Sepsis Unveils T-cell Large Granular Lymphocytic Leukemia in the Setting of End-Stage Renal Disease: A Rare Hematologic Malignancy

Large granular lymphocytic (LGL) leukemia is a rare chronic lymphoproliferative disorder originating from natural killer cells or T lymphocytes. In this report, we present the case of a 66-year-old female initially treated for sepsis, with methicillin-sensitive Staphylococcus aureus identified on initial blood culture prompting intravenous (IV) antibiotic therapy. The patient met systemic inflammatory response syndrome criteria upon admission due to severe neutropenia. Persistent fever led to neurological symptoms, and imaging revealed lung abnormalities along with chronic changes on the CT scan of the head. Multidisciplinary consultations were sought, resulting in treatment adjustments including antifungals and filgrastim. Flow cytometry and bone marrow biopsy confirmed the diagnosis of LGL leukemia.

Acquired Ventricular Septal Defect in Panton-Valentine Leukocidin-Positive Staphylococcus aureus Infective Endocarditis

Infective endocarditis (IE) is life-threatening and can lead to complications if left untreated. A 56-year-old gentleman presented with acute delirium, fever and rigor. Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus (S. aureus) was isolated in the blood culture and the PR interval was prolonged on the electrocardiogram (ECG). However, the transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE) at presentation were unremarkable with no evidence of intracardiac vegetations. Despite expedient intravenous antibiotics, an acquired ventricular septal defect (VSD) developed, which required urgent cardiothoracic surgical repair. It is imperative to consider early surgical interventions and the use of anti-toxin antibiotics in PVL-positive S. aureus IE.

Disseminated Staphylococcus aureus Infection in an Adolescent Patient Following a Traditional Phlebotomy Procedure

Al-Fashdu is a well-known Islamic medicine-based alternative treatment, and it has been widely practiced with the aim of treating certain health issues in various countries. Unfortunately, this therapy can lead to certain complications, including life-threatening infections. We report a case of a 12-year-old male patient who developed a disseminated Staphylococcus aureus infection following Al-Fashdu therapy. He was treated with surgical drainage and intravenous antibiotics. To our knowledge, this is the first report of a disseminated Staphylococcus aureus infection following Al-Fashdu therapy in an adolescent patient.

Successful Treatment of Infective Endocarditis With Oral Antibiotics: A Case Report

Infective endocarditis (IE) is a serious and potentially life-threatening infection of the heart valves. It is commonly treated with prolonged courses of intravenous antibiotics, and in some cases, surgical intervention may also be necessary. While the use of oral antibiotics in the treatment of IE is generally limited, there are select cases where they may be considered as an alternative treatment option. Here, we report a case of staphylococcal right-sided IE successfully treated with oral antibiotics (linezolid and rifampicin). Our case highlights the potential for oral antibiotics to be used as step-down therapy for select patients with IE.

Iliopsoas Hematoma Progression to Abscess in the Setting of Diabetic Ketoacidosis

Iliopsoas hematomas (IPH) are defined as a spontaneous or traumatic retroperitoneal collection of blood involving the iliopsoas muscle. In some cases, intramuscular hematomas can progress to abscesses and put the patient at risk for further complications. Our objectives are: to describe the etiology of intramuscular hematoma and psoas abscess, to describe the clinical signs and treatment of intramuscular hematoma and psoas abscess, and to analyze the association between uncontrolled diabetes mellitus and psoas abscess progression, which we achieve through retrospective case analysis and associated literature review on symptom constellation. We present the case of a 40-year-old male patient with a history of diabetes mellitus and alcohol abuse who presented with three days of increasing back and left lower extremity pain, confusion, auditory hallucinations, and fever found to be in diabetic ketoacidosis. Six days prior, the patient presented to the Emergency Department (ED) after being struck by a motor vehicle while ambulating found to have bruising, weakness in his lower extremities, and an L2 vertebrae fracture found on CT. During the presentation, the patient was found to have decreased muscle strength, leukocytosis with elevated lactate, and CT findings suggestive of a left psoas abscess drained by interventional radiology. Vancomycin and Cefepime were used as an empiric antibiotic regimen. The culture of the wound was then found to grow Methicillin-susceptible Staphylococcus aureus (MSSA) bacteria and antibiotics were then adjusted to Vancomycin and Cefazolin. During the patient's hospital stay, he developed two more abscesses on his bilateral psoas muscles, which were promptly percutaneously drained by interventional radiology. This case describes an uncommon progression of an Iliopsoas hematoma to a psoas abscess, likely due to his immunocompromised status secondary to his uncontrolled diabetes mellitus. Uncontrolled diabetes mellitus has been shown in various studies to be an independent risk factor of intramuscular hematoma progress to psoas abscess. We suggest that patients displaying fever, chills, flank pain, limited hip movement, and indications of uncontrolled diabetes should be approached with a high degree of suspicion for a psoas abscess.

Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Endocarditis

Infective endocarditis is an infection of the inner layers of the heart, seen often in intravenous drug users and patients with valvular lesions or prosthetic heart valves. This entity has high mortality and morbidity. The most common causative microorganism is Staphylococcus aureus. In this comprehensive literature review, we focused on both Staphylococcus aureus infections, i.e., methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, demographics, use of transthoracic echocardiogram and/or transesophageal echocardiogram for diagnostics, and treatments. Although clinical criteria are relevant, transesophageal echocardiogram plays a vital role in establishing and identifying the presence of infective endocarditis and its local complications, with higher sensitivity in patients with prosthetic valves. The antibiotic selection posed a great challenge for clinicians due to antibiotic resistance and the aggressive nature of Staphylococcus aureus. Early diagnosis of infective endocarditis, when suspected, and effective management by a multispecialty team can improve the outcome for the patients.

An Unusual Case of Deep Vein Thrombosis and Concurrent Necrotizing Fasciitis Following a Fall

A 74-year-old male patient presented to the emergency department following a fall with signs and symptoms consistent with right lower extremity (RLE) deep vein thrombosis (DVT) and non-specific skin changes. Further imaging confirmed the initial diagnosis of DVT, and the patient was appropriately treated. However, his condition continued to deteriorate with worsening overlying skin changes, which prompted a computed tomography (CT) scan of his right femur without intravenous (IV) contrast. This revealed fluid tracking along the lateral compartment muscles, which raised suspicion of an abscess. Suspicion for necrotizing fasciitis (NF) was raised with a subsequent CT of the right femur with IV contrast that demonstrated a considerable increase in rim-enhancing fluid collections intramuscularly and extending into both the anterior and posterior compartments, likely correlating with increasing intermuscular abscesses. On imaging, no subcutaneous emphysema or gas accumulation was found, which is a common finding in NF. However, necrotic-appearing muscle was found on surgical debridement and wound cultures confirmed the diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) NF. The patient was then treated with appropriate IV antibiotics and was discharged to long-term inpatient wound care. Similar presentations of DVT and NF made a prompt diagnosis of NF difficult, and it highlights the need for further imaging to rule out NF when a patient has a confirmed diagnosis of DVT.

Morphea (Localized Scleroderma) Presenting With Recurrent Skin and Soft Tissue Infections: A Diagnostic Dilemma

Morphea or localized scleroderma is reported to be triggered through diverse stimuli. We present a case of morphea that presented as a non-healing wound with superimposed methicillin-sensitive Staphylococcus aureus (MSSA) infection. In our case, morphea was thought to have been potentially triggered by a post-surgical infection. We discuss the potential infectious triggers and common infections that may confound the diagnosis.