Cavernosal Abscess due to Streptococcus Anginosus: A Case Report and Comprehensive Review of the Literature

Corpus cavernosum abscesses are uncommon with only 23 prior reports in the literature. Several precipitating factors for cavernosal infections have been described including injection therapy for erectile dysfunction, trauma, and priapism. Common causal organisms include Staphylococcus aureus, Streptococci, and Bacteroides. We report a unique case of a corpus cavernosum abscess due to proctitis with hematological seeding and review the literature on cavernosal abscesses.Key Words: Corpus cavernosum, Penile abscess, Cavernosal abscess, Necrotizing cavernositis, Streptococcus anginosus     

Microwave ablation of liver metastasis complicated by Clostridium perfringens gas-forming pyogenic liver abscess (GPLA) in a patient with past gastrectomy

IntroductionGas-forming pyogenic liver abscess (GPLA) caused by C. perfringens is rare but fatal. Patients with past gastrectomy may be prone to such infection post-ablation.Presentation of caseAn 84-year-old male patient with past gastrectomy had MW ablation of his liver tumors complicated by GPLA. Computerised tomography scan showed gas-containing abscess in the liver and he was managed successfully with antibiotic and percutaneous drainage of the abscess.DiscussionC. perfringens GPLA secondary to MW ablation in a patient with previous gastrectomy has not been reported in the literature. Gastrectomy may predispose to such infection. Even in high-risk patients, empirical antibiotic before ablation is not a standard of practice. Therefore following the procedure, close observation of patients’ conditions is necessary to allow early diagnosis and intervention that will prevent progression of infection.ConclusionPotential complication of liver abscess following MW ablation can never be overlooked. The risk may be enhanced in patients with previous gastrectomy. Early diagnosis and management may minimise mortality and morbidity.     

Secondary pleuropulmonary amoebiasis due to liver abscess rupture: A complication case report in low resource setting

BackgroundPleuropulmonary amoebiasis caused by complications of amoebic liver abscess (ALA) is rare.Case presentationA 23 years old male, presented with shortness of breath, cough with yellowish phlegm, right chest pain, fever, bulging stomach, yellow eyes, and swelling of both legs. Abdominal ultrasound and CT scan thorax and abdomen revealed right fluidopneumothorax and liver abscess. Serological testing leads to Entamoeba histolytica infection, which was treated with metronidazole but no significant improvement on empyema and abscess liver size. Surgery was performed after percutaneous aspiration drainage failed to evacuate the abscess. HE and PAS staining from surgical tissue showed Entamoeba hystolitica infection.DiscussionSerological testing and radiological examination will be more useful in the early detection of cases of Entamoeba hystolitica infection. Surgery may be considered when purulent drainage does not show improvement in the patient's condition.ConclusionALA complication that causes pulmonary empyema can be surgically treated if the pus cannot be drained.     

A case of retroperitoneal abscess caused by Salmonella Oranienburg

The authors report a case of retroperitoneal abscess caused by Salmonella Oranienburg in an 8-year-old girl. This was one case in an epidemic of food poisoning from Salmonella Oranienburg or Salmonella Chester transmitted by many kinds of contaminated dried squid products. This is the first reported case of a retroperitoneal abscess by Salmonella Oranienburg.     

Two cases of Klebsiella pneumoniae liver abscess necessitating liver resection for effective treatment

We report two British cases of liver abscess, due to Klebsiella pneumoniae and associated with synchronous infection elsewhere, which required liver resection for definitive treatment. They illustrate the geographic spread of aggressive K pneumoniae liver infection and demonstrate the importance of early aggressive treatment.     

Ruptured liver abscess presenting as pneumoperitoneum

The presence of free air within the peritoneal cavity, referred to as pneumoperitoneum, in 85% to 90% of cases is due to perforated bowel. The rare case is reported of pneumoperitoneum resulting from a ruptured liver abscess in a young male with no comorbidity.A ruptured pyogenic left lobe liver abscess in a 23-year-old male was accompanied by chest X-ray features suggestive of free gas under the diaphragm with peritonitis. Exploratory laparotomy was performed, with localization and drainage of the liver abscess and thorough peritoneal lavage. Culture of the pus from the liver abscess grew Klebsiella sensitive to Piperacillin and Tazobactam, and antibiotic treatment was administere Conclusion: Although pneumoperitoneum resulting from a ruptured liver abscess is rare, it must be kept in mind as a possible source, especially when the hollow organs are normal.     

Partial laparoscopic splenectomy for splenic abscess because of Salmonella infection: a case report

Splenic abscess as a presentation of a Salmonella infection is described in children and adults. A combination of antibiotics and splenectomy is the standard treatment.We report a 12-year-old girl admitted to the hospital with fever, abdominal pain, and anorexia. White blood cell count was 17,900/μL and C-reactive protein level was 230 mg/L; abdominal ultrasound and abdominal computed tomographic (CT) scan showed a splenic abscess of 11.3 × 12.9 × 13.8 cm in the upper part of the spleen. She was treated with percutaneous drainage and antibiotics for 8 days. A week later, she represented with a recurrent abscess and identical symptoms. She was treated with percutaneous drainage and intravenous (IV) antibiotics for 21 days followed by oral therapy for another 2 weeks. Abscess culture grew Salmonella type B. Because of a persistent abscess on CT scan, she underwent a partial laparoscopic splenectomy with radiofrequency ablation to preserve functional splenic tissue. The operative and postoperative course was uneventful. Pathologic finding showed an inflammatory cystic reaction without epithelial cell lining.Splenic abscess in children is a rare condition. Long-term antibiotic therapy is needed. Percutaneous drainage can be a temporary solution, but (partial) splenectomy is the final treatment in most cases.     

Coagulase-Positive Staphylococcal Necrotizing Fasciitis Subsequent to Shoulder Sprain in a Healthy Woman

Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.     

Subdural Empyema Due to Lactococcus lactis cremoris: Case Report

Lactococcus lactis cremoris (L. lactis cremoris) infections are very rare in humans. Only three case reports of brain abscess have been reported and the infectious routes and pathological features are still unknown. We experienced a subdural empyema due to L. lactis cremoris in an immunocompetent adult. A 33-year-old man was admitted with fever, right facial pain, left hemiparesis, and left hemianopsia. Computed tomography demonstrated low density fluid collection in the right falcotentorial subdural space. Magnetic resonance (MR) images revealed a high signal lesion on a diffusion-weighted image (DWI) and fluid attenuated inversion recovery (FLAIR) images in the right paratentorial and parafalcine subdural space, right maxillary sinus, and bilateral ethmoidal sinus. He underwent two sequential open surgeries for removal and drainage of empyema and was treated with antibiotics including meropenem and ampicillin. To our knowledge, this is the first report of subdural empyema caused by L. lactis cremoris infection. We report the case and discuss the pathological features with the previous literature.     

Mycobacterium fortuitum skin infection as a complication of anabolic steroids: a rare case report

Mycobacterium fortuitum is a rare cause of recurrent skin abscesses in an immunocompetent person. We report the case of a 37-year-old man presenting with multiple recurrent non-healing skin abscesses. Culture of the abscess wall yielded growth of M fortuitum. In our case, we highlight the association of anabolic steroids with non-tuberculous mycobacterial skin abscesses that fail to resolve despite repeated drainage.     

Acute septic arthritis caused by Klebsiella pneumoniae

Septic arthritis caused by Gram-negative bacteria is uncommon. However, Klebsiella pneumoniae is one of the most common pathogens in Taiwan in several clinical entities, including severe community-acquired pneumonia, community-acquired lung abscess, empyema, necrotizing fasciitis, and liver abscess. However, the research focusing on septic arthritis caused by K. pneumoniae is only limited. Herein, we described three cases of K. pneumoniae-associated septic arthritis. Two of them had underlying diabetes mellitus, and one of them was caused by extended beta-lactamase–producing K. pneumoniae. All outcomes were favorable under appropriate management, which included antibiotic treatment or drainage.     

Pneumoperitoneum caused by ruptured gas-containing liver abscess

An 84-year-old woman was admitted to our hospital with high fever, and she suddenly complained of severe abdominal pain the next day. Computed tomography revealed a gas-containing abscess in the lateral segment of the liver, with spontaneous pneumoperitoneum. An emergency lateral segmentectomy was performed, and Klebsiella pneumoniae was cultured from the liver tissue, abscess, and blood. The patient made a satisfactory recovery and was discharged on the thirty-first postoperative day. Pneumoperitoneum caused by the rupture of a gas-containing liver abscess is rare, and to our best knowledge, this is the first report, in the English-language literature, of a patient who has undergone successful hepatectomy for such a condition.     

Disseminated Melioidosis presenting as pneumonia,femoral and sacral osteomyelitis,splenic abscess and high rectal fistula: A case report and review of literature

IntroductionMelioidosis is a rare infectious tropical disease caused by Burkholderia pseudomallei (B. pseudomallei), an environmental saprophyte usually habitating on soils of Southeast Asian fields. Most of the reported cases present with pneumonia and intra-abdominal abscess. Diagnosis is established by culture studies from the blood, sputum or abscess drainage. Management relies on culture-guided antibiotic treatment, with good prognosis. Surgical intervention is required in cases not responsive to medical management.Presentation of caseWe are presenting a case of Melioidosis in a 72 year old Filipino who presented with Pneumonia, Femoral and Sacral Osteomyelitis, Splenic Abscess and High Rectal Fistula. He was successfully managed with systemic antibiotic treatment and surgery. The splenic abscess was managed by splenectomy and a transverse loop colostomy was used for fecal diversion to address the rectal fistula.DiscussionMelioidosis varies in its presentation and thus management should be individualized, depending on the organs involved. Our patient presented with multiple foci of infection which rendered the treatment more complicated as compared to those reported previously in published literature. The pneumonia and the osteomyelitis were managed with aggressive systemic antibiotics but the other sites of infection required drainage and surgery.ConclusionMelioidosis is a rare infection caused by an environmental saprophyte Burkholderia pseudomallei. An accurate diagnosis using culture studies is essential to institute appropriate treatment. Antibiotic treatment complemented by surgery for specific organ involvement is essential for cure.     

Bilateral scrotal abscesses caused by Klebsiella Pneumoniae in a newborn

The management of acute scrotal swelling can be challenging in neonatal age, with scrotal infections being great mimickers of testicular torsion. Only a few unilateral cases of scrotal abscess have been previously reported, mostly caused by Staphylococcus and Salmonella. We describe the case of a newborn who developed bilateral scrotal abscesses caused by Klebsiella pneumoniae and discuss the rarity of the case, regarding both the bilaterality and the pathogen, never reported before.     

Unusual pneumoperitoneum secondary to ruptured liver abscess-A case report

IntroductionPyogenic liver abscess is important cause of hospitalization and life threatening disease in low-middle income countries. Clinical spectrum of ruptured GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis.Case presentationWe reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 27-year-old man with a history of uncontrolled type II diabetes mellitus. He had an abdominal pain, distension of abdomen associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a ruptured liver abscess in the right lobe of the liver.. The patient was in septic shock and hence shifted to ICU with inotropic support. Antibiotic therapy was started according to pus culture sensitivity. Even with the above treatment patient was not improved and on 4th postoperative day the patient collapsed and declared dead.DiscussionPneumoperitoneum secondary to ruptured gas containing pyogenic liver abscess is rare and could represent as life threatening infection. It should be distinguished from perforation of hollow organ by clinical symptoms and image examinations, particularly like CT. Accurate diagnosis with adequate drainage and antibiotic therapy would bring good outcome.ConclusionWe are aware that not every case of pneumoperitoneum is attributable to a perforated hollow viscus. A rapid and prompt surgical intervention with appropriate antibiotics are essential to save a life.     

Spinal epidural abscess with myelitis and meningitis caused by Streptococcus pneumoniae in a young child

Background

Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate.

Design

Case report and literature review.

Findings

A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus.

Conclusions

Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.     

Pyogenic liver abscess of a male patient with diabetes mellitus due to <Emphasis Type="Italic">Escherichia coli</Emphasis> with fever and chills as the only symptoms

Pyogenic liver abscesses (PLAs) are the most frequent visceral abscesses with predominance in men. They are extremely rare and their mechanism of formation is extended to infection of an anatomically contiguous organ or hematogenous seeding. Diabetes mellitus is a major predisposing factor and if so, the mortality rate is high. The most common clinical presentation forms are fever with chills, abdominal pain and hepatomegaly. In the present report we present the case of a 65-year-old Greek male patient with history significant for diabetes mellitus, who attended the emergency department complaining of fever and chills for five days. The final diagnosis was pyogenic liver abscess of the right lobe. Blood cultures were positive for Escherichia coli. The patient was treated with broad spectrum antibiotics and percutaneous drainage of the abscess. To our knowledge, this is the first pyogenic liver abscess in a diabetic patient due to E. coli reported in Western Greece.     

Triparesis caused by gas-containing extensive epidural abscess secondary to Aeromonas hydrophila infection of a thoracic vertebroplasty: a case report

Background context

Aeromonas hydrophila is a motile gram-negative non-sporeforming rod with facultative anaerobic metabolism. Except for gastrointestinal disease, skin and soft-tissue infections represent the second most common site of human Aeromonas infections. However, to our knowledge, A. hydrophila infection of the spine has not been reported to date.

Purpose

To report the first case of A. hydrophila spinal infection of the T7 vertebra after vertebroplasty.

Study design

Case report.

Methods

A 72-year-old man was transferred to our emergency department with chief complaints of severe midthoracic pain and triparesis. He had undergone vertebroplasty for a painful vertebral fracture at T7 5 weeks before transfer. Magnetic resonance imaging showed an infection of the T7 vertebroplasty and an extensive epidural abscess. The epidural abscess originating from the infected T7 vertebroplasty extended from the T8 to the C4 epidural space. Computed tomography demonstrated sparsely scattered gas in the epidural abscess, strongly suggestive of an anaerobic infection.

Results

Emergency multilevel laminectomies from C5 to T8 and a posterior instrumentation from T3 to T10 were performed. A. hydrophila was isolated from the blood cultures. The patient was treated with intravenous ampicillin/sulbactam. Posterior decompression and stabilization in combination with appropriate antibiotic treatment completely resolved the neurologic deficit and infection without the need for further anterior corpectomy of the infected T7 vertebroplasty.

Conclusions

This is the first reported case of spine infection caused by A. hydrophila. The infection developed after vertebroplasty for the management of a painful vertebral fracture. Triparesis occurred rapidly due to an extensive epidural abscess containing gas. Emergency decompression and stabilization in combination with appropriate antibiotic treatment achieved a successful clinical outcome.     

Spinal infections due to Eikenella corrodens: Case report and literature review

Spinal infections with Eikenella corrodens are rare. We report a unique case of infection caused by E. corrodens diagnosed more than two years after cervical surgery. All other published cases of spinal infections caused by E. corrodens were searched. Characteristics of this bacterium, its challenging diagnosis and therapy are discussed.     

肝肿瘤射频消融术后感染性并发症的处理

目的分析肝恶性肿瘤经皮射频消融术(RFA)后感染性并发症的临床特点及处理方法。方法回顾性分析于我科接受RFA治疗的356例肝脏恶性肿瘤患者,其中原发性肝癌296例,肝转移癌60例。对于术后有严重感染表现的患者进行即刻腹部超声和(或)CT增强扫描。明确肝内局部脓肿形成后,采取置管引流、使用抗生素等干预措施,并随访1年。全部脓肿引流液均行细菌学检查并根据药敏结果调整抗生素用药。结果 356例RFA术后共5例患者发生局部严重感染,其中3例为肝脓肿,1例胆汁瘤合并感染,1例为腹壁脓肿。1例肝脓肿患者肝内局部病灶与结肠肝曲形成窦道且经久不愈,经外科手术局部修补+肝内脓肿置管引流后局部及全身症状有所缓解,但于RFA术后8个月死于全身衰竭。1例腹壁脓肿患者经抗感染、置管引流、局部换药处理后局部及全身症状有所缓解,但于RFA术后6个月死于肿瘤进展。1例肝脓肿和1例胆汁瘤合并感染患者经单纯病变部位置管引流+抗生素治疗后临床症状明显缓解,随诊1年达到临床治愈。1例肝脓肿患者经病变部位置管引流+抗生素治疗后,感染灶痊愈,但随访至9个月时死于肝内肿瘤转移导致的多脏器功能衰竭。结论 RFA术后严重感染性并发症并不少见,感染途径可来自肠道菌群逆行感染,Whipple术等导致Oddi括约肌无功能的RFA术后继发严重感染的明确诱因。除根据药敏实验应用敏感抗生素外,及时行脓腔穿刺引流、外科干预等综合治疗是针对RFA术后局部感染性并发症的有效方法。