Successful treatment of ventriculitis due to carbapenem-resistant Acinetobacter baumannii with intraventricular colistin sulfomethate sodium.
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Biomedical subjects
Publications and source records attributed to P Fernandez-Viladrich.
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Pyrazinamide hepatotoxicity is considered secondary to a direct and dose-related toxic effect. At currently used doses, pyrazinamide provides effective short-term treatment and is free from serious side effects. We report a case of pyrazinamide-induced hepatitis for which the rechallenge data strongly suggest a hypersensitivity mechanism.
We report 4 autopsy-proven cases of cytomegalovirus ventriculoencephalitis (CMV-VE) and a further case with dramatic clinical and radiological response to ganciclovir therapy. The diagnoses were based upon clinical features, cerebrospinal fluid (CSF) examination and either brain computerized tomography (CT) or magnetic resonance imaging (MRI), and confirmed by autopsy findings in 4 cases. All patients had previously had an AIDS-defining condition. CMV retinitis was diagnosed in 3 patients, 2 of them before the onset of encephalitis. CMV viremia was present in 4 patients. Examination of CSF demonstrated elevated protein and hypoglycorachia in all cases. CSF culture was negative for CMV in 3 of 3 patients. Periventricular enhancement was detected by MRI in 2 of 3 patients, but in only 1 of 5 patients by CT. Three patients received ganciclovir and 2 patients foscarnet therapy. All 4 patients died. Pathologic examination revealed periventriculitis with ependymal necrosis and CMV intranuclear inclusion bodies all 4 patients. One showed a marked neurological improvement and radiological resolution by MRI after 4 weeks of ganciclovir therapy. We conclude that CMV-VE should be suspected in HIV-infected patients who present with altered neurological status, CMV viremia or retinitis, hypoglycorachia and ventriculitis as demonstrated by MRI. Although more effective therapy is needed, ganciclovir may be beneficial, as shown in one of our patients.
We report three cases of multiple liver abscesses due to Yersinia enterocolitica that led to previously unknown diagnoses of primary hemochromatosis. Y. enterocolitica is an iron-dependent bacterium that relies entirely on exogenous iron for growth. A review of the literature with use of MEDLINE (National Library of Medicine, Bethesda, MD) disclosed 35 cases of Y. enterocolitica liver abscesses; 21 (60%) of these cases were associated with hemochromatosis. In 11 of the remaining 14 cases, two common manifestations of hemochromatosis, diabetes mellitus and cirrhosis of the liver, also were present; these findings were significant. Finally, we emphasize that when iron overload cannot be documented at the time of diagnosis of the liver abscess, long-term follow-up for determination of increasing iron stores is mandatory. With this approach, most manifestations of hemochromatosis in asymptomatic patients can be prevented.
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