Case Studies
Pulmonary Scopulariopsis
Co-existing Fungal Infection
Perigraft infections
Pulmonary Scopulariopsis in a chronictobacco smoker
Satyavani M, Viswanathan R, Harun N S, Mathew L
A 70-year-old male smoker, with a threemonth status of post-balloon angioplasty for ischaemic heart disease, presented with a one-week history of fever, haemoptysis and chest discomfort on coughing. The patient did not report any loss of weight or appetite. On examination, he was febrile. Pulmonary function tests revealed obstructive airway disease. High resolution computed tomography of the lungs revealed fibrosis with bronchiectasis in both the upper lobes and a spiculating subpleural mass in the posterior aspect of the right lung apex. Subsequent bronchoalveolar lavage (BAL) culture yielded the Scopulariopsis species. Our patient was treated with a four-week course of amphotericin B, followed by itraconazole. At the 24-month follow-up, the patient was asymptomatic. Subsequent BAL cultures revealed no fungal growths, and radiological studies showed a regression in the lesion.
Co-existing Fungal Infection in a Case of Temporal Lobe Tuberculoma
Roopa Viswanathan*, Viswanathan Iyer**,Sanat N Bhagwati**, Geeta Parulekar**
An unusual case of temporal lobe tuberculoma with co-existing fungal infection in a diabetic patient is reported. A 54-year-old male with uncontrolled Diabetes mellitus was treated with anti-tuberculosis drugs for six months for temporal lobe tuberculoma. Follow-up scans showed increase in the size of the lesion in-spite of good drug compliance. After complete excision of the lesion, the pus encountered was sent for microbiological investigations, which showed acid-fast bacilli and multi-polar budding yeast cells. So, the patient was treated with antituberculosis drugs and Itraconazole. Follow-up scans after six months showed good resolution. In conclusion, any tuberculoma, which does not respond to medical management alone, should be surgically excised and evaluated for any other co-existing infection.
Perigraft infections due to Salmonella after abdominal aortic aneurysm repair
Viswanathan R, Khee T K, Chong C F
A 70-year-old man with abdominal aortic aneur ysm repair presented with fever accompanied by rigors and abdominal pain one month after the procedure. Radiological investigations showed a perigraft collection. The collection was drained and the abscess cavity was lavaged. Cultures of pus and blood both yielded Group D Salmonella (non-typhi), which was treated with ceftriaxone and ciprofloxacin. The patient was followed-up for the past eight months without any further symptoms. Perigraft infections post abdominal aortic aneurysm repair could be caused by enteric organisms and must be treated with long-term appropriate antibiotics, depending on the microbiological finding, besides surgical drainage and lavage.