Mycobacterium monacense in a patient with a pulmonary tumor

We report on a Mycobacterium monacense infection associated with a pulmonary tumor in a Chinese patient. To our knowledge, this is the first case of M. monacense described in a non-European patient with a tuberculosis-like disease. Further evaluation of the human pathogenic potential of M. monacense is needed.     

Clinical application of a new colonoscope with variable insertion tube rigidity: a pilot study

BACKGROUND: Colonic loop formation can prolong colonoscopy, increase patient discomfort, and preclude complete examination. A colonoscope with variable insertion tube rigidity may facilitate colonoscopy. Our aim was to determine whether the use of a colonoscope with variable insertion tube rigidity reduces insertion time and improves patient acceptance of colonoscopy. METHODS: Fifty patients were randomly assigned to undergo colonoscopy with a conventional colonoscope or a variable rigidity colonoscope (VRC). Patient acceptance, dosage of medication, use of abdominal pressure, and patient repositioning were assessed. Statistical analysis was performed by the 2-sample Wilcoxon rank sum test and an extension of Fisher exact test. RESULTS: The groups were comparable with respect to age, gender, and medications required during colonoscopy. The cecum was reached in all 25 patients who underwent colonoscopy with the VRC, including 1 patient in whom the cecum was not reached at a previous colonoscopy with a conventional instrument. In the conventional colonoscopy group, the cecum was not reached in 4 patients (2 poor preparation, 2 loop formation). There was no significant difference between the 2 groups with respect to insertion time. In the group that underwent colonoscopy with the variable rigidity instrument, less abdominal pressure was required (p = 0.05), and nursing assessment of patient discomfort was more favorable (p = 0.05). There were no complications and no significant differences in the intubation time to cecum or in repositioning, patient acceptance, or patient assessment of abdominal pain. CONCLUSION:The use of a variable rigidity colonoscope reduced the frequency of abdominal pressure but did not affect intubation time to cecum, repositioning, patient acceptance, or patient assessment of abdominal pain.     

Primary renal candidiasis associated with a penile prosthesis in a diabetic man

Infectious complications of penile prostheses are unusual even in diabetic patients, and generally involve Staphylococcus or gram-negative enteric organisms. This paper presents a diabetic patient who developed fatal, primary renal candidiasis associated with an infected penile prosthesis. He is the fourth patient we have seen with refractory nauses and vomiting associated with a cryptic urinary infection. Invasive Candida should always be considered in a diabetic patient with evidence of a urinary tract infection.     

Spontaneous remission of anemia associated with a myelodysplastic syndrome with disease evolution into a myeloproliferative state

A red cell transfusion-dependent patient with a myelodysplastic syndrome had progression into a myeloproliferative state with thrombocytosis. At the same time, the patient became transfusion independent, and a subsequent bone marrow examination revealed a previously undetected loss of chromosome 7. The patient remains well with control of thrombocytosis by anagrelide therapy.     

Significant envenomation from a preserved rattlesnake head (in a patient with a history of immediate hypersensitivity to antivenin)

We present a case of significant envenomation from a severed, preserved rattlesnake head in a 22-year-old man. The patient was treated successfully with 15 vials of Crotalidae polyvalent antivenin despite a history of severe immediate hypersensitivity reaction to antivenin. The patient developed a mild case of serum sickness five days after antivenin infusion that was treated successfully with a course of steroids. The patient experienced complete recovery. This case demonstrates the hazard of even preserved snake heads and fangs.     

Transmission of HIV-1 from an obstetrician to a patient during a caesarean section

We describe a probable case of HIV-1 transmission from a healthcare worker (HCW) to a patient during a caesarean section. Genetic distance comparisons of the viral sequence of the C2V4 region of the viruses from the patient and the obstetrician showed an average nucleotide sequence divergence of 3% (2.8-3.1). HIV can be transmitted from an infected HCW to a patient when percutaneous injuries with subsequent exposure of the patient to the blood of the HCW can occur.     

Hypersensitivity to warfarin in a patient with a mechanical aortic prosthesis.

The case of a patient with a prosthetic aortic valve and warfarin hypersensitivity is presented. On rechallenging the patient with warfarin, a spongiotic dermatitis with heavy superficial perivascular lymphocytic infiltrates with eosinophils was seen. The patient was finally discharged on aspirin therapy alone and is doing well to date. Warfarin hypersensitivity is rare, and only incidental reports exist regarding its incidence and management. It is conceivable that newer antiplatelet agents, whether alone or in combination with aspirin, will provide better control of thromboembolic events in patients with warfarin intolerance.     

Multicentric reticulohistiocytosis in a patient with malignant melanoma: a response to cyclophosphamide and a unique cutaneous feature

We describe a patient with multicentric reticulohistiocytosis and a history of malignant melanoma. His widely disseminated disease did not affect the site of surgical removal of the malignant melanoma nor the donor site of a skin graft. The multicentric reticulohistiocytosis progressed while the patient was taking nonsteroidal antiinflammatory agents, but showed significant response during a 10-month course of cyclophosphamide. While he was taking the cyclophosphamide, however, his melanoma recurred, and the patient subsequently died.     

Colonic cancer in a patient with intestinal malrotation: a case report

We present a case of a 76-year-old patient with intestinal malrotation, with incomplete rotation of the small intestine and abnormal positioning of the duodenum and superior mesenteric vessels over the transverse colon. Furthermore, the patient suffered of a concomitant cancer of the ascending colon.     

Chemoradiotherapy for a patient with a giant esophageal fistula

We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with metastases was treated with chemoradiotherapy. However, a giant esophagomediastinal fistula appeared due to shrinkage of the massive tumor, and all anti-cancer treatment was suspended. However, chemoradiotherapy was restarted at the request of the patient despite the presence of the fistula. After restarting treatment, the giant esophageal fistula was naturally closed despite intensive chemoradiotherapy, and the patient became able to eat and drink. Although the patient finally died, her QOL and prognosis seemed to be improved by the chemoradiotherapy. Anti-cancer treatment could be safely performed despite the presence of a giant fistula. The giant fistula closed while intensive chemotherapy was administered to the patient. Therefore, the presence of a fistula may not be a contraindication for curative chemoradiotherapy. Completion of treatment with proper management and maintenance of patients would be of benefit to patients with fistula.     

Infusion of lymphocytes obtained from a donor immunised with the paraprotein idiotype as a treatment in a relapsed myeloma

A 48-year-old patient with IgA k multiple myeloma received a BMT from his HLA-matched sibling. After transplantation, the disease relapsed. Melphalan therapy followed by reinfusion of haemopoietic blood stem cells collected from the patient led to the improvement of the clinical status, although mixed chimerism and an elevated serum IgA persisted. Successful donor immunisation against an immunogenic preparation of the recipient monoclonal protein was performed before the infusion of donor T lymphocytes (DLI) into the patient. Ten weeks after the lymphocyte infusions, no monoclonal band was evidenced and donor complete chimerism was detected. The patient did not develop GVHD. Once complete remission was achieved, the idiotype vaccine was administered to the patient. Nineteen months after DLI, the patient remains in remission. Bone Marrow Transplantation (2000).     

Electrical remodeling in a patient with biventricular pacemaker

Electrical remodelling in a patient with biventricular pacemaker - a case report. A case of a 70-year-old patient with dilated cardiomyopathy is presented. The patient underwent biventricular pacemaker implantation and improved markedly. Indications for resynchronisation therapy are discussed.     

Pulmonary hemorrhage in a hemophiliac simulating a lung neoplasm

We report an elderly, male smoker with moderate hemophilia B who presented with hemoptysis. Chest imaging revealed a well-circumscribed, pulmonary, mass lesion. Repeated bronchoscopy failed to make a diagnosis, and the patient ultimately underwent open thoracotomy with resection of the mass. Pathologic examination revealed hemorrhagic changes in association with bullous lung disease. This is the first report of symptomatic pulmonary hemorrhage in a patient with hemophilia B. Hemorrhage into a pre-existing bulla can simulate a primary lung neoplasm.     

Ventricular dysfunction in a patient with Plummer's disease: a case report

A 76-year-old female patient complained of intermittent palpitation, shortness of breath, and orthopnea for 10 days. The patient was found to have cardiomegaly, left ventricular dilatation secondary to moderate regurgitation, with impaired ventricular dysfunction and persistent sinus tachycardia. The patient also had a nodular goiter with increased uptake on radionuclide scan on the right side of the thyroid gland, low serum thyroid-stimulating hor-mone, with normal triiodothyronine, and free thyroxine. Plummer's disease with ventricular dysfunction was diagnosed. We present this rare case and a review of the literature. Received: May 28, 2001 / Accepted: October 19, 2001     

Henoch–Schonlein purpura as a complication of a myelodysplastic syndrome

Henoch–Schonlein purpura (HSP) is considered as a small blood vessel systemic vasculitis. We describe a 78-year-old female, known to suffer from a myelodysplastic syndrome (MDS), who developed HSP with renal involvement. The ensuing decline in kidney function progressed to the point where the patient required dialysis. Surprisingly, renal biopsy did not show crescentic glomerulonephritis. MDS, essentially a hematological disorder of the elderly, has been associated with various autoimmune diseases including vasculitis, predominantly cutaneous. Our patient, however, is only the third reported in whom the combination of MDS with HSP was found. The occurrence of HSP in our patient with underlying MDS may represent a paraneoplastic phenomenon.     

Left atrial myxoma in a patient with heart failure after myocardial infarction - a case report

A case of a 54-year-old male patient with left atrial myxoma, coronary heart disease, heart failure and multiple cardiovascular risk factors is described. The patient did not present typical symptoms of myxoma. Diagnosis and treatment of cardiac myxoma as well as the importance of echocardiographic examination in every patient with decompensated chronic heart failure are discussed.     

Bronchoalveolar lavage plasmacytosis in a patient with a plasma cell dyscrasia

A patient with serum monoclonal gammopathy, Bence-Jones proteinuria, and bone marrow plasmacytosis underwent fiberoptic bronchoscopic study for evaluation of interstitial lung disease. Bronchoalveolar lavage fluid contained 47 percent plasma cells, which were monoclonal by immunoperoxidase staining. This is the first time BAL plasmacytosis has been demonstrated in a patient with a plasma cell dyscrasia.     

Treatment of a benign tracheoesophageal fistula in a ventilator dependent quadriplegic patient

Management of an acquired benign tracheoesophageal fistula in a patient who is dependent on mechanical ventilation is controversial, since the usual procedure is weaning before repair. Here, we describe surgical treatment of a tracheoesophageal fistula in a quadriplegic patient with 28 months of follow-up, who has to remain permanently on mechanical ventilation with a tracheostomy cannula.     

Refractory vasospasm with a malignant course

We present a patient with two rare disorders, recurrent vasospastic angina leading to cardiac transplant and acute aortic occlusion. The patient had recurrent episodes of coronary vasospasm presenting with unstable angina, acute myocardial infarction, and sudden cardiac death in spite of adequate therapy with nitrates and calcium-channel blockers. He went on to have a cardiac transplant. The patient later presented with acute aortic occlusion with concomitant renal and mesenteric artery spasm. The circumstances of the presentation raise the possibility of a generalized vasospastic predisposition that is responsible for both events. Smoking, the only known major risk factor other than atherosclerosis, was noted to be temporally related to both events in our patient.     

Malignancy and hypercoagulability: a two-way association revisited

Increasing evidence is highlighting the relationship between malignancy and hypercoagulability as a bidirectional association. We herein share our experience with a patient in whom such an association may be entertained. The patient, who had a history of venous thromboembolism, presented to our care with manifestation of stroke. Extensive workup revealed that the patient carries prothrombotic mutations in the prothrombin and methylenetetrahydrofolate reductase genes. The patient, a non-smoker, was also diagnosed with non-small cell lung carcinoma. The possible association between the patient’s malignancy and prothrombotic state are further discussed.