Prolonged course of eravacycline leading to acute pancreatitis.

Eravacycline is the newest member of the broad-spectrum class of tetracycline antimicrobials. Pancreatitis has been previously associated with the tetracycline class of antibiotics, but, to our knowledge, we believe that this is the first reported case of eravacycline-induced pancreatitis. We describe a 46-year-old male who received eravacycline for treatment of a perirectal abscess. While the patient had slightly elevated lipase levels at baseline post-cardiopulmonary arrest, he developed abdominal pain and a further increase in lipase levels following 10 days of eravacycline, consistent with pancreatitis. Based on the Naranjo adverse drug reaction probability scale, eravacycline was the probable etiology of acute pancreatitis given improvement immediately after discontinuation. Clinicians should be aware of this potential adverse effect of eravacycline and should not initiate eravacycline in those with risk factors for acute pancreatic injury. However, acute pancreatitis should be suspected in all patients complaining of symptoms followed by immediate discontinuation of eravacycline.

Disseminated Streptococcus gallinaceus infection. A new breed of zoonotic Streptococcus.

Streptococcus gallinaceus is a new species of Streptococcus that was first isolated in 2004 in chickens. Infections in humans are associated with chicken exposure. There are very few case reports of human infections with this organism and none with disseminated infection. We report a case of Streptococcus gallinaceus bacteremia complicated by aortic valve endocarditis and lumbar osteomyelitis and paraspinal abscess in a patient with chicken exposure. The patient presented with progressive lower back pain and malaise. Blood culture was positive for Streptococcus gallinaceus. Magnetic resonance imaging (MRI) of the spine showed L2-L3 osteomyelitis with a compression fracture and paraspinal abscess. Transthoracic echocardiography revealed severe aortic insufficiency, 1-cm aortic valve echo density suspected to be a vegetation, and perforation of the right coronary cusp. He subsequently underwent anaortic valve repair. Pathology confirmed acute endocarditis with associated vegetations and granulation tissues. He was successfully treated with a six-week course of ceftriaxone.

Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients.

In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.