Tuberculous Orchiepididymitis, Meningoencephalitis and Hydrocephalus

Tuberculous meningoencephalitis (TBM) is a rare and serious, often fatal presentation of active tuberculosis and account for about 1% of cases. Early diagnosis and prompt treatment of TBM is essential to reduce morbidity and mortality. Here, we report a case of TBM in 60-year-old man. TBM was considered on the basis of clinical presentation, laboratory findings (hyponatraemia), cerebrospinal fluid studies, radiological findings (hydrocephalus on multi-slice computed tomography), and history of orchiepididymitis of unknown origin one year earlier, together with information that the patient originated from Kosovo where incidence of tuberculosis is still high. Mycobacterium tuberculosis was cultured from cerebrospinal fluid on Lowenstein-Jensen medium confirming diagnosis of TBM. Subsequently, acid-fast bacilli (AFB) staining on samples obtained after orchiectomy a year ago was performed, revealing AFB. Anti-tuberculosis therapy is still in course. This is the second case of tuberculous meningoencephalitis with the same disease pattern (i.e. tuberculous orchiepididymitis – meningoencephalitis) in our Department, and this fact was crucial for the presumptive diagnosis and urgent treatment of TBM. The former case was described five years ago

Tuberculous Orchiepididymitis, Meningoencephalitis and Hydrocephalus

Tuberculous meningoencephalitis (TBM) is a rare and serious, often fatal presentation of active tuberculosis and account for about 1% of cases. Early diagnosis and prompt treatment of TBM is essential to reduce morbidity and mortality. Here, we report a case of TBM in 60-year-old man. TBM was considered on the basis of clinical presentation, laboratory findings (hyponatraemia), cerebrospinal fluid studies, radiological findings (hydrocephalus on multi-slice computed tomography), and history of orchiepididymitis of unknown origin one year earlier, together with information that the patient originated from Kosovo where incidence of tuberculosis is still high. Mycobacterium tuberculosis was cultured from cerebrospinal fluid on Lowenstein-Jensen medium confirming diagnosis of TBM. Subsequently, acid-fast bacilli (AFB) staining on samples obtained after orchiectomy a year ago was performed, revealing AFB. Anti-tuberculosis therapy is still in course. This is the second case of tuberculous meningoencephalitis with the same disease pattern (i.e. tuberculous orchiepididymitis – meningoencephalitis) in our Department, and this fact was crucial for the presumptive diagnosis and urgent treatment of TBM. The former case was described five years ago

Mycoplasma pneumoniae induced Stevens-Johnson syndrome

Stevens-Johnsonov sindrom (SJS) je teška bolest kože i sluznica karakterizirana target (iris) lezijama i nekrozom epidermisa kao posljedica reakcije preosjetljivosti potaknute lijekovima, infektivnim uzročnicima ili malignomima. Prikazujemo slučaj Stevens-Johnsonova sindroma u mlađeg muškarca potaknutog atipičnom upalom pluća uzrokovanom infekcijom Mycoplasma pneumoniae (M. pneumoniae). Primjena antimikrobne i kratkotrajne sistemske kortikosteroidne terapije uz simptomatske mjere rezultirala je izlječenjem bez zaostajanja trajnih posljedica.Stevens-Johnson syndrome (SJS) is a severe disease of the skin and mucous membranes characterized by target lesions and epidermal necrosis induced by hypersensitivity to medications, infections and malignancies. We present a case of Stevens-Johnson syndrome in a young male secondary to interstitial pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae). Antimicrobial and short course systemic corticosteroid therapy combined with supportive measures resulted in a recovery without any long-term sequelae

Pyostomatitis Vegetans Associated with Inflammatory Bowel Disease – Report of Two Cases

Pyostomatitis vegetans (PV) is a rare, chronic mucocutaneous disorder associated with inflammatory bowel disease (IBD). Oral lesions of PV are distinct and present as multiple white or yellow pustules with an erythematous base that coalesce and undergo necrosis to form a typical »snail tracks« appearance. Two cases of PV associated with IBD – one with Crohn\u27s disease (CD) and the other with ulcerative colitis (UC) are reported. In the first case, adalimumab therapy brought the oral and gastrointestinal manifestations to complete remission. In the second case, the remission was achieved with systemic steroid therapy, but the disease relapsed after therapy discontinuation. Azathioprine was added leading to sustained remission of PV. Because of persistent active intestinal manifestation of UC, in spite of immunosuppressive therapy, infliximab was introduced. With the therapy remission of intestinal manifestation of UC was achieved as well. Our cases confirm previously reported good experience with immunomodulators and biologics in the treatment of PV. But, before using them we have to exclude an infectious etiology of oral lesions

Splenic Hematoma as a First Manifestation of Cytomegalovirus Infection

Splenic rupture is rare but life threatening complication of mononucleosis syndrome. It has been suggested that subcapsular splenic hematoma formation precedes rupture. The case of 44-year-old, previously healthy, male with splenic hematoma occurring after rising of heavy cargo is reported. Mononucleosis syndrome was suggested based on routine laboratory tests (elevated white blood cell count with predominance of lymphocytes and raised serum transaminases) and CMV infection was confirmed by serological test. Nonoperative management was used since the patient was hemodynamically stable with no further signs of splenic rupture. The same approach has been used in growing number of cases of patients with spontaneous splenic rupture in mononucleosis syndrome. Importance of considering splenic hematoma and/or rupture if abdominal pain occurs in the course of mononucleosis syndrome is outlined as well as importance of routine laboratory tests in suspecting mononucleosis syndrome in otherwise clinically silent patient

Mycoplasma pneumoniae induced Stevens-Johnson syndrome

Stevens-Johnsonov sindrom (SJS) je teška bolest kože i sluznica karakterizirana target (iris) lezijama i nekrozom epidermisa kao posljedica reakcije preosjetljivosti potaknute lijekovima, infektivnim uzročnicima ili malignomima. Prikazujemo slučaj Stevens-Johnsonova sindroma u mlađeg muškarca potaknutog atipičnom upalom pluća uzrokovanom infekcijom Mycoplasma pneumoniae (M. pneumoniae). Primjena antimikrobne i kratkotrajne sistemske kortikosteroidne terapije uz simptomatske mjere rezultirala je izlječenjem bez zaostajanja trajnih posljedica.Stevens-Johnson syndrome (SJS) is a severe disease of the skin and mucous membranes characterized by target lesions and epidermal necrosis induced by hypersensitivity to medications, infections and malignancies. We present a case of Stevens-Johnson syndrome in a young male secondary to interstitial pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae). Antimicrobial and short course systemic corticosteroid therapy combined with supportive measures resulted in a recovery without any long-term sequelae

Bivalvular Staphylococcus aureus endocarditis in a young pregnant woman without known previous risk factors – a case report

Infektivni endokarditis značajan je uzrok pobola i smrtnosti. Posebno je težak klinički entitet u trudnica s obzirom na određeni stupanj imunosupresije u trudnoći, kao i zbog značajnih promjena kardiovaskularne funkcije u trudnica. Većina infektivnih endokarditisa, pa i u trudnoći, uzrokovana je bakterijama, a dominantno je zahvaćen jedan srčani zalistak, najučestalije mitralnog ušća. U ovom radu je prikazan slučaj liječenja i ishoda endokarditisa mitralnog i aortnog zaliska uzrokovanog bakterijom Staphylococcus aureus u prethodno zdrave trudnice.Infectious endocarditis is a significant cause of morbidity and mortality. It is a particularly difficult clinical entity in pregnant women due to a certain degree of immunosuppression in pregnancy, as well as due to significant changes in cardiovascular function in pregnant women. Most infectious endocarditis cases, even in pregnancy, are caused by bacteria, with one heart valve, most commonly the mitral orifice, predominantly affected. This paper presents treatment and outcome of mitral and aortic valve endocarditis caused by Staphylococcus aureus in a previously healthy pregnant woman

The Many Faces of Cat Scratch Disease – A Report of Four Cases

Bolest mačjeg ogreba (BMO) infekcija je uzrokovana Gram negativnom, fakultativno intracelularnom bakterijom Bartonella henselae. Glavni rezervoar infekcije je mačka i oko 75% bolesnika ima podatak o ogrebu ili ugrizu mačke u anamnezi. Rjeđe se infekcija javlja u kontaktu s psom, posredovano mačjom buhom ili neizravnim kontaktom oštećene kože ili sluznice s površinom kontaminiranom mačjom slinom. Infekcija može proći asimptomatski, ali se i prezentirati spektrom kliničkih manifestacija. U 85-90 % bolesnika radi se o klasičnoj BMO s kožnom lezijom i samoograničavajućim, regionalnim limfadenitisom dok ostale, rjeđe kliničke manifestacije, mogu zahvatiti gotovo svaki organ i organski sustav. Prikazujemo četiri bolesnika s BMO liječenih u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka te raspravljamo o dijagnostičkim i terapijskim izazovima ove bolesti.Cat scratch disease (CSD) is an infection caused by the Gram negative, facultative intracellular bacteria Bartonella henselae. The main reservoir of the infection is cat and about 75% of the patients have a cat scratch or a bite in anamnesis. Rarely, infection results from exposure to dogs, cat fleas or from contact with cat saliva through broken skin or mucosal surfaces. Infection can be asymptomatic or present with a number of clinical manifestations. In wast majority (85-90%) of the patients CSD presents as a cutaneous lesion and self-limiting, regional lymphadenitis near the site of organism inoculation, other seldom manifestations, however, can include virtually every organ and organ system. We present four patients with CSD treated at the Clinical Hospital Center Rijeka and discuss diagnostic and therapeutic challenges of the CSD

Tick-Borne Encephalitis Due to Consumption of Raw Goat Milk, Gorski kotar, 2019: Clinical Case Reports

Virus krpeljnog meningoencefalitisa (KME) najčešći je uzročnik infekcija središnjeg živčanog sustava u endemskim područjima srednje Europe. Radi se o prirodno žarišnoj zoonozi, čiji rezervoar čine šumski glodavci, domaće i divlje životinje, a čovjek se zarazi prigodno, ubodom inficiranog krpelja. U posljednje je vrijeme sve više izvješća o epidemijama KME povezanih s konzumacijom svježeg mlijeka i mliječnih proizvoda. Cilj je rada prikazati kliničke značajke i tijek bolesti kod oboljelih od KME u tijeku grupiranja u Primorsko- goranskoj županiji (lipanj 2019. godine), povezanog s konzumacijom nepasteriziranog kozjeg mlijeka iz istog izvora. Tri su bolesnika hospitalizirana s kliničkom slikom meningitisa, a kod dvoje se infekcija prezentirala kao febrilna bolest s mijalgijama i općom slabošću. Kod svih je bolesnika infekcija potvrđena serološkom obradom. Niti jedan bolesnik nije bio cijepljen protiv KME niti je imao podatak o ugrizu krpelja. Ovim radom želimo ukazati na zdravstvene opasnosti prehrambenih navika konzumiranja sirovog mlijeka koje u današnje vrijeme postaje sve popularnije, osobito među zagovornicima „zdrave hrane“.Tick-borne encephalitis (TBE) is the most common central nervous system (CNS) infection in the endemic areas of Central Europe. TBE is a zoonosis whose reservoir are forest rodents, and other mammals and vectors are Ixodes ticks. Humans become infected through a tick bite, but recently many TBE outbreaks after consumption of unpasteurized milk and dairy products from infected livestock have been described. The aim of this study was to analyze clinical characteristics of five TBE cases who were infected after consumption of unpasteurized goat milk and dairy products from a small family farm in Primorje-Gorski Kotar County (June 2019). Tree patients developed CNS infection while two had febrile illness. None of the infected patients reported a history of a tick-bite or were vaccinated against TBE. The infection was confirmed by detection of TBE specific antibodies. Since "healthy" lifestyle that encourages consumption of raw milk and dairy products is increasingly fashionable, we would like to point out the importance of pasteurizing or boiling milk before the consumption

Temporal Bone Actinomycosis Accompanied by Actinomycotic Meningitis and Cervical Lymphadenitis – a Case Report

Aktinomikoza predstavlja rijetku kroničnu infekciju uzrokovanu anaerobnom, Gram pozitivnom bakterijom koja pripada rodu Actinomyces. U ovom smo radu prikazali slučaj aktinomikoze temporalne kosti i meningitisa uzrokovanog Aktinomicetama te limfadenitisa vrata kod imunokompetentne bolesnice s anamnezom kroničnog supurativnog otitisa nakon traumatske perforacije bubnjića starijeg datuma. Liječenje je uspješno provedeno kombiniranom kirurškom i dugotrajnom antimikrobnom terapijom. Ovim prikazom želimo skrenuti pozornost na meningitis kojeg uzrokuje Actinomyces spp. te kojeg je, iako je rijedak, potrebno uključiti u diferencijalnu dijagnozu kroničnog meningitisa, osobito kod pacijenata s kroničnom upalom srednjeg uha i paranazalnih sinusa. Jednako tako, želimo skrenuti pozornost i na ostale manifestacije ove rijetke bolesti.Actinomycosis represents rare chronic infection caused by anaerobic, Gram positive bacteria belonging to Actinomyces genus. Here we present a case of temporal bone actinomycosis accompanied by meningitis and cervical lymphadenitis in imunocompetent patient with case history of chronic suppurative otitis media as a tympanic membrane perforation sequelae. The patient was successfully treated with both surgical and prolonged antimicrobial therapy. This case, although rare, implies cosideration of Actinomyces spp. in diferential diagnosis of chronic meningitis, especially in patients with case history of chronic otitis media or chronic sinusitis