Behçet's disease-like presentation of bullous pyoderma gangrenosum associated with Crohn's disease.

A 47-year-old woman presented with a 2-month history of generalized arthralgia and a 10-day history of oral aphthous ulcers. After hospitalization, papulopustular lesions and perianal ulcerations developed. Pathergy test was positive and ophthalmological examination was normal. The presence of oral aphthous ulcers, genital ulcerations, papulopustular lesions and arthralgia, and the positive pathergy test suggested the diagnosis of Behçet's disease (BD). In a few days, positive pathergy reactions and papulopustular lesions evolved into bullous lesions, which were diagnosed dermatopathologically as pyoderma gangrenosum. Two days after the presentation of papulopustular lesions, the patient experienced diarrhoea accompanied by bloody stools and mucus. Histopathological examination of biopsy specimens showed no vasculitis but revealed findings suggestive of Crohn's disease. The patient responded well to treatment with systemic steroids and 5-aminosalicylic acid. Our case demonstrates that the differential diagnosis of BD and inflammatory bowel disease may be perplexing and that these two diseases may be closely related.

Nosocomial meningitis in a university hospital between 1993 and 2002.

The aim of this study was to establish the relationship between nosocomial meningitis (NM) and surgical interventions, type of pathogens and other hospital infections (HIs). Fifty-one patients diagnosed with NM, according to the criteria of the Centers for Disease Control and Prevention, in the Neurosurgery Department of Ibn-i Sina Hospital of Ankara University between 1993 and 2002 were evaluated retrospectively. All individuals with NM were hospitalized in the intensive care unit. Third-generation cephalosporins were used for surgical prophylaxis and broad-spectrum antibiotics were used for treatment. NM occurred in 0.34% of all admissions and accounted for 0.53% of all HIs. Fourteen cases (28%) had at least one concurrent HI, mainly originating from surgical wounds and related secondary bacteraemia. Four cases had NM following surgical site infection with the same causative agent and three cases had bacteraemia. All the individuals had surgical interventions and 26 (51%) had operations concerning ventriculoperitoneal shunt. A positive microbiological cause was found in the cerebrospinal fluid of 49 patients, with 16 cases having a polymicrobial cause. Of all 67 micro-organisms isolated, 41 (61%) were Gram-negative bacilli, 23 (34%) were Gram-positive cocci and the remaining three (5%) were Candida spp. Staphylococci were the most common pathogens (30%), followed by non-fermentative Gram-negative bacilli (22%).

Statin toxicity: a situation that mimics viral hepatitis.

A case is presented involving a female patient who experienced rhabdomyolysis following high-dose therapy with a statin. Acute renal failure was a complicating factor necessitating the use of hemodialysis. The patient recovered fully within about 6 weeks.

[Case report: two Leuconostoc bacteremia cases]. / Olgu sunumu:Leuconostoc bakteriyemili iki olgu.

Leuconostoc species, which are the members of Streptococcaceae family, have recently been recognized as potential pathogens. They usually cause infections in patients with underlying disease, with venous catheters or previously treated with vancomycin. In this report, we have presented two cases of Leuconostoc bacteremia. The first case was a 42 years old male patient who was diagnosed to have colon adenocarcinoma. He had undergone colon, stomach and distal pancreas resection operation and had given chemotherapy. Blood and catheter cultures yielded methicillin-resistant Staphylococcus aureus. Blood cultures were repeated since teicoplanin therapy had failed, and Gram positive cocci resistant to vancomycin were isolated. The other case was a 26 years old male patient who had undergone a shunt operation because of pineal lesion and hydrocephaly. He had given ampirical vancomycin therapy since he had post-operative high fever, however the therapy had failed. The catheter culture yielded Gram positive cocci resistant to vancomycin. Both isolates were identified as Leuconostoc spp. with API 20 strep identification kit (Bio Merieux), and both of them were found sensitive to penicillin, ampicillin, clindamycin, gentamicin and chloramphenicol, while they were resistant to teicoplanin and vancomycin. The patients were successfully treated with clindamycin. It is concluded that, Leuconostoc spp. should be considered when vancomycin-resistant organisms resembling streptococci are isolated from blood cultures.

Predictive value of nalidixic acid resistance for detecting salmonellae with decreased ciprofloxacin susceptibility.

Seventy-three Salmonella isolates classified as ciprofloxacin susceptible when using the criteria of the National Committee for Clinical Laboratory Standards were studied for nalidixic acid (NA) resistance. The aim of the study was to determine the predictive value of nalidixic acid resistance in screening for decreased ciprofloxacin susceptibility. We observed that isolates with decreased ciprofloxacin susceptibility were all resistant to nalidixic acid. Identification of nalidixic acid resistance by the disk diffusion method provided 100% sensitivity and a specificity of 98.4% in strains with minimum inhibitory concentrations (MICs) >0.008 mg/l.

Bilateral mammary abscess due to Brucella melitensis.

Brucellosis is an important zoonosis, which is widespread as endemic cases in Turkey. Unusual clinical features and complications can sometimes lead to diagnostic difficulties. We describe here a case of a pregnant woman with bilateral mammary abscesses due to Brucella melitensis.

An intramedullary dermoid cyst abscess due to Brucella abortus biotype 3 at T11-L2 spinal levels.

A 17-year-old boy was admitted to hospital with a history of backache, weakness of the lower extremities and fever. While the diagnosis of brucellosis was made his clinical course worsened. Acute medulla spinalis mass effect and signs of meningitis predominated. It was shown that he had a dermoid cyst infected with Brucella abortus biotype 3 which was the same strain growing in his blood cultures.

[Development of resistance in bacteria interacting with subinhibitory antibiotic concentrations]. / Subinhibitör antibiyotik konsantrasyonlarinin bakterilerde direnç gelisimi üzerine etkileri.

In order to determine the role of subinhibitory concentrations of antibiotics in resistance development, we performed an in vitro trial in which E. coli gained resistance after exposure to low concentrations of ampicillin in serial passages, while MIC values for amikacin and gentamicin increased 2 and 4 times, respectively. Pseudomonas also became resistant to ceftazidime whereas the MIC value for ciprofloxacin increased 10 times. There was not any significant change in susceptibility of S. aureus to vancomycin and amoxicillin + clavulanate.