MyMedR

Adult varicella zoster infection complicated with streptococcal retrosternal abscess

Yap FBB, Kiung ST

South. Med. J., 2009 Jun;102(6):653-5.

PMID: 19434036 DOI: 10.1097/SMJ.0b013e3181a49a71

A 43-year-old lady with type 2 diabetes mellitus and bronchial asthma presented with varicella zoster infection, dyspnea, and neck fullness. An urgent computed tomography scan revealed a mediastinal abscess with superior vena cava thrombus. Blood, mediastinal pus, and swab from a vesiculopustule on the neck cultured group A beta hemolytic Streptococcus. She recovered with a combination of broad spectrum antimicrobials, antivirals, and surgical drainage. This case illustrates the rare occurrence of mediastinal abscess and acute superior vena cava obstruction caused by group A beta hemolytic Streptococcus complicating adult varicella zoster.

Matched MeSH terms: Abscess/complications*

Fulltext An unusual presentation of tropical pyomyositis

Sudha V, Abhishek M, Shashikiran U, Annappa K, Mukhyaprana MP

Med J Malaysia, 2005 Jun;60(2):229-31.

PMID: 16114167

Tropical pyomyositis is a primary pyogenic infection of skeletal muscle, often caused by Staphylococcus aureus. The most common presentation of tropical pyomyositis is that of multiple acute abscesses with fever. Hepatitis is a rare manifestation of this disease. We report a case of tropical pyomyositis who presented with hepatic encephalopathy leading to initial diagnostic dilemma.

Matched MeSH terms: Abscess/complications

Fulltext Edwardsiella tarda septicemia with underlying multiple liver abscesses

Yousuf RM, How SH, Amran M, Hla KT, Shah A, Francis A

Malays J Pathol, 2006 Jun;28(1):49-53.

PMID: 17694959 MyJurnal

Edwardsiella tarda has recently been described as a member of the family Enterobacteriaceae. The genus Edwardsiella contains three species; E. hoshinae, E. ictaluri and E. tarda. Edwardsiella tarda is the only species which has been recognised as pathogenic to humans, especially in those with an underlying disease. The most common presentation is watery diarrhoea. Extra intestinal infections have been reported infrequently. Humans seem to be infected or colonised with Edwardsiella through ingestion or inoculation of a wound. This report is of a patient with multiple liver abscesses due to E. tarda who later developed bacterial peritonitis and septicaemic shock.

Matched MeSH terms: Liver Abscess/complications*

Eikenella corrodens from a brain abscess

Karunakaran R, Marret MJ, Hassan H, Puthucheary SD

Malays J Pathol, 2004 Jun;26(1):49-52.

PMID: 16190107

A 2-year-old boy with underlying congenital cyanotic heart disease presented with seizures and fever and was found to have bilateral parietal cerebral abscesses. Drainage of the pus from the abscesses was done in stages; on the day of admission, four days after admission and 3 weeks after admission. Although the pus from the first drainage did not grow any organisms, the pus from the second drainage on the fourth day of admission yielded a mixed growth of Eikenella corrodens and Streptococcus milleri. Following the second drainage of pus, the child was noted to have mild weakness (grade 3/5) and increased tone in the left upper limb. Three weeks after admission, due to recurring fever, further neurological signs and findings of an enlarging right cerebral abscess on a repeat CT scan, a third drainage was carried out. However no growth was obtained from this specimen. This patient was managed both surgically and with appropriate antibiotics. Over the next four months, serial CT scans revealed gradual resolution of the abscesses with disappearance of the surrounding oedema. The child showed gradual recovery of his left sided weakness with resolution of tone and reflexes to normal.

Matched MeSH terms: Brain Abscess/complications

Fulltext Computed tomography of focal splenic lesions in patients presenting with fever

Joazlina ZY, Wastie ML, Ariffin N

Singapore Med J, 2006 Jan;47(1):37-41.

PMID: 16397719

INTRODUCTION: There is an awareness of the increased incidence of splenic abscess in Southeast Asia giving rise to unexplained fever. This study looks at the role of computed tomography (CT) in evaluating focal splenic lesions in patients presenting with fever.
METHODS: 37 patients presenting with fever of unknown origin underwent CT and this study retrospectively analyses the findings in these patients. 13 patients also had associated abdominal pain. Patients with conditions at high risk for splenic infection include: diabetes mellitus in ten patients, leukaemia in seven patients, human immunodeficiency virus infection in five patients, intravenous drug abuse in six patients, and steroid therapy in two patients. No risk factors could be identified in seven patients.
RESULTS: Splenic abscess was diagnosed in 28 patients. A range of infecting organisms was isolated but the most frequent were Staphylococcus aureus (eight), tuberculosis (four), Streptococcus (four), fungal (four) and melioidosis (four). No infecting organism could be identified in ten cases though in patients with leukaemia with multiple low attenuation areas, the cause was presumed to be fungal. Six patients were diagnosed to have splenic infarcts though differentiation from splenic abscess could be difficult; these patients were treated for an abscess and all had endocarditis. Three patients were subsequently diagnosed with lymphoma. Percutaneous abscess drainage was performed in five patients and splenectomy was carried out in six patients.
CONCLUSION: CT proved to be very useful as it not only revealed the size and extent of any splenic abnormality but it assisted with guidance for percutaneous drainage, determined the site for biopsy, and provided follow-up after treatment.

Matched MeSH terms: Abscess/complications

Fulltext Parotid abscess: an unusual cause of facial nerve palsy

Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2009 Jun;64(2):172-3.

PMID: 20058583 MyJurnal

Facial nerve palsy with a parotid mass is usually associated with malignant neoplasm of parotid gland. Its occurrence as a complication of parotid abscess is extremely rare. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess were reported. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction. Underlying neoplasia was excluded.

Matched MeSH terms: Abscess/complications*

Fulltext Mycotic bronchial artery aneurysmal rupture in the early stage of lung abscess: A case report

Mohd Alkaf AL, Syed Rasul SH, Abdul Rahman I

Med J Malaysia, 2016 04;71(2):96-7.

PMID: 27326956 MyJurnal

Symptomatic bronchial artery aneurysm warrants urgent intervention. It has a known association with pulmonary infection caused by Staphylococcus aureus. We hereby report an elderly lady with a ruptured left superior bronchial artery mycotic aneurysm. She was in the early stages of treatment for a left lung abscess. She had multiple episodes of haemoptysis following which she underwent a left lower lobectomy. Presentation of lung abscess with a concurrent ruptured mycotic aneurysm warrants early surgical intervention and can be curative as seen in this case.

Matched MeSH terms: Lung Abscess/complications*

Fulltext Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury

Chek Siang KC, Ahmad Fauzi A, Hasnan N

J Spinal Cord Med, 2017 01;40(1):113-117.

PMID: 26871508 DOI: 10.1080/10790268.2015.1133016

CONTEXT: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.

FINDINGS: A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.

CLINICAL RELEVANCE: We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.

Matched MeSH terms: Abscess/complications

Median mental sinus in twins

Ong ST, Ngeow WC

Dent Update, 1999 May;26(4):163-5.

PMID: 10765768

Sinus on the chin can be the result of a chronic apical abscess due to pulp necrosis of a mandibular anterior tooth. The tooth is usually asymptomatic, and a dental cause is therefore not apparent to the patient or the unsuspecting clinician. Not infrequently, the patient may seek treatment from a dermatologist or general surgeon instead of a dentist. Excision and repair of the fistula may be carried out with subsequent breakdown because the dental pathology is not removed. This paper reports the presence of median mental sinus of dental origin in twins. One case healed following root canal therapy while the other required both root canal therapy and surgery to eliminate the infection.

Matched MeSH terms: Periodontal Abscess/complications*

Fulltext Lower lip numbness due to peri-radicular dental infection

Ngeow WC

Med J Malaysia, 1998 Dec;53(4):446-8.

PMID: 10971994

Lower lip numbness has always been a sinister symptom. Much has been written about it being the sole symptom of pathological lesions and metastatic tumours in the mandible. It may also be a symptom of manifestations of certain systemic disorders. A case of lower lip numbness resulting from the compression of the mental nerve by a peri-radicular abscess is presented because of the unusual nature of this spread of infection.

Matched MeSH terms: Periapical Abscess/complications*

Sevoflurane induction in acute airway obstruction

Chiu CL, Delilkan AE

Hosp Med, 1998 Oct;59(10):828.

PMID: 9850310

Matched MeSH terms: Abscess/complications

Multiple external root resorption

Yusof WZ, Ghazali MN

J Am Dent Assoc, 1989 Apr;118(4):453-5.

PMID: 2708724

Presented is an unusual case of multiple external root resorption. Although the cause of this resorption was not determined, several possibilities are presented. Trauma from occlusion, periodontal and pulpal inflammation, and resorption of idiopathic origin are all discussed as possible causes.

Matched MeSH terms: Periodontal Abscess/complications

Fulltext Acute stridor in childhood; retropharyngeal abscess

Yeo TC

Med J Malaysia, 1988 Mar;43(1):65-73.

PMID: 3244324

Thirty-eight patients with acute stridor were admitted to the Paediatric Unit of the Alor Setar General Hospital over a three-year period (1984 - 1986). The causes are discussed and retropharyngeal abscess is highlighted as it is often initially overlooked. The clinical presentation and the problems in the diagnosis of the latter are discussedwith reference to the three cases seen.
Key words: Acute stridor in childhood, retropharyngeal abscess

Matched MeSH terms: Abscess/complications*

Protein calorie malnutrition: a major health problem of multiple causation in Malaysia

Chen ST

Southeast Asian J. Trop. Med. Public Health, 1974 Mar;5(1):85-9.

PMID: 4209141

Matched MeSH terms: Lung Abscess/complications

Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin

Varghese LL, Bhattacharya A, Sharma P, Apratim A

BMJ Case Rep, 2020 Jul 20;13(7).

PMID: 32690568 DOI: 10.1136/bcr-2020-234699

Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.

Matched MeSH terms: Periodontal Abscess/complications*

Fulltext Comparison of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score and Rapid Acute Physiology Score for predicting the outcomes of adult splenic abscess patients in the emergency department

Hung SK, Ng CJ, Kuo CF, Goh ZNL, Huang LH, Li CH, et al.

PLoS One, 2017;12(11):e0187495.

PMID: 29091954 DOI: 10.1371/journal.pone.0187495

BACKGROUND: Splenic abscess is rare but has mortality rates as high as 14% even with recent improvements in management. Early and appropriate intervention may improve patient outcomes, yet at present there is no identified method that can predict mortality risk rapidly and accurately for emergency physicians, surgeons, and intensivists to decide on the ideal course of action.

OBJECTIVE: This study aims to evaluate the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) for predicting the mortality risk of adult splenic abscess patients. This will expedite decision making in the emergency department (ED) to increase survival rates and help avoid unnecessary splenectomies.

METHODS: Data of 114 adult patients admitted to the EDs of 4 research and training hospitals who had undergone an abdominal contrast CT scan and diagnosed with splenic abscess between Jan 2000 and April 2015 were analyzed. The MEDS, MEWS, REMS, and RAPS and their corresponding mortality risks were calculated, with their abilities to predict patient mortality assessed through receiver operating characteristic curve analysis and calibration analysis.

RESULTS: MEDS was found to be the best performing scoring system across all indicators, with sensitivity, specificity, and accuracy of 92.86%, 88.00%, and 88.60% respectively; its area under curve for AUROC analysis was 0.92. With a cutoff value of 8, negative predictive value of MEDS was 98.88%.

CONCLUSION: Our series is the largest multicenter study in adult ED patients with splenic abscess. The results from the present study show that MEDS is superior to MEWS, REMS and RAPS in predicting mortality, thus allowing earlier detection of critically ill adult ED splenic abscess patients. Therefore, we recommend that MEDS be used for predicting severity of illness and risk stratification in these patients.

Matched MeSH terms: Abscess/complications*

Fulltext Life-threatening parapharyngeal and retropharyngeal abscess in an infant

Balasubramanian A, Shah JR, Gazali N, Rajan P

BMJ Case Rep, 2017 Oct 09;2017.

PMID: 28993356 DOI: 10.1136/bcr-2017-221269

Severe extensive deep neck abscess in an infant is uncommon. We share the case of a previously well 4-month old infant who was referred for a 4-day history of fever, lethargy and left lateral neck swelling. Contrast-enhanced CT scan revealed a large 5.3×8 cm collection involving the left parapharyngeal and retropharyngeal space, causing significant airway narrowing. 40 mL of frank pus was drained via intraoral incision and drainage with the aid of endoscope, and undesirable complications from an external approach were averted. The infant was extubated 48 hours postsurgery and was discharged home well after completion of 1 week of intravenous antibiotics. The child was discharged well from our follow-up at 1 month review. We discuss the pathophysiology of deep neck space abscesses, its incidence in the paediatric population and the various management options.

Matched MeSH terms: Retropharyngeal Abscess/complications

Fulltext The management of psoas abscess

Bajaj HN, Choong LT

Med J Malaysia, 1998 Sep;53 Suppl A:95-8.

PMID: 10968189

The presentation and management of psoas abscess was studied prospectively in 5 patients and retrospectively in 4. 3 patients had bilateral abscesses. All patients had back pain and a mass in loin or iliac fossa. 7 patients had no hip findings. One patient had a perinephric abscess and another had radiological features of tuberculosis of the spine. In the other seven no cause for the abscess could be identified. Ultrasonography demonstrated the abscess in all patients; CT scanning done in 5 patients was confirmatory. Drainage was done by an extraperitoneal route. Biopsy of the abscess wall in 2 patients demonstrated tuberculosis. They, the patient with TB spine and 3 others put empirically on anti-tuberculosis chemotherapy responded well. The perinephric abscess grew Pseudomonas sensitive to gentamycin, but she and two other patients died due to multiorgan failure.

Matched MeSH terms: Abscess/complications; Psoas Abscess/complications

Fulltext Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis--a case report

Shaharuddin NR, Leong CL, Chidambaram SK, Lee C

Med J Malaysia, 2012 Jun;67(3):337-9.

PMID: 23082432

Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.

Matched MeSH terms: Abscess/complications; Psoas Abscess/complications

Fulltext Ludwig's angina--a case report

Nor GM

Med J Malaysia, 1989 Dec;44(4):344-7.

PMID: 2520046

Ludwig's angina is a potentially lethal oro-facial cellulitis due to oro-dental infection. The aetiology and management of a case of Ludwig's angina are briefly discussed.

Matched MeSH terms: Periapical Abscess/complications

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