trimethoprim--sulfamethoxazole-drug-combination and Muscular-Diseases

Although disseminated nocardiosis has been increasing with the expansion of immunosuppressive therapy and improvement in diagnostic methods, muscle abscess is a rare complication. There have been only nine case reports of muscle abscess due to Nocardia infection in the English-language published work. We present a case of muscle abscess with disseminated nocardiosis, and review the published work. The patient had been taking prednisolone at 20 mg a day for autoimmune hemolytic anemia for 14 years. She presented with erythema on her thigh resembling cellulitis. Computed tomography showed muscle abscess. The isolated organism was identified as Nocardia farcinica employing polymerase chain reaction and antibiotic sensitivity testing. The diagnosis of muscle abscess due to nocardiosis can be easily missed because there are no characteristic symptoms.

Topics: Abscess; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Immunosuppressive Agents; Middle Aged; Muscular Diseases; Nocardia; Nocardia Infections; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

Whipple's disease is a systemic bacterial infection that once was uniformly fatal and now is treatable with several different antibiotics in most cases. The exact nature of the Whipple's bacillus is unknown, since the organism cannot consistently be cultured. There is also controversy concerning the role of immunologic dysfunction in patients with Whipple's disease. In addition to the small intestine, Whipple's disease can involve the remainder of the gastrointestinal tract, as well as the lymph nodes, joints, nervous system, heart, eyes, hematopoietic system, lungs, liver, and other organs. The clinical manifestations, diagnosis, and treatment of this rare but fascinating disease will be reviewed in this article.

Topics: Bacterial Infections; Diagnosis, Differential; Drug Combinations; Eye Diseases; Heart Diseases; Hematologic Diseases; Humans; Joint Diseases; Lung Diseases; Lymphatic Diseases; Muscular Diseases; Nervous System Diseases; Penicillins; Skin Diseases; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Sarcocystosis is a zoonotic infection that causes intestinal and muscular illnesses in humans. Sarcocystosis was until recently considered rare in humans. To complete their life cycle, Sarcocystis species require both a definitive and an intermediate host. Humans are the definitive host when infected by one of two species: Sarcocystis hominis (from eating undercooked beef) or Sarcocystis suihominis (from eating uncooked pork). Infection with either of these species results in intestinal sarcocystosis, causing a self-limited disease characterized by nausea, abdominal pain, and diarrhea. Humans act as the intermediate host when infected by Sarcocystis nesbitti, resulting in the markedly different clinical picture of muscular sarcocystosis. Most documented cases of muscular sarcocystosis were assumed to be acquired in Malaysia, in addition to other regions of Southeast Asia and India. Published cases of muscular sarcocystosis from the Middle East, Central and South America, and Africa are all rare. Although the clinical presentation of muscular sarcocystosis remains to be fully characterized, fever, myalgia, and headache are among the most common symptoms. Here, we report a patient from sub-Saharan Africa with chronic Sarcocystis myopathy and well-controlled HIV-AIDS.

Topics: Acquired Immunodeficiency Syndrome; Africa South of the Sahara; Anti-HIV Agents; Antiparasitic Agents; Canada; Glucocorticoids; Humans; Male; Middle Aged; Muscular Diseases; Sarcocystis; Sarcocystosis; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Muscles; Actinomycosis; Anti-Infective Agents; Biopsy, Needle; Combined Modality Therapy; Diagnosis, Differential; Humans; Male; Middle Aged; Muscular Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

An 82-year-old man was referred to our hospital because of bilateral leg swelling and ecchymosis. A hemostatic study showed prolonged aPTT, <1% factor VIII coagulant activity, and a high titer (30.4 Bethesda Units/ml) of factor VIII inhibitor. The diagnosis of acquired hemophilia A (AHA) was made, and treatment with prednisolone (PSL) was started. Within one month of treatment, the hemorrhagic symptom disappeared, aPTT levels returned to normal, and his factor VIII inhibitor was eradicated; however, factor VIII inhibitor was detected again when PSL was decreased to 10 mg/day. We then added cyclosporine A (CyA) to PSL as a second line salvage therapy. CyA therapy resulted in the resolution of AHA with marked and prolonged efficacy; however, hot, red tumors appeared in his right arm and left thigh. Needle aspiration of the tumors revealed muscle abscess, and Nocardia brasiliensis was isolated. We started treatment with sulfamethoxazole-trimethoprim, and the abscess healed promptly without recurrence.

Topics: Abscess; Aged, 80 and over; Biopsy, Fine-Needle; Cyclosporine; Hemophilia A; Humans; Immunocompromised Host; Male; Muscular Diseases; Nocardia Infections; Opportunistic Infections; Prednisolone; Salvage Therapy; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination