An unusual case of tropical pyomyositis: cryptococcal pyomyositis.

The more common manifestations of cryptococcal infections are restricted to the central nervous system and lungs. A young man, suffering from idiopathic dilated cardiomyopathy with a left ventricular ejection fraction of 20%, presented with subacute, painful tender swelling in both legs initially attributed to congestive cardiac failure. No response to diuretics was achieved. Metabolically active lesions in the muscles of both lower limbs suggestive of muscle abscesses were found. A diagnosis of tropical pyomyositis was therefore made, but aspiration surprisingly revealed gram-positive yeast cells, staining of which on India ink and culture confirmed Cryptococcus. A good response to a combination of liposomal amphotericin B and flucytosine was obtained, but nevertheless the patient died from heart failure after induction of antifungal therapy.

Invasive Mediastinal Aspergillosis in Immunocompetent Male with Invasion of Left Atrium and Hilar Structures.

Aspergillus is described as mould characterised by septate hyphae about 2-4µ in diameter, it is ubiquitous in nature and spreads by inhalation of spores. It causes opportunistic infections in almost six forms namely Allergic bronchopulmonary aspergillosis, Aspergillus sinusitis, Cutaneous aspergillosis, Aspergilloma, Chronic pulmonary aspergillosis, Invasive aspergillosis. Invasive aspergillosis of mediastinum in an immunocompetent patient has rarely been reported. We present a case of a young male who had presented with chest pain, cough and breathleness was later diagnosed as fulminant mediastinal aspergillosis. Incisional biopsy with histology report and endotracheal cultures helped in diagnosing mediastinal aspergillosis. Despite initiation of the right antifungal therapy and best supportive measures, patient died of septic shock and multiorgan dysfunction. This case report highlights the need for higher suspicion in such cases of mediastinal masses and early tissue biopsy which can help in reducing mortality.

Association Between Chlamydia pneumoniae and Migraine: A Study from a Tertiary Center in India.

AIMS: To investigate the association between circulating Chlamydia pneumoniae (C pneumoniae) immunoglobulin G (IgG) antibody and migraine in Indian patients. METHODS: A total of 300 migraine patients and 150 age-matched and sex-matched controls were recruited from the Department of Neurology at Yashoda Hospital in Hyderabad, India, during the study period between August 2011 and July 2013. All patients and controls were assessed for the presence of the C pneumoniae IgG antibody and also C-reactive protein (CRP) as well as for depression, which was assessed by the Hamilton Depression Rating Scale (HDRS). RESULTS: Of the patients with migraine, 69% were female and the mean age ± standard deviation (SD) was 45.8 ± 4.8 years (range 18 to 62 years). The C pneumoniae IgG antibody was present in 151 of the patients (50.3%; P < .0001), CRP in 180 (60%; P < .0001), depression in 270 (90%; P < .0001), and history of sleep disturbances in 70 (23.3%; P < .0001); all measurements were significantly higher in migraine patients compared with controls. After adjustment for multiple logistic regression analyses, C pneumoniae IgG antibody positivity (odds ratio [OR] 2.6; 95% confidence interval [CI] = 1.3 to 3.7), CRP positivity (OR 6.2; 95% CI = 3.3 to 11.6), mild depression (OR 16.9; 95% CI = 6.5 to 39.4), and history of sleep disturbance (OR 2.1; 95% CI = 1.1 to 3.1) were independently associated with migraine. CONCLUSION: This study showed that the presence of C pneumoniae IgG antibody was independently associated with migraine in Indian patients.