Neuropsychiatric Disorder Associated with Group G Streptococcus Infection

Immune-mediated central nervous system manifestations of group A β-hemolytic Streptococcus (GABHS) infection include Sydenham's chorea, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS)—which includes tic and obsessive compulsive disorders—and a variety of neurobehavioral disorders. We report a case of Streptococcus dysgalactiae subspecies equisimilis (group G Streptococcus) (GGS) infection associated with involuntary movements, complex tics, and emotional lability in an 11-year-old Japanese girl. Serum IgM and IgG antibodies to lysoganglioside were positive, and she responded rapidly to intravenous immunoglobulin treatment. Neuropsychiatric disorder associated with GGS infection was ultimately diagnosed. The present findings suggest that neuropsychiatric disorders can result from GGS infection and that the pathogenic mechanism is similar to that of GABHS infection. Future large-scale studies should examine the relation between GGS infection and onset of neuropsychiatric disorder.

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Late onset hyperornithinemia-hyperammonemia-homocitrullinuria syndrome - how web searching by the family solved unexplained unconsciousness: a case report

Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome, a rare inherited urea cycle disorder, can remain undiagnosed for decades and suddenly turn into an acute life-threatening state. Adult presentation ...

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Sepsis and Pleural Empyema Caused by Streptococcus pyogenes after Influenza A Virus Infection

Streptococcus pyogenes (also referred to as group A streptococci, GAS) causes severe invasive diseases such as bacteremia, necrotizing fasciitis, pneumonia, osteomyelitis, septic arthritis, and toxic shock syndrome in children. However, there are only a few reports on pleural empyema caused by GAS in children. Here, we report the case of a 4-year-old boy who presented with pleural empyema due to GAS after influenza A virus infection. With intravenous antibiotic administration and continuous chest-tube drainage, followed by video-assisted thoracoscopic surgery, his condition improved. During the clinical course, cytokines induced in response to the influenza virus, especially IL-1β and IL-10, were elevated 1 week after influenza A infection, but these decreased as the symptoms improved. Reportedly, the IL-10 production increases during influenza virus-bacteria superinfection. These observations suggest that the immunological mechanisms induced by the influenza virus can play an important role in influencing the susceptibility to secondary bacterial infections, such as GAS, in children.

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Dermoscopy of skin metastases from breast cancer: two case reports

Cutaneous metastatic breast cancer is the most common cutaneous metastatic malignancy in women. The assessment of cutaneous metastatic disease can be perplexing because the clinical presentation appears simila...

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Rare case of Propionibacterium acnes-related splenic abscess

A 64-year-old woman with a medical history of morbid obesity, chronic hepatitis C, essential hypertension, multiple episodes of abdominal cellulitis, diabetes mellitus type 2 on insulin, intravenous and subcutaneous drug abuse presented to the emergency department complaining of left lower chest pain for 6 weeks along with multiple episodes of vomiting. Initial laboratory data revealed leucocytosis of 17 200x10³/μL with left shift. She reported multiple episodes of fever spikes. Abdominal and pelvic CT showed a splenic hypodense lesion. Specimens from interventional radiology aspiration and splenectomy grew Propionibacterium acnes. Following splenectomy, patient's symptoms resolved. To the best of our knowledge, this would represent the fifth reported case of P. acnes splenic abscess.

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Alpha-2 antiplasmin-associated aortic valve thrombus presenting as a STEMI in a patient with Graves disease

Description  

A 36-year-old Caucasian woman with a medical history of Graves disease presented to the emergency department with typical chest pain, and she was found to have a ST-elevation myocardial infarction (STEMI) via ECG and elevated troponins. Emergent cardiac catheterisation revealed distal blockages in the left anterior descending artery and second obtuse marginal artery (figure 1A,B). After distal balloon angioplasty, the decision was made to further treat the patient medically and discharge home after clinical stability was achieved. She was readmitted 2 days later for new onset of palpitations with up-trending troponins. Laboratory tests were significant for a low thyroid-stimulating hormone of <0.01 µLU/mL (reference range: 0.27–4.2 µLU/mL), and elevated free T4 of 4.02 µLU/mL (reference range: 0.9–1.7 ng/dL), free T3 of 4.8 pg/mL (reference range: 2.5–4.3 pg/mL) and a thyroid stimulating immunoglobulin of 386 (reference range: <140% baseline). She was immediately started on both methimazole 20 mg and potassium iodine oral solution (SSKI). Further workup...

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Haemorrhagic cholecystitis: a rare entity not to be forgotten

Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.

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