ro13-9904 and Edema

A 34-year-old road builder was admitted to the authors' emergency department due to progressive dyspnoea that had been present for 6 days. The patient had a history of excessive smoking (60 cigarettes/day). The medical history was otherwise unremarkable. A transient rash had occurred during work 2 weeks previously. The patient could not remember a bite. The electrocardiogram showed 2:1 atrioventricular (AV) block with narrow QRS complexes. D‑dimer and C‑reactive protein were slightly elevated; all other laboratory findings were within normal range. Echocardiography revealed normal findings. ELISA and western blot analysis confirmed acute Lyme disease. Cardiac magnetic resonance imaging (MRI) disclosed myocardial edema in the interventricular septum. Antibiotic treatment with ceftriaxone was initiated for 2 weeks. The heart block improved to a first degree AV block (PR interval 274 ms) at day 5 of treatment. At discharge, the patient had a normal PR interval of 190 ms. Follow-up cardiac MRI revealed almost complete regression of the cardiac septal edema.. Ein 34-jähriger Straßenbauer stellte sich wegen einer seit 6 Tagen bestehenden progredienten Dyspnoe in unserer Notaufnahme vor. Außer einem Nikotinkonsum von 60 Zigaretten pro Tag war die Anamnese unauffällig. Vierzehn Tage zuvor war ein flüchtiges generalisiertes Exanthem bei der Arbeit aufgetreten. Ein Insektenstich war nicht erinnerlich. Das Elektrokardiogramm zeigte einen 2:1-atrioventrikulären (AV) Block mit schmalen QRS-Komplexen. Laborchemisch bestand eine geringe Erhöhung von D‑Dimer und C‑reaktivem Protein. Alle übrigen Parameter waren im Normbereich. Die transthorakale Echokardiographie zeigte einen Normalbefund. Die mikrobiologische Untersuchung bestätigte eine akute Lyme-Borreliose im „enzyme-linked immunosorbent assay“ (ELISA) und Western Blot. Die kardiale Magnetresonanztomographie (MRT) zeigte ein myokardiales Ödem des interventrikulären Septums. Es erfolgte eine 14-tägige antibiotische Therapie mit Ceftriaxon. Hierunter bildete sich der AV-Block am Tag 5 in einen AV-Block ersten Grades mit einer PQ-Zeit von 274 ms zurück. Am Entlassungstag war die PQ-Zeit mit 190 ms im Normbereich. Die Kontroll-MRT zeigte eine nahezu komplette Rückbildung des myokardialen Ödems.

Topics: Adult; Atrioventricular Block; Ceftriaxone; Edema; Electrocardiography; Humans; Lyme Disease; Myocarditis

The purpose of this study was to review a case comprised of a cervical spinal epidural abscess, cervical and thoracic paraspinous edema, and widening of the right thoracic neural foramen secondary to a phlegmon.. We reviewed the case of a spinal epidural abscess managed medically in a 4-year-old male and performed a review of the literature with 15 other cases that have previously been reported.. The current mainstay of treatment is largely variant but generally falls into a laminectomy-based surgical approach or longstanding antibiotics. Our review of the literature concluded that there are currently no clear guidelines established to recommend treatment, and current practice is largely based on the discretion of the pediatric neurosurgeon.. Based on the literature review, and our personal case illustration, we conclude that an antibiotic-based treatment is a valid approach for therapy if initiated promptly in a pediatric patient with no neurological deficit.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Child, Preschool; Daptomycin; Edema; Epidural Abscess; Humans; Magnetic Resonance Imaging; Male; Spinal Diseases; Treatment Outcome

Malakoplakia (from the Greek malakos, 'soft' and plakos 'plaque') is a granulomatous inflammatory condition, commonly presenting as a plaque in the genitourinary system, but has been shown to affect a wide variety of structures including the skin. Presentation is varied and a high degree of clinical suspicion is needed to make a diagnosis. We report a case of cutaneous malakoplakia presenting as an inguinal swelling in a 48-year-old kidney transplant patient with temporally associated graft dysfunction. New groin swelling in an immunosuppressed patient often prompts investigation centred on a malignant cause. While this is often appropriate, less common infectious and inflammatory causes should be considered. This case highlights the importance of thorough workup and investigation, including histopathology, in immunosuppressed cohorts and acts as a reminder that less common and more complex diagnoses warrant consideration in this group.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Ceftriaxone; Constriction, Pathologic; Diagnosis, Differential; Edema; Groin; Humans; Immunocompromised Host; Kidney Transplantation; Malacoplakia; Male; Middle Aged; Rare Diseases; Skin; Skin Diseases; Treatment Outcome; Ureteral Diseases

Supported by years of clinical use in some countries and more recently by literature on experimental models, as well as its compassionate use in Europe and in the United States, bacteriophage (phage) therapy is providing a solution for difficult-to-treat bacterial infections. However, studies of the impact of such treatments on the host remain scarce. Murine acute pneumonia initiated by intranasal instillation of two pathogenic strains of

Topics: Administration, Intranasal; Animals; Anti-Bacterial Agents; Bacteremia; Bacterial Load; Blood Cell Count; Ceftriaxone; Cytokines; Edema; Escherichia coli Infections; Lung Diseases; Male; Mice, Inbred BALB C; Myoviridae; Phage Therapy; Pneumonia; Podoviridae; Treatment Outcome

Deep vein thrombosis (DVT) is rare in infancy. In pediatric populations, thrombosis occurs most frequently in hospitalized children and those with central venous catheters. The presence of a DVT in the general pediatric population indicates a hypercoagulable state and requires rapid diagnosis and treatment of both the thrombosis and the underlying process.. A previously healthy 6-month-old male was brought to the emergency department by his family with a chief complaint of left leg swelling. Duplex ultrasonography in the emergency department revealed multiple DVTs in the leg vasculature. The patient was treated with anticoagulation and antibiotic therapy in the emergency department and admitted. Blood cultures revealed the subsequent growth of methicillin-resistant Staphylococcus aureus (MRSA). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: While rare in infants, new-onset swelling in an extremity may be caused by thrombosis and be the initial symptom of an underlying hypercoagulable state. Duplex ultrasonography is a relatively benign test that can be readily performed in most emergency departments, and it allows physicians to rule out thrombosis. When present, DVT in the general pediatric population can indicate a critical illness, such as malignancy or infection, and requires rapid treatment and admission to a pediatric service for management.

Topics: Anti-Bacterial Agents; Anticoagulants; Bacteremia; Ceftriaxone; Clindamycin; Edema; Emergency Service, Hospital; Enoxaparin; Fever; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Ultrasonography; Vancomycin; Venous Thrombosis

A 32-year-old woman presented with bilateral periorbital oedema of 2 days duration which progressed to proptosis, chemosis with diminution of vision rapidly within a week. She was a known case of adenocarcinoma of the rectum who was treated with surgery and chemotherapy 6 months earlier. Metastasis workup carried out then was negative. On examination, she had bilateral axial proptosis with sluggish pupillary reactions with restricted extra ocular movements. Fundus examination was normal. Systemically, the patient was of poor build and was undernourished. Haemogram showed raised total counts and erythrocyte sedimentation rate. CT orbit and brain showed metastasis to the frontal bones and orbit. On investigating further, the patient had liver and lung metastasis. The patient was started on chemotherapy, but she succumbed to the disease within a week. This case is reported to highlight how bilateral orbital cellulitis can be a presenting sign of systemic metastasis in treated malignancies.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Diagnosis, Differential; Edema; Female; Humans; Metronidazole; Orbital Diseases

Liquid injectable silicone has been used to increase volume in determined cutaneous districts, particularly in aesthetical reconstructive surgery. Although considered biologically inert for a long time this substance produced various complications as granulomatous foreign body reaction (siliconomas), secondary limphedema, tissue destruction and lethal embolism. A 35-year-old Caucasian woman came to our department with erithema and edema on the right leg, fever and chills. A thorough examination of the patient's history revealed injection of liquid silicone 7 years before for cosmetic volume increase of both legs. A closer observation revealed a small fistulous element from which came out white-yellow puruloid material. Antibiotic therapy and drainage of the abscess were undertaken. Within few days of treatment erithema and swelling essentially improved and the patient was discharged. After two months she came back to our department due to the same disease on her left leg that we treated with the therapy previously used. We highlight the long time, 7 years, elapsed between liquid silicone injection and onset of cutaneous symptoms.

Topics: Abscess; Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Ceftriaxone; Cosmetic Techniques; Cutaneous Fistula; Drainage; Drug Therapy, Combination; Edema; Erythema; Female; Humans; Injections, Subcutaneous; Leg Injuries; Rifamycins; Silicones; Streptococcal Infections; Streptococcus agalactiae; Time Factors; Wound Infection

Topics: Anti-Infective Agents; Ceftriaxone; Constriction, Pathologic; Diagnosis, Differential; Edema; Emotions; Heart; Heart Diseases; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease; Wit and Humor as Topic

Topics: Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Edema; Endocarditis, Subacute Bacterial; Fingers; Gentamicins; Hand Dermatoses; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Nail Diseases; Rheumatic Heart Disease; Ultrasonography

We present a case of pyogenic pubic symphysitis presenting in the third trimester with progressive suprapubic pain, fever and massive vulvar oedema. This case demonstrates a rare, but important cause of sepsis in pregnancy, which, if not recognised and treated promptly, may result in significant morbidity.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Edema; Female; Fever; Gentamicins; Humans; Infant, Newborn; Metronidazole; Pain; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Pubic Symphysis; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vulvar Diseases

Topics: Anti-Bacterial Agents; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Edema; Female; Foot Diseases; Humans; Lyme Disease; Middle Aged; Pseudolymphoma; Toes; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Clostridioides difficile; Diagnosis, Differential; Diarrhea; Edema; Enterocolitis, Pseudomembranous; Esophagus; Female; Fever; Foreign Bodies; Gastritis, Hypertrophic; Humans; Infant; Male; Radiography; Respiratory Sounds; Vomiting

Topics: Ceftriaxone; Cephalosporins; Edema; Humans; IgA Vasculitis; Infant; Male

Streptococcus pneumoniae is a common cause of infection in the pediatric population, as well as an important cause of septic arthritis. The increased prevalence of drug-resistant S pneumoniae in North America has renewed interest in the use of pneumococcal vaccines. We describe the case of a child with isolated acute septic arthritis caused by infection with penicillin-resistant S pneumoniae.

Topics: Acute Disease; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Cephalosporins; Combined Modality Therapy; Debridement; Drainage; Edema; Elbow Joint; Humans; Infant; Leukocyte Count; Male; Microbial Sensitivity Tests; Nafcillin; Pain; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Prevalence; Streptococcus pneumoniae