Non-immunocompromised Patient Research Articles

Spontaneous clostridial myonecrosis with abdominal involvement in a nonimmunocompromised patient

Spontaneous clostridial myonecrosis is a rare but aggressive disease usually associated with underlying immunosuppression or malignancy. We present a fatal case of clostridial myonecrosis arising in a patient with intact immune defenses.

Pasteurella Multocida Abscess Complicating a Femoral Vein Thrombosis

We describe the first reported case of a Pasteurella multocida thigh abscess complicating a femoral vein thrombosis in a non-immunocompromised patient with no history of animal bites or scratches.

Nocardiose cérébrale après une plaie oculaire traumatique

We report a case of multiple brain abscesses related to Nocardia asteroides infection, occurring after an ocular wound in a non-immunocompromised patient.

Case report: Frontal aspergilloma — A complication of paranasal aspergillosis

Aspergillosis is a rare cause of intracranial disease in the non-immunocompromised patient. We report a case of invasive paranasal aspergillosis with extensive frontal lobe involvement, and discuss the role of computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosis.

Successful orthotopic liver transplantation in a patient with refractory biliary candidiasis

The authors present a nonimmunocompromised patient who developed refractory fungal (Candida albicans) cholangitis and who subsequently underwent successful orthotopic liver transplantation for progressive destruction of intrahepatic and extrahepatic bile ducts. Liver biopsy specimens showed periductal abscesses, and cholangiograms showed rapidly progressive destruction of intrahepatic and extrahepatic bile ducts. Standard immunosuppressive therapy and perioperative amphotericin B were administered. At 6 months, the patient was clinically well with no evidence of recurrent biliary candidiasis. The authors suggest that orthotopic liver transplantation may be a reasonable therapeutic option for patients with refractory biliary candidiasis.

Cutaneous Histoplasma capsulatum in a nonimmunocompromised patient with previously treated cutaneous Mycobacterium kansasii

This report describes a black woman with a history of cutaneous Mycobacterium kansasii responsive to antituberculous drugs. A culture several years later of cutaneous lesions was also positive for Histoplasma capsulatum. Both cutaneous diseases are rare and most often occur in immunocompromised hosts. There is no known association between these two diseases. This patient may have an as-yet unidentified immunodeficiency that predisposes her to these rare infections. Her case emphasizes the importance of repeat biopsy for atypical skin lesions.

Acute Diverticulitis

We reviewed the records of 209 patients with acute diverticulitis treated from 1984 through 1989 to determine if immunocompromised patients have a worse prognosis than nonimmunocompromised patients. Forty immunocompromised patients and 169 nonimmunocompromised patients with acute diverticulitis were identified. Free perforation into the peritoneal cavity occurred in 43% (17/40) of immunocompromised patients and 14% (24/169) of nonimmunocompromised patients. Operations were performed in 58% (23/40) of immunocompromised patients and 33% (55/169) of nonimmunocompromised patients. Postoperative morbidity was 65% (15/23) in immunocompromised patients and 24% (13/55) in nonimmunocompromised patients; postoperative mortality was 39% (9/23) and 2% (1/55), respectively. We conclude that acute diverticulitis in the immunocompromised patient is a complicated problem; there is a greater risk of free perforation and need for surgery than in the nonimmunocompromised patient. Furthermore, the prognosis for immunocompromised patients who undergo surgery is worse than that for nonimmunocompromised patients.

Progressive Pulmonary Cryptococcal Infection in a Nonimmunocompromised Host

DOI: http://dx.doi.org/10.5915/23-1-15228 This case report describes a 29-year-old, non-immunocompromised patient who presented with pulmonary and central nervous system (CNS) cryptococcosis. While the neurological infection responded to systemic antifungal therapy, the pulmonary infection progressed, necessitating an excision of the pulmonary lesion. Subsequently the patient had a fatal relapse of cryptococcal meningitis. We are reporting this interesting and informative case because of extensive pulmonary and CNS cryptococcosis in the presence of a normal immune status.

上肢静脈血栓様症状で発症した劇症Ａｅｒｏｍｏｎａｓ ｈｙｄｒｏｐｈｉｌａ敗血症の１例

We report a case of Aeromonas hydrohila septicemia in a previously healthy and non-immunocompromised patient without any trauma. The onset was sudden with symptoms resembling acute deep vein thrombosis. Shortly, the patient suffered progressive myonecrosis and gas gangrene with rapid fatal outcome. A 55-year-old man noticed left elbow pain 12 hours prior to admission. The left upper extremity was diffusely swollen with several hemorrhagic bullae on the dorsum of the hand and forearm. Angiographic findings revealed no obstructive changes in the vein. Despite the intensive therapy, his general condition progressively worsened, and gas production with a foul odor began. With the diagnosis of gas gangrene, disarticulation of the left upper extremity was performed. Postoperatively, the patient became hypotensive without response to intravenous fluid and cathecholamines and he died 24 hours after admission. Aeromonas hydrophila was identified from samples of arm muscle and blood obtained at the operation.

Tracheal Stenosis and Failure to Wean from Mechanical Ventilation due to Herpetic Tracheitis

A 64-year-old man with chronic obstructive pulmonary disease presented with pneumococcal pneumonia that progressed to respiratory failure within one week, requiring mechanical ventilation. Despite a low minute ventilation and clear chest roentgenogram, multiple weaning attempts failed. Bronchoscopy revealed significant narrowing of the distal trachea with erythema, edema, and ulceration of the mucosa. Cytology of tracheal washings was consistent with herpes simplex virus, and the patient was successfully extubated following treatment with intravenous acyclovir. Bronchoscopy following acyclovir therapy demonstrated resolution of the inflammation and narrowing. Herpetic tracheitis is a rarely recognized reversible cause of tracheal stenosis, especially in a nonimmunocompromised patient. It should be suspected in patients without an obvious cause of failure to wean from mechanical ventilation, and can be successfully treated with acyclovir.

Haemophilus influenzae type b cellulitis of the lower extremity in a non-immunocompromised elderly patient.

An 83-year-old non-immunocompromised man who developed Haemophilus influenzae cellulitis on his lower left leg is described. H. influenzae type b was isolated by conventional bacteriological cultures from one blood culture and from a cutaneous blister fluid aspirate, and identified within the dermis by immunofluorescence on a punch biopsy of lesional skin. Evolution was characterized by a slow healing during appropriate systemic antibiotherapy, and absence of any significant increase in antibodies to the capsular polysaccharide of H. influenzae type b.

Lovastatin-induced acute rhabdomyolysis

Severe rhabdomyolysis complicated by respiratory and renal failure developed three weeks after initiation of low dose lovastatin therapy in a 79 year old, non-immunocompromised patient. The concomitant use of gemfibrozil may increase the risk of this complication.

Primary Cerebral Abscess due to Nocardia Presenting as ‘Ghost Tumor’

We report a case of a primary cerebral abscess due to Nocardia asteroides in a nonimmunocompromised patient with a particular clinical course. The first symptom (right subacute brachial palsy) and the lesion in a computed tomographic (CT) scan (left parietofrontal edema suggestive of brain tumor) disappeared after corticosteroid treatment and the patient was discharged with total recovery. After 2 months she complained of headache and visual disturbance. A new CT scan showed an annular lesion in the left occipital lobe. A cerebral biopsy was diagnosed of nocardia infection. The patient died 2 weeks after this biopsy. A postmortem study showed an occipital brain abscess but not structural abnormalities were seen in the left parietofrontal area. We believe that the first episode could be a local inflammatory response to cerebral implantation of nocardia which disappeared clinically in the CT scan and in the postmortem study after corticosteroid treatment. Then the nocardia could have displaced by the hematological route to the second and definitive cerebral lesion.

Coccidioidomycosis

The significance of coccidioidomycosis is heightened by the rapid population growth in the American Southwest, increased travel to and through the area, and the rise of this deep fungal infection as an opportunistic infection in immunocompromised patients. Prevalence rates appear to be declining in some endemic areas, probably because of environmental factors, and a reduction in morbidity and mortality from disseminated disease has been noted. Approximately half of all symptomatic infections have cutaneous manifestations, and the skin is the organ most frequently involved in cutaneous coccidioidomycosis, with a challenging diversity of morphologic presentations. Spherulin has improved the sensitivity of skin testing, and serodiagnostic techniques have been refined. Ketoconazole has a definite role in the treatment of many cases of disseminated disease, and itraconazole appears very promising. With current treatment, prognosis in the nonimmunocompromised patient is excellent.

Inflammatory Lesions of the Basal Ganglia and Thalamus: Review of Twenty-one Cases

We report a series of 21 patients with basal ganglia and thalamic granulomas or abscesses treated over 7 years. Among them, 15 were tubercular, 5 were pyogenic, and 1 was fungal. Pyogenic abscesses, usually hematogenous, also occurred secondary to osteomyelitis of the skull and chronic otitis media. The fungal abscess developed in a nonimmunocompromised patient with no intercurrent malignancy. Evidence of tuberculosis elsewhere in the body was detected in only 7 patients with tuberculomas. The computed tomographic (CT) image morphology characterizing an abscess or a tuberculoma was present in all except 2 patients with tuberculomas. The fungal abscess resembled a malignant glioma. The only hospital mortality occurred in a deeply unconscious patient with a thalamic pyogenic abscess. A 12-month or longer follow-up in 16 patients showed that 3 continued to be handicapped neurologically, and 2 died 13 and 16 months later, respectively. We conclude that inflammatory lesions at these sites are not uncommon and that CT scans are diagnostic in the great majority. Doubtful diagnosis merits stereotactic aspiration or biopsy of the lesion. Satisfactory results follow adequate medical therapy.

Invasive mucormycosis in a non-immunocompromised patient

Primary invasive cutaneous mucormycosis in a non-immunocompromised patient is described. Cultures from the infected tissues yielded a zygomycete which was identified as Saksenaea vasiformis. The patient was successfully treated with debridement of the lesion and amphotericin B.

Solitary pulmonary nodule due to cryptococcus neoformans and mycobacterium tuberculosis

This report describes a rare combined infection of Cryptococcus neoformans and Mycobacterium tuberculosis that manifested as a solitary pulmonary nodule in a nonimmunocompromised patient. Transthoracic needle aspiration biopsy was initially nondiagnostic, and histopathologic and culture confirmation of the diagnosis was eventually attained after wedge resection of the nodule. An extensive review of the English literature failed to reveal any reported cases of such a combined infection with a similar clinical presentation. The variable morphologic features of C. neoformans in tissue sections and the protean histologic features of pulmonary cryptococcosis can lead to diagnostic difficulties, as illustrated by this case.

Cytomegalovirus infection with acute erosive esophagitis

A healthy young adult is described in whom acute erosive esophagitis developed four weeks after undergoing splenectomy and receiving six units of blood because of trauma. Cytomegalovirus inclusion bodies were identified in esophageal mucosa, and Cytomegalovirus was cultured from blood and throat. Within three weeks, the patient's anticytomegalovirus antibody had increased four-fold. The patient was initially anergic and had a titer of antinuclear anti-body of 1:10,240. His symptoms and histopathologic findings disappeared over five weeks, and his immunologic abnormalities were partially corrected. It is suggested that Cytomegalovirus was the primary cause of gastrointestinal disease in this nonimmunocompromised patient.

INVASIVE PROCEDURES FOR DIAGNOSING PULMONARY INFECTION: A Critical Review

SUMMARY AND CONCLUSIONS Several diagnostic modalities are available to the clinician seeking the cause of pulmonary infiltrates in either the immunocompromised or nonimmunocompromised patient. The four procedures discussed herein should be regarded as complementary. For example, bronchoscopy is done for more central lesions, aspiration lung biopsy for more peripheral lesions or focal pulmonary processes, and bronchoscopy or open lung biopsy for more diffuse processes. Clearly, the immunocompromised patient is at great risk from diffuse or focal lung disease, and a rapid, specific etiologic diagnosis is vital. There is disagreement regarding the question of whether outcome is influenced by invasive diagnostic procedures. Until prospective data are available indicating which circumstances, if any, clearly do not warrant an aggressive approach to diagnosing lung infection in immunosuppressed patients, we suggest that a sequential series of steps be carried out to attempt to diagnose specifically the cause of pulmonary infiltrates in these patients. Which procedures are chosen should be based upon the diagnostic yield at the institution treating patients with suspected lung infection.