piperacillin--tazobactam-drug-combination and Tuberculosis

Serratia marcescens is a saprophytic gram-negative bacillus capable of causing a wide range of infections. A 57-year-old female was admitted to our hospital for four weeks with community acquired pneumonia. A chest x-ray, six weeks after discharge, demonstrated multiple, bilateral 'cannon ball'-like opacities and mediastinal lymphadenopathy which were highly suspicious of disseminated malignancy or tuberculosis. The only symptom that this patient had was a productive cough. She had multiple commodities, but no specific immunodeficiency disorder. Interestingly, her sputum and bronchial washing samples grew S. marcescens. The computed tomography-guided lung biopsy demonstrated necrotic granulomatous changes. There was no pathological evidence of tuberculosis or fungal infection, malignancy or vasculitis. There are only a handful of reported cases of Serratia granulomas. Thus, we are reporting a rare instance of pulmonary Serratia marcescens granuloma radiologically mimicking metastatic malignancy and tuberculosis infection.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Female; Hospitalization; Humans; Opportunistic Infections; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia; Radiography, Thoracic; Serratia Infections; Serratia marcescens; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis

Tuberculosis is a public health problem worldwide. Between 19% and 43% of the world's population is infected with Mycobacterium tuberculosis. Tubercular sternal osteomyelitis is a rare manifestation of tuberculosis. Tuberculous sternal osteomyelitis manifests with fever, weight loss, and chest wall lesions. Computed tomography (CT) scan defines the extent of the thoracic extension, and standard microbiologic methods diagnose this entity. Four-drug anti-tuberculous therapy is effective. The authors report a case of tuberculous osteomyelitis of the sternum not associated with pulmonary tuberculosis.

Topics: Abscess; Adult; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Humans; Male; Mycobacterium Infections; Mycobacterium tuberculosis; Ofloxacin; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sternum; Thorax; Tomography, X-Ray Computed; Tuberculosis; Vancomycin