Indian Journal of Critical Care Case Report

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2023 | March-April | Volume 2 | Issue 2

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FROM THE EDITOR'S DESK

Subhash Todi

From the Editor's Desk

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/ijccr-2-2-v  |  Open Access | 

299

CASE REPORT

Aashna Gandhi, Nikhil Shirsi, Anjali Khalane, Guruprasad P Bhosale, Geethu Joe, Rajeev Soman

Pneumocystis Pneumonia: The Challenges Continue

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:3] [Pages No:31 - 33]

Keywords: Carcinoma of pancreas, Gemcitabine, Pneumocystis pneumonia

   DOI: 10.5005/jp-journals-11006-0042  |  Open Access |  How to cite  | 

Abstract

A 56-year-old female patient with carcinoma of the pancreas on chemotherapy with gemcitabine, presented with a short history of fever, cough, and breathlessness. She was found to be hypoxic on admission and there were diffuse ground glass opacities with peripheral and basal sparing on high-resolution computed tomography (HRCT). Serum lactate dehydrogenase (LDH) and serum β-D-glucan (BDG) were high, and gomori methamine silver (GMS) staining from the throat gargle specimen showed typical cysts of Pneumocystis pneumonia (PCP). Therefore, she received treatment with trimethoprim/sulfamethoxazole (TMP/SMX) and steroids at first, which was later changed to primaquine + clindamycin in view of TMP/SMX-related toxicity. However, despite all measures, she succumbed to the illness. This case highlights the importance of PCP in immunocompromised hosts other than human immunodeficiency virus (HIV), the role of serum markers like LDH and BDG,6 and the use of throat gargle samples5 for microscopy and polymerase chain reaction (PCR). An unmet clinical need is a guide to prophylaxis, therapy, and adjuvant steroids in non-HIV patients.9

316

CASE REPORT

Vineetha Kanneganti, Harpreet Singh, Ashish Bhalla

An Unusual Manifestation of Cardiac Tamponade in Autoimmune Thyroiditis

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:3] [Pages No:34 - 36]

Keywords: Beck's triad, Cardiac tamponade, Hypothyroidism, Massive pericardial effusion

   DOI: 10.5005/jp-journals-11006-0043  |  Open Access |  How to cite  | 

Abstract

Cardiovascular manifestations of hypothyroidism include bradycardia, diastolic hypertension and increased peripheral vascular resistance. Pericardial effusion occurs in about 30% of hypothyroid individuals, but cardiac tamponade is rare because fluid accumulation occurs slowly, allowing the pericardium to stretch. Here we report a case of a young female who presented with cardiac tamponade, which on evaluation, was diagnosed as autoimmune thyroiditis. The patient was managed with emergency echocardiography directed pericardiocentesis and levothyroxine supplementation.

294

CASE REPORT

Sudipta Mukherjee, Pralay S Ghosh, Santanu Bagchi, Sanjay Bhattacharya

Clinical Significance of Trichosporon in Urine of Immunocompromised Host

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:3] [Pages No:37 - 39]

Keywords: Echocardiography, Immunocompromised host, Sepsis

   DOI: 10.5005/jp-journals-11006-0044  |  Open Access |  How to cite  | 

Abstract

Yeasts such as Trichosporon are being increasingly reported in catheterized urine of hospitalized patients. However, guidelines to interpret their clinical significance are lacking. The following case highlights the need for research and evidence-based recommendations for the management of funguria, especially for Trichosporon in urine for critically ill patients with nonresolving sepsis. This is a case of metastatic carcinoma lung on immunotherapy, which developed nonresolving sepsis along with repeated isolation of Trichosporon from urine. Patient had shown clinical response only after treatment with voriconazole.

261

CASE REPORT

Smita Sharma, Gyanendra Agrawal, Diksha D Yadav, Sharique Ahmed

Coronavirus Disease 2019-associated Disseminated Histoplasmosis in Immunocompetent Host

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:4] [Pages No:40 - 43]

Keywords: Coronavirus disease 2019, Histoplasmosis, Immunocompetent

   DOI: 10.5005/jp-journals-11006-0046  |  Open Access |  How to cite  | 

Abstract

We hereby report the first case in the Indian subcontinent to the best of our knowledge of dual infection of disseminated histoplasmosis in an immunocompetent host with coronavirus disease 2019 (COVID-19) infection. We herein report a case of a 22-year-old COVID-19-positive immunocompetent male who presented with fever, breathing difficulty, pancytopenia, and skin exanthem. The bone marrow and skin biopsy established the diagnosis of disseminated histoplasmosis. The case was successfully treated with amphotericin and itraconazole. Diagnosis of opportunistic or coinfection infection in COVID-19 patients requires a high-index of suspicion, especially in immunocompetent patients.

329

CASE REPORT

Shubham Kumar, Pankaj Soni, Hari K Yadav, Omaim JSA Saleh

Comamonas testosteroni: A Rare Case of Bacteremia in a Patient with Chronic Liver Disease

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:2] [Pages No:44 - 45]

Keywords: Bacteraemia, Comamonas testosteroni, Sepsis

   DOI: 10.5005/jp-journals-11006-0049  |  Open Access |  How to cite  | 

Abstract

Background: Despite recent advancements, patients with sepsis and septic shock continue to have high morbidity and mortality. Appropriate empiric antimicrobials form the cornerstone of therapeutic interventions and are vital for improving patient outcomes. Rare infections may sometimes complicate clinical diagnosis and make a choice of empiric antimicrobials challenging. Hence, recognition of rare infections and their antimicrobial susceptibility pattern is imperative for the management of such cases. Case description: Comamonas spp. are common environmental nonfermentative gram-negative bacilli that occasionally cause human disease. Human infections are not usually life-threatening. We present a case of bacteremia secondary to Comamonas testosteroni (C. testosteroni) in a 35 years old patient with chronic liver disease (CLD). Conclusion: Comamonas testosteroni (C. testosteroni) is an emerging human pathogen and may rarely cause sepsis and septic shock, especially in immunocompromised patients. The sensitivity pattern and choice of antibiotics need to be further evaluated for this rare infection, as early appropriate therapy may affect outcomes.

305

CASE REPORT

Amit Goel, Sandeep Budhiraja

Hemophagocytic Lymphohistiocytosis (HLH) Secondary to Scrub Typhus: An Unusual Presentation

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:3] [Pages No:46 - 48]

Keywords: Hemophagocytic lymphohistiocytosis, H-score, Scrub typhus, Steroids

   DOI: 10.5005/jp-journals-11006-0047  |  Open Access |  How to cite  | 

Abstract

Introduction: Patients with scrub typhus usually present with constitutional symptoms and respond to the standard treatment. However, ongoing clinical deterioration warrants consideration for other associated conditions. Case description: Here, we describe a patient diagnosed with scrub typhus with rare but life-threatening immune dysfunction. Conclusion: Hemophagocytic lymphohistiocytosis (HLH) syndrome is due to an atypical immune response commonly triggered by infection. An alarm should be raised, and HLH should be considered in patients with scrub typhus who are nonresponsive to standard treatment. Quick and timely treatment had shown to have a better outcome. Hence physicians should be aware of this rare association and its management for better patient outcomes.

401

CASE REPORT

Aayush Chawla, Nitish Parmar, Riddhi Kundu, Vandana Saluja

Recurrent Fever in Dengue? Think of This!

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:2] [Pages No:49 - 50]

Keywords: Dengue, Fever, Hemophagocytic lymphohistiocytosis, Severe dengue, Tropical fever

   DOI: 10.5005/jp-journals-11006-0051  |  Open Access |  How to cite  | 

Abstract

Introduction: Dengue is one of the commonest causes of fever in India. Also known as “break-bone fever” and “7-day fever,” dengue most often causes fever lasting for a few days, severe body aches, and thrombocytopenia. Although rare, viral infections, including dengue, can trigger another autoimmune, life-threatening condition called hemophagocytic lymphohistiocytosis (HLH). Clinical case: We describe one such case of dengue complicated by HLH, which was diagnosed and treated successfully. Conclusion: Diagnosis of HLH in the critically ill requires a high degree of suspicion, as it mimics sepsis, severe dengue etc. One clue to suspect HLH-complicating dengue is a recurrent fever after initial defervescence and a new fever occurring beyond 7 days of onset.

549

Case Discussion

Aravinth Srinivas, Balaji Rajaram

Hot and Clot: The Diagnostic Conundrum

[Year:2023] [Month:March-April] [Volume:2] [Number:2] [Pages:4] [Pages No:51 - 54]

Keywords: Catastrophic antiphospholipid syndrome, Collaborative treatment strategy, Diabetes mellitus, Fever

   DOI: 10.5005/jp-journals-11006-0045  |  Open Access |  How to cite  | 

Abstract

Fever of unknown origin (FUO) in the intensive care unit can often be elusive and lead to diagnostic dilemmas. It could be an uncommon presentation of a common disease or could be an index presentation of an uncommon disease. It requires a thorough history, physical examination, and syndrome-based diagnostic testing with a systematic approach. Catastrophic antiphospholipid syndrome (CAPS) presenting as FUO is rare, and we present here one such case report of a patient who presented to our center.

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