Pearls from Dr. Marcus Pereira

56 y/o OHT with syncope found to have Nocardia brain abscess

2016-07-27

  • PRES - Posterior Reversible Encephalopathy Syndrome - associated with patients being on immunosuppression

    Posted 07/27/16 11:07:52 AM by Adam Faye

  • Brain Abscesses: Common Bugs
    *If it were septic emboli to the brain - often localizes to grey-white matter junction

    Posted 07/27/16 11:13:55 AM by Adam Faye

  • Patients with focal neuro signs from possible mass effect - CT Head before LP to minimize the possibility of herniation.

    Posted 07/27/16 11:17:49 AM by Adam Faye

  • Nocardia Treatment:
    Toxo Treamtent:

    Posted 07/27/16 11:23:44 AM by Adam Faye

  • Ring Enhancing Lesions Differential:

    Posted 07/27/16 11:25:17 AM by Adam Faye

  • Middle aged man w/ hx IVDU p/w LBP, found to have epidural abscess/vertebral osteomyelitis due to Chryseobacterium indologenes

    2016-11-23

  • Epidural abscess

    Posted 11/23/16 10:44:45 AM by Matthew Cummings

  • Clindamycin and D-test

    Posted 11/23/16 10:49:12 AM by Matthew Cummings

  • Multiple GNR infections (esp. separated in time and anatomic location)? Think Strongyloides (GNR translocation in gut)

    Posted 11/23/16 10:50:01 AM by Matthew Cummings

  • Chryseobacterium indologenes

    Posted 11/23/16 10:55:29 AM by Matthew Cummings

  • For further reading...

    Spinal epidural abscess clinical review (NEJM)
    D-test for clindamycin and macrolide resistance
    Clinical and epidemiological features of Chryseobacterium indologenes infections

    Posted 11/23/16 10:57:35 AM by Matthew Cummings

  • 61 y/o man s/p allogeneic HCT 1.5 yrs ago, p/w endopthalmitis, ring-enhancing CNS lesions, and lung mass due to disseminated nocardiosis

    2017-03-22

  • Acute Renal Necrosis DDx (emphasis on infectious agents)

    Posted 03/22/17 09:57:10 AM by Matthew Cummings

  • Multiple-ring enhancing CNS Lesions = MAGIC DR

    Posted 03/22/17 10:01:52 AM by Matthew Cummings

  • Nocardiosis

    Posted 03/22/17 10:15:51 AM by Matthew Cummings

  • For further reading...

    Nocardiosis: Updates and Clinical Overview (Mayo Clinical Review)
    Multiple ring-enhancing lesions of the brain (J Postgrad Med)
    Acute Retinal Necrosis: Features, Management, and Outcomes (Opthalmology 2007)

    Posted 03/22/17 10:18:33 AM by Matthew Cummings

  • 55yo F s/p renal transplant who presents with 3 months of whole body rash found to have disseminated cutaneous VZV

    2017-07-05

  • Immunosupressed patients who present with diffuse rash has broad differential.  Think: VZV, HSV, coxsackie, mycobacterium, actinomyces, cryptococcus (usually not vesicular, more nodular), histoplasmosis, sporotrichosis (usually lymphatic spread confined to one limb).

    Posted 07/05/17 10:24:09 AM by Emily Miller

  • Disseminated viral infection - look for atypical lymphocytes of CBC differential.  Helpful, but not diagnostic. 

    Posted 07/05/17 10:24:51 AM by Emily Miller

  • Tzanck smear can be helpful in narrowing differential if multinucleated giant cells are present.  However, cannot differentiate between VZV and HSV.

    Posted 07/05/17 10:35:54 AM by Emily Miller

  • Acyclovir does not treat CMV, but ganciclovir does treat VZV.  Think of Ganciclovir is the broad spectrum herpesvirus antiviral.  

    Posted 07/05/17 10:37:19 AM by Emily Miller

  • Transplant ID

    2017-11-09

    36yo M s/p OHT p/w fever and cough found to have pulmonary and CNS nocardia

    2017-11-13

    CMV in Solid Organ Transplant

    2017-12-14

    EBV Infections

    2017-12-28

    24yo F w/ shock, renal dysfunction, PNA and rash found to have GAS bacteremia and TSS

    2018-02-28

    44yo M p/w sore throat and enlarged cervical LN found to have Prevotella intermedia

    2018-07-09

    31 yo F s/p DLT p/w abdominal pain found to have disseminated VZV

    2019-04-18


    Created by Christopher Kelly
    Book be65e564ffbc09cd3ee32372501a5ece813f14b576dc711ff66870a4906e7f62
    Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
    The information on the website does not constitute official guidelines except where explicitly stated.
    It is not meant to replace the advice of a health professional.