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RISS 인기검색어
- 검색키워드
- 저자 : ( Subhasis S Talapatra ) (검색결과 2 건)
- 무료
- 기관 내 무료
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Poster Session : PS 0381 ; Infectious Disease ; An Unusual Case of Headache
( Subhasis S Talapatra ),( Tommy Tsang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 45 year old man, presented with headache in the context of recent travel to Thailand and wet soil contact. He was immune competent and had no history of chronic diseases. His initial clinical examination was unremarkable except the reproducible pain over left temporal region. Initial laboratory assay was suggestive of an infective pathology but no positive microbiological diagnosis. A CSF assay was unremarkable and travel region endemic infective screening was negative. Computed tomography and magnetic resonance imaging studies did not reveal any acute abnormality. He developed high grade fevers for fi rst three days of hospitalisation but his vitals remained stable without any evidence of any organ dysfunction. Emperical therapy commenced with third generation cephalosporin and tetracycline, with improvement of infi ammatory biomarkers but persisting left temporal headache and nocturnal diaphoresis with fever. However a clinical improvement was noted by day seven with no constitutional symptoms but persisting low grade headache. A nuclear bone scan revealed focal gallium activity in the left temporoparietal region of the skull vault, indicating an infiammatory focus. Neurosurgical and Infectious diseases team opinion was sought and patient transferred to a tertiary hospital for further workup. An incisional drainage of left temporal sub-galeal abscess and a bone biopsy was performed and tissue culture revealed Burkholderia pseudomallei while bone biopsy suggested acute on subacute osteomyelitis. Meliodosis serology was positive. A diagnostic conclusion of Burkholderia pseudomallei osteomyelitis of left temporal bone with subgaleal abscess was made. Pathogenesis was attributed to hematogenous spread following initial respiratory inoculation from wet soil contact. He was successfully treated with intravenous Ceftazidime 6g daily for 6 weeks and Trimethoprim-Sulfamethoxazole DS 800mg/150mg two tablets BD for one month followed by 800mg/150mg one tablet bd for total duration of therapy of 6 months, with complete resolution of symptoms.
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( Subhasis S Talapatra ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
An 80 year old lady presented to the hospital following a generalised tonic clonic seizure in the context of well controlled epilepsy consequent to cerebral injury (meningitis and cerebral abscess in 1975 and subsequent neurosurgery). She was loaded with Phenytoin, in addition to her regular Sodium Valproate. She developed diffuse erythematous rash after 3 days of hospitalisation, which dramatically progressed within 48 hours to a myriad of dermatological manisfestations from erythematous macules with purpuric centers, vesicles and bullae to epidermal necrolysis, desquamation (and positive Nikolsky sign), consistent with fulminant toxic epidermal necrolysis. Subsequently, she was transferred to a tertiary hospital Intensive care unit with support from specialised burns unit and dermatology services. Her dermatological manifestation progressed to 100% total body surface area epidermal necrolysis and skin loss, complicated with systemic mucosal involvement (and ocular sparing) and a fatal outcome due to uncontrollable extensive fl uid losses and multi-organ failure, highlighting poor outcomes of fulminant toxic epidermal necrolysis in the elderly.
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