Hemoptysis, Low back pain and upper mediastinal widening
52 year male presented with increasing hemoptysis, low grade fever and back pain since 2 weeks. Medical history included diabetes since 14 years and recurrent boils on thighs since past 1 year. CXR showed widened upper mediastinum.
CT scan of the chest showed calcified aorta with soft tissue density in upper mediastinum -> actively bleeding pseudoaneurysm with surrounding hematoma. A MRI of the lumbosacral spine showed 11 x 8 cm collection in the right paraspinal region (L4-L5). 2D echo revealed LVEF 65%, no e/o regional wall motion abnormalities / no vegetation / no AS/AR.
Methicillin resistant staphylococci was isolated from pus aspirated from the lumbar collection. MRSA was also isolated from blood cultures.
Teicoplanin 600mg IV q24h was started. On D7, the patient underwent a left carotid to left subclavian bypass (saphenous venous graft) and endovascular stenting of distal arch of aorta and upper descending thoracic aorta.
Plan @ discharge: 6 weeks of IV teicoplanin
MRSA endaortitis / pseudoaneurysm with metastatic lumbar abscess
Fatal pneumonia after near-drowning
A 20 year old male was brought to the emergency after a near-drowning accident in a well. He became tachypneic and hypoxemic in the emergency necessitating endotracheal intubation and mechanical ventilation. A chest radiograph showed bilateral symmetrical infiltrates at presentation. Broad spectrum antibiotics were initiated.
The patient developed bilateral pneumothoraces over the next 2 days. He was extubated on the fifth day of ICU stay, but developed new onset hypoxemia, tachypnea and septic shock on sixth day. Broad spectrum antibiotics, vasopressors and mechanical ventilation was instituted. Despite these measures he continued to deteriorate and died on seventh day of hospital stay. Septate filamentous fungus was isolated from blood cultures drawn on day 5 which was identified as Scedosporium apiospermum.
Fatal Scedosporium apiospermum pneumonia and fungemia after near-drowning