Mediastinal pancreatic pseudocyst diagnosed based on black pleural effusion.

Mediastinal pancreatic pseudocysts are rare complications of pancreatitis associated with alcohol consumption. Here, we report a case of mediastinal pancreatic pseudocyst. A 61-year-old Japanese woman presented to our hospital with epigastric pain and dyspnea. A chest radiograph revealed right-sided massive pleural effusion. Thoracentesis retrieved black pleural fluid with remarkably high fluid amylase levels were. Thoracic computed tomography (CT) after drainage revealed encapsulated fluid. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) were performed because abdominal CT and ultrasonography did not reveal any pancreatic problems. MRCP showed cystic masses and pancreatic tail cysts extending to the stomach and lower oesophagus. ERCP confirmed leakage of contrast medium from the pancreatic tail into the retroperitoneum. We diagnosed the patient with a pancreatic pseudocyst extending to the mediastinum. A mediastinal pancreatic pseudocyst should be considered a differential diagnosis in patients with black pleural fluid with a high amylase level.

Vogesella urethralis-induced aspiration pneumonia and bacteremia in an elderly man: a first case report and literature review.

BACKGROUND: Vogesella species are common aquatic Gram-negative rods that were first reported in 1997. Vogesella urethralis bacterium was first isolated from human urine in 2020. Only two cases of disease caused by Vogesella species have been reported with no case of Vogesella urethralis-caused disease being reported as yet. Herein, we report a case of aspiration pneumonia and bacteremia caused by Vogesella urethralis. CASE PRESENTATION: An 82-year-old male patient was admitted with dyspnea, increased sputum production, and hypoxia. Gram-negative rods were isolated from the blood and sputum cultures of the patient. He was diagnosed with aspiration pneumonia and bacteremia. Initially, Vogesella urethralis was wrongly identified as Comamonas testosteroni based on fully automated susceptibility testing; however, additional 16S rRNA gene sequencing identified the causative as Vogesella urethralis. The patient was treated with piperacillin and tazobactam. Unfortunately, he developed aspiration pneumonia again and died during hospitalization. CONCLUSIONS: Since no database exists for rare bacteria in traditional clinical microbiology laboratories, 16S rRNA gene sequence analysis is useful. We report the first case of Vogesella urethralis-induced aspiration pneumonia and bacteremia.

Severe COVID-19 Pneumonia Treated by Intensive Immune Suppression Therapy With a Combination of Steroid Pulse and Tocilizumab Followed by a Tapering Dose of Steroid Therapy During the Delta (B.1.617.2) Variant Outbreak: A Successfully Treated Case.

A 55-year-old man developed a low-grade fever (day 1). His wife had already been infected with COVID-19 four days previously and he had been isolated in his house as a close contact. Polymerase chain reaction for COVID-19 was positive. He had untreated diabetes mellitus. On day 7, his percutaneous saturated oxygen fell to <70% and he was transported to a hospital by ambulance. He underwent tracheal intubation, mechanical ventilation, and treatments with half steroid pulse, tocilizumab, remdesivir, and heparin. However, his ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) decreased to 120 under mechanical ventilation and he was transported to our hospital. On arrival, he did not synchronize with mechanical ventilation well. Initially, he was treated using a muscle relaxant and deep sedation to facilitate complete synchronization with mechanical ventilation and his P/F ratio improved to 247; thus, he was treated with mechanical ventilation alone with intermittent placement in the prone position. In addition, he was treated with steroid pulse therapy after steroid tapering therapy for nearly one month, glycyrrhizin, γ-globulin, azithromycin, and heparin. On day 20, the tracheal tube was removed after the improvement of the P/F ratio. We herein present the case of a patient with severe COVID-19 pneumonia who survived following treatment by intensive immune suppression therapy, including the combination of steroid pulse and tocilizumab, followed by a tapering dose of steroid therapy, after an outbreak of COVID-19 Delta variant. Further studies are needed to investigate the usefulness of this regimen.