Staphylococcus lentus (S. lentus) is a commensal organism commonly isolated from the skin of animals and in people working in close contact with animals. However, the role of this organism as a pathogen is less defined. We present a case of a 58-year-old gentleman who was presented to us with sepsis with multiorgan dysfunction, with ecthyma gangrenosum (EG)-like lesions in his face and legs. Further evaluation led to the isolation of S. lentus from the pus culture swab of the lesion. The culture sensitivity-guided antibiotic treatment led to the cure of sepsis and the resolution of lesions.

Infective endocarditis (IE) is a significant cause of mortality and morbidity, especially in patients with underlying acquired structural heart disease in developing countries. IE caused by non-Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella (HACEK) gram-negative bacteria (GNB) accounts for approximately 2% of all cases and is characterized by high mortality. Pseudomonas aeruginosa (P. aeruginosa) IE accounts for <0.4% of all endocarditis cases. Gram-negative endocarditis is further compounded by the problem of antimicrobial resistance. We report a very rare case of carbapenem-resistant P. aeruginosa IE (CRIE) from India to highlight the difficulties of managing such cases with the challenges of antimicrobial resistance in our settings.

Osmotic demyelination syndrome (ODS) is an uncommon neurological disorder, generally following rapid correction of hyponatremia resulting in demyelination of the white matter of the pons and certain extrapontine regions. The neurological symptomatology can vary from mild confusion to severe dense global paralysis, coma, or death. Once ODS is established, there is no proven treatment. Several experimental therapies, such as reinduction of hyponatremia, intravenous immunoglobulin (IVIG), plasma exchange, and steroids, have been tried with variable success. In this case report, we describe a case of ODS with global paralysis that responded well to plasma exchange therapy despite a full month has passed since the onset of symptoms. This is probably one of the first few cases reported from this part of the country.

Introduction: Sphingomonas paucimobilis (S. paucimobilis) is a non-fermenting, gram-negative bacillus with very low pathogenic potential. These bacilli are found to inhabit the soil and aquatic milieu and are usually transmitted in the hospital environment by means of contaminated drugs, equipment, and water, causing infection in immunocompromised individuals. Case description: We present a case of a 26-year-old immunocompetent patient suffering from dengue hemorrhagic fever followed by secondary bacteremia with S. paucimobilis which was isolated from peripheral blood and bone marrow samples. Conclusion: A microorganism with low pathogenic potential like S. paucimobilis is also capable of causing bacteremia in immunocompetent individuals. Awareness among physicians about this rare pathogen can promote early treatment with appropriate antibiotics.

Burkholderia pseudomallei (B. pseudomallei), a gram-negative bacterium, is ubiquitously found in water, soil, and surface. Although it infrequently affects the brain, it causes significant morbidity and mortality. Neuromelioidosis can manifest either as encephalomyelitis or brain abscess. Herein we are reporting an extremely rare case of Burkholderia brain abscess following trauma and undergoing surgery for abscess drainage. The postoperative period was complicated by refractory seizure, which was managed by early initiation of appropriate antibiotics along with an optimal dose of antiepileptic drug. Early detection and initiation of appropriate antibiotic therapy, along with surgical management, remains the mainstay of treatment.

Fat embolism syndrome (FES) and pulmonary embolism (PE) are the most common systemic complications seen after a long bone fracture. Though there may be a partial overlap of clinical symptoms and signs, the pathophysiology and management of both entities are totally different. It is important to correctly diagnose the entity to proceed with appropriate treatment. Both complications in most cases occur separately. But in very rare cases both fat embolism and PE coexist together, giving a diagnostic and therapeutic challenge. We present one such rare case of a young female post-road traffic accident with a bilateral tibia fracture who underwent bilateral tibia intramedullary interlocking nailing under regional anesthesia after initial stabilization. Postoperatively patient developed signs of pulmonary thromboembolism which was diagnosed with computed tomography pulmonary angiogram (CTPA). The patient was treated with anticoagulation, and at a later date, she developed signs of encephalopathy. Diagnosis of cerebral fat embolism was made based on magnetic resonance imaging (MRI) brain findings. She had a stormy postoperative period. We hereby describe the challenges we faced in the perioperative period to diagnose and treat her successfully.

Coronary artery involvement though known is rare in eosinophilic granulomatosis with polyangiitis. Cardiac involvement is associated with worse outcomes but early detection and appropriate treatment can prevent progression, and reduce overall mortality. We highlight the need for an open approach in younger patients presenting with chest pain, particularly the ones without major risk factors for atherosclerosis. This should prompt suspicion of a vasculitic cause of the chest pain and thereby help with early detection.

Introduction: Extracorporeal life support (ECLS) is often used as a salvage therapy for respiratory failure refractory to conventional interventions, but its use in immunosuppressed states, including hematopoietic stem cell transplant (HSCT) has been considered a relative contraindication due to increased risk of complications and high mortality. Case description: We present the case of a 49-year-old male with multiple myeloma who developed peri-engraftment respiratory distress syndrome (PERDS) and Pneumocystis jirovecii pneumonia (PJP) following HSCT and was successfully managed with two runs of venovenous extracorporeal membrane oxygenation (VV-ECMO). Conclusion: If used judiciously, ECMO can be an effective support strategy in carefully selected immunocompromised patient populations.

Immobilization-induced hypercalcemia (IIH) is a rarely seen condition of which etiology is unclear. It has been described as a complication in adult patients with prolonged movement limitations depending on severe acute trauma, multiple bone fractures, and stroke or young adults with immobilization depending on spinal cord injuries. Diagnosis requires a detailed evaluation to exclude other conditions causing hypercalcemia. This is a case report of a 64-year-old male with prolonged immobilization related to hypoxic brain injury who presented with severe hypercalcemia and contributed to identifying hypercalcemia as a result of immobilization.

Introduction: Intercostal lung herniation is characterized by congenital or acquired herniation of the lung or other viscera through the thoracic wall. Case description: A young adult male presented with a history of trauma to the chest due to the handlebar of a bicycle. Chest radiograph findings were concerning for a lung contusion, mild pneumothorax, and hemothorax. A computed tomography (CT) scan in addition showed herniation of lung parenchyma along the anterior aspect of the left second rib. Given the relatively small size of the defect, the patient underwent a reduction of the herniated lung, followed by primary closure. He had an uneventful postoperative period and was doing well on follow-up. Discussion and conclusion: Computed tomography (CT) plays a crucial role in selecting the appropriate management approach in the intercostal lung herniation. The goals of imaging are to assess the defect size, lung viability, and severity of the injury and rule out other trauma-related findings. Small defects with minimal herniation are amenable to conservative management, but those with large defects and/or disruption of the thoracic wall require surgery with flap/mesh reconstruction. With prompt treatment, these patients are expected to have good long-term functional outcomes.