Brucellar spondylitis and meningoencephalitis: a case report

Brucellosis, a zoonosis with a worldwide distribution, is a systemic infection that can present with involvement of both nervous and musculoskeletal systems. We report a case of spondylitis and meningoencephalitis and describe the clinical features, and difficulties in treatment. Osteoarticular complications of brucellosis are common but involvement of the nervous system is rare and it should be included in the differential diagnosis of any obscure neurologic disorder.     

Lyme meningoencephalitis: report of a severe, penicillin-resistant case

Although Lyme disease frequently attacks the central nervous system, this involvement is rarely severe, and high-dose intravenous penicillin usually is adequate treatment. The patient we describe developed severe Lyme meningoencephalitis despite receiving a full course of penicillin, and his condition continued to deteriorate after reinstitution of this treatment. Intravenous chloramphenicol was used successfully and resulted in a substantial improvement.     

Aseptic meningoencephalitis presenting with bilateral vestibular ataxia: a case report

Bilateral vestibular dysfunction is a rare condition, of which peripheral disorders are most common, whereas central disorders are extremely rare. A 35-year-old woman developed fever, headache, dizziness, convulsion, and disturbance of consciousness at the same time. MRI findings were normal. Based on the neurological findings and laboratory abnormalities, she was diagnosed as having aseptic meningoencephalitis. Steroid pulse therapy successfully ameliorated her encephalitis sign. However, isolated bilateral vestibular ataxia and dizziness, together with severe decrease of Caloric nystagmus, became apparent and lasted for the following 3 months, without cerebellar/brainstem involvement.     

Relapsing polychondritis presenting as meningoencephalitis with valvular abnormality: a case report

Relapsing polychondritis is a rare rheumatologic disorder that is characterized by recurrent inflammation of selected connective tissue sites and destruction of cartilage throughout the body. We report a case of newly diagnosed relapsing polychondritis in a 40-year-old man presenting with episcleritis, deformed “cauliflower” ears, aortic regurgitation, and aseptic meningoencephalitis. Steroid therapy was instituted with good resolution of his clinical symptoms.     

Invasive cervical cancer as an AIDS-defining illness in Europe

OBJECTIVE(S): To evaluate the frequency and correlates of invasive cervical cancer (ICC) as an AIDS-defining illness (ADI) in Europe. DESIGN: Statistical analysis of data from: national AIDS surveillance systems of 15 European countries with >or= 50 female AIDS cases; and from population-based cancer registries of the same nations. METHODS: AIDS cases notified between 1993 (when ICC was included among ADI) and 1999 in women aged 20-49 years were taken into consideration. The association between the presence of ICC as an ADI and potential determinants was assessed by calculation of odds ratios (OR) and 95% confidence intervals (CI). Country-specific incidence rates of ICC in women aged 20-49 years were correlated with selected AIDS-associated variables by means of the Pearson correlation coefficient (r). RESULTS: The OR of having ICC as an ADI increased with age and was significantly elevated in southern (3.1) and central (2.5) compared with northern Europe. It was also increased among injecting drug users (IDU; 1.5). The proportion of ICC as ADI was inversely correlated with incidence rates of ICC in the general female population, but directly correlated with the proportion of IDU among female AIDS cases. CONCLUSIONS: The frequency of ICC as an ADI in Europe was independent from the background risk of ICC in the general population. It was higher where IDU predominated among female AIDS cases and where population-based ICC screening programs were less effective.     

A rare case of meningoencephalitis by Listeria monocytogenes in systemic lupus erythematosus: case report and review

Clinical Rheumatology - Patients with systemic lupus erythematosus (SLE) have a high risk of infection. Central nervous system infection and neuropsychiatric SLE are both major causes of death. It...     

Pneumocystis carinii pneumonia in a patient without a predisposing illness: case report and review

A case of Pneumocystis carinii pneumonia in a patient without an underlying immunosuppressing condition is reported, and 12 other previously reported cases are reviewed. When compared with Pneumocystis carinii pneumonia in association with AIDS and in other immunosuppressing conditions, Pneumocystis carinii pneumonia in patients without predisposing conditions resembles more closely that seen in immunosuppressing conditions other than AIDS.     

Primary amoebic meningoencephalitis: a new case from Venezuela

Primary amoebic meningoencephalitis (PAM) is not often seen. To date, less than 300 cases have been communicated to the medical literature since the disease was first discovered in 1965. Six of these reports originated in Venezuela. The authors describe a new spontaneous case of PAM in a 33-year-old previously healthy Western-Venezuelan man.     

Eosinophilic meningoencephalitis due to Toxocara canis: case report and review of the literature

Toxocariasis is usually manifested as visceral larva migrans. Nervous system involvement is a rare complication. In this report, we describe one case of meningoencephalitis due to Toxocara canis and review the literature. We report a previously healthy two-year-old boy who was admitted after 24 hours of severe neurologic symptoms with marked eosinophilic pleocytosis in the cerebrospinal fluid and a single subcortical lesion detected by cerebral magnetic resonance imaging. Both serum and spinal fluid tested positive for T. canis. Initial treatment with thiabendazole was ineffective. After marked improvement in clinical and laboratory results were achieved using albendazole and corticosteroids, the child was discharged.     

Brachial plexus neuritis in the context of acute HIV seroconversion illness: a case report

We report an unusual case of bilateral brachial plexus neuritis occurring during the seroconversion stage of an HIV infection in a 45-year-old man. Brachial plexus neuritis is thought to be an immune mediated inflammatory reaction resulting in acute onset of shoulder pain followed by muscle weakness and wasting. There is often a history of viral illness, diagnosis is clinical, and treatment is supportive. Many sufferers are left with residual defects. Clinicians should consider the possibility of HIV infection when managing a patient with brachial plexus neuritis.     

Intracerebral haemorrhage as a rare complication of HSV-1 meningoencephalitis: case report and review of the literature

We present a case of herpetic meningoencephalitis confirmed by PCR in a 22-y-old male, with accompanying appearance of a large intracerebral haematoma as a complication. Despite the impressive imaging findings, the final outcome of the patient's progress was favourable.     

Acute quadriplegia complicating critical illness polyneuropathy in a patient with infective endocarditis: a case report

A 75-year-old woman with infective endocarditis developed critical illness polyneuropathy (CIP) with quadriplegia after cardiac surgery. The quadriplegia resolved gradually after aggressive treatment of the underlying infection and with rehabilitation. However, a MEDLINE search of the English-language literature failed to yield results matching quadriplegia and infective endocarditis. CIP is a complication of septic syndrome and sepsis. This complication has been largely unrecognized in intensive care units owing to difficulties in performing a clinical examination or electrophysiologic studies. Difficulty in weaning from the ventilator is an important early manifestation of CIP. Electroneuromyography (ENMG) should be routinely performed to establish the diagnosis. We suggest that any septic patients with unexplained muscle weakness, paralysis, or difficulty in weaning from the ventilator should be evaluated for CIP.     

Tuberculosis should not be considered an AIDS-defining illness in areas with a high tuberculosis prevalence.

OBJECTIVE: To assess the prognosis of human immunodeficiency virus (HIV) associated tuberculosis in a high tuberculosis prevalence setting. METHODS: Survival and subsequent AIDS-defining illnesses (ADI) of patients with tuberculosis were compared with patients remaining tuberculosis-free in a prospective cohort study in two university-affiliated adult HIV clinics in Cape Town. RESULTS: Tuberculosis without prior or simultaneous ADI was diagnosed in 141 patients. CD4+ T-lymphocyte count was >200 cells/microl in 67% of the incident tuberculosis cases. Survival in tuberculosis patients was comparable to that of patients with oral hairy leukoplakia and/or oral candidiasis (median = 23.6 vs. 27.8 months respectively; P = 0.59, adjusted hazard ratio [AHR] = 0.87; 95%CI 0.63-1.58), and better than in patients with AIDS (median = 11.5 months; P < 0.001, AHR = 2.37; 95% CI 1.93-4.66). Subsequent ADI were less frequent in tuberculosis than in AIDS patients (AHR = 0.36; 95%CI 0.23-0.58). Survival of patients with pulmonary or extra-pulmonary tuberculosis was similar (P = 0.32). CONCLUSION: Tuberculosis in HIV-infected patients from areas endemic with tuberculosis occurs across a wide spectrum of immune suppression and has a considerably better prognosis than other ADI. Inclusion of tuberculosis in the clinical case definition of AIDS in such areas should be reconsidered.     

Testicular schistosomiasis caused by Schistosoma mansoni: a case report from Brazil.

Testicular schistosomiasis by Schistosoma mansoni is exceedingly rare, with only 11 cases reported in PubMed. We report a new case from Brazil. A 31-year-old man from the northeast region of the country presented with a 2 cm nodule in the right testis. Ultrasonography showed a well-delimited hypoechoic tumor, suggestive of a granulomatous lesion. Magnetic resonance imaging revealed an irregular tunica albuginea signal. A biopsy showed interstitial tissue with schistosome ova and granuloma formation. The nodule was excised, and the patient was treated with oxamniquine. He has remained symptom free for 10 years. A testicular nodule should raise suspicion of numerous pathologies, including schistosomiasis. Treatment should include therapy with oxamniquine or praziquantel, and nodule excision should be done whenever possible.     

Microbiologically confirmed meningoencephalitis due to Enterococcus avium: a first report

We describe an 80-year-old lady with a meningoencephalitic illness followed by vertebral discitis. Enterococcus avium was cultured from her cerebrospinal fluid. No other pathogen was incriminated in her illness. The meningoencephalitic illness settled after 3 weeks of antimicrobials, but the vertebral discitis required longer therapy.     

Chromobacterium violaceum infection in Brazil. A case report

We report the second case of infection with Chromobacterium violaceum that occurred in Brazil. A farm worker living in the State of S?o Paulo presented fever and severe abdominal pain for four days. At hospitalization the patient was in a toxemic state and had a distended and painful abdomen. Chest X-ray and abdominal ultrasound revealed bilateral pneumonia and hypoechoic areas in the liver. The patient developed failure of multiple organs and died a few hours later. Blood culture led to isolation of C. violaceum resistant to ampicillin and cephalosporins and sensitive to chloramphenicol, tetracyclin, aminoglicosydes, and ciprofloxacin. Autopsy revealed pulmonary microabscesses and multiple abscesses in the liver. The major features of this case are generally observed in infections by C. violaceum: rapid clinical course, multiple visceral abscesses, and high mortality. Because of the antimicrobial resistance profile of this Gram-negative bacillus, for appropriate empirical antibiotic therapy it is important to consider chromobacteriosis in the differential diagnosis of severe community infections in Brazil.