PubMed · 9593792
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L B Ferzoco, V Raptopoulos, W Silen. 1998-05-21. Acute diverticulitis.. https://doi.org/10.1056/nejm199805213382107
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Splenic abscesses are caused by Staphylococcus aureus, Streptococcus and bacteria belonging to the family Enterobacteriaceae. We report a case of splenic abscess caused by an unusual serotype of Salmonella. A 55 year old man was admitted with complaints of fever and abdominal pain. On the basis of clinical findings and laboratory reports, a diagnosis of chronic myeloid leukemia was made. Ultrasonography of the abdomen revealed a single large cystic lesion in the spleen. Percutaneous drainage of the abscess was carried out. Salmonella enterica serotype Worthington was isolated from a pus sample taken from the abscess. The isolate was resistant to ampicillin, gentamicin, cefotaxime, chloramphenicol and tetracycline, and sensitive to amikacin and norfloxacin. Serotype Worthington is an emerging pathogen. This is the first report of isolation of this serotype from a splenic abscess. In seriously ill patients, such infections should be treated with a combination of antibiotics to circumvent problems with multidrug resistance.
Superior vena cava (SVC) syndrome is usually caused by extrinsic compression by malignant tumors, but para-aortic abscess can be responsible for this syndrome. We report a case of SVC syndrome caused by para-aortic abscess caused by Aerococcus viridans infection in a man who received orthotopic heart transplantation. A. viridans is a common saprophytic organism in hospital environments. There are reports of this organism being the cause of endocarditis, but no reports of it as the cause of a para-aortic abscess. This is a first report of A. viridans infection in organ transplant patients.
Paradoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) ( P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy.