Aspergillus myofasciitis in a chronic granulomatous disease patient: first case report.

Aspergillus myofasciitis is a rare infection of the muscles and their fascial sheaths that has been reported in patients with immune deficiencies of various kinds but, until now, not with chronic granulomatous disease (CGD). Patients affected by CGD are at high risk of invasive aspergillus infections. The case described involves a 14-year-old boy with a severe autosomal recessive CGD who was admitted to hospital with an Aspergillus myofasciitis of the left forearm. He was treated with liposomal amphotericin for 14 days and then with oral voriconazole for three months with an excellent clinical outcome. He did not evidence any recurrence in the following 30 months using itraconazole prophylaxis.

Bacillus cereus fasciitis: a unique pathogen and clinically challenging sequela of inoculation.

Bacillus cereus is an aerobic, spore-forming, gram-positive rod. It has historically been associated with "fried rice syndrome," a foodborne diarrheal and emetic illness resulting from eating fried rice dishes that have been sitting at room temperature for hours. We report the case of a 9-year-old boy who developed culture-positive B cereus fasciitis of the right lower extremity after being impaled on a tree branch. This case report further elucidates and emphasizes the importance of recognizing B cereus as a possible cause of severe soft-tissue infection. It must be included in the differential diagnosis of gas gangrene and necrotizing fasciitis.

Eosinophilic Fasciitis associated with Mycoplasma arginini infection.

Eosinophilic fasciitis (EF) with generalized sclerodermiform skin lesions developed over a 19-month period in a previously healthy 23-year-old man. Although we confirmed EF by skin histology and laboratory tests, the recurrent fevers and the clinical observation of sclerotic prepuce with urethritis indicated further bacteriological analysis by conventional microbiological and DNA-based tests. Urethra cultures were positive for an arginine-hydrolyzing mycoplasma and Ureaplasma urealyticum. The patient also had serum IgM antibodies to Mycoplasma pneumoniae using enzyme-linked immunosorbent assay (ELISA)-based qualitative detection. Mycoplasma arginini was isolated from two independent venous blood serum samples and was identified by conventional microbiological tests and sequencing of the 16S rRNA and rpoB genes (GenBank sequence accession numbers HM179555 and HM179556, respectively). M. arginini genomic DNA also was detected by species-specific PCR in the skin lesion biopsy sample. Treatment with corticosteroids and long-term courses of selected antibiotics led to remission of skin symptoms and normalization of laboratory values. This report provides the first evidence of EF associated with mycoplasma infection and the second report of human infection with M. arginini and therefore suggests that this mycoplasma infection might have contributed to the pathogenesis of the disease.

Should we wait for development of an abscess before we perform incision and drainage?

Deep neck infections are infections (either abscess or cellulitis) that are within the potential spaces and fascial planes of the head and neck. Deep neck infections should not be ignored, and no surgeon should underestimate the necessity of appropriate and timely treatment of deep neck infections due to the serious and potentially life-threatening nature of these infections. This article discusses and reviews the literature with regard to a question that has long been debated in the surgical literature, "Should we wait for the development of an abscess before performing incision and drainage?"

[Frequency and clinical outcome of odontogenic cervicofacial infection]. / Frecuencia de infección cervicofacial odontógena que requiere hospitalización.

OBJECTIVE: To measure frequency, mortality, hospitals stay and the requirement of attention in the intensive care unit (ICU) of patients with cervical infections. METHODS: A descriptive, observational and transversal study was carried out. We analyzed the database of patients admitted to Emergency Room of High Specialty Hospital, with cervical and facial infection with odontogenic origin, during a year period. RESULTS: In three cases were ambulatory and 19 where hospitalized; only three required ICU attention. The average of hospital stay was 6.3 days and the mortality of 8.3%. CONCLUSIONS: The mortality is significant in patients who require ICU and whose age is older than 60 years. Therefore this group of patients required a rapid multidisciplinary care to improve their expectations for survival expectancy.

Enterococcus faecalis cellulitis/fasciitis after hypospadias surgery.

We describe a case of Enterococcus faecalis-associated cellulitis/fasciitis after hypospadias surgery.

Necrotizing fasciitis caused by Salmonella enteritidis.

A 57-year-old immunocompromized female developed a necrotizing fasciitis with sepsis a few days after abdominal complaints and diarrhoea. Surgery was performed because of progressive worsening of the patient's situation and during surgery the decision was made to perform an amputation. After surgery the patient was brought to the intensive care department for a few days. She recovered from her sepsis within a few days. Cultures showed Salmonella enteritidis.

A case of the otogenic variant of Lemierre's syndrome with atypical sequelae and a review of pediatric literature.

We report a case of an 8-year-old girl who presented with the clinical picture of Lemierre's syndrome (LS) secondary to bilateral mastoiditis. She developed unilateral sensorineural hearing loss (SNHL) along with internal jugular vein (IJV) thrombosis, septic arthritis of her ankle and cervical fasciitis. Combined antimicrobial, anticoagulant and surgical treatment helped reverse all the effects of the sequelae, including nearly all the hearing loss. This is a unique case of this uncommon variant of the syndrome and with an uncommonly reported complication. The literature indicates that pediatric cases are a minority and enforces that successful management rests on awareness of the condition, vigil and promptness of communication of a multidisciplinary pediatric team.

[Buruli disease and plastic surgery]. / Ulcère de Buruli et chirurgie plastique, au dispensaire.

The Buruli ulcer is a skin infection with Mycobacterium ulcerans which progresses silently. This infection affects mostly women and children who live near stagnant waters. Buruli ulcer is disease that has terrible consequences if not promptly diagnosed and treated. It destroys progressively skin tissues and consequently leaves very important scars. There is no efficient medical treatment. This presentation proposes to take care efficiently of the Buruli ulcer by simple plastic surgery techniques. We relate our experience of a mission in Benin, in the context of the national programme of struggle against the Buruli ulcer.

Dermatomyositis with tuberculous fasciitis.

A case of dermatomyositis with tuberculous fasciitis is described. A 69-year-old Japanese man treated with prednisolone for dermatomyositis developed erythema and bilateral swelling of arms and forearms. A diagnosis of tuberculous fasciitis was confirmed by the presence of acid-fast bacilli in a biopsy specimen and the growth of Mycobacterium tuberculosis from tissue cultures. The unusual presenting clinical features resulted in delayed diagnosis. We emphasize that tuberculous fasciitis should be considered in an immunocompromised patient who is treated with steroids, especially if the results of initial treatment are not satisfactory.

Tuberculous fasciitis in scleroderma.

A 25-year old woman visited the hospital because of a painful swelling for 20 days in the midposterior portion of her right thigh. She had been diagnosed with systemic sclerosis and treated for 10 months. An MRI scan of the right thigh showed diffuse fascial thickening and involved the superficial portion of thigh muscles, which were hyperintense on the T(2)-weighted image. A biopsy of the involved muscles revealed chronic granulomatous inflammation with several acid-fast bacilli on a Ziehl-Neelsen stain. We here report a case of tuberculous fasciitis manifest with painful swelling of the midposterior muscles of the right thigh without pulmonary tuberculosis in a patient with scleroderma.