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/veterinariaAsunto(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 , PreescolarAsunto(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.
Asunto(s)
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
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.
Asunto(s)
Absceso , Anomalías de los Vasos Coronarios , Ecocardiografía Transesofágica , Humanos , Masculino , Anciano , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/cirugía , Diagnóstico Diferencial , Absceso/diagnóstico , Absceso/cirugía , Ecocardiografía Transesofágica/métodosRESUMEN
This is a case of a woman in her 50s with HIV and uncontrolled diabetes who presented to the emergency department with urinary retention and a painful gluteal cleft lesion, admitted for cellulitis. Since initial CT and soft tissue ultrasound (US) were negative for fluid collection, the care team was surprised to find her symptoms continued to progress despite intravenous antibiotics. Finally, MRI 9 days into her admission demonstrated a 12-cm perirectal horseshoe abscess. The patient was ultimately treated with incision and drainage with Penrose drain placement. This case demonstrates the importance of maintaining a high suspicion for horseshoe abscess, a complex form of ischiorectal fossa abscess which can be missed on CT and US imaging, and which may expand rapidly in immunosuppressed patients.
Asunto(s)
Absceso , Diagnóstico Tardío , Drenaje , Humanos , Femenino , Persona de Mediana Edad , Absceso/diagnóstico por imagen , Absceso/diagnóstico , Drenaje/métodos , Imagen por Resonancia Magnética , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Infecciones por VIH/complicaciones , Nalgas/diagnóstico por imagen , Retención Urinaria/etiologíaRESUMEN
BACKGROUND: Perianal abscess is a common condition among adults. The treatment of choice includes early and efficient drainage. The data regarding risk factors for abscess recurrence, fistula formation, and complications are limited as recent publications mainly focus on patients with inflammatory bowel disease. OBJECTIVES: To determine risk factors for abscess recurrence and fistula formation with regard to patient and surgical characteristics. METHODS: A retrospective analysis was performed on patients who presented to the emergency department and were diagnosed with perianal abscess between 2011-2020. RESULTS: We included 983 consecutive patients; 741 men, average age 43 years. Recurrence was documented in 434 cases. Crohn's disease was reported in 70, of which 50 had recurrent episodes (P < 0.0001); 121 of the 234 patients who smoked had recurrence (P = 0.0078); 8% had short symptomatic period (< 24 hours), which was a predisposing factor for recurrence, P < 0.0001. Patients in the non-recurrent group waited 2.53 hours less for surgical intervention (P < 0.0005(. The average time for recurrent episode was 18.95 ± 33.7 months. Fistula was diagnosed in 16.9% of all cases, while 11.6% were within the recurrent group. Surgical expertise of the physician did not significantly change the recurrence rate. CONCLUSIONS: Crohn's disease and smoking were the only significant risk factors for recurrence of perianal abscess. Timely intervention and drainage of sepsis should not be delayed. Involvement of more experienced surgeons did not seem to alter the natural history of the disease.
Asunto(s)
Absceso , Enfermedades del Ano , Enfermedad de Crohn , Drenaje , Recurrencia , Humanos , Masculino , Factores de Riesgo , Adulto , Femenino , Estudios Retrospectivos , Absceso/etiología , Absceso/diagnóstico , Absceso/epidemiología , Absceso/terapia , Enfermedades del Ano/epidemiología , Enfermedades del Ano/etiología , Enfermedades del Ano/diagnóstico , Enfermedades del Ano/terapia , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Drenaje/métodos , Persona de Mediana Edad , Fumar/efectos adversos , Fumar/epidemiología , Fístula Rectal/etiología , Fístula Rectal/epidemiologíaRESUMEN
Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by S aureus. Simple folliculitis typically is self-limited. Topical benzoyl peroxide is a first-line nonantibiotic treatment. Mupirocin and clindamycin are topical antibiotic options. For treatment-resistant cases, oral cephalexin or dicloxacillin is an appropriate option. Impetigo is a common, self-limited infection in children. Bullous impetigo is caused by S aureus, and nonbullous impetigo is caused by beta-hemolytic streptococci, S aureus, or both. In most cases, topical mupirocin or retapamulin (Altabax) is effective. Oral antibiotics should be considered for household outbreaks or patients with multiple lesions. Abscesses are red, painful collections of purulence in the dermis and deeper tissues caused by S aureus or polymicrobial infections. Furuncles are abscesses of a hair follicle, whereas carbuncles involve several hair follicles. In recurrent cases of these lesions, culture of the exudate is recommended. Abscess, furuncle, and carbuncle management consists of incision and drainage. Oral antibiotics are not necessary in most cases but should be prescribed for patients with severe immunocompromise or systemic signs of infection. In bacterial skin infections, methicillin-resistant S aureus coverage should be considered for patients with infections that have not improved with treatment.
Asunto(s)
Antibacterianos , Celulitis (Flemón) , Impétigo , Enfermedades Cutáneas Bacterianas , Humanos , Niño , Antibacterianos/uso terapéutico , Adolescente , Impétigo/diagnóstico , Impétigo/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/terapia , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/terapia , Foliculitis/diagnóstico , Foliculitis/tratamiento farmacológico , Foliculitis/microbiología , Erisipela/diagnóstico , Erisipela/tratamiento farmacológico , Absceso/diagnóstico , Absceso/terapia , Absceso/microbiología , Forunculosis/diagnóstico , Forunculosis/tratamiento farmacológico , Forunculosis/terapia , Forunculosis/microbiología , Ántrax/diagnóstico , Ántrax/terapiaRESUMEN
Actinomycosis is a rare endogenous infection characterised by indolent progression, contiguous spreading, abscess formation and draining sinuses. Here, we present a case of Schaalia odontolytica causing a mediastinal abscess that is unique in its acuity and location. Our patient presented with worsening dysphagia, and CT of her chest revealed a new mass in the posterior mediastinum displacing the oesophagus. Oesophagram revealed mild motility disorder, but no masses or ulcers within the oesophagus. Oesophagogastroduodenoscopy with endoscopic ultrasound revealed extrinsic compression of the oesophagus. Fine-needle aspiration of the mass yielded purulent fluid, which was cultured. A single colony of S. odontolytica was isolated. Initially, medical treatment was favoured, but as she developed worsening dysphagia, the abscess was drained. She continued on long-term antibiotic therapy after drainage and had complete resolution of the abscess at 1 year.
Asunto(s)
Actinomicosis , Trastornos de Deglución , Huésped Inmunocomprometido , Enfermedades del Mediastino , Humanos , Femenino , Actinomicosis/diagnóstico , Actinomicosis/complicaciones , Actinomicosis/tratamiento farmacológico , Trastornos de Deglución/etiología , Enfermedades del Mediastino/diagnóstico , Diagnóstico Diferencial , Absceso/diagnóstico , Absceso/microbiología , Antibacterianos/uso terapéutico , Tomografía Computarizada por Rayos X , Drenaje , Persona de Mediana Edad , MediastinoRESUMEN
BACKGROUND: From June 2021 to July 2021, our hospital confirmed 3 cases of Mycobacterium infection in skin abscesses. All 3 patients underwent thread embedding and weight loss surgery at the same informal beauty institution, with a history of silk protein injection. None of the patients had any other underlying diseases or surgical history. Symptoms and signs show that the disease is acute and the course of the disease is short. All patients have found subcutaneous masses in different parts of the body. In most cases, the masses show redness and swelling, and some of the masses are accompanied by tenderness, wave sensation, and rupture. After some of the masses rupture, purulent secretions can be seen. METHODS: The pus secreted by the skin lesions of the three patients were cultured to a single bacterium, which was identified by MALDI-TOF MS. Multiple locus sequence typing (MLST) was performed using three specific genes (hsp65, rpoB, and secA1) and seven housekeeping genes (argH, cya, glpK, gnd, murC, pta, and purH). The results were queried through the MLST database of Mycobacterium abscess. RESULTS: All three strains of bacteria were Mycobacterium abscess type ST279 massiliense subtype. Three antibacterial drugs including cefmetazole, amikacin, and clarithromycin were administered in combination with 5-aminolevulinic acid photodynamic therapy (ALA-PDT). After 3 - 6 months, there was no obvious redness or swelling in the surrounding tissues of the wound, and no obvious purulent secretions were observed. All patients were cured and discharged from the hospital. After a follow-up of six months, there was no recurrence of the lesions. CONCLUSIONS: Medical institutions must strictly follow infection control guidelines and take preventive measures to prevent such incidents from happening again. ALA-PDT as a combination therapy for nontuberculous Mycobacterium (NTM) skin infections can improve treatment efficacy and shorten antibiotic usage time.
Asunto(s)
Antibacterianos , Brotes de Enfermedades , Infecciones por Mycobacterium no Tuberculosas , Humanos , Femenino , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Adulto , Antibacterianos/uso terapéutico , Enfermedades Cutáneas Bacterianas/epidemiología , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Absceso/microbiología , Absceso/epidemiología , Absceso/diagnóstico , Mycobacterium abscessus/aislamiento & purificación , Mycobacterium abscessus/genética , Micobacterias no Tuberculosas/aislamiento & purificación , Micobacterias no Tuberculosas/genética , Micobacterias no Tuberculosas/efectos de los fármacosRESUMEN
This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5-S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.
Asunto(s)
Isquemia , Humanos , Masculino , Adulto , Isquemia/etiología , Isquemia/diagnóstico , Espacio Retroperitoneal , Osteomielitis/complicaciones , Osteomielitis/diagnóstico , Diverticulitis del Colon/complicaciones , Diverticulitis del Colon/cirugía , Extremidad Inferior/irrigación sanguínea , Antibacterianos/uso terapéutico , Absceso Abdominal/cirugía , Absceso Abdominal/etiología , Embolectomía/métodos , Colostomía , Absceso/complicaciones , Absceso/terapia , Absceso/diagnósticoRESUMEN
A late middle-aged woman presented with a large, painful neck mass, with a history of rapid increase of size since 1 week and associated voice change, dyspnoea and odynophagia. Prior radiological investigation showed a multiloculated cystic mass in the left thyroid lobe. Fine needle aspiration revealed a predominant cluster of neutrophils. Blood investigations showed leucocytosis and high blood glucose levels suggestive of sepsis. The patient underwent surgical drainage of the thyroid abscess with total thyroidectomy which was managed through multidisciplinary teamwork between surgeons, haematologists, endocrinologists and anaesthesiologists. In addition, urine culture and thyroid pus culture both showed Escherichia coli growth suggestive of bacterial sepsis. The patient was treated successfully and made a complete recovery following surgery with normalisation of voice.
Asunto(s)
Drenaje , Sepsis , Enfermedades de la Tiroides , Tiroidectomía , Humanos , Femenino , Sepsis/complicaciones , Sepsis/microbiología , Drenaje/métodos , Persona de Mediana Edad , Enfermedades de la Tiroides/complicaciones , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/microbiología , Enfermedades de la Tiroides/cirugía , Absceso/microbiología , Absceso/diagnóstico , Absceso/complicaciones , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/terapia , Glándula Tiroides/patología , Glándula Tiroides/diagnóstico por imagen , Antibacterianos/uso terapéuticoRESUMEN
Myiasis is a neglected tropical disease caused by the larvae of dipterous flies. Cutaneous infestation is the predominant type documented in sub-Saharan Africa, and ocular involvement is uncommon. We report the rare occurrence of a case of eyelid ophthalmomyiasis caused by Cordylobia anthropophaga in a Nigerian female to raise awareness among practitioners in both tropical and nonendemic areas.
Asunto(s)
Dípteros , Miasis , Humanos , Miasis/diagnóstico , Miasis/parasitología , Femenino , Animales , Absceso/diagnóstico , Absceso/parasitología , Larva , Nigeria , Diagnóstico Diferencial , Infecciones Parasitarias del Ojo/diagnóstico , Infecciones Parasitarias del Ojo/parasitología , Adulto , Enfermedades de los Párpados/diagnóstico , Enfermedades de los Párpados/parasitología , CalliphoridaeAsunto(s)
Absceso , Agammaglobulinemia , Enfermedades Genéticas Ligadas al Cromosoma X , Humanos , Agammaglobulinemia/complicaciones , Agammaglobulinemia/diagnóstico , Enfermedades Genéticas Ligadas al Cromosoma X/diagnóstico , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Masculino , Absceso/diagnóstico , Absceso/complicaciones , Enfermedades Musculares/diagnóstico , Enfermedades Musculares/complicaciones , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVES: Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke's cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. METHODS: We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. RESULTS: The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. CONCLUSIONS: Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.
Asunto(s)
Enfermedades de la Hipófisis , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Enfermedades de la Hipófisis/diagnóstico , Enfermedades de la Hipófisis/cirugía , Enfermedades de la Hipófisis/terapia , Anciano , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/terapia , Neoplasias Hipofisarias/patología , Absceso Encefálico/diagnóstico , Absceso Encefálico/terapia , Absceso/diagnóstico , Absceso/terapia , Antibacterianos/uso terapéuticoRESUMEN
Brucellosis is a zoonotic disease endemic in many developing countries, including Türkiye. Among the species that are pathogenic for humans; Brucella melitensis is isolated from livestock animals like sheep and goats, Brucella abortus from cattle and Brucella suis from pigs. Laboratory diagnosis of infection caused by Brucella species with gram-negative coccobacillus morphology; can be made through characteristic culture features, serological tests and molecular methods. Brucellosis, which has a wide distribution of clinical signs and symptoms; can cause various complications by affecting many organs and systems. Among all complications, the probability of thyroid abscess is less than 1%. In this case report; an example of thyroid abscess, one of the rare complications of brucellosis that is not frequently encountered in the literature, was presented. During the physical examination of a 45-year-old female patient who admitted with the complaint of pain in the neck area, fever, neck swelling, redness and pain that increased with palpation were detected. Leukocytosis, lymphopenia, high sedimentation and CRP, low TSH and high T4 values were detected in laboratory tests and subacute thyroiditis was considered as the preliminary diagnosis. Surgical abscess drainage was planned as the patient's clinical findings progressed during follow-up and spontaneous pus discharged from the midline of the neck. The abscess aspirate sample taken during surgical intervention and the blood culture samples taken before were evaluated microbiologically. Microorganisms that did not grow on EMB agar but grew on 5% sheep blood and chocolate agar at the 72-96th hour of incubation of culture plates; were detected to have gram-negative coccobacillus morphology and positive for catalase, oxidase and urease. Although the Wright test was negative with a titer of 1/20, the Rose Bengal test was positive, Coombs test was positive with a titer of 1/160 and the Brucellacapt test was positive with a titer of >1/5120. Microorganisms growing on culture plates were identified as B.melitensis at the species level with specific antisera. As a result of antibiotic susceptibility tests evaluated according to the European Committee on Antimicrobial Susceptibility Testing version 14.0 (EUCAST v14.0), the isolate was susceptible to rifampicin, doxycycline, gentamicin and trimethoprim-sulfamethoxazole at standart dosing regimen and susceptible to ciprofloxacin and levofloxacin at increased exposure. The patient, who was started on doxycycline and rifampicin combination treatment, was discharged without any complaints. In the diagnosis of infection due to Brucella species, which is one of the pathogens that early diagnosis and initiation of treatment greatly affects the prognosis; in addition to culture, which is the gold standard method, serological tests are also very important. If diagnosis is delayed, complications may develop due to involvement in almost every part of the body, depending on the affected organs and systems. In areas where brucellosis is endemic, patients with symptoms such as neck swelling, shortness of breath and difficulty in swallowing, thyroid tissue involvement due to brucellosis should definitely be considered etiologically.