Multiple Subcutaneous Abscesses Research Articles

Multiple subcutaneous abscesses by Corynebacterium amycolatum in a patient with severe idiopathic aplastic anaemia

AbstractCorynebacterium amycolatum is a part of the normal skin flora and has been underestimated as a pathogen. However, in recent years, the species has gained recognition as an important pathogen causing severe infections, particularly in immunocompromised patients. Nevertheless, identifying these organisms at the species level is difficult in routine clinical microbiology, leading to limited knowledge of their clinical manifestations in infectious diseases. In this study, we report a rare case of multiple subcutaneous abscesses in a patient with severe neutropenia, wherein C.amycolatum was identified as the causative organism through genotyping tests. This case highlights the importance of this organism as an aetiological agent of severe skin infections in patients with compromised immune systems.

Disseminated Tuberculosis with Cutaneous Findings in an Immunocompetent Patient: A Case Report

BackgroundTuberculosis (TB) is one of the leading causes of infectious disease, and emergency medicine providers are often the first physicians to encounter patients with untreated or undiagnosed disease. Case ReportWe present the case of a 30-year old man with disseminated TB with multiple musculoskeletal and subcutaneous tubercular abscesses. The diagnosis was suspected in the Emergency Department, but his inpatient treatment was complicated by various social issues. Why Should an Emergency Physician Be Aware of This?This case highlights uncommon examination findings of TB and illustrates the importance of considering this disease when treating patients who present with atypical manifestations of it.

Melioidosis: A case of multiple subcutaneous abscesses with sepsis

Melioidosis has lately expanded its endemic areas to encompass the Indian subcontinent, despite being well-known in Southeast Asia and Northern Australia.Though cases have been reported from Bangladesh, it might be a significantly underdiagnosed cause of infection & death in this agricultural country. We report a case of melioidosis with multiple abscesses & fulminant sepsis in a 55-year-old farmer diagnosed based on pus samples, which revealed gram-negative bacillus Burkholderiapseudomallei. Bangladesh J Medicine 2022; 33: 308-311

Multiple subcutaneous tuberculous abscesses in a dermatomyositis patient without pulmonary tuberculosis: a case report and literature review

BackgroundEven though remarkable progress for diagnostics of pulmonary TB has been made, it is still a challenge to establish a definitive diagnosis for extrapulmonary TB (EPTB) in clinical practice. Among all the presentations of EPTB, cold abscesses are unusual and deceptive, which are often reported in the chest wall and spine. Subcutaneous abscess in the connective tissue of limbs is extremely rare.Case presentationA 48-year-old man with dermatomyositis was hospitalized because of multiple subcutaneous tuberculous abscesses in his limbs, but without pulmonary tuberculosis. Particularly, one insidious abscess appeared during anti-TB treatment due to “paradoxical reaction”. After routine anti-TB therapy, local puncture drainage and surgical resection, the patient was cured and discharged.ConclusionsTuberculous infection should be kept in mind for the subcutaneous abscess of immunocompromised patients, even without previous TB history. Treatment strategy depends on the suppurating progress of abscess lesions. Meanwhile, complication of newly-developed insidious abscess during treatment should be vigilant.

Multiple Subcutaneous Abscesses by MSSA Related to Peripherally Inserted Central Catheter Infection in an Extremely Low Birth Weight Infant

Multiple Subcutaneous Abscesses by MSSA Related to Peripherally Inserted Central Catheter Infection in an Extremely Low Birth Weight Infant

A Case of Barely Diagnosed Multiple Subcutaneous Abscesses Caused by <i>Mycobacterium chelonae</i> Intection

A Case of Barely Diagnosed Multiple Subcutaneous Abscesses Caused by <i>Mycobacterium chelonae</i> Intection

Noncontiguous multi-tiered spinal tuberculosis associated with sternal localization: a case report

BackgroundTuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare.Case presentationWe report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution.ConclusionsTo avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.

Spontaneous Remission of Subcutaneous Scedosporiosis Caused by Scedosporium dehoogii in a Psoriatic Patient

To date, only one case of post-traumatic endophthalmitis caused by Scedosporium dehoogii has been reported, but its contamination or colonization might not be precluded due to the absence of pathogenic isolation and/or pathological examination. We report the first case to our knowledge of S. dehoogii-induced subcutaneous scedosporiosis in a psoriatic patient. A 58-year-old man with 5-year history of psoriasis vulgaris and immunosuppressant therapy developed pyrexia and multiple subcutaneous abscesses on both knees. Direct microscopy of the yellowish pus showed masses of bright green short spores. Skin biopsy revealed some branched septate hyphae within the granuloma. Two aspirated pus specimens collected at a 1-week interval produced white cottony colonies on Sabouraud dextrose agar. Bacterial cultures of one blood and two purulent samples were negative, and fungal culture of blood sample was not performed. The isolate was identified as S. dehoogii using β-tubulin phylogeny and species-specific PCR with primer MSDE1/MSA2. Without addition of antifungal treatment, subcutaneous lesions disappeared spontaneously after immunosuppressant withdrawal and no relapse occurred during 64-month follow-up. The spontaneous recovery may result from immune reconstitution following immunosuppressant discontinuation.

Multiple Subcutaneous Abscesses Complicating Staphylococcus aureus Bacteremia associated with BCG Vaccination

Staphylococcus aureus (S. aureus) is one of the most common causes of pyogenic skin and/or soft tissue infections [1]. In bacterial infections, including staphylococcal infections, transient bacteremia are not rarely observed, in particular in febrile children with the infections, but occult severe infections such as sepsis, endocarditis, pneumonia, osteomyelitis, and disseminated multiple abscesses are uncommon in healthy children with bacteremia [2,3]. S. aureus bacteremia can be caused by various conditions including intramuscular injection. However, latter condition has been rarely described as a cause of staphylococcal abscesses and/or septicemia [4], and there are few case reports of bacteremia and subsequent multiple soft tissue abscesses that were originated from the intradermal injection site. We describe a case which had multiple subcutaneous abscesses on right anterior chest wall and osteomyelitis of left clavicle, caused by S. aureus, 1 week after an intradermal Bacillus Calmette-Guerin (BCG) vaccination.

FRI0013 Anti-IL-6 autoantibody inhibited elevation of serum C-reactive protein level in two patients with severe bacterial infection

BackgroundC-reactive protein (CRP) is an acute phase reactant, of which serum level is generally elevated in patients with bacterial infection and is useful in determining severity of infection and effectiveness...

Multiple subcutaneous abscesses: A rare presentation of cutaneous cryptococcosis

Multiple subcutaneous abscesses: A rare presentation of cutaneous cryptococcosis

Community acquired methicillin resistant Staphylococcus aureus pneumonia presenting along with multiple subcutaneous abscesses

Community onset necrotizing pneumonia due to community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is an emerging clinical entity, especially, following a viral infection, with substantial morbidity and mortality and survivors, have long-term pulmonary complications requiring treatment. The infectious diseases society of America guidelines has recently addressed the issue of MRSA as a possible pathogen that warrants empiric antibiotic therapy for community-acquired pneumonia (CAP) in patients requiring inpatient intensive care unit treatment, recommending the use of vancomycin or linezolid, with linezolid having an advantage due to its documented suppression of panton valentine leukocidin toxin production in CA-MRSA. We report a case of a child presenting with pyothorax and multiple subcutaneous absceses over the deltoid region. The pus from the abscesses and pyothorax and the expectorated sputum showed the growth of MRSA. The case was diagnosed as CA-MRSA pneumonia and was successfully treated with vancomycin but the patient required pulmonary decortications and long-term physiotherapy. The case highlights the importance of considering CA-MRSA in the initial empirical therapy for severe CAP and the long-term morbidity associated with this otherwise fatal disease.

A Case of Phaeohyphomycosis Caused by Exophiala oligosperma Successfully Treated with Local Hyperthermia

A 58-year-old Japanese woman who was engaged in dairy farming presented with multiple subcutaneous nodules and abscesses on the dorsum of her left hand from 5 months ago. These had been unsuccessfully treated with oral itraconazole. The patient had a history of Sjögren syndrome and diabetes mellitus, for which she had been taking oral prednisolone for 10 years. Direct microscopy of a pus sample treated with potassium hydroxide (KOH) showed brownish-red branching hyphae. In fungal culture, black colonies covered with gray-white villi were formed. Slide culture showed conidiogenesis from an annellide. The fungal strain was identified as Exophialia oligosperma by molecular biological techniques. Histopathological examination revealed abscesses and surrounding granulomatous infiltration in the dermis and subcutis, and hyphae in the granulomatous infiltration in the outer area. However, no eumycotic granules were observed. The diagnosis was phaeohyphomycosis caused by E. oligosperma. Since the previous treatment with itraconazole had not been effective, we performed daily hyperthermia using a disposable body warmer and drainage of the pus, which ceased after 3 weeks. After approximately 4 months, the skin eruptions became scarred. To the best of our knowledge, this is the second case of phaeohyphomycosis caused by E. oligosperma reported in Japan which was successfully treated with hyperthermia.

575 Iliopsoas Abscess in the Neonate with Immunodeficiency

Psoas abscess is rare, especially in the neonatal period. It may be primary or rarely secondary to extend on from adjacent structures or to bacteremia caused by distant cutaneous infections....

Mechanism of Influenza A Virus Mediated Inhibition of IL-23 Expression in Macrophage Cells

achieve an autopsy and numerous samples (on animals and the environment) for bacteriological, mycological, parasitological, histological and serological tests. Clinical information, results of autopsies and of histological examinations, results of other complementary tests and bacteriological culture of virulent R. equi strains on numerous samples allowed confirming an outbreak of rhodococcosis in adult equidae. The occurrence of unusual clinical forms of rhodoccoccosis (including multiple subcutaneous abscesses without pulmonary involvement) affecting exclusively the ponies seems to have a multifactorial origin with the intervention of a lack of acclimatization of the ponies to local climatic conditions (tropical humid lowland region) associated with constant hyperthermia even at rest, maybe some failures in the everyday breeding practices and the probable involvement of biting arthropods.

Recurrent insulin injection abscesses: Atypical etiology

Sir, A 63-year-old man with type 2 diabetes presented with a 2-month history of swellings and discharge over his thighs and abdomen at the injection sites of insulin. He was using glargine insulin for the past one year, once daily at night time, with vial and syringe. He used to change the syringe once in 3 days and follow the storage guidelines for the insulin.. His previous glycemic control was poor with evidence of microvascular and macrovascular complications and HbA1c of 10.2%. Clinical examination revealed normotensive individual with multiple subcutaneous abscesses over anterior abdominal wall and thighs [Figure ​[Figure1a1a and ​andb].b]. Pus drained from the abscesses did not stain any organism on Gram's stain and no organism was grown after 7 days culture in agar medium. The patient was treated initially with beta lactam antibiotics and cephalosporins without any improvement. Figure 1 Insulin site abscesses over anterior abdominal wall (a) and thighs (b) Repeat staining with Ziehl–Neelsen stain showed the presence of alcohol fast bacilli (AFB) and prolonged culture led to the isolation of the pathogen. Recurrent abscesses coupled with negative cultures led to the possibility of atypical organism. Positive AFB staining and culture characteristics of the bacteria confirmed the diagnosis of Mycobacterium chelonae as the underlying etiology of injection abscesses. Cultures from the tip of insulin syringe needles and insulin from the bottle did not reveal presence of this organism. He was treated with clarithromycin (500 mg thrice daily) and lineozolid (600 mg twice daily) for 8 weeks. The abscesses healed completely without any recurrence. M. chelonae is an atypical mycobacterium and is classified under rapid growers (Group IV of Runyon's classification).[1] The organism is present ubiquitously in the environment and is difficult to culture. Cutaneous infections are seen in immunocompetent individuals and disseminated disease in immunocompromised patients. The portal of entry commonly is skin, leading to cellulitis, granulomas, nodules, ulcers, and abscesses.[2] Disseminated infections lead to deep-seated infections like osteomyelitis, endocarditis, meningitis, and keratitis. M. chelonae is not amenable to antitubercular therapy and is sensitive to clarithromycin, linezolid, and ciprofloxacin.[3] Deep-seated infections require parenteral mode of therapy in addition to use of imipenem in resistant cases. To conclude, our case highlights the need to look for atypical organisms in cases of recurrent insulin injection site abscesses.

Chronic Myositis in an Australian Alpaca (Llama Pacos) Associated with Sarcocystis Spp

An alpaca (Llama pacos), born and raised in Australia, was presented with multiple subcutaneous abscesses. Histological findings indicated a severe necrotizing and histiocytic myositis and cellulitis associated with central caseation and multiple sarcocysts. Ultrastructural examination supported the diagnosis; however, cyst wall characteristics were not consistent with the 2 known species found in alpacas. While seroconversion in camelids is reported to be near ubiquitous, myositis is rare, and this is the first case reported outside of the Americas.

Corynebacterium Pseudotuberculosis Infection (Caseous Lymphadenitis) in Camels (Camelus Dromedarius) in Jordan

Problem statement: This study was conducted to describe and report for the first time outbreaks of natural C.pseudotuberculosis infection in adult camel herds (Camelus dromedarius) in Jordan. An infectious disease syndrome was reported in three camel herds (Camelus dromedarius) intensively raised at south province in Jordan. Approach: The herds included over 160 adult camels out of which about 8% were affected with multiple muscle and subcutaneous abscesses at various sites of the body. The camels were also heavily infested with ticks. Results: The infected camels did not respond favorably to several broad spectrum antibiotics. Post-mortem examination of 5 carcasses revealed emaciation and presence of external and internal multiple abscesses particularly in the lungs. The abscesses were encapsulated by fibrous tissue and contained creamy yellowish white pus. The lymph nodes were slightly congested and swollen. Conclusion: Corynebacterium pseudotuberculosis type I strain or biovar ovis (the known cause of caseous lymphadenitis in sheep) was isolated from pus, lymph nodes, ticks, milk, blood and liver samples. The clinical symptoms, nature and distribution of lesions of caseous lymphadenitis in camels are not as typical as in sheep. Recommendations for pseudotuberculosis control were given.

Immune Reconstitution Inflammatory Syndrome Presenting as Multiple Subcutaneous Cryptococcal Abscesses in an Organ Transplant Patient

Abstract An immune reconstitution-like syndrome associated with cryptococcosis has been recently described in immunocompromised patients such as organ transplant patients and those with HIV. Most commonly, the clinical presentation resembles an exacerbation of the initial infection that occurs after appropriate treatment. We report an organ transplant patient who presented with multiple subcutaneous cryptococcal abscesses distinct from his initial presentation.

Identification and control of an outbreak of ciprofloxacin-susceptible EMRSA-15 on a neonatal unit

We report the identification and control of an outbreak of a ciprofloxacin-susceptible strain of UK epidemic meticillin-resistant Staphylococcus aureus (EMRSA)-15 on a neonatal unit (NNU). All babies were screened for MRSA on admission using ciprofloxacin-containing media which did not detect the outbreak strain. The first identified case was a premature baby who developed MRSA bacteraemia with associated tibial osteomyelitis and multiple subcutaneous abscesses. The outbreak strain was subsequently identified in the nasopharyngeal secretions of a second child who was not clinically infected. Screening of all patients on the NNU using non-ciprofloxacin-media identified two other colonised babies. All four patient isolates were EMRSA-15, spa type t022, SCCmec IV, Panton-Valentine leucocidin (PVL) negative, indistinguishable by pulsed-field gel electrophoresis and susceptible to all non-beta-lactam antimicrobials tested. The outbreak strain was cultured from four of 48 environmental sites in a communal milk-expressing room. Unsupervised movement of mothers to and from the milk-expressing room may have contributed to the outbreak. Control measures included cohort isolation of affected babies, improved environmental cleaning, increased emphasis on hand hygiene and education of mothers. Ciprofloxacin-containing media should be used with caution for MRSA screening in settings where ciprofloxacin-susceptible strains (including community-associated MRSA) are increasing in prevalence.