Case # 1. A 45 year old immunocompetent woman with h/o recent AVR 2/2 RHD, recent h/o subarachnoid hemorrhage, p/w acute onset headache and fever 2/2 Mycobacterium mageritense
1. Mycobacterium mageritense is a rapid growing mycobacterial species that was first isolated in Spain in 1987 and assigned its own species in 1997. It has been reported to cause CLABSI in immunocompromised patients, post-surgical wound infection, disaster-associated soft tissue infection, and granulomatous disease. It is universally resistant to clarithromycin but susceptible to a variety of agents.
2. Prosthetic valve endocarditis secondary to mycobacterial species is mostly caused by rapid growers (M. chelonae > M. fotuitum > M. abscessus). Surgery and appropriate antimicrobial therapy are necessary. It is unclear as to the duration of antibiotic therapy but based on case reports, the duration of therapy is the same as other bacterial causes of endocarditis.
3. Differential diagnoses for AFB in the blood: rapid growing mycobaterial species, Nocardia, Rhodococcus, Tsukamurella, and Gordonia.
4. For this case, the infection may have been a result of her recent AVR done at an OSH. Infection control should always be alerted in such cases. Patient was treated with imipenem, moxifloxacin, and doxycyline.
Case # 2. A 9 year old girl s/p 2nd lung transplant and recent diagnosis of PTLD, p/w R eye pain and swelling associated with an invasive nasal mass on imaging 2 months after receiving chemotherapy; sinus culture grew MDR Pseudomonas plus other bacterial flora; endoscopy did not show evidence of invasive fungal infection; biopsy showed PTLD
1. Discussion focused on positive and negative predictors of survival in patients with acute invasive fungal sinusitis. Age and intracranial extension are negative predictors while diabetes and surgery are positive predictors.
2. Majority of pediatric PTLD are EBV negative while majority of adult PTLD are EBV positive.
Case # 3. A 65 year old immunocompetent veteran who originally p/w acute low back pain secondary to MSSA bacteremia and thoracic epidural abscess for which he was receiving nafcillin, presented with recurrence of fever and new-onset hematochezia secondary to CMV colitis
1. CMV reactivation can occur in immunocompetent patients who are critically ill. Most of these patients are admitted in the ICU, were older, and had h/o shock or organ failure. In once case series, 71% of these patients died during hospital admission.
