ro13-9904 and Keratitis

Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated.. We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate.. Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.

Topics: Agglutination Tests; Animals; Anti-Infective Agents; Anticoagulants; Brucella melitensis; Brucellosis; Ceftriaxone; Child, Preschool; Coronary Aneurysm; Diagnostic Errors; Fever; Humans; Keratitis; Male; Meningoencephalitis; Rifampin; Sulfamethoxazole; Treatment Outcome; Zoonoses

A 29-year-old man presented with a 5-day history of a red eye with a purulent discharge. Three years previously, he had undergone laser in situ keratomileusis elsewhere. A diagnosis of gonococcal keratoconjuntivitis was made clinically and confirmed with culture. The patient subsequently developed diffuse lamellar keratitis (DLK). The keratoconjunctivitis and DLK resolved with antibiotic therapy and topical steroids. The cause and effect relationship of these 2 uncommon events is of interest.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Corneal Stroma; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Gonorrhea; Humans; Keratitis; Keratoconjunctivitis; Keratomileusis, Laser In Situ; Male; Neisseria gonorrhoeae; Surgical Flaps

We document the case of a young woman with bilateral nonluetic, interstitial keratitis, vestibuloauditory problems, and bilateral recurrent facial palsies, who had strongly positive serologic tests of Lyme borreliosis. To our knowledge, this is the first reported case of positive serologic tests for Borrelia burgdorferi in a patient with Cogan's syndrome.

Topics: Adult; Antibodies, Bacterial; Ceftriaxone; Enzyme-Linked Immunosorbent Assay; Facial Paralysis; Female; Hearing Loss; Hearing Loss, Bilateral; Humans; Keratitis; Lyme Disease; Penicillins; Serologic Tests; Syndrome