Pembrolizumab for the treatment of Progressive Multifocal Leukoencephalopathy (PML) in a patient with AIDS: A case report and literature review.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic central nervous system (CNS) infection caused by the reactivation of John Cunningham polyomavirus (JCV) from suppression of the host immune system due to conditions such as human immunodeficiency virus causing acquired immunodeficiency syndrome (HIV/AIDS), hematological malignancies, multiple sclerosis, and use of immunosuppressant medications. Pembrolizumab is an immune checkpoint inhibitor targeting programmed cell death protein-1 (PD-1) receptors on lymphocytes. In recent years its use is expanding to treat several malignancies and it is a drug of interest for the treatment of PML. In this case report, we present a case of an HIV/AIDS patient who was given a trial of pembrolizumab for treatment of PML. We also provide a literature review of the reported cases of use of this medication in other immunocompromised states.

Prevalence of SARS-CoV-2 among community members presenting for testing in Peoria, Illinois from 21 April to 15 May 2020.

Expanding easily accessible community SARS-CoV-2 screening is essential in the response to the COVID-19 pandemic. In this report, we describe the findings from the initial 25 days of a SARS-CoV-2 drive-up and walk-up testing initiative was organized in Peoria, Illinois. Eighty-seven out of 4,073 individuals (2.1%) tested positive for SARS-CoV-2, and 46% of these were asymptomatic at the time of testing. There were ten frontline workers without symptoms consistent with COVID-19 who tested positive, including six that did not report any known exposure to SARS-CoV-2. These results stress the importance and effectiveness of widely available community SARS-CoV-2 testing and suggest a possible benefit to screening of asymptomatic individuals at higher risk for infection.

Pregnancy-associated pyogenic sacroiliitis: case report and review.

BACKGROUND: Pyogenic sacroiliitis occurs infrequently during the peripartum period. CASE: A case at our institution and a review of the literature were analyzed. A total of 15 cases were discovered. The onset of illness was during pregnancy (40% of cases), within 3 weeks postpartum (40%) or post-abortion (20%), and the presentation was usually acute (< 7 days in 67% of cases). Frequent manifestations included localized pain in the hips or buttock, sacroiliac joint tenderness and fever. Computed tomography or magnetic resonance imaging revealed joint involvement in all cases tested. Microbiology was confirmed by blood (40%) or joint aspirate (75%), and most patients were treated with antibiotics. Surgical intervention took place in five cases. Preterm labor was reported in only one case. All patients responded well to therapy without locomotive disability, and persistent pain was uncommon. CONCLUSION: Septic sacroiliitis should be considered in peripartum patients who present with fever and severe localized pain. Medical management is usually curative, and without an adverse effect on pregnancy.

Staphylococcus aureus bacteremia: compliance with standard treatment, long-term outcome and predictors of relapse.

The long-term outcome of compliance with standard treatment recommendations for Staphylococcus aureus bacteremia was assessed. Cases of S. aureus bacteremia at our institution over a 2-y period were reviewed and follow-up performed by review of subsequent admissions or contact with primary care physicians. We encountered 226 cases (age 64.7 +/- 15.8 y) and most (171/226, 75.7%) had no removable source. In-hospital mortality rate was 32.7% (74/226). Follow-up of 104/152 (68.4%) survivors (for 386.7 +/- 449.8 d) revealed 23.1% (24/104) relapses: recurrent bacteremia (n = 19), distant site (n = 3) and local recurrence (n = 2). Most relapses (21124; 87.5%) occurred within 90 d of therapy. Relapse rate was higher with vancomycin treatment (20148 vs. 4/56; p < 0.001), bacteremia for > or = 3 d (9/20 vs. 15/84; p = 0.001), and failure to remove the source (6/7 vs. 6/22; p = 0.006). Vancomycin effect was independent of oxacillin susceptibility. Treatment for less than the standard 2-week duration among 19 patients with short duration of bacteremia (< 3 d) did not increase relapse rate (1/19; 5.3%). Duration of bacteremia, vancomycin therapy and failure to remove the source were predictors of relapse. Prospective studies are needed to determine if S. aureus bacteremias of short duration can be treated for 2 weeks or less, and define the optimal duration for prolonged bacteremia when vancomycin is used.

Uterine granulomas: clinical and pathologic features.

We retrospectively studied the clinical and pathologic features of uterine granulomas over a 10-year period. Granulomas were detected in 30 women, 22 to 81 years old, in the cervix (n = 12/1,090 cervical specimens; 1.1%) or uterine corpus (n = 18/12,000 uterine specimens; 0.15%). They were discovered during evaluation of abnormal bleeding, cytologic specimens, or other gynecologic conditions. None of the patients had constitutional symptoms. These granulomas were often focal (n = 25 [83%]), exhibiting features of foreign body-type (n = 17 [68%]); or they were diffuse (n = 5 [17%]), all with negative acid-fast bacilli or fungal stains and sometimes necrotizing (2 [40%]). Focal granulomas were highly associated with a preceding biopsy or surgery (22/25 vs 14/53 age-matched control subjects). Follow-up of 28 patients (median, 16 months) showed that 27 remained healthy; only 1 patient developed generalized lesions consistent with sarcoidosis 16 months later Uterine granulomas are rare. They are eitherfocal, related to previous biopsy or surgery, or diffuse, usually representing local reaction without an obvious cause. Association with infection or systemic granulomatous disorders is uncommon.

Coccidioidal meningitis: incidental diagnosis 3 y after ventriculo-peritoneal shunt placement for hydrocephalus.

A patient from the American Midwest developed hydrocephalus after a trip to southwest California, necessitating placement of a ventriculo-peritoneal shunt. Coccidioidal meningitis was diagnosed incidentally 3 y later, during evaluation for shunt malfunction.