Wide Spectrum Antibiotic Therapy Research Articles

ACUTE DESTRUCTIVE HIP SEPTIC ARTHRITIS IN A YOUNG ADULT PATIENT: CASE REPORT (v2)

The Authors describe a case of rapid right hip destructive septic arthritis in a 50-year-old male patient with no previous noteworthy medical history. Patient arrived to our attention following a one week history of right hip pain. Laboratory markers and imaging at presentation were negative. However, on a follow-up examination significant joint effusion was noted and joint tap was performed. Despite wide spectrum antibiotic therapy institution, significant joint damage was observed. This required surgical femoral head excision with antibiotic loaded spacer, followed by hip arthroplasty surgery 12 weeks afterwards. Complete healing of the infection and recovery of pain-free joint motion was noted at 1 year follow-up.

Evaluation of the effect of vacuum assisted closure in the surgical management of Fournier's gangrene: A single center experience

Fournier's gangrene is a surgical emergency arising in the perineum and genital area and is characterized as necrotizing fasciitis of the perineum and genital area. It quickly spreads between the fascial planes and causes soft tissue necrosis. Diabetes mellitus is the most prevalent predisposing factor. Early diagnosis and management are critical in the progression of the disease. Surgical debridement and wide-spectrum antibiotic therapy are the first steps in treatment. Despite advancements in diagnosis and treatment procedures and changes in critical care techniques, the disease has a death rate of 16-40%. This research compares patients operated on for Fournier's gangrene between January 2016 and January 2022, including those treated with vacuum-assisted closure technique, vs those who were not. We acquired and analyzed the data on the patients' demographic and clinical features from hospital records. The study involved 16 patients, six (38%) in Group 1 and 10 (62%) in Group 2, 11 men (68 %) and five women (32%). Swelling in the wound region was the most prevalent complaint. The most common gangrene site was the perianal region, and diabetes was the most common predisposing condition. Group 2 had a significantly shorter hospital stay (p=0.02). There was no statistically significant difference in mortality or other parameters between the groups. The main advantages of VAC therapy are that it requires fewer dressings, causes less pain, and reduces the risk of contamination. The advantages of the traditional wet dressing include its ease of use and low cost and the fact that VAC therapy promotes faster wound healing and shorter hospital stays.

Retropharyngeal abscess as an example of a deep neck infection in children

Deep neck infections are severe complications of the inflammatory processes in the upper respiratory tract. They can be divided into retropharyngeal, parapharyngeal, peritonsillar and submandibular abscesses, depending on the affected region. Deep neck infections are considered as acute bacterial complications with a progressive course and life-threatening character and that’s why they require immediate wide-range, intravenous antibiotic therapy. A 7-year-old female patient presented to her general practitioner with persistent, recurrent fever lasting for 3 days. Fever subsided after 2 days of antibiotic therapy, but she developed trismus, severe sore throat, especially on the right side, radiating to the right ear and dysphagia. The patient was referred to the Pediatric Otolaryngology Department as a matter of urgency. On examination she had enlarged lymph nodes on the right side of the neck with limited head and neck movements to the right side and posteriorly. There was also an asymmetry of the pharynx behind the right palatopharyngeal arch observed. Laboratory blood tests showed high CRP level (3.84 mg/dl, n < 0.5). CT scan was performed and showed multiloculated abscess in right retropharyngeal space. Our patient was qualified for the surgical procedure – drainage of the abscess under general anaesthesia together with wide spectrum antibiotic therapy in a form of cefuroxime and clindamycin. During procedure a large amount of pus was evacuated, and a sample was sent for microbiological results. It showed growth of Staphylococcus hominis, probably multiplication of local physiological colonization. She also received anti-inflammatory drugs and has had physiotherapy throughout the hospitalization period to prevent torticollis. We observed gradual local and general improvement, together with normalization of the inflammatory markers. She was discharged from the hospital after 7 days of intravenous treatment. Accurate diagnosis and immediate proper treatment of deep neck infections are essential in prevention of further local (to the surrounding regions) and general expansion (like thrombosis, sepsis, meningitis) of the inflammatory process and of persistent changes (like stenosis of the respiratory tract). Fortunately, in the post-antibiotic era most patients are fully healed, further complications are almost unseen and mortality rates are low.

Vesico-Vaginal and Recto-Vaginal Fistula and Death Caused by a Vaginal Foreign Body in a Body-Packer

Foreign body retained for long duration sometimes causes vesico-vaginal and recto-vaginal fistula. We report a 60-year-old woman with vaginal foreign body causing vesico-vaginal and recto-vaginal fistula; she died after foreign body removal due to septic shock. The patient had vaginal purulent discharge, abdominal pain, and a septic shock. A fragment of stone (limestone) was present in the vagina, which was removed. The patient developed urinary incontinence and fecal incontinence after removal of the foreign body. The examination demonstrated the presence of vesico-vaginal and recto-vaginal fistula. The patient died four days after removal of the foreign body due to septic shock and multi-visceral failure. During the extraction foreign body, bacteria could be disseminated into the systemic circulation and might cause septic shock. Thus, wide-spectrum antibiotic therapy must be used before the procedure, which may decrease the chance of septic shock.

Necrotizing descending mediastinitis by Acinetobacter Baumannii in an out-patient: a case report

BackgroundComplicated cervico-facial cellulitis is an infectious disease which can have fatal prognosis. Necrotizing descending mediastinitis is a rare and fatal complication of cervico-thoracic cellulitis. This is the case of necrotizing descending mediastinitis complicating by a multi-resistant Acinetobacter Baumannii in a 27-year-old female, with early management of hemodynamic, respiratory and surgical emergencies, and very careful post-operative care, resulting in very satisfying outcome.Case presentationThe patient presented was first treated with broad spectrum antibiotics for Ludwig’s angina for 10 days, then presented with a swelling of sub-mandibular, sub-mental, and cervical regions, a mild respiratory distress, with clinical enhancement of dyspnea in proclive position, tachycardia of 100 beats per minute, and arterial blood pressure of 10/5.Clinical exam showed a tight trismus, with oral opening inferior to 1 cm, no inflammatory signs in facial and cervical swollen areas, and a saturation of 95% in proclive position. Auscultation suspected a pericardial effusion.CT scan with and without injected contrast medium showed diffuse abscesses of sub-mental, sub-mandibular, retro-pharyngeal, para-pharyngeal regions, along with mediastinal abscesses and pericardial effusion. Trans-thoracic ultrasound showed 2 cm pericardial effusion, preserved function of myocardium, and without signs of tamponade.The diagnosis of necrotizing descending mediastinitis with pericardial effusion was established.The patient underwent a course of wide spectrum antibiotic therapy, low doses of cathecholamine, and a surgical drainage through cervical approach of all implicated zones. The surgical dissection was thorough and difficult due to diffuse fibrosis found in tissues of cervical regions. Two hundred milliliters of pus was evacuated, with a placement of surgical drains and Delbet blades.Bacteriological exam found an Acinetobacter Baumannii sensitive to colistin only.The post-operative outcome showed clinical and biological enhancement; however, a residual mediastinal collection appeared in control CT scan after 48 h, which indicated a surgical revision through mediastinoscopy.The post-operative outcome was satisfying with stabilized clinical, biological, and radiological aspects.ConclusionsNecrotizing descending mediastinitis is an infectious disease correlated with a very elevated mortality rate, and management is based on airway control, antibiotic therapy, and surgical treatment, as well as the post-operative intensive unit care.Early diagnosis and appropriate management enhances outcome and decreases mortality significantly.

"Pyoderma gangrenosum of the breast: A challenging diagnosis".

Pyoderma gangrenosum (PG) of the breast is a rare, ulcerative disease of rapid onset normally associated with systemic disorders and triggered by surgery or trauma. Pyoderma gangrenosum poses a diagnostic challenge. Early diagnosis and appropriate treatment are essential to minimize morbidity and sequelae. We performed a retrospective review of all breast PG cases admitted to Cruces University Hospital over a 5-year (2015-2019) period. Medical history, clinical course, and management strategies were assessed. Three patients were analyzed. None of them had previous surgery. No definitive etiology was identified in one case, and the other two were probably biopsy-driven. Histological findings were reported as nonspecific. Similar skin lesions elsewhere on the body and resistance to wide-spectrum antibiotic therapy were observed. These features raised awareness on the diagnosis of PG. Ulcerations healed completely within 2months following treatment with Cyclosporine A or corticosteroid therapy. A complicated late-diagnosis case that presented with advanced breast and forearm necrosis was managed with steroids followed by trans-forearm amputation and mastectomy. The breast is an unusual site for PG, but this differential diagnosis should be considered in the presence of breast ulceration. In patients with a strong clinical and histological PG suspicion, we suggest early management with systemic corticosteroids and immunosuppressive therapy prior to any surgical debridement to minimize morbidity and poor esthetic outcomes.

Complex clinical and therapeutic rehabilitation approach of a patient with complete AIS/Frankel A tetraplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study

Introduction: Spinal cord injury is a complex neurologic condition that embeds multiple complications, which are often debilitating for patients as the disease progresses. Materials and Methods: This paper presents a case of a 44-year-old patient with a longilin asthenic constitution and no previous medical history, who accidentally fell off a trailer resulting in burst fracture dislocation of C6/C7 associated with immediate loss and consciousness and onset of complete ASIA-A tetraplegia with C5 neurologic level. The patient received a complex nursing program, which included extensive debridement of the necrotic tissue, daily antiseptic wound dressing using Chloramine solution and silver sulfadiazine cream along with wide-spectrum antibiotic therapy with slow but favorable progression. During hospitalization the patient developed an episode of respiratory distress which responded favorably to Levocetirizine daily. Results: The complex neuro-muscular rehabilitation program along with the medical treatment and surgical debridement the patient received have improved of the clinical outcome with the shrinkage of the pressure point lesions, adequate respiratory function which permitted the mobilization of the patient with the wheelchair. Conclusions: Patients with spinal cord injuries are prone to a vast majority of complications including pressure sores complicated with necrotizing fasciitis and respiratory distress that could alter the quality of life. Proper monitoring and management of these kind of complications in the context of neuromuscular rehabilitation are necessary for the enhancement of the quality of life. Key words: spinal cord injury, tetraplegia, complications,

Hyperbaric oxygen therapy as adjuvant therapy in necrotizing fasciitis of the face: case report

Facial necrotizing fasciitis is a rare bacterial infectious disease. Rapid necrosis of the tissues and suppurative fasciitis is pathognomonic. It can be seen following odontogenic infection. Early aggressive debridements and wide-spectrum antibiotic therapy are currently accepted treatments. A 60-year-old man was admitted to the otolaryngology clinic for facial pain and swelling after odontogenic infection. Inflamed left maxilla and orbit were seen, and abscess contents spontaneously drained into the mouth. It was determined that infectious markers were increased in the blood. On MRI, a broad abscess with edema and gas formation was seen. Debridement of the necrotic tissue was performed immediately and wide-spectrum antibiotic therapy was started. Infection was stopped and wound was closed, with four weeks of antibiotic therapy, three sessions of debridement, and 30 sessions of hyperbaric oxygen (HBO2) therapy. HBO2 therapy must not replace the combination of early aggressive debridements and wide-spectrum antibiotic therapy, but rather must be considered as an important adjuvant treatment.

Pelvic Thrombophlebitis: a Case Report of a 34-Year-Old Woman with Klebsiella Positive Blood Culture

Background: Septic Thrombophlebitis is one of the rare complications of hysterectomy, which is well known through an uncontrolled fever after wide spectrum antibiotic therapy. One of the very rare pathogens to cause bacteremia in this situation is Klebsiella pneumonia, which is a vaginal normal flora. Although it is accepted that the main treatment for thrombophlebitis is anticoagulant therapy, however, in cases with co morbid bacteremia antibiotic therapy remains a critical procedure.Cases Report: We present a case with a history of recent hysterectomy who was admitted to the Vali-e-Asr hospital of Zanjan with uncontrolled high fever 72 hours after her surgical procedure.Conclusion: Fever is one of the most common post-surgical complications which could be due to post- operative infections. Thrombophlebitis of pelvic veins is one of the very rare complications which can alternatively cause bacteremia. Although uncommon, Klebsiella could be the leading cause of bacteremia. So it is important to consider a thorough work up in patients presenting with fever after hysterectomy.

Abdominal Wall Necrotizing Fasciitis - A Hidden Presentation

A 55-Year-Old female, known case of type 1 diabetes, presented to the emergency department complaining of weakness and Abdominal Pain. The pain was constant, initiated since 10 days ago and was localized at the Right side of the Abdomen. She had no fever, vomiting or abnormal Bowel habits. Initial vital signs were as followings: Blood pressure: 110/60 mmHg, Pulse Rate: 120/min, Respiratory Rate: 18/min, Oxygen Saturation: 93% (Room Air), Oral Temperature: 37.8°C. On inspection, the patient had mild erythema on the area (from inguinal ligament up to lower costal margin) without any bulla or discharge. Crepitation was found by palpation of the skin. Other parts of the abdomen were soft without any tenderness or guarding. Supine Abdominal X-ray (Figure 1) revealed gas formation at the Right Side of the abdomen; the finding was confirmed by an emergent non-contrast abdominal Computed tomography (Figure 2). Primary Laboratory tests showed: Hemoglobin: 11.5 g/dl, white blood cell count 16.2 × 103 /ml (neutrophil 85%), mild hyponatremia (Na 127 mmol/l), hyperkalemia (K 5.5 mmol/l), serum creatinine 1.8 mg/dl and urea 50.2 mmol/l. The ultimate diagnosis was Abdominal necrotizing Fasciitis. Along with immediate resuscitation with intravenous fluid and antibiotics, patient was prepared and transferred to operating room. Unfortunately Despite prompt extensive surgical debridement, wide spectrum antibiotic therapy and 2 days of intensive care, unfortunately, the patient did not survive. Discussion Necrotizing fasciitis is a critical diagnosis that needs aggressive debridement, and broad spectrum antibiotic therapy. In 85% of cases, at first examination, necrotizing fasciitis has misleading clinical manifestations [1]. There are cases of necrotizing fasciitis that just presented as mild cellulitis [2]. Necrotizing fasciitis has dire outcomes in 50% to 80% of patients [3]. Mortality depends on comorbid diseases and complications that would rise during the course of the disease (acute renal insufficiency, acute respiratory distress syndrome, multi-organ failure) [4]. Conclusion Necrotizing fasciitis should always be considered as a critical diagnosis, especially in immunocompromised and diabetic patients.

Lemierre's syndrome from odontogenic infection: Review of the literature and case description.

Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: “Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival.” We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.

Small bowel diverticulitis with severe anemia and abdominal pain

The current case report is related to a male patient with diabetes, obesity [body mass index (BMI) 33], hypertension and recurrence of anemia associated to melena and deep asthenia. M.P., a 60-year-old obese individual, was referred to our department by the primary care unit (PCU) of our hospital for severe anemia (Hemoglobin 6.5 g/dL) associated to episodes of melena and abdominal pain. In the past 5 mo the patient referred to the local hospital 3 times for episodes of melena (hemoglobin levels showed anemia 9.8 g/dL) but the main gastroenterological exams were completely negative (colonoscopy and gastroscopy). The PCU of our Hospital, after stabilization of the main parameters and blood transfusion for the low levels of hemoglobin, referred the patient to gastroenterologists: the patient was subjected to both colonoscopy and gastroscopy that were negative. Due to the condition of acute severe hemorrhage the patient, during the first 3 h from the access to the PCU, was subjected to arteriography that did not reveal any hemorrhagic foci or vascular alterations. The video capsule for the study of the small bowel showed the presence of blood beginning from the third portion of duodenum but deep gastroscopy did not reveal it. The patient was then subjected to double balloon endoscopy that revealed a severe diverticulosis of the small bowel with blood from the diverticula. The entero-tomografia computerizzata confirmed the diagnosis and revealed an extension of the diverticula for almost the entire small bowel (no diverticula in the colon). The patient was subjected to wide spectrum antibiotic therapy with resolution of the symptoms and stabilization of hemoglobin levels. The surgeon suggests no indication to surgery for the wide area involved from the disease and potential high risk of complication due to the high BMI. At home, the patient started a monthly therapy with rifaximin and probiotics associated to mesalazine. At present, after 12 mo from the last episode of hemorrhage, the patient is in good clinical condition, reduced his body weight of about 7 kg and the hemoglobin levels appear in slow progressive increase (last measurement 13.2 g/dL).

Platelet‐rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections

Despite the large choice of wide-spectrum antibiotic therapy, deep sternal wound infection (DSWI) following cardiac surgery is a life-threatening complication worldwide. This study evaluated that the use of platelet-rich plasma (PRP) applied inside the sternotomy wound would reduce the effect of sternal wound infections, both superficial and deep. Between January 2007 and January 2012, 1093 consecutive patients underwent cardiac surgery through median sternotomy. Patients were divided into two groups. Group B, the study group, included those who received the PRP applied inside the sternotomy wound before closure. Group A, the control group, included patients who received a median sternotomy but without the application of PRP. Antibiotic prophylaxis remained unchanged across the study and between the two groups. Occurrence of DSWI was significantly higher in group A than in group B [10 of 671 (1·5%) versus 1 of 422 (0·20%), P = 0·043]. Also, superficial sternal wound infections (SSWIs) were significantly higher in group A than in group B [19 of 671 (2·8%) versus 2 of 422 (0·5%), P = 0·006]. The use of PRP can significantly reduce the occurrence of DSWI and SSWI in cardiac surgery.

Pituitary tumor apoplexy presenting as infective meningoencephalitis

We report on a case of a 80-year-old man who developed progressive drowsiness with headache, fever and signs of meningeal irritation 2 days after a head trauma. Suspecting an infective meningoencephalitis, the patient was treated with wide spectrum antibiotic and antiviral therapy. Brain CT scan revealed a previously unknown pituitary expansive lesion. A brain MRI study confirmed the presence of an intrasellar lesion, which presented remarkable contrast ring enhancement, and showed non-specific inflammatory tissue on the clivus, possibly responsible of the clinical features of sterile meningitis. A biopsy proven diagnosis of pituitary apoplexy was made. This case highlights MRI as an important investigation for earlier recognition of pituitary apoplexy that can present with a clinical picture resembling an infective meningoencephalitis.

Peritonitis terciaria: tan difícil de definir como de tratar

Tertiary peritonitis is the most delayed and severe outcome of patients with complicated intra-abdominal infections. The major difficulty lies in giving a common, precise and consensus definition in order to know when to make its diagnosis and how it can be avoided and/or treated. This condition requires early and repeated surgery, wide spectrum antibiotic therapy against multi-resistant bacteria and intensive systemic support measures. Despite all this, the prognosis is extremely poor since it has a mortality which can reach up to 60%, with preventions being the most important measure to avoid it developing. In this article, we have made a specific review of tertiary peritonitis, of the accepted definitions, the risk factors, its pathophysiology, the microbiological flora involved, and its treatment.

Letter to the Editor

Letter to the Editor

Infection Complications in Patients with Multiple Myeloma Treated with New-Drug Combinations Including Thalidomide.

Abstract 2828Poster Board II-804Studies including thalidomide showed a rate of severe infection that can be life-threatening complication or compromise compliance to therapy ranging from 6% to 22%. Therefore, antibacterial prophylaxis has become a routine clinical practice despite its role in the new-drugs era has to be defined.We performed a post-hoc analysis of patients treated with thalidomide based combinations within controlled trials in order to assess time, type and outcome of infections. We analysed the main demographic and disease related variables to search for factors affecting onset of infections during induction and build a risk model in order to perform targeted prophylaxis.Two hundred and twenty four patients were eligible for this study. Median age was 70 years (range 31-90 years) and 141 patients (63%) had more than 65 years. Fifty three percent of patients had de novo MM whereas the remaining had received thalidomide as second or subsequent lines of therapy. ISS stage 2-3 and renal impairment were present in 156 (69%) and 38 (17%) of patients, respectively. Induction therapy consisted in the following protocols: ThaDD (160 patients: 71.5%), ThaDD-V (42 patients: 19%), VMPT (9 patients: 4%), TD (8 patients: 3.5%) and VTD (5 patients: 2%). Prophylaxis for infections was administered to 168 patients (75%) and consisted of quinolones (72%) or thrimethoprim-sulphamethoxazole (28%).Eighty six patients (38.5%) developed an infection resulting of grade 3-4 in 39 of them (17.5%) (12% grade 3, 5.5% grade 4). Probability of infection at six months was 39% although that of severe infection was 20% (18% at 4 months and just 2% from 4 to 6 months). Among the 39 patients with severe infection, 23 (59%) developed pneumonia, 9 FUO (23%), 6 bacteremia (1 septic shock) and 1 an orbital abscess. Aetiology of severe infection was recognized in 7 patients (4 Gram-negative bacteria, 1 Gram-positive bacteria, 1 CMV and 1 probable fungal infection). Eighty percent of severe infections occurred during the first 3 courses of induction therapy and only 12% during neutropenia. Fifteen percent of patients undergoing antibiotic prophylaxis developed infection vs 25% of patients who did not (p= 0.084). There were no difference between quinolones and thrimethoprim-sulphamethoxazole prophylaxis regarding incidence of infections. The majority of infections were empirically treated and cured with wide spectrum antibiotic therapy except when a specific aetiology was recognized. Only one patient died because of septic shock during neutropenia and 2 patients withdrawn from protocol because of infection. In univariate analysis monoclonal component > 2 g (p=0.021), platelets < 130.000/ml (p= 0.005), newly diagnosed MM (p=0.083) and antibiotic prophylaxis (p=0.061) were factors predicting severe infection development whereas age, sex, ECOG performance status, MM type, D-S stage, plasmacell infiltration in bone marrow, haemoglobin concentration, serum b2-microglobulin, serum albumin, ISS, serum C-Reactive Protein, serum creatinine, previous stem cell transplantation were not. Cox regression analysis selected monoclonal component > 2 g (p=0.015 HR= 1.8) and platelets < 130.000/ml (p=0.003 HR= 2.3) as covariates associated to severe infection. The 25 patients without adverse factors, the 125 with 1 and the 74 with 2 adverse factors had a probability of severe infection equal to 4%, 17% and 32 % (p= 0.023), respectively. This model remains useful apart from prophylaxis since the probability of severe infection in patients with at least 1 risk factors receiving prophylaxis is 17% vs 4% in patients without risk factors. Of note, patients developing severe infection had a significantly higher incidence of deep venous thrombosis (DVT) compared with patients who did not (20.5% vs 9%: p= 0.041). DVT occurred after a median time of 0.9 months (range 0.1-5 months; 75% within 2 months) from infection onset.In conclusion, despite antibiotic prophylaxis, patients receiving thalidomide combination therapy can develop severe infections particularly pneumonia. Wide spectrum antibiotic therapy is effective in the majority of cases since viral or fungal infections are very rare. Patients with large size of disease, represented by high MC and low platelets count, are at higher risk of severe infection that in turn significantly increase the risk of DVT. Therefore, these patients at high-risk should receive more suitable antimicrobial prophylaxis. Disclosures:Off Label Use: Thalidomide, Bortezomib and Doxil.

Immunological disturbances in Good’s syndrome

Immunodeficiency with a thymoma (Good's syndrome) is a rare condition occurring in patients with adult-onset hypogammaglobulinaemia. We describe the case of a 38-yr-old woman with an upper mediastinal mass and inflammatory infiltrations in the lungs. After thymectomy, the patient's condition did not improve. The HRCT scan showed bronchiectasies with parenchymal opacities. As pulmonary infection persisted despite wide spectrum antibiotic therapy, additional tests were performed to diagnose an immunodeficiency. Serum immunoglobulin levels were very low. T cell response to mitogens was normal, but to Staphylococcus aureus Cowan I was impaired. Immunophenotyping of peripheral blood and bone marrow aspirate showed a very low number of B-cell at all the stages of development (CD10+CD19+, CD5+CD20). In peripheral blood 2.5% of CD19+ lymphocytes were found. On the basis of clinical history and immunological analysis, Good's syndrome was recognized. Treatment with intravenous gammaglobulin and antibiotics improved the patient's performance. Measurement of serum immunoglobulin concentration is recommended for all patients suspected of thymoma.

Septal myocardial abscess in a male great Anglo‐French hound

We report the diagnosis and follow-up of a septal myocardial abscess in a seven-year-old Anglo-French hound suffering from both renal failure and urinary infection. Serial echocardiography showed the abscess enlarging and progressing into a fistula between the left ventricular outflow tract and the right ventricle. The dog died despite early wide-spectrum intravenous antibiotic therapy. Post-mortem examination confirmed the diagnosis. Bacterial and fungal myocardial abscesses have been described in immunodeficient human beings. To our knowledge, fistulae have rarely been described in dog hearts and only as a consequence of previous valvular endocarditis. In our case, the sigmoid cusps were not involved, so this is the first description of a septal myocardial abscess in a dog.

Ropień podtwardówkowy w przebiegu przewlekłego zapalenia zatok przynosowych – opis przypadku

Subdural empyema is an uncommon and serious complication of sinusitis. Authors reported a case of 34-year-old man without internal loads/ chronic diseases in the course of chronic sinusitis of odontogenic origin. Diagnostic procedures were described. Early employed wide spectrum antibiotic therapy and inflammatory focus removal did not prevent intracranial complications. The patient required two-staged neurosurgical operation.