cefotaxime and Cytomegalovirus-Infections

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cefotaxime; Cells, Cultured; Cephalosporins; Cytomegalovirus Infections; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Erythromycin; Female; Fetal Diseases; Herpes Genitalis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Ultrasonography, Prenatal; Virus Diseases

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Cefotaxime; Cholestasis; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Eosinophilia; Exanthema; Ganciclovir; Hepatitis A; Humans; Hydrocortisone; Immunoglobulins; Male; Syndrome; Young Adult

Bile-plug syndrome is defined as an obstruction of the common bile duct by bile sludge in full-term infants. It is a correctable cause of obstructive jaundice in infants and is generally treated surgically. Here, we present a case of a 5-month-old infant with bile-plug syndrome, which was treated by percutaneous biliary interventions. To the best of our knowledge, percutaneous treatment of bile-plug syndrome is reported for the first time in an infant. This minimal invasive treatment modality may be a useful alternative to surgery in infants with bile-plug syndrome.

Topics: Bile; Catheterization; Cefotaxime; Cholangiography; Cholangitis; Cholecystostomy; Combined Modality Therapy; Common Bile Duct Diseases; Cytomegalovirus Infections; Drainage; Fibrosis; Fluoroscopy; Ganciclovir; Hepatitis, Viral, Human; Hepatomegaly; Humans; Infant; Jaundice, Obstructive; Male; Radiography, Interventional; Ultrasonography; Ursodeoxycholic Acid

Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Bone Marrow Transplantation; Carmustine; Cefotaxime; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Doxorubicin; Drug Therapy, Combination; Etoposide; Humans; Idarubicin; Immunocompromised Host; Immunosuppressive Agents; Levofloxacin; Lymphoma, T-Cell; Male; Melphalan; Ofloxacin; Penicillin Resistance; Pneumococcal Infections; Prednisone; Recurrence; Rifampin; Splenectomy; Streptococcus pneumoniae; Transplantation Conditioning; Vincristine