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The detection of pneumococcal antigens in urine is an alternative to gram staining, and their culture is central to the diagnosis of pneumococcal pneumonia. We present a case of the false-positive detection of urinary

species pneumococcal antigen with a BinaxNOW test. This resulted in delayed diagnosis of a liver abscess.

A 70-year-old woman presented to the emergency department with a 1-day history of chills and difficulty walking. She had a fever and her physical examination was normal. Non-contrast chest computed tomography (CT) revealed a slight ground-glass opacity in the left lower lobe. Laboratory tests revealed liver injury and elevated C-reactive protein levels. A urinary pneumococcal antigen test was positive, and she was diagnosed with acute bronchopneumonia caused by

. She was treated with ceftriaxone. However, abdominal contrast-enhanced CT performed the next day revealed portal vein thrombus and a left lobe liver abscess.

was detected in a puncture specimen of the liver abscess. It ws of pneumococcal pneumonia caused by Streptococcus pneumoniae and unnecessary antimicrobial therapy.False-positive results can occur in patients with infections caused by other Streptococcus species (e.g., liver abscess caused by Streptococcus constellatus).The optimal use of pneumococcal urinary antigen tests needs to be studied in clinical practice settings.We report a case of a bronchial artery pseudoaneurysm presenting as acute retrosternal pain. We want to discuss and to announce the extremely rare finding of a bronchial artery pseudoaneurysm. Bronchial artery aneurysms and pseudoaneurysms are uncommon; however, missing this diagnosis is associated with significant morbidity and mortality. When suspecting this pathology urgent CT angiography and selective angiography (DSA) are crucial. Urgent treatment with transarterial embolization is preferred.

Bronchial artery pseudoaneurysms are uncommon; however, missing this diagnosis is associated with significant morbidity and mortality.Haemoptysis and chest pain are the most common symptoms of bronchial artery pseudoaneurysms.Diagnosis is made with CT angiography and selective angiography (DSA). Transarterial embolization is the preferred type of treatment.

Bronchial artery pseudoaneurysms are uncommon; however, missing this diagnosis is associated with significant morbidity and mortality.Haemoptysis and chest pain are the most common symptoms of bronchial artery pseudoaneurysms.Diagnosis is made with CT angiography and selective angiography (DSA). Transarterial embolization is the preferred type of treatment.Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are both rheumatological diseases of the elderly with a strong association with each other and which rarely present with normal inflammatory markers. Here we present the case of a 61-year-old Caucasian woman who had typical symptoms of both diseases. At the time of presentation, her blood work showed normal inflammatory markers, but because of the high clinical suspicion for GCA, a temporal artery biopsy was done which was positive for giant cells and disruption of the internal elastic lamina. Our patient responded very well to treatment with oral steroids and steroid-sparing medication and was able to return to her normal life without experiencing any complications of the disease. find more By sharing our case, we aim to increase the awareness of medical personnel regarding the importance of focusing on the clinical presentation as well as the laboratory and pathological aspects of diagnosing GCA and PMR.

Normal levels of inflammatory markers like C-reactive protein and the erythrocyte sedimentation rate do not rule out the diagnosis of giant cell arteritis (GCA).We aim to increase clinician recognition and awareness of other parameters, particularly the clinical presentation, that should be considered when diagnosing GCA or polymyalgia rheumatica.If the index of suspicion for the disease is high, it is crucial to start treatment as early as possible for better management and to avoid harmful complications.

Normal levels of inflammatory markers like C-reactive protein and the erythrocyte sedimentation rate do not rule out the diagnosis of giant cell arteritis (GCA).We aim to increase clinician recognition and awareness of other parameters, particularly the clinical presentation, that should be considered when diagnosing GCA or polymyalgia rheumatica.If the index of suspicion for the disease is high, it is crucial to start treatment as early as possible for better management and to avoid harmful complications.

Phenazopyridine is an over-the-counter urinary analgesic commonly used to alleviate the burning and urgency associated with lower urinary tract infections. Methaemoglobinaemia is an uncommon adverse effect of phenazopyridine use. We report a case of methaemoglobinaemia in a patient prescribed daily phenazopyridine to treat urethral and bladder irritation caused by a chronic indwelling Foley catheter.

A 55-year-old female resident of a long-term acute care facility with a chronic Foley, tracheostomy and ventilator-dependent respiratory failure was observed to have generalized dusky skin and hypoxia. Pulse oximetry was reading in the high 80s despite administration of 100% FiO2. ABG revealed paO2 of 451, oxyhaemoglobin level 75% and methaemoglobin level 22%. Medication review indicated that the patient was prescribed phenazopyridine 400 mg TID for the previous 2 months. This medication was discontinued. Considering she was chronically taking mirtazapine, she can increase risk of serotonin syndrome should she with G6PD deficiency).

20%. Vitamin C can be used as an alternative agent if there is a contraindication to methylene blue (for example, with patients simultaneously receiving serotonergic medications and/or those with G6PD deficiency).

Mild encephalitis/encephalopathy and a reversible splenial lesion (MERS) is a clinicoradiological syndrome with an unknown pathogenic mechanism, which usually involves children. Thus, adult-onset MERS is quite rare.

A 71-year-old man, undergoing haemodialysis due to diabetes-induced chronic kidney disease, manifested a persistent fever and disorientation. Blood culture detected methicillin-resistant

(MRSA), while echocardiography revealed vegetation in the aortic and mitral valves. Magnetic resonance imaging of the head revealed a fluid-attenuated inversion recovery-high, diffusion-weighted image-high lesion in the splenium of the corpus callosum, with a number of emboli. Accordingly, the patient was diagnosed with MERS induced by MRSA endocarditis.

Neurological impairment by MERS can be reversible. However, the differential diagnosis of the disease includes ischaemic lesions, multiple sclerosis, malignant lymphoma, acute disseminated encephalomyelitis, and posterior reversible encephalopathy. Clinicians should consider these diseases when MERS is suspected.

Adult-onset mild encephalitis/encephalopathy and a reversible splenial lesion (MERS) is quite rare, and physicians should be aware of it as a differential diagnosis of a diffusion-weighted image-high lesion in the splenium of the corpus callosum.Methicillin-resistant

(MRSA) has rarely been reported as a triggering factor for MERS.

Adult-onset mild encephalitis/encephalopathy and a reversible splenial lesion (MERS) is quite rare, and physicians should be aware of it as a differential diagnosis of a diffusion-weighted image-high lesion in the splenium of the corpus callosum.Methicillin-resistant Staphylococcus aureus (MRSA) has rarely been reported as a triggering factor for MERS.A myeloid sarcoma is an extramedullary tumour arising from infiltration by leukemic cells at an anatomic site other than the bone marrow. Most commonly it precedes acute myeloid leukaemia but occasionally occurs simultaneously. It may also be associated with myeloproliferative neoplasms, myelodysplastic syndrome and the blast phase of chronic myeloid leukaemia. The most common sites for extramedullary tumours are bone, periosteum, soft tissue, lymph node and skin. Although this disease can affect a wide range of body sites, there are very few reports of peritoneal myeloid sarcoma or cavity effusion. The authors present the case of a 68-year-old man with myelodysplasia-related acute myeloid leukaemia and peritoneal myeloid sarcoma with myeloid ascites. The definitive diagnosis is challenging, requires a high level of suspicion, and relies on the exclusion of all alternative diagnoses and especially on complementary tests such as flow cytometry and immunohistochemistry analysis of ascitic fluid in order to deterough ascitic fluid flow cytometry and immunophenotypic analysis.Although allergies to antibiotics are commonly stated, anaphylactic reactions are uncommonly reported. This is especially the case with reactions to fluoroquinolone antibiotics. Furthermore, airway emergencies are rare. We present a case of ciprofloxacin-induced acute airway obstruction and anaphylaxis, necessitating emergent surgical cricothyrotomy following respiratory distress.

Anaphylactic reactions to fluoroquinolone antibiotics are extremely rare.There are currently no standardized diagnostic tests, making the diagnosis of anaphylaxis challenging and largely based on history alone.Treating clinicians should be aware of this rare, but potentially rapidly fatal adverse drug reaction.

Anaphylactic reactions to fluoroquinolone antibiotics are extremely rare.There are currently no standardized diagnostic tests, making the diagnosis of anaphylaxis challenging and largely based on history alone.Treating clinicians should be aware of this rare, but potentially rapidly fatal adverse drug reaction.Hepatic encephalopathy is a common complication in chronic liver disease and cirrhosis. Here we describe two patients with hepatic encephalopathy who did not respond to standard empiric treatment and were found to have non-convulsive status epilepticus. Both patients improved with antiepileptic therapy. Non-convulsive status epilepticus should be considered in the differential diagnosis of patients with suspected hepatic encephalopathy who do not respond to empiric treatment.

Non-convulsive status epilepticus (NCSE) is a rare complication of hepatic encephalopathy (HE).Clinical evaluation should be used to rule out different causes of altered mental status in patients with chronic liver disease.Consider EEG to diagnose NCSE in patients with suspected HE not responding to empiric treatment.

Non-convulsive status epilepticus (NCSE) is a rare complication of hepatic encephalopathy (HE).Clinical evaluation should be used to rule out different causes of altered mental status in patients with chronic liver disease.Consider EEG to diagnose NCSE in patients with suspected HE not responding to empiric treatment.Hydropneumopericardium is a rare event with a risk of serious complications. Timely diagnosis and treatment is important as it can improve prognosis. We report the case of a 77-year-old male patient who presented with acute interscapular pain which developed during a meal. An oesophago-pericardial fistula was found in the context of malignant oesophageal disease.

Hydropneumopericardium secondary to oesophageal tumour is a rare but life-threatening finding that has a very poor prognosis.A high level of suspicion is needed, as the clinical manifestations are very unspecific and timely treatment can improve prognosis.Successful management of an oesophago-pericardial fistula includes surgical treatment and antibiotic therapy.

Hydropneumopericardium secondary to oesophageal tumour is a rare but life-threatening finding that has a very poor prognosis.A high level of suspicion is needed, as the clinical manifestations are very unspecific and timely treatment can improve prognosis.Successful management of an oesophago-pericardial fistula includes surgical treatment and antibiotic therapy.