Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report

<p>Abstract</p> <p>Introduction</p> <p><it>Scedosporium apiospermum </it>is increasingly recognized as a cause of localized and disseminated mycotic infections in near-drowning victims.</p> <p>Case presentation</p> <p>We report the case of a 59-year-old Japanese woman who was a survivor of a tsunami in northeastern Japan and who had lung and brain abscesses caused by <it>S. apiospermum</it>. Initially, an aspergillus infection was suspected, so she was treated with micafungin. However, computed tomography scans of her chest revealed lung abscesses, and magnetic resonance images demonstrated multiple abscesses in her brain. <it>S. apiospermum </it>was cultured from her bronchoalveolar lavage fluid, and antimycotic therapy with voriconazole was initiated. Since she developed an increase in the frequency of premature ventricular contractions, an adverse drug reaction to the voriconazole was suspected. She was started on a treatment of a combination of low-dose voriconazole and liposomal amphotericin B. After combination therapy, further computed tomography scans of the chest and magnetic resonance images of her brain showed a demarcation of abscesses.</p> <p>Conclusions</p> <p>Voriconazole appeared to have a successful record in treating scedosporiosis after a near drowning but, owing to several adverse effects, may possibly not be recommended. Thus, a combination treatment of low-dose voriconazole and liposomal amphotericin B may be a safe and effective treatment for an <it>S. apiospermum </it>infection. Even though a diagnosis of scedosporiosis may be difficult, a fast and correct etiological diagnosis could improve the patient's chance of recovery in any case.</p

POST-CONTRAST ACUTE KIDNEY INJURY AFTER CATHETER ANGIOGRAPHY AND EVALUATION OF RISK FACTORS

Purpose : The present study aimed to determine the rate of post-contrast acute kidney injury (PC-AKI) after catheter angiography other than cardiac angiography (CAG), and identify relevant risk factors.Materials and methods : This retrospective study analyzed data from 314 patients who underwent angiography between October 2013 and September 2018. We investigated the incidence of PC-AKI, defined as a ≥50% increase or ≥0.3 mg/dL increase in serum creatinine (SCr) values 1-3 days after angiography according to the European Society of Urogenital Radiology guidelines on contrast media, version 10.0. The effects of patient- and procedure-related factors on the incidence of PC-AKI were evaluated. Data were analyzed using chi-squared and Mann-Whitney U tests, and multivariate logistic regression analysis.Results : PC-AKI developed in 16/314 patients (5.1%). Multivariate logistic regression analysis revealed a correlation of incidence of PC-AKI with advanced age, decreased estimated glomerular filtration rate (eGFR), shock symptoms, and high-dose contrast media within 24 hours. In all patients with PC-AKI, SCr values returned to baseline within 2 weeks.Conclusions : PC-AKI after angiographic examinations developed in 5.1% of patients, and the increase in SCr was reversible. Advanced age, decreased eGFR, shock symptoms, and highdose contrast media within 24 hours are possible risk factors

COMPARISON OF VIRTUAL UNENHANCED AND TRUE UNENHANCED ATTENUATION VALUES BY DUAL-ENERGY CT FOR DETECTING INDISTINCT LIVER METASTASES ON CONTRAST-ENHANCED CT

Purpose : We aimed to evaluate the differences between true unenhanced (TUE) and virtual unenhanced (VUE) computed tomography (CT) performed by contrast-enhanced CT with dualenergy CT in the assessment of liver metastases that were difficult to visually identify with contrast- enhanced CT. Materials and methods : Between April 2018 and September 2019, we identified 266 patients with liver metastases who underwent unenhanced and contrast-enhanced CT with dual-energy CT at our institution, and enrolled 43 liver metastases in 19 patients (7.1%) that were indistinct on contrast-enhanced CT.　Mean CT attenuation values for liver metastases and liver parenchyma were measured, and differences between the CT attenuation values for liver metastases and liver parenchyma were analyzed using VUE CT and TUE CT. Results : The mean CT attenuation values for liver metastases and liver parenchyma in VUE CT versus TUE CT were 51.0 vs. 41.0 HU (p<0.001) and 58.2 HU vs. 61.2 HU (p=0.027), respectively.　The differences in CT attenuation values between liver metastases and liver parenchyma were 10.1 HU on VUE CT vs. 19.3 HU on TUE CT (p<0.001). Conclusion : The contrast between lesions and liver parenchyma on VUE CT was significantly lower than that on TUE CT.　VUE CT cannot currently replace TUE CT

PALLIATIVE REIRRADIATION WITH AN ACCUMULATED DOSE OF 80 GY FOR PAINFUL BRACHIAL PLEXUS METASTASIS AFTER 60 GY IRRADIATION FOR LYMPH NODE METASTASIS OF BREAST CANCER : A CASE REPORT

The rare condition of brachial plexus metastasis (BPM) from malignant carcinoma causes extreme pain and can limit activities of daily living. A few reports have indicated that palliative irradiation is an effective and safe treatment for BPM ; however, the efficacy and safety of reirradiation for BPM are not well-known. In the present report, we describe the case of a patient with BPM of breast cancer who had a history of receiving 60 Gy of irradiation in 30 fractions to bilateral subclavian areas to treat lymph node metastases, developed extremely painful BPM in the primary irradiated area, and underwent further irradiation with 20 Gy in five fractions. This palliative reirradiation initially resulted in significant pain relief, and the tumors reduced in size immediately after the treatment. Regrowth of the tumors and recurrence of the pain occurred five months after irradiation ; however, further irradiation was not administered as it could be associated with a high risk of plexopathy or myelopathy. This case report describes the tolerability and effectiveness of reirradiation for BPM, the decision process of reirradiation, and the usefulness of modern diagnostic imaging for deciding radiation field and technique to deliver safe and effective reirradiation