Complex Management of Septic Joint and Cutaneous Nocardiosis in an Immunocompromised Patient: A Case Report.

Nocardia, an opportunistic, gram-positive, catalase-positive, rod-shaped bacterium found in soil and water, is known to cause infections in humans, predominantly among immunocompromised individuals, through inhalation or direct inoculation. This report details a rare case of a septic joint caused by Nocardia brasiliensis, which subsequently led to cutaneous involvement, in a patient with multiple underlying health issues. The management of this case was complicated by the patient's extensive medical history, including diabetes, chronic urinary tract infections, and recent surgical procedures, which necessitated a nuanced approach to antibiotic therapy. The treatment regimen underwent several adjustments in response to concurrent infections in other organs and the emergence of multidrug-resistant organisms. Despite an expanded arsenal of therapeutic options for Nocardia infections, treating such infections remains challenging due to potential adverse outcomes, particularly in immunocompromised patients prone to infection relapse. This case underscores the complexities involved in diagnosing and managing Nocardia infections and highlights the importance of tailored antibiotic therapy in achieving favorable outcomes while minimizing the risk of relapse.

A Recurrent Case of Mesothelial Pericardial Cyst.

This is a case of a 37-year-old female patient with past medical history of mitral valve prolapse and benign mesothelial pericardial cyst status post laparoscopic resection who presented to the emergency department with a chief complaint of right-sided sharp non-radiating chest pain due to recurrent case of benign mesothelial pericardial cyst. Though this is not a common pathology, it does overlap with common cardiovascular symptoms/conditions; not limited to but including chest pain, dyspnea, palpitations, pericardial effusions, infections and arrhythmias. It is crucial to have appropriate history and physical exam and appropriate evaluation to rule out pericardial cysts as well as their locations and their potential lethal mechanical implication on crucial nearby structures. This is significant in order to avoid uncommon but lethal cardiac complications in this condition such as cardiac arrhythmias, cardiac tamponade, right ventricular outflow tract and even sudden cardiac death.

Life-Threatening Airway Obstruction and Septic Shock Due to Submandibular Space Infection: A Case Report.

Submandibular space infection, a rare and aggressive form of cellulitis, affects the floor of the mouth and neck, potentially leading to life-threatening complications. Although commonly associated with oral trauma and contiguous abscesses, the severity of these odontogenic infections often escalates due to underlying comorbidities. This report presents a unique case of a 74-year-old man who developed severe complications following an outpatient oral procedure. The patient exhibited fever and mouth swelling within a short time, which quickly advanced to impending airway compromise and septic shock. Diagnostic imaging revealed extensive swelling from the left submandibular region extending to the anterior neck and parapharyngeal space, effacing the airway. This necessitated immediate nasotracheal intubation and mechanical ventilation. Medical management comprised emergent antibiotic administration, airway protection, and admittance to the intensive care unit. This case underscores the potential severity of complications arising from an odontogenic infection in the presence of multiple comorbidities following an oral procedure. It emphasizes the need for prompt symptom recognition, emergency airway management, and the initiation of antibiotic therapy. Furthermore, this case illustrates the critical role of various imaging modalities and the choice of intubation technique in patients with an anticipated difficult airway. Despite the severity of submandibular space infection, a timely, effective, and multidisciplinary approach can mitigate fatal outcomes and improve patient prognosis.

A Case of Asymptomatic Massive Inguinoscrotal Bladder in Acute Renal Failure.

Inguinal hernia is a common condition that typically affects males in the age group of 50-70 years. While often asymptomatic or mildly symptomatic, complications such as urinary bladder herniation and obstructive uropathy can occur if left untreated. We present a unique case of a 60-year-old man with a body mass index of 37 kg/m2 with a 20-year history of untreated bilateral inguinal hernias. His condition progressed to a complicated right inguinoscrotal hernia involving the bladder, leading to obstructive uropathy, acute renal failure, and pulmonary edema. Diagnostic imaging revealed hydronephrosis and obstruction of the distal right ureter, necessitating several procedures, including diuretic therapy, a nephrostogram, a nephrostomy, and ultimately hemodialysis due to persistent renal failure. Surgical management was achieved through an emergent robotic-assisted repair of the right inguinal hernia using resorbable mesh while repairing the left hernia was delayed to mitigate potential risks. This case illustrates the severe complications that can arise from a longstanding untreated inguinal hernia, highlighting the importance of routine monitoring and early intervention. It also emphasizes the diagnostic role of different imaging modalities and immediate pharmacological and surgical intervention in managing such complications. Despite the commonality of inguinal hernia, a lack of timely treatment can lead to life-threatening conditions, necessitating a comprehensive approach to management to improve patient outcomes.

Mediastinal Bronchogenic Cyst With Superior Vena Cava Syndrome: A Case Report.

Bronchogenic cysts are rare in adults and often remain undetected until discovered incidentally on imaging or during a symptomatic investigation. The possibility of superior vena cava (SVC) compression due to a bronchogenic cyst arises in complex patient presentations. SVC syndrome poses several unique challenges due to the wide range of clinical symptoms and difficulty identifying the cause when symptoms first manifest. This case report examines a 39-year-old male who presented with symptoms resulting from SVC compression caused by a bronchogenic cyst, leading to SVC syndrome. We discuss the various imaging modalities used to assess the severity of the obstruction and the surgical interventions employed to alleviate the symptoms. A surgical intervention provides symptomatic relief and promises an excellent prognosis when performed without complications.

A Challenging Case of Metastatic Non-Small Cell Carcinoma of the Lung.

Primary lung carcinoma with distant metastasis is a life-threatening diagnosis that presents many unique challenges due to the severity of the disease at the time of presentation. We investigated a life-threatening primary lung carcinoma with distant metastasis in a 73-year-old transgender woman, which posed unique challenges due to the advanced stage of the disease at presentation. The patient exhibited nonspecific musculoskeletal and neurological symptoms resulting from the primary lung carcinoma metastasizing to her liver, bones, and brain. We evaluated various imaging modalities that aided in determining the disease's severity and identifying complications related to metastasis. Although these efforts can offer symptomatic relief, the overall prognosis remains poor when metastasis spreads to multiple organs, particularly the brain, as remission may no longer be attainable.

A Complicated Case of Rheumatoid Arthritis in Septic Shock.

Sepsis is significantly associated with increased mortality among hospitalized patients. Patients can deteriorate rapidly, leading to septic shock (i.e., tissue hypoperfusion and organ dysfunction despite fluid resuscitation that can ultimately require a vasopressor). Patients immunocompromised from medical conditions such as rheumatoid arthritis with multiple joint arthroplasties are at a major risk of increased infections. Equally, medications that impair the immune system's normal function make this clinical case challenging. As noted in this case of a patient with a complex medical history and nontypical sepsis presentation, early intervention and a multidisciplinary approach to patient care is vital to patient improvement and survival during septic shock.