fast bacilli on smear, had normal cerebrospinal fluid (CSF) adenosine deaminase and glucose levels. Six weeks post-admission, the CSF culture demonstrated Mycobacterium tuberculosis. The altered immunological responses caused by anti-TNF treatment made the diagnosis challenging. Clinicians should bear this in mind and, if suspected, treatment should be initiated immediately.
Sujet(s)
Antituberculeux/effets indésirables , Arthrite juvénile/complications , Arthrite juvénile/traitement médicamenteux , Méningite tuberculeuse/diagnostic , Méningite tuberculeuse/étiologie , Inhibiteurs du facteur de nécrose tumorale , Adolescent , Issue fatale , Humains , Imagerie par résonance magnétique , Mâle , Mycobacterium tuberculosis/isolement et purification , Réaction de polymérisation en chaîne , Méningite tuberculeuse/liquide cérébrospinalRÉSUMÉ
Abstract The prognosis of tuberculous meningitis, a rare form of extrapulmonary tuberculosis, depends on the stage of treatment initiation. We report a fatal case of tuberculous meningitis. The patient had received successive tumor necrosis factor (TNF) antagonists and abatacept to treat juvenile idiopathic arthritis, with negative results for polymerase chain reaction and acid-fast bacilli on smear, had normal cerebrospinal fluid (CSF) adenosine deaminase and glucose levels. Six weeks post-admission, the CSF culture demonstrated Mycobacterium tuberculosis. The altered immunological responses caused by anti-TNF treatment made the diagnosis challenging. Clinicians should bear this in mind and, if suspected, treatment should be initiated immediately.
Sujet(s)
Humains , Mâle , Adolescent , Arthrite juvénile/complications , Arthrite juvénile/traitement médicamenteux , Méningite tuberculeuse/diagnostic , Méningite tuberculeuse/étiologie , Inhibiteurs du facteur de nécrose tumorale , Antituberculeux/effets indésirables , Méningite tuberculeuse/liquide cérébrospinal , Imagerie par résonance magnétique , Réaction de polymérisation en chaîne , Issue fatale , Mycobacterium tuberculosis/isolement et purificationRÉSUMÉ
Brevibacterium spp. are catalase-positive, non-spore-forming, non motile, aerobic Gram- positive rods that were considered apathogenic until a few reports of infections in immunocompromised patients had been published. To the best of our knowledge, this is the first report of B. casei catheter-related bloodstream infection in a child with acute leukemia. We aim to enhance the awareness of pediatric hematology and infectious disease specialists about this pathogen and review of the literature.
Sujet(s)
Humains , Mâle , Enfant , Infections à Actinomycetales/microbiologie , Brevibacterium/isolement et purification , Infections sur cathéters/microbiologie , Leucémie-lymphome lymphoblastique à précurseurs B/complications , Brevibacterium/classificationRÉSUMÉ
Brevibacterium spp. are catalase-positive, non-spore-forming, non motile, aerobic Gram-positive rods that were considered apathogenic until a few reports of infections in immunocompromised patients had been published. To the best of our knowledge, this is the first report of B. casei catheter-related bloodstream infection in a child with acute leukemia. We aim to enhance the awareness of pediatric hematology and infectious disease specialists about this pathogen and review of the literature.
Sujet(s)
Infections à Actinomycetales/microbiologie , Brevibacterium/isolement et purification , Infections sur cathéters/microbiologie , Leucémie-lymphome lymphoblastique à précurseurs B/complications , Brevibacterium/classification , Enfant , Humains , MâleRÉSUMÉ
We present a case of a 4.5-month-old boy from Turkey with hemophagocytic lymphohistiocytosis (HLH) associated with H1N1 virus and Leishmania spp. coinfection. Because visceral leishmaniasis can mimic hematologic disorders like HLH, it is important to rule out this clinical condition before starting immunosuppressive therapy. In our case, treatment with liposomal amphotericin B resulted in a dramatic resolution of clinical and laboratory abnormalities.
Sujet(s)
Sous-type H1N1 du virus de la grippe A , Grippe humaine/complications , Leishmaniose viscérale/complications , Lymphohistiocytose hémophagocytaire/complications , Amphotéricine B/usage thérapeutique , Antiprotozoaires/usage thérapeutique , Enfant d'âge préscolaire , Humains , Grippe humaine/diagnostic , Grippe humaine/traitement médicamenteux , Leishmaniose viscérale/diagnostic , Leishmaniose viscérale/traitement médicamenteux , Lymphohistiocytose hémophagocytaire/diagnostic , MâleRÉSUMÉ
We present a case of a 4.5-month-old boy from Turkey with hemophagocytic lymphohistiocytosis (HLH) associated with H1N1 virus and Leishmania spp. coinfection. Because visceral leishmaniasis can mimic hematologic disorders like HLH, it is important to rule out this clinical condition before starting immunosuppressive therapy. In our case, treatment with liposomal amphotericin B resulted in a dramatic resolution of clinical and laboratory abnormalities.
É relatado um caso de um menino de 4,5 meses de idade, da Turquia, com linfohistiocitose hemofagocítica (HLH) associado à coinfecção com o vírus H1N1 e leishmaniose visceral. Como a leishmaniose visceral pode imitar doenças hematológicas como HLH, é importante afastar essa condição clínica antes de iniciar a terapia imunossupressora. No caso relatado, o tratamento com anfotericina B lipossomal resultou em uma resolução dramática das anomalias clínicas e laboratoriais.