MyMedR

Fulltext A case report: Community-acquired Pseudomonas aeruginosa necrotizing fasciitis in a morbidly obese diabetic young man can be fatal

Mazlan MZ, Zainal Abidin H, Wan Hassan WMN, Nik Mohamad NA, Salmuna ZN, Ibrahim K, et al.

IDCases, 2020;22:e01001.

PMID: 33204633 DOI: 10.1016/j.idcr.2020.e01001

We present a case study of a 26-year-old morbidly obese man with a three-day history of right leg pain and swelling. The swelling was associated with low grade fever. He was alert and conscious upon presentation to the hospital. His physical examination showed gross swelling of the entire right lower limb with no systemic manifestations. There was no discharge and bullae from the swelling area of the leg. He had high blood sugar and was newly diagnosed with type 2 diabetes mellitus. He was diagnosed with necrotizing fasciitis. An intravenous imipenem-cilastatin 500 mg every 6 h together with clindamycin 900 mg every 8 h was started empirically. Extensive wound debridement was performed. The swab culture obtained intraoperatively grew Pseudomonas aeruginosa. He required an above knee amputation due to worsening infection despite wound debridement. Post-operatively, he developed acute kidney injury with severe metabolic acidosis, which required daily hemodialysis. However, the patient deteriorated due to septic shock with multi-organ failure, resulting in his death.

Fulltext Lumbar tinea versicolor and spinal anaesthesia

Mazlan MZ, Chong SE, Salmuna Ayub ZN, Mohamad NAN

IDCases, 2019;16:e00520.

PMID: 31024798 DOI: 10.1016/j.idcr.2019.e00520

Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section.

Cutaneous larva migrans in a beach volleyball player

Krzywanski J, Kuchar E, Mierzynski R

IDCases, 2021;24:e01084.

PMID: 33889485 DOI: 10.1016/j.idcr.2021.e01084

Athletes playing beach volleyball come into contact with sand and may contract skin parasites. We present a case of cutaneous larva migrans in a 20-year-old Polish female beach volleyball player. The athlete participated in The World Tour in Asia (China, Malaysia, Cambodia) a month before. In the beginning, her skin lesions were misdiagnosed as allergic reactions and treated with antihistamines. The disease in the form of a pruritic, migratory serpiginous skin eruption on legs was diagnosed during routine medical examination at the National Centre for Sports Medicine in Warsaw. She was treated successfully with albendazole and cetirizine. The skin lesions resolved entirely within two weeks.

Fulltext Case report : Actinomyces naeslundii complicating preterm labour in a trisomy-21 pregnancy

Ong HC, Ling AC, Ng DS, Ng RX, Wong PL, Omar SFS

IDCases, 2021;23:e01051.

PMID: 33532241 DOI: 10.1016/j.idcr.2021.e01051

Preterm birth is a global concern with considerable morbidity and mortality. Intrapartum infection is a known cause of preterm birth and Actinomyces infection is one of the infections contributing to preterm birth. We report a case of preterm birth of a trisomy-21 neonate to a mother with positive Actinomyces naeslundii from an intra-operative placental swab sample and discussed the relationship of this bacteria and preterm delivery, and the role of postpartum antibiotics use in this case.

Fulltext Central nervous system melioidosis in systemic lupus erythematosus: A clinical vignette

Cheok LH, Tang ASO, Desmond S, Wong YL, Cheong YK, Ng SC, et al.

IDCases, 2021;26:e01255.

PMID: 34458097 DOI: 10.1016/j.idcr.2021.e01255

Central nervous system melioidosis is an uncommon presentation of melioidosis infection. We report a case of a disseminated melioidosis infection with central nervous system, pulmonary, spleen, bone and cutaneous involvement in a patient with underlying systemic lupus erythematous. The diagnosis was confirmed based on positive blood and cerebrospinal fluid cultures coupled with radiological findings. Agriculture contact and underlying immunocompromised state were the predisposing risk factors for melioidosis infection in this case. Our patient was successfully treated with 10 weeks of intensive antibiotics therapy and 1 year of eradication antibiotics therapy with significant clinical and radiological improvement.

Fulltext Acute bacteremic pneumonia due to melioidosis developing in the intensive care setting

Zainal Abidin H, Muhd Besari A, Nadarajan C, Wan Shukeri WF, Mazlan MZ, Chong SE, et al.

IDCases, 2017;8:63-65.

PMID: 28417070 DOI: 10.1016/j.idcr.2017.03.010

In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR) and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium.

Fulltext Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis

Chua WC, Mazlan MZ, Ali S, Che Omar S, Wan Hassan WMN, Seevaunnantum SP, et al.

IDCases, 2017;9:91-94.

PMID: 28725564 DOI: 10.1016/j.idcr.2017.05.002

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.

Fulltext Aseptic abscess syndrome associated with traveler's diarrhea after a trip to Malaysia

Panos Z, Giannopoulos G, Papangeli E, Antalis E, Pavli A, Spathis A, et al.

IDCases, 2016;6:23-5.

PMID: 27672562 DOI: 10.1016/j.idcr.2016.09.001

The first, to our knowledge, case of the aseptic abscesses syndrome as a complication of traveler's diarrhea after a trip to Malaysia is presented. The patient failed to respond to several antimicrobials. The diagnosis was histologically confirmed and the patient only responded to immunomodulatory therapy with corticosteroids and methotrexate. Travel physicians should be aware of this entity reviewed herein in the context of traveler's diarrhea.

Fulltext Klebsiella pneumoniae sacroiliac septic arthritis: First case report

Chee YC, Lim CH

IDCases, 2018;14:e00459.

PMID: 30386726 DOI: 10.1016/j.idcr.2018.e00459

Infective sacroiliitis is a rare disease with misleading clinical signs that often delay diagnosis. We report a case of pyogenic sacroiliac joint septic arthritis caused by Klebsiella pneumoniae that has not been reported in the literature highlighting it as one of the important etiologies of infective sacroiliitis especially among diabetics.

Fulltext Periorbital cellulitis and eyelid abscess as ocular manifestations of melioidosis: A report of three cases in Sarawak, Malaysian Borneo

Chang CY

IDCases, 2020;19:e00683.

PMID: 31908947 DOI: 10.1016/j.idcr.2019.e00683

Melioidosis is an infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis can affect any organ and result in a broad spectrum of diseases. Ocular involvement in melioidosis is rare but can potentially lead to devastating outcomes. We describe ocular manifestations in 3 patients diagnosed with culture-confirmed melioidosis in Kapit, Sarawak, Malaysian Borneo. Melioidosis affecting the eye can present as periorbital cellulitis and eyelid abscess. High clinical suspicion and early empirical treatment were crucial to a successful outcome. Surgical drainage of the abscess was an important part of management beyond standard antimicrobial therapy.

Fulltext Melioidosis-related mycotic aneurysm: Three cases

Tong TK, Shan G, Sibangun FJ, Keung BLD

IDCases, 2021;26:e01295.

PMID: 34646734 DOI: 10.1016/j.idcr.2021.e01295

Background: Melioidosis-related mycotic aneurysm (MA) is rare but a potentially life-threatening disease with high morbidity and mortality rate.

Case presentation: We report a case series of mycotic aneurysm caused by Burkholderia pseudomallei and the subsequent outcomes. Here, we illustrate their clinical characteristics, laboratory results, radiological findings, mode of therapies and clinical outcomes.

Conclusion: Melioidosis-associated MA may manifest in an atypical presentation. Its outcome is often lethal if antimicrobial therapy and surgical intervention are not offered promptly.

Fulltext Exophiala dermatitidis, 'the real black fungus' fungemia in a patient with COVID-19

Tzar MN, Meor Jamaludin WHB, Abdul Wahab A, Ding CH

IDCases, 2022;27:e01428.

PMID: 35127454 DOI: 10.1016/j.idcr.2022.e01428

The second wave of the COVID-19 pandemic in India had brought with it a surge of 'black fungus' co-infection, which is a misnomer for mucormycosis. The present case illustrates the 'real black fungus' infection in a 50-year old male patient with COVID-19 pneumonia, who otherwise had no significant previous medical history. He was admitted on day 8 of COVID-19 illness and was intubated due to persistently low oxygen saturation. Blood cultures were positive for flask-shaped dematiaceous budding yeasts with pseudohyphae formation, which grew as brown-black fuzzy colonies on Sabouraud dextrose agar. The isolate was identified as Exophiala dermatitidis based on phenotypic characterization. Despite antifungal therapy with amphotericin B and itraconazole, the patient deteriorated rapidly and succumbed to acute respiratory distress syndrome and multiorgan failure. A review of reported cases of Exophiala dermatitidis fungemia over the last 5-years is discussed.

Fulltext Cavitary lung lesions: Melioidosis and pulmonary embolism causing necrotizing pneumonia

Mohammad N, Wan Ghazali WS

IDCases, 2017;10:4-6.

PMID: 28791214 DOI: 10.1016/j.idcr.2017.07.008

Cavitary lung lesions of various etiologies may be encountered in patients with respiratory symptoms associated with fever. Non-malignant cavitary lesions may mimic malignant lung lesions on most of radiographic modalities including chest radiographs or thoracic computed tomography (CT). Primary lung malignancy can be detected in as high as one-fifths of CT thorax as cavitary lesions and the remaining aetiologies may be due to bacterial, parasitic, and invasive fungal infections, as well as Granulomatosis with polyangiitis (GPA), sarcoidosis, septic thrombo-embolism, and lung metastasis from extra-pulmonary primaries. We report an interesting case of melioidosis infection complicated with pulmonary embolism, both of which can lead to cavitary lung lesions and subsequently cause a clinical conundrum.

Fulltext An unusual case of primary melioidotic prostatic abscess complicated by perianal abscess

Chee YC, Chee YN

IDCases, 2018;11:51-52.

PMID: 29349040 DOI: 10.1016/j.idcr.2018.01.001

Burkholderia pseudomallei is recognized to cause severe and fatal infections. Most of the infections caused by this facultative intracellular gram-negative bacterium are pneumonia, soft tissue, genito-urinary and central nervous system infection. We report an unusual case of primary prostatic abscess complicated by perianal abscess caused by Burkholderia pseudomallei. Melioidosis related anorectal infections have not been previously reported in the literature.

Fulltext A case of cerebral toxoplasmosis: "Eccentric and concentric sign" in MRI

Awang Senik NIS, Halim SA, Sapiai NA

IDCases, 2023;33:e01824.

PMID: 37434609 DOI: 10.1016/j.idcr.2023.e01824

Central nervous system (CNS) toxoplasmosis is an opportunistic infection caused by the intracellular protozoan parasite Toxoplasma gondii. This organism typically causes disease in immunocompromised patients with human immunodeficiency virus (HIV). We reported a case of a 52-year-old woman with neurology symptoms and Magnetic resonance imaging (MRI) brain shows both eccentric and concentric target signs, which are typical signs in a patient with cerebral toxoplasmosis but rarely displayed in the same lesion. The MRI played a crucial role in diagnosing the patient and distinguishing CNS diseases commonly found in HIV patients. Our objective is to discuss the imaging findings that aided in the patient's diagnosis.

Fulltext Protothecosis algaemia in a patient presenting with septic arthritis: A rare case of Prototheca zopfii isolated from Malaysia

Palaniappan PA, Abot CA, Mohd Tap R, Amran F

IDCases, 2021;24:e01121.

PMID: 33912392 DOI: 10.1016/j.idcr.2021.e01121

Prototheca species have been reported to cause infections in human. Typically, clinical symptoms of protothecosis include cutaneous infection, olecranon bursitis, tenosynovitis and disseminated systemic disease. We report a case of septic arthritis in which Prototheca zopfii was isolated from blood. Joint aspirate was also sent for cultures but did not yield any growth. No other organisms were isolated from this patient during his admission. The blood isolate was identified to species level via Polymerase Chain Reaction (PCR) method. The patient improved with administration of intravenous itraconazole.

Fulltext A rare case of disseminated rhinosporidiosis mimicking tuberculosis

Ahmad MF, Samri SB, Ahmed WAW, Jalil NAC, Sapiai NA

IDCases, 2024;36:e02009.

PMID: 38947561 DOI: 10.1016/j.idcr.2024.e02009

Rhinosporidiosis is one of the granulomatous diseases endemic in Asia, Africa, and Europe, with Southern India and Sri Lanka having the greatest prevalence rates. It is typically understood to affect the upper respiratory system. Involvement of the lungs beyond the trachea is infrequent as compared to the upper respiratory tract. We revealed an uncommon case of disseminated rhinosporidiosis in a diabetic patient, who initially presented with shortness of breath associated with cough and fever. Two months prior to these symptoms, he was having oral ulcer and dysphagia and, subsequently, loss of weight. Chest radiograph and CT thorax revealed military nodules with multiple suppurative neck and mediastinal lymphadenopathy and bilateral adrenal lesions. He was initially investigated for tuberculosis, metastatic malignancy, or lymphangitic carcinomatosis before a biopsy revealed Rhinosporidiosis. Hence, histopathological or laboratory evidence is frequently crucial to back up imaging concerns so the appropriate treatment can be given.

Isolated lymphadenopathy sporotrichosis-A rare presentation in adults: Case report

Chantrapitak J, Salee P, Towachiraporn S, Kongkarnka S, Krasaewes K

IDCases, 2024;37:e02060.

PMID: 39224872 DOI: 10.1016/j.idcr.2024.e02060

Here we present a case of atypical manifestation of Sporothrix schenkii infection where the patient complained solely of lymphadenopathy without any prior noticeable skin lesions. A Thai female who had been working in Malaysia presented to a healthcare facility with a three-month history of progressively larger and more painful lymphadenopathy at her right chin.

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