Jeremy D. Gradon

Thyroid abscess due to Acinetobacter calcoaceticus: case report and review of the causes of and current management strategies for thyroid abscesses.

Thyroid abscess was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. We report the case of a unique cause of thyroid abscess, the environmental Gram-negative bacterium Acinetobacter calcoaceticus. Review of the published causes of thyroid abscess since 1980 demonstrated that although Gram-positive bacteria (Staphylococcus and Streptococcus species) remain the most common causes, there has been a marked decrease in the number of cases caused by mycobacteria, Salmonella species, and anaerobes when compared with the early part of the 20th century. Patients infected with the human immunodeficiency virus, however, still develop mycobacterial and fungal thyroid infections with some regularity. Reported modes of management of thyroid abscess vary, but drainage remains an integral component of therapy for resolution of the infection.

Bacteremia due to Comamonas species possibly associated with exposure to tropical fish.

Comamonas species are environmental gram-negative rods that grow forming pink-pigmented colonies. Despite their common occurrence in nature, they rarely cause human infection. We present a case of Comamonas bacteremia that we think may have been related to tropical fish exposure. The patient was treated successfully with levofloxacin.

Causes and presentation of meningitis in a baltimore community hospital 1997"2006

Objectives: Described here is the clinical presentation and etiology of community-acquired meningitis in adult patients in a Baltimore community hospital from 1997 to 2006. Method: A retrospective chart review was performed. Data were collected regarding demographics, presenting symptoms, cerebrospinal fluid findings, and outcome. Results: Of 80 patients identified, 17 were diagnosed with bacterial meningitis, 18 with viral meningitis, 39 with aseptic meningitis of unclear etiology, and 6 with other noninfectious causes. Streptococcus pneumoniae was the most common bacterial pathogen. Herpes simplex virus, enteroviruses and West Nile encephalitis virus were the most common viral pathogens. The classic triad of fever, neck stiffness and change of mental status was less common than previously reported, found in 5.0% of all the patients and 21.4% of the patients with bacterial meningitis. Conclusion: Meningitis should be suspected with any suggestion of central nervous system complaint, even in the absence of the classic triad of symptoms and signs.

Massive Hepatic Enlargement with Fatty Change Associated with Ketoconazole

Several forms of hepatic toxicity have been described with the antifungal agent ketoconazole. We report a case of massive liver enlargement with fatty infiltration presenting as gastric compression. This occurred in a young woman with AIDS taking ketoconazole as maintenance therapy for cryptococcal meningitis. This is the first reported case of ketoconazole causing fatty change in the liver.

RETROPHARYNGEAL SPACE INFECTIONS IN A COMMUNITY HOSPITAL

The emergency physician often has to deal with infectious disease emergencies. The authors have seen four cases of retropharyngeal infection of potentially life-threatening severity in less than 1 year, all were admitted through the emergency department (ED). Reporting these cases is important to increase awareness among emergency physicians of this classic disease entity. The characteristics of the patients are discussed including initial diagnostic approaches and the use of computed tomography (CT) scanning of the neck and mediastinum. One case of retropharyngeal space infection caused by Neisseria meningitidis serotype W-135 is described. This is the first such reported case. The recommendations are that, in the absence of overt focal infection, a non-surgical approach to the treatment of these patients is indicated. This should include suitable neck roentgenograms, CT scanning, and high-dose, intravenous, beta-lactamase-resistant antibiotics.

Neuroleptic Malignant Syndrome Possibly Caused by Molindone Hydrochloride

The case of a patient who developed neuroleptic malignant syndrome (NMS) on three separate occasions is presented. Her third bout of this syndrome possibly was caused by molindone hydrochloride. This medication has been reported only once previously to cause NMS. The pharmacology of molindone is reviewed and a complicating factor in this case—the recent onset of hypothyroidism—is discussed together with its implication in the development of the clinical manifestations of this syndrome.

The fortuitous diagnosis of cholera in a two-year-old girl

We are reporting the fortuitous diagnosis of a case of cholera and the unusual failure of the commercial bacteriologic media that led to the unexpected isolation of Vibrio cholerae. The case demonstrates the need for communication between the medical staff and laboratory personnel when an uncommon disease, such as cholera, is suspected. This case also alerts the clinician to the possibility of multiple enteric pathogens coinfecting a traveller.