Severe pneumonia after intravesical BCG instillation in a patient with invasive bladder cancer: case report and literature review

We present here the case of a 66 year old man with a severe bilateral community acquired pneumonia secondary to dissemination after an intravesical instillation of bacilllus Calmette-Guérin (BCG). Diagnosis was based on positive polymerase chain reaction (PCR) for mycobacterium tuberculosis complex in bronchoalveolar lavage and on the finding on transbronchial biopsy of non necrotising granulomas histopathologically similar to the granulomas found in bladder biopsies. These findings were confirmed using a validated real time PCR assay demonstrating the presence of the BCG genome in transbronchial and bladder biopsies

Severe pneumonia after intravesical BCG instillation in a patient with invasive bladder cancer: case report and literature review

We present here the case of a 66 year old man with a severe bilateral community acquired pneumonia secondary to dissemination after an intravesical instillation of bacilllus Calmette-Guérin (BCG). Diagnosis was based on positive polymerase chain reaction (PCR) for mycobacterium tuberculosis complex in bronchoalveolar lavage and on the finding on transbronchial biopsy of non necrotising granulomas histopathologically similar to the granulomas found in bladder biopsies. These findings were confirmed using a validated real time PCR assay demonstrating the presence of the BCG genome in transbronchial and bladder biopsies

Successful antiviral treatment of chronic hepatitis C in patients with rare comorbidities. Two case-reports

Antiviral therapy in patients suffering from chronic hepatitis C virus (HCV) infection and rare comorbidities cannot be easily started, as it can reduce the likelihood of a good therapeutic response with an increased frequency of side effects. We report two patients presenting unusual comorbidities associated with chronic C hepatitis: one with the Ehlers-Danlos Syndrome (EDS), a rare genetic disease caused by a defect in collagen synthesis, the other one with the Charcot Marie Tooth (CMT) disease, an uncommon but severe form of demyelinating peripheral neuropathy. Both patients were successfully treated with pegylated Interferon (Peg-IFN) and ribavirin (RBV) combined therapy, with the achievement of a sustained viral response (SVR) and a low occurrence of adverse effects. Up to now there are no reports of patients suffering from chronic C hepatitis associated with these uncommon but severe comorbidities treated with antiviral therapy. In conclusion, in such clinical situations, anti-HCV therapy may be started and tailored, especially if the patient is highly motivated and if optimal predictors of response (i.e. young age, favourable genotype and low baseline viraemia) do exist

Risposta Virologica Sostenuta dopo terapia anti-HCV in paziente con neuropatia di Charcot Marie Tooth tipo 1

Circa 170 milioni di persone nel mondo sono affette da epatite cronica C, la cui terapia si basa sull’associazione di Interferone peghilato (pegIFN) e Ribavirina (RBV) che permette tassi di eradicazione del 75-90% per i genotipi 2 e 3 e del 45-50% per i genotipi 1 e 4. La presenza di comorbidità (cardiovascolari, psichiatriche, neurologiche ecc.) in tali pazienti limita applicabilità ed efficacia del trattamento standard anti-HCV, spesso gravato anche da severi effetti collaterali. Importante in questi casi considerare la presenza di eventuali fattori predittivi di risposta (es. genotipo 2 o 3, bassa viremia basale) oltre alla motivazione del paziente prima di intarprendere il trattamento. Descriviamo il primo caso di un paziente affetto da neuropatia di Charcot Marie Tooth (CMT), rara neuropatia motorio-sensitiva, e disturbo ossessivo compulsivo, trattato con successo per epatite cronica C

Tuberculosis Reactivation in a Patient with Chronic HBV Infection Undergoing PEG-Interferon Therapy: Case Report and Literature Review

Pegylated (PEG) -interferon therapy is a first-line choice to treat both chronic hepatitis B and C. Its side effects are well known and include fatigue, anaemia, weight loss, neuropsychiatric disorders, immune disregulation and white blood cells decrease. All these events could play a role in reactivation of a latent tubercular infection (LTBI), and some authors reported development of Tuberculosis (TB) during anti-HCV treatment with PEG-interferon and ribavirin. We report here the first case of TB reactivation during PEG-interferon monotherapy for HBV in a Chinese man, managed with interruption of interferon and starting of a therapy with a nucleotide analogue, in combination to anti-tubercular standard regimen, which led to a successful treatment of both diseases without significant side effects. Our report highlights the need of increasing the control of TB, by diagnosing and treating people with latent tubercular infection, that add up to one third of global population, in particular those with a high risk of reactivation

Post-Sternotomy Chronic Infection by Serratia Marcescens. Case Report and Literature Review. Pubblicato in Microbiologica, 2011.

Serratia marcescens is an opportunistic gram negative bacterium, responsible for 2% of nosocomial infections and bacteremia (yearly incidence, 1.03 per 100,000 population) with high morbidity and mortality especially in Neonatal Intensive Care Units. Diagnosis and treatment often represent a problem for clinicians because of spreading of Multi Drug Resistant Bacterial Strains. This case describes the management of a post-surgery infection by AmpC S. marcescens in a 47 years-old immunocompetent man undergone sternotomy following mitral valvuloplasty. After cardiosurgery treatment, complicated by severe left ventricular heart failure, S.marcescens was isolated in blood samples and quinolones were given. Owing to persistence and in vitro resistance to most β-lactamins of S.marcescens in the surgery wound, the patient was repeatedly treated with targeted therapy including aminoglycosides and quinolones without clinical improvement. The patient was admitted at our Institution for a further exacerbation of sternal infection, with fistula secreting purulent material. Serratia was isolated again. The C-reactive protein was normal. A toracic CT scan showed a sternal mass (foreign body granuloma with dishomogeneous structure of retrosternal soft tissue), while scintigraphy with labeled leukocytes demonstrated the persistence of sternal infectious process without any deep tissues involvement. Microbiological results for Serratia isolates were similar as above, with a good susceptibilty to carbapenems (MIC <=1μg/mL). Ertapenem plus ciprofloxacine administered for 8 weeks with local debridement and removal of a suture string led to a temporary improvement. Because of new exacerbation occurred after several months, we decided to restore ertapenem plus prulifloxacine therapy for further 2 month. This association led to a complete recovery. The follow-up with scintigraphy with labeled leukocytes after 6 and 12 months didn’t show any inflammation process. Management of chronic osteomyelitis represents an important challenge for clinicians. It often occurs without laboratory alterations and can alternate clinically silent periods with new exacerbation phases. A targeted and prolonged antibiotic treatment must be often combined with a surgery debridement considering the frequent formation of biofilm. Serratia osteomyelitis may be commonly caused exogenously by surgery, as our case demonstrated. We suspected AmpC producer Serratia on the basis of its cefoxitine resistance and its eradication with carbapenems and quinolones. Risk factors for severe Serratia infection were not documented in our patient except for cardio surgery treatment. Reports of post-cardiosurgey infections by Serratia are rare. These, however, must be suspected in immunocompetent patients if undergone major surgery. Use of ertapenem, instead of other carbapenems, in combination to prulifloxacine could represent a valid alternative for osteomielitis due to S.marcescens, with once daily administratio