Gemella haemolysans spondylodiscitis: a report of two cases

We report on two cases of infective spondylodiscitis caused by Gemella haemolysans in otherwise healthy patients. This organism has only rarely been identified as a cause of bone and joint infection, with only two previous reports of infective spondylodiscitis. We describe the clinical features, investigations and treatment options.     

Postoperative spondylodiscitis from Aspergillus fumigatus in immunocompetent subjects

The authors describe a case of spondylodiscitis from Aspergillus fumigatus which occurred subsequent to surgery for lumbar disc herniation in a non-immunodepressed patient. The results obtained by combined medical and surgical treatment are discussed.     

Colonic tuberculosis in an immunocompetent patient

INTRODUCTIONOne-third of the world's population is infected with tuberculosis (TB), with intestinal TB representing the sixth most common presentation of extrapulmonary TB. The diagnosis of intestinal TB is a challenge for physicians due to its diverse clinical manifestations that mimic other infectious, autoimmune, and neoplastic disorders, and is thus rarely considered as the causative agent of disease.PRESENTATION OF CASEWe present a 55-year-old male with no relevant familial history, who presented due to a loss of 10 kg of weight in 2 months accompanied by nocturnal diaphoresis and continuous abdominal distension.DISCUSSIONThe incidence and the severity of intestinal TB are increased in immunosuppressed patients and more rapidly progress due to deficient immune response. However, our immunocompetent had severe progression resulting in surgery less than a month after the diagnosis was made.CONCLUSIONWhile the diagnosis of intestinal TB, and specifically colonic TB, is difficult and is almost never the first diagnosis entertained outside the immunocompromised population, we present a rare case in which the disease presents in an immunocompetent patient.     

Multifocal pyomyositis in an immunocompetent patient

Pyomyositis is defined as suppurative infection of the skeletal muscle and usually occurs in immunocompromized patients. We managed a 23-year-old man admitted for myalgia and evidence of infection, with onset after a strenuous physical activity. Numerous muscles were involved. Multiple abscesses were visualized by ultrasonography and computed tomography, with predominant involvement of the pelvic muscles. Examination of the aspirate from a forearm abscess recovered Staphylococcus aureus. No factors associated with immunodeficiency were found. Appropriate antimicrobial therapy ensured complete resolution of the infection. Pyomyositis is rare in immunocompetent individuals. Myalgia, fever, and rhabdomyolysis should suggest pyomyositis. Computed tomography and magnetic resonance imaging are the best investigations for confirming the diagnosis.     

Polyarticular septic arthritis in an immunocompetent patient

Septic arthritis is an uncommon condition with an incidence of 2–3/100,000. It is clinically notable, however, as it is a rapidly destructive joint disease with significant associated morbidity and mortality. Polyarticular septic arthritis has an estimated incidence of 15% of all cases of infectious arthritis.We report a case of polyarticular septic arthritis with involvement of bilateral shoulders and wrist to highlight the importance of early diagnosis and treatment as well as the high mortality rates associated with this condition. Bilateral septic shoulder arthritis poses a challenge to treat, and its significance should not be underestimated as even with early surgical intervention and aggressive antibiotic and fluid resuscitation death is a sad but perhaps not uncommon outcome. It is therefore imperative that the diagnosis of polyarticular septic arthritis is kept prominent in the physician’s mind when confronted with a patient with symptomatic polyarthralgia.     

Salivary gland nocardiosis in an immunocompetent patient

We report a case of nocardiosis in an immunocompetent patient who presented with pain and multiple swellings in the face. Nocardia asteroides was isolated from the parotid and submandibular salivary glands. The patient was successfully treated by surgical drainage and oral administration of trimethoprim and sulfamethoxazole. To the best of our knowledge, this is the first reported case from India on N. asteroides affecting the salivary gland.     

Isolated ocular cryptococcosis in an immunocompetent patient.

A 62-year-old woman without evidence of immunocompromise was evaluated for uveitis and a subretinal lesion in the right eye. Laboratory evaluation, including cerebrospinal fluid analysis, revealed no apparent cause. The diagnosis of subretinal cryptococcosis was established by transscleral needle biopsy of the subretinal mass. Treatment with intravenous amphotericin B and oral 5-flucytosine brought recovery of visual acuity to 20/30-1 and resolution of the inflammation. This patient demonstrates that ocular cryptococcal infection must be suspected, even in the absence of predisposing factors or systemic findings, and that subretinal fine-needle aspiration is an important diagnostic tool in this setting.     

Coccidioidomycosis of the spine in an immunocompetent patient

Coccidioidomycosis is a fungal disease caused by inhalation of airborne particles of Coccidioides spp. Coccidioidomycosis is endemic in several parts of the South-western US and South America. There are no symptoms in 60% of cases and, when symptoms exist, they usually consist of mild flu-like manifestations or mild lung disease. Disseminated coccidioidomycosis accounts for only 5% of symptomatic cases but can be life-threatening. The main targets of disseminated coccidioidomycosis are the skin, lymphoid tissue, central nervous system, and musculoskeletal system. Prolonged antifungal therapy is required and some patients may need surgical debridement. We report a case of disseminated spinal coccidioidomycosis in an immunocompetent patient.     

Acute acquired toxoplasmosis presenting as polymyositis and chorioretinitis in immunocompetent patient

The parasite Toxoplasma gondii mainly encysts in brain, retina, myocardium, and skeletal muscle. It has been implicated in the genesis of inflammatory myopathies for years, but the parasite usually cannot be detected in the muscle. It is established, however, that toxoplasmosis can cause myositis either by recent infection or by reactivation. The case of a non-HIV patient who developed an acute polymyositis upon infection by T. gondii is reported. We suggest that all patients with polymyositis should have serological tests for toxoplasmosis as a part of their initial evaluation and early trial of antiprotozoal therapy in case of positive findings.     

Mycobacterium fortuitum associated with fasciotomy in an immunocompetent patient

A 40-year-old woman presented with a skin disease, characterized by confluent erythematous nodules and purulent material discharges, which affected the right arm. A Ziehl–Nielsen stain of purulent material revealed the presence of acid-fast bacilli. The isolated microorganism was identified by standard biochemical procedures as a member of the Mycobacterium fortuitum group. Molecular identification performed by amplification and sequencing of the 16S rRNA revealed 100% identity with strains of M. fortuitum. The following report reveals an extensive cutaneous affection caused by M. fortuitum in a non-predisposed immunocompetent patient.     

Subcutaneous nodules with pseudomonas septicaemia in an immunocompetent patient

Pseudomonas septicaemia presenting with subcutaneous nodules, though rare, is well described in immunocompromized populations. It is, however, very uncommon in immunocompetent patients. We describe a case of a 42-year-old woman who presented with community-acquired. Pseudomonas aeruginosa septicaemia and subcutaneous nodules. No precipitating cause or immune dysfunction was found. She was successfully treated with appropriate antibiotics, respiratory and cardiovascular support in the Intensive Care Unit. The difficulty in eradicating the organism from the skin lesion and the need for investigating the immune function of septicaemia patients are discussed.