heroin and Meningitis

Topics: Acquired Immunodeficiency Syndrome; Amphetamines; Animals; Borrelia Infections; Central Nervous System Diseases; Central Nervous System Neoplasms; Cocaine; Cytomegalovirus Infections; Heroin; Herpesviridae Infections; Humans; Lymphoma; Lymphomatoid Granulomatosis; Meningitis; Meningitis, Fungal; Mycoses; Neurosyphilis; Sympathomimetics; Vasculitis

Fungal nervous system infection can be a difficult diagnosis to make, due to the fact that there are no specific manifestations of the disease and laboratory confirmation is difficult to confirm.. We report a young male who presented to our emergency department with a variety of unilateral visual field complaints. While he initially denied recent IV drug abuse, his physical examination was highly suggestive of a fungal infection known to result from brown heroin use. He was ultimately diagnosed with meningitis, ventriculitis, and endogenous endophthalmitis believed to result from a Candida species. The response to treatment with vitrectomy and broad-spectrum antimicrobials gave support to the presumed diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We provide a rarely described report of a possible complication from the use of IV brown heroin that led to a central nervous system infection involving vision loss by fungal infection.

Topics: Antifungal Agents; Candida; Central Nervous System Diseases; Cerebral Ventriculitis; Diagnosis, Differential; Emergency Service, Hospital; Endophthalmitis; Heroin; Humans; Male; Meningitis; Mycoses; Substance Abuse, Intravenous; Visual Fields; Voriconazole; Young Adult

We report a case in which the signs of a malignant meningitis could have been confused with complications of an in-dwelling epidural catheter which was being used for analgesia. This confusion could have had disastrous implications for the patient's pain relief. We also discuss some of the issues and problems surrounding the use of in-dwelling epidurals in terminal care patients.

Topics: Analgesia, Epidural; Catheters, Indwelling; Diagnosis, Differential; Diagnostic Errors; Fatal Outcome; Heroin; Humans; Male; Meningitis; Middle Aged; Narcotics; Pain, Intractable; Palliative Care

A case of bilateral necrotizing scleritis due to Aspergillus oryzae is reported. The patient was a former addict of intravenous narcotics treated five years previously for meningitis due to the same organism. A seeding focus in the thoracic spine was eventually found. The patient responded well to combined local and systemic therapy with amphotericin B, flucytosine, and natamycin. This represents, to the best of our knowledge, both the first reported case of ocular disease due to this species of Aspergillus and of isolated scleral, nonintraocular involvement in endogenous oculomycosis.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus oryzae; Child; Cocaine; Eye Diseases; Female; Flucytosine; Heroin; Humans; Inflammation; Injections, Intravenous; Meningitis; Natamycin; Sclera; Substance-Related Disorders

Topics: Adolescent; Adult; Brain Abscess; Brain Edema; Cerebral Hemorrhage; Deafness; Heroin; Humans; Male; Meningitis; Myelitis, Transverse; Myoglobinuria; Myositis; Neuritis; Neurocognitive Disorders; Polyradiculopathy; Substance-Related Disorders; Tetanus

Topics: Adult; Aged; Brain Diseases; Cerebral Cortex; Endocarditis, Bacterial; Female; Fungi; Granuloma; Heroin; Humans; Male; Meningitis; Middle Aged; Morphine Dependence; Substance-Related Disorders

Topics: Abscess; Arthritis; Arthritis, Infectious; Bacteroides; Benzoates; Brain Abscess; Camphor; Cellulitis; Endocarditis; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Hepatitis; Hepatitis B virus; Heroin; Humans; Infections; Meningitis; Methicillin; Opium; Penicillin G; Pneumothorax; Sepsis; Staphylococcal Infections; Substance-Related Disorders; Toxicology