trimethoprim--sulfamethoxazole-drug-combination and Mediastinal-Diseases

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is routinely performed for diagnostic evaluation of mediastinal lymphadenopathy due to various etiologies with excellent sensitivity and specificity. Melioidosis can have atypical features like isolated mediastinal lymphadenopathy mimicking as tuberculosis or lymphoma. Differentiation of such atypical melioidosis presentation become difficult due to similar clinical, radiological and even similar EBUS lymph node characteristics. Role of EBUS TBNA in diagnosing melioidosis is under investigated and sparsely reported. We describe two cases of melioidosis diagnosed by point of care rapid lateral flow immunoassay antigen testing and culture of EBUS-TBNA samples from necrotic mediastinal lymph nodes.

Topics: Administration, Intravenous; Administration, Oral; Aged; Anti-Bacterial Agents; Burkholderia pseudomallei; Doxycycline; Drug Therapy, Combination; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Immunoassay; Lymph Nodes; Lymphadenopathy; Male; Mediastinal Diseases; Melioidosis; Meropenem; Sensitivity and Specificity; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aftercare; Anti-Bacterial Agents; Drug Therapy, Combination; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Linezolid; Lymphadenitis; Male; Mediastinal Diseases; Mediastinum; Middle Aged; Nocardia; Nocardia Infections; Positron Emission Tomography Computed Tomography; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Chest Pain; Cough; Diagnosis, Differential; Doxycycline; Humans; Lung; Lung Diseases, Fungal; Male; Mediastinal Diseases; Middle Aged; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis

Nocardiosis is a rare, mixed suppurative and granulomatous, bacterial infection that can affect various organs, but most commonly lungs. Clinical manifestation is usually uncharacteristic; can mimic fungal, parasitic and mycobacterial infections or malignancy. Presentation can be also similar to that of the other granulomatous diseases, among them sarcoidosis. We present an unusual case of disseminated nocardiosis in a patient diagnosed before with sarcoidosis and treated with glucocorticoids. Clinical symptoms initially mimicked exacerbation of pulmonary sarcoidosis. The course of disease was severe.

Topics: Abscess; Adult; Anti-Infective Agents; Diagnosis, Differential; Disease Progression; Glucocorticoids; Humans; Male; Mediastinal Diseases; Methylprednisolone; Nocardia Infections; Opportunistic Infections; Sarcoidosis, Pulmonary; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination