Young Immunocompetent Patient Research Articles

Rare case of acute pyomyositis presenting with severe systemic septic shock in a young immunocompetent patient

Rare case of acute pyomyositis presenting with severe systemic septic shock in a young immunocompetent patient

Concurrent Extraparenchymal and Spinal Neurocysticercosis in an Immunocompetent Patient Treated for Obstructive Hydrocephalus and Spinal Cord Compression

Introduction: Neurocysticercosis (NCC) is a condition caused by infection of the central nervous system (CNS) by Taenia solium, or pork tapeworm, larvae. Despite commonly infecting the CNS, it may be easily misdiagnosed for more common pathologies, such as arachnoid cysts or tumors. Though most frequently seen in endemic areas, immigration patterns are altering its traditional distribution. Extraparenchymal neurocysticercosis (including ventricular, spinal, and subarachnoid types) carries a poorer prognosis Objective: We present a case of NCC presenting in a young immunocompetent patient which was initially thought to be an arachnoid cyst due to non-pathognomonic imaging results and symptoms. This case illustrates a challenging NCC diagnosis. Case Report: A 24-year-old male without known past medical history presented with 2 years of chronic headache, 2 months of blurry vision in the left eye, and 1 week of progressive nausea and vomiting found to have aqueductal stenosis with obstructive hydrocephalus and bilateral 1.5 cm, peripherally-enhancing cystic lesions of the cerebellopontine angle with associated mass effect, initially described as arachnoid cysts, as well as a left sided foramen magnum cyst. He had an external ventricular drain placed and later underwent ventriculoperitoneal shunt (VPS) insertion. He presented 10 days later with sepsis symptoms and the initial workup was concerning for tuberculosis-associated meningitis and he underwent shunt externalization and re-internalization after clinical improvement, though he was lost to follow up. Two months later he presented with acute urinary retention and right sided weakness. He had spinal cord compression of the cervicothoracic and thoracolumbar spine due to cystic lesion and underwent right C7-T1 and T10-T11 hemilaminotomies for cyst resection, with pathology consistent with NCC. Conclusion: Neurocysticercosis (NCC) is a complex disease which is largely overlooked and is increasing in prevalence in non-endemic areas such as the United States. NCC has various symptoms and presentations depending on location and progression of larval development, which may mimic more common pathologies. The clinical manifestations depend on the parasite load and the host’s immune response regarding their location in CNS and their evolutionary stage. There are two types of NCC, the parenchymal and the extraparenchymal form. The extraparenchymal racemose NCC has the worst prognosis among all forms of NCC with mortality ranging between 30% and 80%. This reinforces the need for a broad differential diagnosis in these scenarios, as well as the importance of close Infectious Disease follow up for patients diagnosed with concurrent cranial and spinal NCC.

Acute Neuro-Retinitis Secondary to a Recently Acquired Ocular Toxoplasmosis in a Young Immunocompetent Patient

A 27-year-old male patient with no medical history presented with a painless unilateral vision loss in the right eye, counting fingers at 5 meters, with active vitreous inflammation, stage II papilledema, whitish lesion on the superior-temporal border of the optic disc and a poor macular reflex, without any active or scarring chorioretinal lesion in the periphery. Multimodal imaging showed intra- and subretinal macular edema with early hypo-fluorescence followed by progressive centripetal filling of the peripapillary lesion and finally papillary diffusion. The visual field revealed an inferotemporal defect. Blood work showed hyperleukocytosis with positive toxoplasma serology, the rest of the workup was negative, especially no immunosuppression. The diagnosis of toxoplasmic anterior optic neuropathy was made due to the papillary and peripapillary involvement without a distant active or scarring lesion, with positive toxoplasma IgG and IgM serology. Trimethoprim/sulfamethoxazole antibiotic treatment with systemic corticosteroid therapy was initiated in our patient with an excellent outcome, including restoration of visual acuity to 10/10, complete vitreous clearance, complete resolution of the papillary and macular edema, and the peripapillary lesion without visible scarring, but leaving a persistent defect of the corresponding retinal nerve fibers. This clinical case thus illustrates a toxoplasmic anterior optic neuropathy with direct papillary involvement complicated by macular edema, a rare and atypical clinical entity of ocular toxoplasmosis, especially in a young immunocompetent subject, reflecting the clinical polymorphism of this pathology.

Co-existing pulmonary hydatid cyst with aspergillosis.

Pulmonary hydatid cyst is known to occur, but incidental detection of Aspergillus colonisation in an unruptured cyst wall, especially in immunocompetent patients, is very rare. Presentation can be hemoptysis or asymptomatic, depending upon immune status. Colonisation of the cyst wall may be due to immune dysregulation, structural abnormalities, invasion of fungal organisms through channels between airways and cyst and other mechanisms. Here, we report a rare case of Aspergillus colonisation in the hydatid cyst wall in a young immunocompetent patient and also try to describe the pathogenetic mechanism for the same.

Cutaneous mucormycosis in a young immunocompetent trauma patient: a case report

Introduction: Mucormycosis, a rare and life-threatening infection, is caused by microorganisms of the Mucorales order. It affects almost exclusively immunocompromised and diabetic patients, requiring extensive surgical debridement and prolonged antifungal therapy. Discussion/Results: We report the case of a 26-year-old immunocompetent woman, presenting with cutaneous mucormycosis after suffering blunt force trauma. This rare occurrence of mucormycosis in an immunocompetent patient reinforces the importance of elevated clinical suspicion and early initiation of adequate surgical and antifungal treatment. Conclusion: Mucormycosis is a challenging condition with potentially devastating consequences. Timely diagnosis and appropriate management are vital to mitigate the morbidity and mortality associated with this condition.

Cytomegalovirus esophagitis associated with gastroesophageal reflux disease in an immunocompetent patient: case report

Cytomegalovirus infection has a wide variability of clinical presentations depending on the patient's immunity, ranging from asymptomatic infections in immunocompetent individuals to infections with significant morbidity and mortality in immunocompromised patients. We originally described a clinical case of severe cytomegalovirus esophagitis, confirmed by blood polymerase chain reaction (PCR) test and esophageal biopsy, in a young immunocompetent patient with a long-standing diagnosis of gastroesophageal reflux disease. Clinical improvement occurred only after the initiation of specific treatment with ganciclovir, providing a negative viral load. This report reinforces the importance of ruling out the etiology of cytomegalovirus infection in severe ulcerative esophagitis, even in immunocompetent individuals.

A Rare Primary Mucocutaneous Presentation of Chronic Disseminated Histoplasmosis in an Immunocompetent Young Female: A Case Report

Classical Histoplasmosis also known as Darling’s disease is a systemic mycosis caused by dimorphic fungus, Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var duboisii. It is an opportunistic fungal infection that usually affects immunocompromised patients. Though microbiology culture methods are the gold standard, scrape cytology and histopathology give a relatively rapid diagnosis. It may pose a diagnostic dilemma on histopathology and morphology needs to be carefully studied to rule out other differentials. We present a rare case of chronic disseminated histoplasmosis with primary mucocutaneous lesions in an immunocompetent young female patient. This study is ethically approved from the institute and due written consent for publication from the patient has been taken.

Paucisymptomatic pulmonary tuberculosis in an immunocompetent young patient

This report presents the case of a 20-year-old student girl with no medical history, no usual medications, no known allergies and living in a clean and sanitary environment.

Persistent Stomach Pain In The young Age Patient: A Case Of Primary Gastric Burkitt's Lymphoma

Lymphoma is the second most common gastric cancer, following gastric adenocarcinoma. Most gastric lymphomas are mucosa-associated lymphoid tissue lymphomas or diffuse large B-cell lymphomas. Primary gastric Burkitt’s lymphoma is a subtype of non-Hodgkin lymphoma and represents an aggressive and rare malignity with the fewest cases reported globally. Primary gastrointestinal non-Hodgkin lymphoma is a rare condition. Burkitt’s lymphoma is an aggressive form of B-cell lymphoma endemic to Africa while it is not endemic to the rest of the world. Here we presented a young immunocompetent male patient who had weight loss and was admitted with a stomachache. Upper gastrointestinal endoscopy and biopsy detected a large primary gastric Burkitt’s lymphoma. While long-term survival rates are possible with early diagnosis and timely appropriate treatment, delay in treatment can be fatal for such patients.

A Case Report of Acute Viral Retinal Necrosis: ARN Syndrome

ARN syndrome or acute retinal necrosis is a clinical syndrome following a viral disease in an immunocompetent patient and which may jeopardize the visual prognosis if diagnosis and therapy delay, due to the Herpes group viruses. In this report, we present a case of acute viral retinal necrosis in a young immunocompetent patient whose antiviral and anti-inflammatory therapy was favorable.

Respiratory syncytial virus pneumonia in an immunocompetent adult: an important differential diagnosis of COVID-19.

We present a case of RSV pneumonia in a 36-year-old immunocompetent young female patient having a contacted history of RSV pneumonia from her daughter. Since the clinical and radiological findings were similar, clinicians should consider this classical disease in differential diagnosis, particularly in the pandemic settings of COVID-19.

Orchi-épididymite réactionnelle post angine streptococcique : une association rarissime chez l'adulte

We report here a rare case of a non-complicated epididymo-orchitis following of a confirmed and streptococcal angina correctly treated in a young immunocompetent patient. All investigations were negative except anti-streptodornase antibodies which were weakly positive. The outcome was spontaneously favorable with a 12-month follow-up.

Story of an Abscess: A Case of Mycobacterium abscessus Infection in an Immunocompetent Patient.

Mycobacterium abscessus is a very unusual cause of infection in immunocompetent patients. It is a rapidly growing microbe that rarely causes disseminated infection or native valve endocarditis. This organism exhibits intrinsic and acquired resistance to multiple antibiotics and hence becomes a major issue in planning treatment regimens. We report a unique case of a young immunocompetent male patient presenting with stroke and persistent fever. After extensive investigations, he was found to have an abscess caused by M. abscessus in the sinus of Valsalva and thrombi in the aorta that was the sequelae following coronary angioplasty. This case report explains the difficulties in the diagnosis and treatment of M. abscessus.How to cite this articleMaheshwarappa HM, Machanalli G, Thilakchand KR, Tejaswini DDS. Story of an Abscess: A Case of Mycobacterium abscessus Infection in an Immunocompetent Patient. Indian J Crit Care Med 2022;26(4):533–534.

Cytomegalovirus Retinitis in an Immunocompetent Patient

We report the case of a young immunocompetent patient with cytomegalovirus retinitis, received in the ophthalmological emergency room with a unilateral decrease in visual acuity due to macular localization. The clinico-tomographic follow-up was particularly satisfactory after 3 weeks on Ganciclovir with complete recovery of visual acuity after 2 months of treatment (interesting iconographic illustration).

A malignant disseminated tuberculosis: concurrent intracranial tuberculosis with skipped multilevel spondylitis in a young immunocompetent patient

Background/aim. Mycobacterium tuberculosis (M. tuberculosis) infection can cause pulmonary and extrapulmonary tuberculosis (TB), resulted from hematogenous or lymphatic dissemination of the bacteria. Disseminated TB is characterized by the presence of two or more non-contiguous sites from the spread. Dissemination to the central nervous system (CNS TB) has several manifestations that can cause devastating neurological complications. Several predisposing factors include older age, human immunodeficiency virus (HIV) coinfection, and pharmacological immunosuppression. As the manifestation of CNS TB itself is rare, diagnosing it remains a challenge. Prompt antituberculosis treatment is needed to improve patient’s outcome. This paper aims to present a rare case of malignant disseminated TB in a young immunocompetent patient. Case. This case presents an immunocompetent 17-year-old male with weakness in the four extremities. Through comprehensive history taking and examination, the patient was diagnosed with malignant disseminated TB, presenting as cerebellar tuberculoma, tuberculous meningitis, and multiple skipped level spondylitis TB; and concurrent pulmonary TB. Then, the patient underwent a surgery for the cervical lesion and was started on antituberculosis treatment in combination with corticosteroid. After the treatment, the patient’s motoric and sensoric functions improved and he was able to urinate and defecate normally. Conclusion. This case demonstrates the importance of considering disseminated TB in the differential diagnosis of a patient with neurological deficits, regardless of the fact that the patient is young and immunocompetent. Prompt diagnosis and rapid initiation of treatment can improve the patient’s outcome.

Herpes zoster in an immunocompetent young patient following mRNA-1273 vaccine for COVID-19: A case report

Herpes zoster in an immunocompetent young patient following mRNA-1273 vaccine for COVID-19: A case report

Varicella zoster virus and meningitis in immunocompetent patients: Specificity and questions

• Varicella-Zoster virus (VZV) cause meningoencephalitis in immunocompromised patients, on the occasion of viral reactivation. • VZV is also a non rare etiology of acute lymphocytic meningitis in immunocompetent. • In VZV meningitis, the cutaneous eruption typical of herpes zoster may be discrete or even be absent. • The pronostic of these meningitis is usually benign as illustrated in our series. Varicella-zoster virus (VZV) is the causative agent for high-mortality-rate meningoencephalitis in immunocompromised patients, but there it can cause meningitis in immunocompetent patients. The purpose of this study was to describe the characteristics and clinical course of symptomatic VZV meningitis occuring in immunocompetent patients without encephalitis. We used the Clermont-Ferrand University Hospital Laboratories database to select the files of adult patients from June 2015 to August 2017 with lymphocytic CSF pleocytosis and/or VZV-positive PCR on CSF analysis. Then, the medical files of this patients were analysed. We focused on immunocompetent patients with acute isolated clinical meningitis, lymphocytic CSF pleocytosis and/or VZV-positive PCR on CSF analysis and bacterial culture-negative CSF. In total, 325 adult patients meet the screening criteria. Forty patients met criteria for analysis: lymphocytic CSF pleocytosis, immunocompetent patient, acute clinical isolated meningitis. PCR in LCR detected Enterovirus in 19 patients and VZV in 5 patients. Median age of this 5 patients was 33 years and 3/5 had cutaneous lesions, which in 2 cases were found on later examination. Median duration of antiviral therapy was 10 days (range 10–14), including a first 5 days (range 5–7) of IV delivery. Clinical course was favorable in every case. Clinical meningitis related to VZV reactivation can occur in young immunocompetent patients. Shingles typical rash can be discrete or absent. Clinical course was favorable in every case, raising the question of whether there is a rationale for systematic IV antiviral therapy. Early oral antiviral therapy would probably be a reasonable option.

MANUBRIOSTERNAL JOINT SEPTIC ARTHRITIS IN A MAN WITH A HISTORY OF IV DRUG USE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Septic arthritis is a well-documented disease, much of which contains specific guidelines and recommendations for management. Manubriosternal joint septic arthritis is a rare entity described in literature that lacks consistently successful treatment options. (1) We present the case of a patient found to have a tender chest wall mass and imaging concerns for manubriosternal septic arthritis. CASE PRESENTATION: A 47-year-old male with history of heart failure with reduced ejection fraction, drug-induced non-ischemic cardiomyopathy, cirrhosis, and history of intravenous drug use was admitted to the hospital from heart failure clinic for acute on chronic heart failure exacerbation and mild encephalopathy. He was afebrile but tachycardic with a leukocytosis (13 k/ul) upon presentation. During examination a tender, fluctuant mass was discovered over the sternum. He reported pain in this area began three weeks prior with a mass developing over the previous one week. Chest roentgenogram showed an enlarged cardiac silhouette. Follow-up chest computed tomography revealed a 5 cm x 6 cm mass containing gas surrounding the manubriosternal joint anteriorly and posteriorly. He underwent incision and drainage by cardiothoracic surgery where purulent material was found and appeared to connected to the posterior sternal fluid collection. Wound culture grew Streptococcus agalactiae. Sternal bone biopsy was negative for osteomyelitis. He was placed on IV penicillin G for four weeks of therapy. DISCUSSION: Primary manubriosternal joint infections have been rarely documented in literature with approximately 20 (adult and pediatric) cases noted in a PubMed literature search. (1) Cases appear to be more common in men approaching middle-age. Predisposing risk factors are often present and similar to those for septic arthritis of more typical joint locations including intravenous drug use, immunosuppression, and secondary sources of infection. (1,2,3) Specific treatment guidelines are not clearly defined in literature, likely due to the rarity of this disease process. (1) Various treatment methods have been reported which include various combinations of IV antibiotics, incision and drainage, and aggressive manubriosternal joint resection. (1,2,3) The most common treatment noted during the literature review was conservative management with IV antibiotics. CONCLUSIONS: Manubriosternal joint infections are infrequently seen. A majority of cases reported have presented with typical risk factors for septic arthritis. Consistent treatment guidelines are not available due to the rarity of this disease process though many are treated conservatively with IV antibiotics. Patients should be evaluated by a multidisciplinary team of cardiothoracic surgeons and infectious disease specialists for patient-centered decision making efforts. REFERENCE #1: Ali B, Shetty A, Borah G, Demas C, Schwartz JD. Successful management of sternomanubrial joint septic arthritis with pectoralis muscle flap closure: a case series. J Surg Case Rep. 2020;2020(4):rjaa035. Published 2020 Apr 29. REFERENCE #2: Peng EW, McKillop G, Prasad S, Walker WS. Septic arthritis of the manubriosternal joint. Ann Thorac Surg. 2007;83(3):1190-1194. REFERENCE #3: Carnevale A, Righi R, Maniscalco P, et al. Primary septic arthritis of the manubriosternal joint in an immunocompetent young patient: A case report. Radiol Case Rep. 2017;12(4):682-685. Published 2017 Sep 11. DISCLOSURES: No relevant relationships by Joseph Frederickson, source=Web Response No relevant relationships by Bryton Perman, source=Web Response no disclosure on file for Akshat Sood; No relevant relationships by David Wessling, source=Web Response

Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A New Approach

Inflammation of the meningeal linings of the central nervous system (CNS), also known as meningitis, is one of the serious presentations in the emergency because it carries high morbidity and mortality. The most common cause is pus-producing organisms. However, non-suppurative meningitis, termed aseptic meningitis, is another cause of meningeal inflammation. Many etiologies stand behind aseptic meningitis. Those etiologies include viral and non-viral, drug-induced, malignancy, and systemic inflammation. Drug-induced aseptic meningitis is a rare type of meningitis. Although it is easily treated, it can be a challenging disease if not present in the differential diagnosis. It is commonly associated with nonsteroidal anti-inflammatory drugs (NSAIDs). Nonetheless, other medications have been also reported to cause aseptic meningitis, including antibiotics. Trimethoprim-sulfamethoxazole (TMP-SMX) is one of the most prescribed antibiotics as a prophylactic and therapeutic drug due to its effectiveness and low cost. Although immunocompromised patients are at a higher risk to develop aseptic meningitis, immunocompetent patients are also at risk. Unrelated to the source of the infection, TMP-SMX carries a risk of aseptic meningitis and should be considered as an etiology in patients presenting with meningeal signs and symptoms. Hereby, we report a young immunocompetent patient who developed aseptic meningitis eight days after being prescribed TMP-SMX. Like all drug-induced aseptic meningitis, all his symptoms resolved two days after stopping the medication.

Recurrent renal abscess complicating Staphylococcus saprophyticus infection in an immunocompetent young female patient: A case report and review of literature

Staphylococcus saprophyticus is second only to Escherichia coli as the most frequent causative organism of uncomplicated urinary tract infections (UTIs) among the sexually active female population. However, it is considered a rare cause of complicated UTIs in immunocompetent hosts with no identifiable risk factors for the occurrence of a complicated urinary tract infection. We report an exceedingly rare case of a 20-year-old otherwise healthy female patient, with no identifiable risk factors for complicated UTIs, who presented with a recurrent renal abscess secondary to S. saprophyticus. Serial cultures from multiple sources were negative, and the culprit organism was identified by a polymerase chain reaction (PCR) analysis of the drained pus that identified the 16 s rDNA sequences of S. saprophyticus on serial occasions. To our current date, similar cases have been rarely reported in the available literature.Our case also highlights the diagnostic value of molecular biology techniques in the identification of causative pathogens in cases of culture-negative infections when conventional microbiologic tests fail to isolate the culprit organisms. Clinical microbiology studies are needed to further explore the exact possible interactions between bacterial-specific characteristics and host-related factors that may explain the occurrence of the complicated UTIs that are associated with S. Saprophyticus among patients who are not considered to have certain risk factors that would usually predispose to complicated UTIs.