A Patient with Tubo-Ovarian Abscess with Endometriosis after Transvaginal Oocyte Retrieval

Ultrasound-guided oocyte retrieval is a standard procedure for ovum pick up (OPU) during in vitro?fertilization. Possible complications include tubo-ovarian abscesses (TOAs) in the fallopian tubes, and endometriosis may be associated with increasing?the severity of pelvic infection. A 35-year-old?woman who had been treated for infertility and endometriosis presented with abdominal pain that appeared several days after OPU. There were no significant changes in the size of both ovaries and fallopian tubes. A week later, transvaginal echography revealed right oviduct enlargement. Because conservative treatment with antibiotics before this revelation had not been successful, laparoscopy was performed for abscess drainage and/or excision of the adnexa. Intraoperative findings were an abscess in the right adnexa involving the ovary and fallopian tube. Preservation of the right fallopian tube was difficult due to the risk of prolonged infection, and a right appendectomy was performed. The diagnosis was a right TOA. Severe cases of pelvic infection after OPU may cause infertility. The presence of endometriosis may aggravate the infection, but the relationship between the extent of the endometriosis and the severity of the infection is not known. Even if the endometriosis is mild, as it was in this patient, surgical treatment should be considered if a severe infection occurs after OPU and conservative treatment is not effective.

Diverticulitis presenting as a tubo-ovarian abscess with subsequent colon perforation

Described here is an unusual complication of a common condition; diverticulitis resulting in a tubo-ovarian abscess. The etiology of this abscess was clinically unapparent due to atypical presenting symptoms and signs. Furthermore, radiological diagnosis was misleading because of an inflammatory reaction of the colon which prevented visualization of diverticula. Failure to correctly identify the underlying pathology early in the patient's course of treatment led to a perforation of the colon.

Molecular mechanism of Xuebijing in treating pyogenic liver abscess complicated with sepsis

BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.

Amebic liver abscess: An update

Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.

Brain abscess caused by Streptococcus anginosus group:Three case reports

BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.

Coexistence of liver abscess, hepatic cystic echinococcosis and hepatocellular carcinoma: A case report

BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The coexistence of CE and HCC is exceedingly rare,and only several well-documented cases have been reported.In addition to this coexistence,there is no report of the coexistence of CE,HCC,and liver abscess to date.Herein,we aimed to report a case of coexistence of liver abscess,hepatic CE,and HCC.CASE SUMMARY A 65-year-old herdsman presented to the department of interventional therapy with jaundice,right upper abdominal distension and pain for 10 d.Laboratory test showed that he had positive results for HBsAg,HBeAb,HBcAb,and echino-coccosis IgG antibody.The test also showed an increased level of alpha fetopro-tein of 3400 ng/mL.An abdominal computed tomography(CT)scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver.In addition,CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images,the diagnoses of hepatic CE(CE4 subtype)and HCC were established.Initially,transarterial chemoembolization was performed for HCC.In the follow-up,liver abscess occurred in addition to CE and HCC;thus,percutaneous liver puncture drainage was performed.In the next follow-up,CE and HCC were stable.The liver abscess was completely resolved,and the patient was discharged with no evidence of recurrence.CONCLUSION This is the first reported case on the coexistence of liver abscess,hepatic CE,and HCC.Individualized treatment and multidisciplinary discussions should be performed in this setting.Therefore,treatment and diagnosis should be based on the characteristics of liver abscess,hepatic CE,and HCC,and in future clinical work,it is necessary to be aware of the possibility of this complex composition of liver diseases.

Cerebral syphilitic gumma misdiagnosed as brain abscess: A case report

BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.

Endoscopic retrograde appendicitis treatment for periappendiceal abscess: A case report

BACKGROUND Acute appendicitis is the most common abdominal emergency.At present,the main treatments for periappendiceal abscess include antibiotics and surgery.However,the complications and mortality of emergency surgery are high.The preferred therapy is conservative treatment with antibiotics first,ultrasound-guided puncture drainage or surgical treatment is followed when necessary.Endoscopic retrograde appendicitis therapy(ERAT)for acute uncomplicated appendicitis have been proved clinically effective,but it is rarely used in periap-pendiceal abscess.CASE SUMMARY We report a patient admitted to hospital because of“right lower abdominal pain for six days”.The computerized tomography(CT)of patient showed that appendicitis with fecaliths and abscess in the pelvis.The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths,irrigation and stent placement.CONCLUSION The patient did not receive surgery because of impoverished family.Abdominal pain did not recur during the follow-up period.This case confirms the value of ERAT in the treatment of periappendiceal abscess.

Brain abscess from oral microbiota approached by metagenomic next-generation sequencing: A case report and review of literature

BACKGROUND Brain abscess is a serious and potentially fatal disease caused primarily by microbial infection.Although progress has been made in the diagnosis and treatment of brain abscesses,the diagnostic timeliness of pathogens needs to be improved.CASE SUMMARY We report the case of a 54-year-old male with a brain abscess caused by oral bacteria.The patient recovered well after receiving a combination of metagenomic next-generation sequencing(mNGS)-assisted guided medication and surgery.CONCLUSION Therefore,mNGS may be widely applied to identify the pathogenic microor-ganisms of brain abscesses and guide precision medicine.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma:A case report

BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

A case study illustrating the use of an integrated approach to treat secondary Anal Fistula Post I&D of Perianal Abscess

Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pus drainage.It is linked to Bhagandar in Ayurveda,and in Sushruta Samhita,Acharya has mentioned 5 forms of Bhagandar.The boil in the present case was Shukla,sthira i.e.hard and firm,with Picchila strava and Kandu resembling the features of Parisraavi bhagandar.Aim and objective:The current case was diagnosed as Parisravi bhagandar,which resembles trans-sphincteric or intersphincteric fistula in modern ano.In Ayurveda,the management of Parisraavi Bhagandar,Shastra,kshara,and Agnikarma is advised and the use of Ksharasutra,which contributes to complete cutting and healing of the track without reoccurrence,similarly Modern surgeon depends on surgery i.e radical excision of the track,ligation with Seton,and use of chemical irritants like urethane,silver nitrates,etc.A cutting seton(tight)gently slices the confined muscle to close the fistula with the least interruption to continence.This operation is especially advised when a one-stage fistulotomy poses a considerable risk of incontinence.Material and methods:The method performed here was Core Partial Fistulectomy followed by Ksharasutra application till complete healing of the wound.Discussion and conclusion:This case study provides the successful management of Parisraavi Bhagandara(high anal,trans-sphincteric fistula in ano)in 61-year-old male patient with an integrated surgical&Ayurvedic management approach.

Clinical Study on the Effectiveness of Xian Fang Huo Ming Yin for Treating Cutaneous Infections and Promoting Wound Healing in Patients with Perianal Abscess

Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.

Pyogenic liver abscess secondary to gastric perforation of an ingested toothpick:A case report

BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.

Lactation breast abscess treated with Gualou Xiaoyong decoction and painless lactation manipulation:A case report and review of literature

BACKGROUND Breast abscess during lactation is a severe complication of acute mastitis,which can lead to discomfort,high fever,breast fistula,sepsis,septic shock,breast damage,disease persistence and frequent hospitalization.Breast abscesses may also lead the mother to discontinue breastfeeding,thereby harming the infant’s health.The predominant pathogenic bacteria are Staphylococcus aureus,Staphylococcus epidermidis and Streptococcus.The incidence of breastfeeding abscesses in breastfeeding women ranges between 4.0%and 11.0%.In cases of breast abscess,the rate of cessation of lactation is 41.0%.In instances of breast fistula,the rate of cessation of lactation is very high(66.7%).Furthermore,50.0%of women with breast abscesses must be hospitalized and treated with intravenous antibiotics.Treatment includes antibiotics,abscess puncture and surgical incision and drainage.The patients suffer from stress,pain and easily induced breast scarring;the disease’s progression is prolonged and recurrent,interfering with infant feeding.Consequently,it is crucial to discover an adequate cure.CASE SUMMARY A 28-year-old woman with a breast abscess was treated with Gualou Xiaoyong decoction and painless breast opening manipulation 24 d after cesarean delivery.On the 2nd d of treatment,the patient’s breast mass was significantly reduced,the pain was significantly reduced,and the general asthenia was improved.All conscious symptoms disappeared after 3 d,breast abscesses faded after 12 d of treatment,inflammation images disappeared after 27 d,and normal lactation images were restored.CONCLUSION In treating breast abscesses during breastfeeding,the combination of Gualou Xiaoyong decoction and painless lactation provides a positive therapeutic impact.This disease’s treatment offers the advantages of a short course of treatment,no need to discontinue breastfeeding and the ability to rapidly mitigate symptoms,which can be used as a reference in clinical practice.

Isolated cerebral mucormycosis that looks like stroke and brain abscess:A case report and review of the literature

BACKGROUND Cerebral mucormycosis is an infectious disease of the brain caused by fungi of the order Mucorales.These infections are rarely encountered in clinical practice and are often misdiagnosed as cerebral infarction or brain abscess.Increased mortality due to cerebral mucormycosis is closely related to delayed diagnosis and treatment,both of which present unique challenges for clinicians.CASE SUMMARY Cerebral mucormycosis is generally secondary to sinus disease or other disseminated disease.However,in this retrospective study,we report and analyze a case of isolated cerebral mucormycosis.CONCLUSION The constellation of symptoms including headaches,fever,hemiplegia,and changes in mental status taken together with clinical findings of cerebral infarction and brain abscess should raise the possibility of a brain fungal infection.Early diagnosis and prompt initiation of antifungal therapy along with surgery can improve patient survival.

Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients

BACKGROUND The degree of psychological stress and the difficulty and efficacy of laparoscopic surgery differ in patients with pelvic abscesses after different durations of antiinfection treatment.AIM To compare and analyse the effects of different durations of anti-infective therapy on patients’preoperative psychological stress level and the clinical efficacy of laparoscopic surgery in patients with pelvic abscesses to offer a reference for the selection of therapy plans.METHODS A total of 100 patients with pelvic abscesses who were admitted to the Department of Gynecology of Suzhou Ninth Hospital affiliated to Soochow University(Suzhou Ninth People's Hospital)from January 2018 to December 2022 were retrospectively enrolled.According to the different durations of antiinfective therapy,they were divided into Group S(50 patients,received antiinfective therapy for 24-48 h)and Group L(50 patients,received anti-infective therapy for 48-96 h).Baseline data,state-trait anxiety score at admission and before surgery,self-rating anxiety scale(SAS)+self-rating depression scale(SDS)score,surgery time,adhesion grading score,intraoperative blood loss,presence or absence of intraoperative intestinal injury,ureteral injury or bladder injury,postoperative body temperature,length of hospital stay,and presence or absence of recurrence within 3 mo after surgery,chronic pelvic pain,incision infection,dysmenorrhea,menstrual disorder or intestinal obstruction were compared between the S group and the L group.RESULTS There was no significant difference in the background data between the S group and the L group(P<0.05).There was no significant difference in the state-trait anxiety score or SAS+SDS score between the S group and the L group on admission(P<0.05).The state-trait anxiety score and SAS+SDS score of the S group were lower than those of Group L after receiving different durations of anti-infective therapy(P<0.05).There was no significant difference in the incidence of intestinal,ureteral or bladder injury between the S group and the L group(P<0.05).The surgery time of Group S was shorter than that of Group L,and the adhesion score and intraoperative blood loss volume were lower than those of Group L(P<0.05).There was no significant difference in the incidence of incision infection,dysmenorrhea,menstrual disorder or intestinal obstruction between the S group and the L group(P<0.05).The postoperative body temperature of Group S was lower than that of Group L(P<0.05),and the hospital stay was shorter than that of Group L(P<0.05).The incidences of recurrence and chronic pelvic pain within 3 mo after surgery were lower than that of Group L(P<0.05).CONCLUSION Twenty-four to forty-eight hours of anti-infective therapy is better than 48-96 h of anti-infective therapy for patients with pelvic abscesses because the degree of psychological stress is lower,which is more conducive to achieving better outcomes after laparoscopic surgery.

A rare case of purulent pericarditis secondary to subdiaphragmatic abscess

Subdiaphragmatic abscess is the accumulation of pus in the space between the diaphragm and the transverse colon and its mesentery.[1]Subdiaphragmatic abscess is clinically characterized by fever and local pain.Its clinical manifestations are often vague and diverse,and its symptoms and signs together constitute thoracoabdominal syndrome,leading to delayed diagnosis and a high incidence rate and mortality.[2]Subdiaphragmatic abscess is often secondary to acute peritonitis or remote infection with hematogenous dissemination.The bacteriological characteristics of these abscesses include aerobic and facultative bacteria,such as Escherichia coli,group D Enterococcus and Staphylococcus aureus,as well as less common anaerobic organisms,such as Bacteroides.

Prostatic Abscess Due to Idiopathic Granulomatous Disease: A Rare Complication of a Chameleon Disorder —Prostatic Abscess Due to Idiopathic Granulomatous Disease

Background: Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis (GP). Four cases of idiopathic xanthogranulomatous GP have been described previously and the present case report is the first of typical idiopathic variety. The case: A 60-year-old man presented with urine retention that was associated with pyuria and massively enlarged prostate. Cystoscopy revealed prostatic abscess (PA) that was opened. Urine and prostatic culture were negative for bacteria. Prostatic biopsy revealed multiple non-caseating granulomata surrounded by lymphocytes, plasma cells yet without foamy histiocytes, parasites and vasculitis. Special stains were negative for vasculitis, fungiand acid-fast organisms. The patient was treated with Solumedrol 1 g intravenously daily for 3 days followed by Prednisone 1 mg/kg/day for 1 month followed by gradual tapering till discontinuation by 3rd month. Moreover, he had received Mycophenolate mofetil (MMF) 1 g twice/daily. By the end of 2nd month;he was asymptomatic and without pyuria. Repeat cystourethroscopy and MRI scan of the prostate showed near normal prostate. In Conclusion: Idiopathic GP can present with PA that requires proper drainage and since it is a locally hyperimmune disease with genetic predisposition;MMF therapy will be maintained for a total of 2 years to prevent future disease-relapse.

Brain Abscess after COVID-19: Case Report

As the COVID-19 pandemic progresses, complications and unusual presentations of the disease have been described. Among them, the involvement of distinct parts of the neuroaxis. We report a rare case of brain abscess in elderly after SARS-Cov-2 infection readmitted in our health unit. Patient was treated with ceftriaxone, metronidazole and vancomycin with good clinical and therapeutic response. The satisfactory conduct of the case was only possible by the involvement of a multiprofessional team, which sought early diagnosis, surgical intervention and adequate duration of treatment.