Pearls from Dr. Marcus Pereira

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


  • 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


  • 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


  • 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


  • 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


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


    CMV in Solid Organ Transplant


    EBV Infections


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


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


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


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