RESUMEN
A 10-year-old spayed female mixed-breed dog was brought to the Ohio State University Veterinary Medical Center because of a suspected mass located to the right kidney. The mass was diagnosed by abdominal ultrasound following a recurrent lower urinary tract infection. Abdominal computed tomography revealed 2 isoattenuating, peripherally hypoattenuating, and centrally non-contrast-enhancing nodules in the right kidney; the larger one measured 1.9 cm. Initial attempts at fine-needle aspiration were unsuccessful. The dog was returned and the mass was aspirated using ultrasound guidance under heavy sedation. Cytology confirmed the presence of septic inflammation, consistent with a renal corticomedullary abscess. The dog was administered oral enrofloxacin (15 mg/kg, q24h) after diagnosis. Ultrasound guidance was used 2 wk later, under general anesthesia, to achieve percutaneous drainage of ~0.25 mL of fluid and instillation of 5.7 mg (0.25 mL) of enrofloxacin into the abscess capsule. Two weeks after percutaneous drainage, ultrasound examination showed complete resolution of the renal corticomedullary abscess. Urine culture confirmed resolution of the urinary tract infection. To the authors' knowledge, kidney-sparing medical management has never been successfully reported in a dog with a renal corticomedullary abscess. Key clinical message: Renal corticomedullary abscesses occur infrequently in dogs. Medical management is feasible and can result in complete resolution of clinical signs and imaging abnormalities.
Diagnostic et prise en charge médicale réussie d'un abcès corticomédullaire rénal chez un chienUne chienne croisée de 10 ans, stérilisée, a été amenée au centre médical vétérinaire de l'Ohio State University en raison d'une masse suspectée située au niveau du rein droit. La masse a été diagnostiquée par échographie abdominale à la suite d'une infection récurrente du tractus urinaire inférieur. La tomodensitométrie abdominale a révélé 2 nodules isoatténuants, hypoatténuants en périphérie et centralement sans contraste dans le rein droit; le plus grand mesurait 1,9 cm. Les premières tentatives d'aspiration à l'aiguille fine ont échoué. Le chien est revenu et la masse a été aspirée sous guidage échographique sous sédation lourde. La cytologie a confirmé la présence d'une inflammation septique, compatible avec un abcès corticomédullaire rénal. Le chien a reçu de l'enrofloxacine par voie orale (15 mg/kg, toutes les 24 heures) après le diagnostic. Le guidage échographique a été utilisé 2 semaines plus tard, sous anesthésie générale, pour obtenir un drainage percutané d'environ 0,25 mL de liquide et l'instillation de 5,7 mg (0,25 mL) d'enrofloxacine dans la capsule de l'abcès. Deux semaines après le drainage percutané, l'échographie a montré une résolution complète de l'abcès corticomédullaire rénal. La culture urinaire a confirmé la résolution de l'infection des voies urinaires. À la connaissance des auteurs, une prise en charge médicale préservant les reins n'a jamais été rapportée avec succès chez un chien présentant un abcès corticomédullaire rénal.Message clinique clé:Les abcès corticomédullaires rénaux surviennent rarement chez le chien. La prise en charge médicale est réalisable et peut aboutir à une résolution complète des signes cliniques et des anomalies d'imagerie.(Traduit par Dr Serge Messier).
Asunto(s)
Absceso , Antibacterianos , Enfermedades de los Perros , Enrofloxacina , Animales , Perros , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/diagnóstico por imagen , Femenino , Absceso/veterinaria , Absceso/tratamiento farmacológico , Absceso/diagnóstico , Enrofloxacina/uso terapéutico , Enrofloxacina/administración & dosificación , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Infecciones Urinarias/veterinaria , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/diagnóstico , Enfermedades Renales/veterinaria , Enfermedades Renales/tratamiento farmacológico , Enfermedades Renales/diagnóstico , Drenaje/veterinaria , Fluoroquinolonas/uso terapéutico , Fluoroquinolonas/administración & dosificación , Ultrasonografía/veterinariaRESUMEN
OBJECTIVE: To retrospectively analyze the clinical practicability and value of ultrasound-guided minimally invasive catheterization combined with compound Phellodendron Phellodendri liquid in the treatment of breast abscess during lactation. METHODS: 139 patients with lactational breast abscess discharged from our hospital from January 2021 to November 2023 were selected. We divided them into groups according to treatment methods, analyzed whether there were statistical differences in observation indexes among groups and the risk factors affecting breastfeeding rate and treatment satisfaction. RESULTS: We found that numerical rating scale(NRS) score and incidence of breast fistula in group A were significantly lower than other, the continuous decrease of postoperative drainage in group A was higher than other, there were significant differences among groups (p<0.001). Univariate analysis showed that recovery time, drainage tube placement time, postoperative redness and swelling regression time, scar length, and VAS score of six groups were statistically significant (p<0.001). We found that the overall satisfaction and the rate of continued breastfeeding in group A (96.2%) were higher than other, the differences were statistically significant(p<0.05). Logistic regression analysis revealed that the significant risk factors influencing treatment satisfaction included the time of drainage tube placement, postoperative redness and swelling regression time, treatment group, surgical method, NRS score on the first day after operation, postoperative drainage volume, healing time, scar length, flushing drugs, and VAS score. Postoperative redness and swelling regression time, treatment group, operation method and VAS score are all risk factors that influence the outcome of breastfeeding. CONCLUSION: Ultrasound-guided minimally invasive catheterization combined with compound cortex phellodendri fluid in the treatment of breast abscess during lactation can not only reduce the pain caused by dressing change, but also offer numerous advantages, including shorter healing time, beautiful appearance, lower incidence of breast fistula, high satisfaction and high rate of continued breastfeeding.
Asunto(s)
Absceso , Enfermedades de la Mama , Drenaje , Humanos , Femenino , Adulto , Enfermedades de la Mama/terapia , Enfermedades de la Mama/cirugía , Enfermedades de la Mama/diagnóstico por imagen , Estudios Retrospectivos , Absceso/terapia , Absceso/cirugía , Drenaje/métodos , Lactancia Materna , Lactancia , Ultrasonografía Intervencional/métodos , Cateterismo/métodosRESUMEN
BACKGROUND: Inadequate surgical interventions can lead to serious complications such as tubo-ovarian abscesses in the upper female genital system, often resulting from untreated pelvic inflammatory disease. Pelvic inflammatory disease, caused by infections like Chlamydia trachomatis and Neisseria gonorrhoeae, leads to scarring and adhesions in the reproductive organs, with common risk factors including intrauterine device use and multiple sexual partners. Pelvic inflammatory disease primarily affects sexually active young women and can manifest with varied symptoms, potentially leading to complications like ectopic pregnancy, infertility, and chronic pelvic pain if untreated. CASE PRESENTATION: This case report presents a unique scenario involving a 17-year-old sexually inactive female who experienced concurrent tubo-ovarian abscess, acute cystitis, and pancolitis following laparoscopic ovarian cystectomy. Pelvic inflammatory disease and its complications are well-documented, but the simultaneous occurrence of acute cystitis and pancolitis in this context is unprecedented in the medical literature. The patient's presentation, clinical course, and management are detailed, highlighting the importance of considering diverse and severe complications in individuals with a history of gynecological surgeries. CONCLUSIONS: Our case report highlights the need for healthcare professionals to remain vigilant for atypical presentations of gynecological complications and emphasizes the value of interdisciplinary collaboration for optimal patient care. We encourage further research and awareness to enhance understanding and recognition of complex clinical scenarios associated with gynecological procedures.
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Absceso , Cistitis , Laparoscopía , Humanos , Femenino , Adolescente , Laparoscopía/efectos adversos , Cistitis/etiología , Absceso/etiología , Enfermedades del Ovario/etiología , Enfermedades del Ovario/cirugía , Complicaciones Posoperatorias/etiología , Enfermedad Inflamatoria Pélvica/etiología , Enfermedad Aguda , Enfermedades de las Trompas Uterinas/etiología , Enfermedades de las Trompas Uterinas/cirugíaAsunto(s)
Absceso , Inmunoglobulina E , Síndrome de Job , Receptores de Interleucina-6 , Humanos , Síndrome de Job/diagnóstico , Síndrome de Job/inmunología , Inmunoglobulina E/sangre , Masculino , Femenino , Absceso/diagnóstico , Receptores de Interleucina-6/inmunología , Niño , Adolescente , PreescolarRESUMEN
Staphylococcus aureus is a notorious pathogen predominantly involved in skin and soft tissue infections, exhibiting a distinct innate sex bias. This study explores the influence of testosterone on the virulence of S. aureus and elucidates its underlying mechanisms. Utilizing a skin abscess model in intact and castrated male mice, we assessed the effects of testosterone on S. aureus pathogenicity. Compared to controls, castrated mice showed significantly reduced abscess sizes and decreased bacterial loads, highlighting the role of testosterone in modulating the severity of S. aureus infections. In vitro experiments revealed that testosterone enhances the hemolytic activity, cytotoxicity, and oxidative stress resistance of S. aureus. Real-time quantitative PCR analysis showed a significant upregulation of the genes encoding α-hemolysin (hla) and phenol-soluble modulin (psmα). Importantly, testosterone treatment significantly enhanced the expression of the accessory gene regulator (Agr) quorum-sensing system components (agrC, agrA, agrB, agrD), while the SaeRS system (saeR, saeS, and sbi) exhibited only slight changes. Gene knockout experiments revealed that deletion of agrC, rather than saeRS and agrBD, abolishes the testosterone-induced enhancement of hemolysis and gene expression, underscoring the key role of AgrC. Molecular docking simulations indicated a direct interaction between testosterone and AgrC protein, with a strong binding affinity at the active site residue SER201. This study provides new insights into the mechanistic basis of how testosterone enhances the pathogenicity of S. aureus, potentially contributing to increased male susceptibility to S. aureus infections and offering a targeted approach for therapeutic interventions.
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Proteínas Bacterianas , Infecciones Estafilocócicas , Staphylococcus aureus , Testosterona , Masculino , Testosterona/farmacología , Testosterona/metabolismo , Animales , Staphylococcus aureus/genética , Staphylococcus aureus/patogenicidad , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/metabolismo , Ratones , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Virulencia , Infecciones Estafilocócicas/microbiología , Transactivadores/genética , Transactivadores/metabolismo , Regulación Bacteriana de la Expresión Génica , Percepción de Quorum , Simulación del Acoplamiento Molecular , Toxinas Bacterianas/metabolismo , Toxinas Bacterianas/genética , Absceso/microbiología , Hemólisis , Proteínas Hemolisinas/metabolismo , Proteínas Hemolisinas/genéticaAsunto(s)
Absceso , Tuberculosis Cutánea , Humanos , Absceso/diagnóstico , Absceso/microbiología , Absceso/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Inmunocompetencia , Masculino , Antituberculosos/uso terapéutico , Niño , Diagnóstico Diferencial , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
Diabetic mastopathy is a rare and benign pathology affecting young individuals with type 1 diabetes or autoimmune diseases. It clinically resembles breast cancer, necessitating a histological examination for a definitive diagnosis. These cases underscore the diagnostic challenges and the importance of histological examination. This report details two cases of diabetic mastopathy at Mohammed VI Hospital in Marrakech. The first case involved a 35-year-old with type 1 diabetes and mastodynia, revealing a 4 x 3 cm nodule in the left breast. Biopsies confirmed fibrous breast tissue with lymphocytic infiltrates, characteristic of diabetic mastopathy, with no recurrence during follow-up. The second case featured a 38-year-old with trisomy 21 and type 1 diabetes presenting with a right breast abscess. Drainage revealed lymphocytic infiltrates, confirming diabetic mastopathy. Though diagnostically challenging, diabetic mastopathy lacks a direct link to breast cancer. Long-term cancer risks in affected patients mirror the general population.
Asunto(s)
Enfermedades de la Mama , Diabetes Mellitus Tipo 1 , Humanos , Femenino , Adulto , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/diagnóstico , Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Neoplasias de la Mama/complicaciones , Mastodinia/diagnóstico , Mastodinia/etiología , Biopsia , Síndrome de Down/complicaciones , Marruecos , Absceso/diagnóstico , Absceso/patologíaRESUMEN
ABSTRACT: Splenic abscess is a life-threatening condition, which is very rare in children. There is usually an infective focus or pre-disposing factors such as immunodeficiencies towards developing splenic abscesses. Only one case of splenic abscess with brain abscesses in an adult has been reported in the English literature. We, therefore, report a case of an 11-year-old boy who was otherwise healthy, but presented with fever and weight loss for 2 months, right upper abdominal pain, vomiting, hypochondrial tenderness for 1 week and later on developed a left hemiplegia and right facioparesis 2 days before presentation. Diagnosis of splenic abscess and right intracerebral abscesses was confirmed with abdominopelvic ultrasound scan and abdominal and cranial computerised tomographic scans. He subsequently had percutaneous ultrasound-guided drainage of the splenic abscess which was not successful necessitating splenectomy with aggressive antibiotics treatment to which the patient responded with resolution of the brain abscesses and recovery of power in affected limbs. This report aimed to highlight the need for increased suspicion of splenic abscesses in children who are apparently immunocompetent and to add to the knowledge of management of this rare condition in children. We conclude that splenic abscess with intracerebral abscess is a rare but life-threatening condition which is amenable to treatment with drainage of abscess and aggressive guided antimicrobial therapy.
Asunto(s)
Absceso Encefálico , Drenaje , Enfermedades del Bazo , Tomografía Computarizada por Rayos X , Humanos , Masculino , Niño , Enfermedades del Bazo/cirugía , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/diagnóstico por imagen , Absceso Encefálico/diagnóstico , Absceso Encefálico/cirugía , Absceso Encefálico/terapia , Absceso Encefálico/diagnóstico por imagen , Drenaje/métodos , Antibacterianos/uso terapéutico , Absceso/diagnóstico , Absceso/cirugíaRESUMEN
A toddler presented with recurrent subcutaneous abscesses, otitis media and pneumonia, requiring frequent hospitalisations and intravenous antimicrobials. He also had oral thrush and difficulty in gaining weight; hence, an underlying inborn error of immunity (IEI) was strongly suspected. The complete haemogram showed leucocytosis with neutrophilic predominance. Both erythrocyte sedimentation rate and C reactive protein were elevated. Klebsiella pneumoniae was isolated from blood culture. The dihydrorhodamine-123 assay was negative, and the immunoglobulin profile showed an increased IgG level. Whole exome sequencing revealed a novel homozygous pathogenic variation in the IL-17RA gene (c.2563G>A, p. Asp855Asn). He showed remarkable improvement following intravenous colistin and fluconazole with complete resolution of abscesses. Thus, it is prudent to consider the possibility of IL-17RA deficiency in children with a history of recurrent abscesses, skin ulcerations and pneumonia after excluding the common groups of IEI.
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Absceso , Receptores de Interleucina-17 , Preescolar , Humanos , Masculino , Absceso/diagnóstico , Absceso/tratamiento farmacológico , Absceso/microbiología , Antibacterianos/uso terapéutico , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/complicaciones , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Neumonía/tratamiento farmacológico , Neumonía/diagnóstico , Neumonía/microbiología , Receptores de Interleucina-17/genética , RecurrenciaRESUMEN
The patient was a 35-year-old man who saw his first doctor with the chief complaint of painful urination. A contrast- enhanced CT scan of the abdomen revealed a diagnosis of abscess-forming appendicitis with inflammatory spread to the bladder, and conservative treatment was decided. Since antibiotic treatment failed to reduce the size of the abscess, he underwent surgery. The bladder wall was highly inflamed, only appendectomy was performed. Pathology revealed appendiceal mucinous carcinoma invading the bladder, so he was referred to our department. Because a total cystectomy was required for curative resection and there was concern about seeding associated with the initial surgery, he was judged to be unresectable, and received chemotherapy. After 6 courses of CAPOX+bevacizumab therapy, he was able to have a bladder- sparing curative resection because of the absence of distant metastasis and shrinkage of the tumor. He remains stable without recurrence 6 months after surgery. We herein report, with some discussion of the literature, this case of bladder-invading appendiceal mucinous carcinoma arising from abscess-forming appendicitis, for which a curative resection was possible after chemotherapy.
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Absceso , Adenocarcinoma Mucinoso , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Apéndice , Apendicitis , Invasividad Neoplásica , Neoplasias de la Vejiga Urinaria , Humanos , Masculino , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/tratamiento farmacológico , Neoplasias del Apéndice/cirugía , Adulto , Apendicitis/cirugía , Apendicitis/tratamiento farmacológico , Adenocarcinoma Mucinoso/tratamiento farmacológico , Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma Mucinoso/patología , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/cirugía , Absceso/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , ApendicectomíaRESUMEN
We report a case of pathological complete response to neoadjuvant chemotherapy for abscess-forming rectal cancer. A woman in her 60s visited her primary care physician because she noticed an increase in the quantity of vaginal discharge. An irregular mass of goose-egg size found on the right vaginal wall was diagnosed as adenocarcinoma on biopsy, and she was referred to our hospital. After further examination, the mass was diagnosed as RbP, cT4b(vaginal), cN1a, cM0, cStage â ¢c rectal cancer with abscess formation. After 6 courses of CAPOX as neoadjuvant chemotherapy, rectal resection(combined resection of the posterior vaginal wall) was performed. Pathological diagnosis showed no tumor cells and lymph node metastasis. Four courses of CAPOX were administered as postoperative adjuvant chemotherapy. The patient is still alive 4 years after surgery, without recurrence. When neoadjuvant chemotherapy is successful, radical resection is possible, even in cases with abscess formation, and long-term survival can be expected.
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Absceso , Terapia Neoadyuvante , Neoplasias del Recto , Humanos , Neoplasias del Recto/patología , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Femenino , Absceso/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Adenocarcinoma/patología , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
It has not yet been proven whether sepsis affects the tissue around the anal canal. To address this issue, we established three-dimensional models for various types of anorectal abscesses and utilize 3D reconstruction of Magnetic Resonance Imaging scans to assess the extent of muscle damage caused by anorectal abscesses. Patients diagnosed with anorectal abscess, selected from January 2019 to January 2022 underwent pre- and post-operative scanning of pelvic floor and perianal tissues. The aforementioned structures were segmented for the reconstruction of a three-dimensional visual model and measurement of volumes for the abscess as well as the internal and external sphincters and levator ani muscle. The study included a total of 42 patients. Three-dimensional visualization models were created for different types of anorectal abscesses, including perianal, intersphincteric, ischiorectal, and supralevator abscesses. No statistically significant differences were observed in the volume of the internal sphincter, external sphincter, and levator ani muscle between pre- and post-operative patients. The 3D model of anorectal abscess, reconstructed from MRI data, offers a precise and direct visualization of the anatomical structures associated with various types of anorectal abscesses. The infection did not result in any damage to the internal and external anal sphincter and levator ani muscle.
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Absceso , Canal Anal , Imagenología Tridimensional , Imagen por Resonancia Magnética , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Femenino , Imagenología Tridimensional/métodos , Absceso/diagnóstico por imagen , Absceso/patología , Persona de Mediana Edad , Adulto , Canal Anal/diagnóstico por imagen , Canal Anal/patología , Anciano , Enfermedades del Ano/diagnóstico por imagen , Enfermedades del Ano/patología , Enfermedades del Recto/diagnóstico por imagen , Enfermedades del Recto/patología , Diafragma Pélvico/diagnóstico por imagen , Diafragma Pélvico/patologíaRESUMEN
More frequent among adults, phenocopies may be caused by somatic mutations or anti-cytokine autoantibodies, mimicking the phenotypes of primary immunodeficiencies. A fourteen-year-old girl was referred for a two-year history of weight loss and multiple recurrent abscesses, complicated recurrent pneumonia, pyelonephritis, osteomyelitis, and septic shock, without fever. She had started with nausea, hyporexia, and weight loss, then with abscesses in her hands, knee, ankle, and spleen. She also developed a rib fracture and left thoracic herpes zoster. The patient was cachectic, with normal vital signs, bilateral crackles on chest auscultation, tumefaction of the knee joint, and poorly healed wounds in hands and chest, oozing a yellowish fluid. Chest computed tomography revealed multiple bilateral bronchiectases. Laboratory workup reported chronic anemia, leukocytosis, neutrophilia, mild lymphopenia, thrombocytosis, pan-hypergammaglobulinemia, and elevated acute serum reactants. Lymphocyte subsets were low but present. Mycobacterium tuberculosis was detected via polymerase chain reaction in a bone biopsy specimen from ankle osteomyelitis. Whole-exome sequencing failed to identify a monogenic defect. Interleukin-12 was found markedly elevated in the serum of the patient. Phosphorylation of STAT4, induced by increasing doses of IL-12, was neutralized by patient serum, confirming the presence of anti-IL12 autoantibodies. IL-12 and IL-23 are crucial cytokines in the defense against intracellular microorganisms, the induction of interferon-gamma production by lymphocytes, and other inflammatory functions. Patients who develop neutralizing serum autoantibodies against IL12 manifest late in life with weight loss, multiple recurrent abscesses, poor wound healing, and fistulae. Treatment with anti-CD20 monoclonal antibodies was effective.
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Absceso , Autoanticuerpos , Humanos , Femenino , Autoanticuerpos/inmunología , Autoanticuerpos/sangre , Adolescente , Absceso/inmunología , Subunidad p40 de la Interleucina-12/inmunología , Recurrencia , Osteomielitis/inmunologíaAsunto(s)
Absceso , Imagen Multimodal , Tomografía Computarizada por Rayos X , Humanos , Absceso/diagnóstico por imagen , Absceso/cirugía , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Ecocardiografía/métodos , Ecocardiografía Transesofágica/métodos , Monitoreo Intraoperatorio/métodos , Imagen Multimodal/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
ABSTRACT: Surgical operations such as lymph node dissection may inadvertently damage the lymphatic system and lead to lymphorrhea. Excessive lymphatic exudation can cause a chronic wound. However, for surgery that does not involve the lymphatic system, lymphorrhea is a rare postoperative complication. This case report describes a 38-year-old patient who presented with lymphatic cutaneous leakage after incision and drainage of a skin abscess on the lower extremity. Persistent lymphorrhea increased the amount of wound exudation, which affected wound healing. After treatment of the lymphorrhea, the lower extremity wound healed completely within 4 weeks and did not result in lymphedema. Ligation of lymphatic vessels is a simple and easily performed treatment method for lymphatic leakage.
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Absceso , Drenaje , Humanos , Adulto , Drenaje/métodos , Absceso/cirugía , Enfermedad Crónica , Masculino , Cicatrización de Heridas/fisiología , Extremidad Inferior , Complicaciones Posoperatorias/etiología , Linfedema/cirugía , Linfedema/terapia , Linfedema/etiología , Resultado del TratamientoRESUMEN
This case involves a man with longstanding Crohn's disease on azathioprine therapy who developed a rare manifestation of tuberculosis, presenting as a subcutaneous tuberculous abscess and tuberculous spondylitis. The patient's immunocompromised state due to azathioprine raised the risk for opportunistic infections. The unique aspects include the absence of disseminated tuberculosis and the development of tuberculous paraspinal and subcutaneous abscesses in a patient with Crohn's disease. The case underscores the importance of vigilance for rare infections in immunosuppressed individuals and highlights the need for tuberculosis screening before initiating immunosuppressive therapies. The patient was successfully treated with antituberculous medication, emphasising the importance of a tailored approach in managing such cases.
Asunto(s)
Absceso , Antituberculosos , Enfermedad de Crohn , Tuberculosis de la Columna Vertebral , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Masculino , Absceso/microbiología , Absceso/tratamiento farmacológico , Tuberculosis de la Columna Vertebral/tratamiento farmacológico , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/diagnóstico , Antituberculosos/uso terapéutico , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Azatioprina/uso terapéutico , Azatioprina/efectos adversos , Huésped Inmunocomprometido , Adulto , Persona de Mediana EdadRESUMEN
BACKGROUND The tip-flexible suctioning ureteral access sheath (TFS-UAS) can be bent under flexible ureteroscopes, which facilitates removal of renal stone segments by irrigation and suctioning effects. Small-scale comparative studies found it safer and more efficacious than traditional UAS. However, complications such as renal abscess were not documented after TFS-UAS combined with digital FURS. CASE REPORT A 57-year-old woman had right lumbar pain that persisted for 1 year. A plain computed tomography (CT) scan revealed multiple renal pelvicalyceal stones (maximum diameter 20×9 mm). She was admitted to undergo elective surgery with a TFS-UAS combined with digital flexible ureteroscopic lithotripsy. The operation was deemed successful and she was given postoperative antibiotics for 2 days before discharge. Eight postoperative days later, she was admitted to the emergency department due to high fever (39.6°C). Plain CT revealed intact double-J stents and no abnormalities. She was readmitted to the urological department to receive antibiotic therapy, which progressed to septic shock (blood pressure 80/50 mmHg) and required immediate transfer to the intensive care unit. Contrast-enhanced CT revealed a right renal abscess. She was promptly resuscitated and given stronger antibiotics. She recovered well and was discharged with 2-week oral levofloxacin treatment. Follow-up ultrasound found no renal abscess. CONCLUSIONS While TFS-UAS with digital FURs is an effective approach for multiple renal stones, there is a risk of postoperative renal abscess, possibly due to altered intrarenal pressure.
Asunto(s)
Absceso , Cálculos Renales , Litotricia , Ureteroscopía , Humanos , Femenino , Persona de Mediana Edad , Ureteroscopía/efectos adversos , Litotricia/efectos adversos , Cálculos Renales/cirugía , Absceso/etiología , Absceso/terapia , Succión , Complicaciones Posoperatorias , Enfermedades RenalesRESUMEN
RATIONALE: Splenic abscess is relatively rare in clinical practice as an invasive disease. However, during the continuous prevalence of coronavirus disease 2019 (COVID-19), the incidence rate of splenic abscess showed an upward trend. However, because the etiology of splenic abscess is not specific, it is easy to be covered by the respiratory symptoms of COVID-19, resulting in omission or delay in diagnosis. If splenic abscesses cannot be treated in a timely manner, the mortality rate can reach 100%. Therefore, it is important to fully understand the correlation between COVID-19 and the development of splenic abscesses. PATIENT CONCERNS: A female patient, 71 years of age, was admitted to our hospital because of cough and sputum for 1 week and fever for 2 days. According to the positive results of novel coronavirus nucleic acid and chest computed tomography, novel coronavirus pneumonia was diagnosed. On the 4th day after treatment, abdominal distension and vomiting were observed. Abdominal ultrasound indicated splenomegaly and mixed echo masses in the spleen and abdominal computed tomography indicated 2 new round low-density lesions were found in the spleen. DIAGNOSES: The patient was diagnosed with secondary splenic abscess after COVID-19 infection. INTERVENTIONS: The patient and her family members refused to undergo ultrasound-guided splenic puncture drainage and splenectomy. In terms of treatment, she was given meropenem combined with vancomycin to continue anti-infection treatment. OUTCOMES: The patient's body temperature and infection indicators gradually increased, and the scope of splenic abscess continued to expand. The infection worsened and progressed to septic shock. The patient abandoned rescue drugs and invasive treatment, and died on the 9th day after admission. LESSONS: This case introduces the clinical characteristics of secondary splenic abscess caused by COVID-19 from the aspects of etiology, disease course, clinical manifestations, auxiliary examinations, and treatment methods. The focus is on improving the understanding of clinical doctors about secondary splenic abscesses caused by COVID-19, providing reference for early diagnosis and timely treatment.
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COVID-19 , SARS-CoV-2 , Enfermedades del Bazo , Humanos , COVID-19/complicaciones , COVID-19/diagnóstico , Femenino , Enfermedades del Bazo/etiología , Anciano , Absceso/etiología , Meropenem/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Congenital coronary artery anomalies are rare and most often clinically benign. We present a case of a 67-year-old male with osteomyelitis and persistent bacteremia with an anomalous left coronary artery mimicking an aortic root abscess. A transesophageal echocardiogram revealed a hypoechoic potential space around the aortic root, highly suspicious for a root abscess. Urgent cardiac surgery was performed, revealing no infection but an anomalous coronary artery arising from the right coronary sinus. This case highlights the importance of considering atypical anatomy in the diagnosis of infectious cardiac processes. While this resemblance should not delay intervention for suspected abscesses, it emphasizes the need to be aware of congenital differences in imaging for patients with known anomalies or asymptomatic patients with unknown anatomy.
Abnormal coronary arteries are rare and are usually not dangerous. We present a case of a 67-year-old male with an infection in the bone and persistent findings of bacteria in the blood who had an abnormal coronary artery that mimicked an infected space. Ultrasound of the heart found thickening and a space around the aortic root, highly suspicious for an infection in the setting of bacteria in the blood. Urgent surgery was performed, revealing no signs of infection but abnormal coronary artery anatomy. This case highlights the importance of considering atypical anatomy in the diagnosis of infection around the heart. While this should not delay intervention, it emphasizes the need to be aware of differences in anatomy.