Discussion: The presentation of UTI in melioidosis is an unusual but clinically significant combination, often overlooked, contributing to diagnostic complexity. What sets this case apart is the uncommon presentation of melioidosis as a UTI. It is noteworthy that the patient's travel history from an endemic country like Laos played a pivotal role in early diagnosis, emphasizing the importance of considering travel history even in non-endemic regions. This case underscores the significance of swift identification and treatment, providing valuable insights for managing similar cases, particularly in regions where melioidosis is not endemic, while emphasizing the role of travel history in early diagnosis.
an extended treatment regimen. Despite showing improvements in DKA and laboratory values, the patient continued to experience fever. A subsequent CT scan revealed multiple lung nodules and patchy nodular opacities in the bilateral lower lobes, in addition to a small cavitary focus in the left upper lobe. Collaborative discussions with infectious disease specialists and epidemiologists prompted an extension of the initial intensive phase of intravenous antibiotic therapy. The patient's leukocytosis resolved, liver function improved, and the fever subsided. Over time, blood cultures eventually yielded negative results. Given the patient's decision to return to his home country of Laos after just two weeks of antibiotics, a treatment plan was established, consisting of an additional two weeks of meropenem, followed by six months of oral Bactrim DS BID.
A CURIOUS CASE OF RECURRENT VTE – A NEW DIAGNOSIS OF BEHCET DISEASE Stephen T Hollingsworth MD, Garrett Allen MD, Anisha Memdani MD, Karthik Reddy MD; Department of Medicine, Baton Rouge General, Baton Rouge Medical Center, LA.
Introduction: Behcet Disease is an uncommon systemic vasculitis that can lead to a multitude of problems if left undiagnosed. Due to the heterogeneity of the disease, we hope to raise clinical awareness and educate on the signs, symptoms, diagnostic criteria, and treatment of Behcet disease. Case: A 36-year-old male presented for evaluation of right lower extremity swelling. He has had a previous diagnosis of venous thromboembolism (VTE) in bilateral lower extremities, but the exact cause was unclear. He was undergoing hypercoagulability workup in the outpatient setting. He failed treatment with direct oral anticoagulants and was now on warfarin with an inferior vena cava filter in place. The patient was tachycardic at 128 bpm and hypertensive at 149/96 mmHg. Physical exam revealed right lower extremity discoloration, swelling, and tenderness from the knee to ankle. He also had large right inguinal lymphadenopathy. Labs revealed subtherapeutic INR at 1.3. Venous doppler showed an acute VTE in both the right common femoral artery and superficial femoral artery. Computed tomography
of the chest, abdomen, and pelvis revealed multiple enlarged lymph nodes with largest at 5.7cm in right inguinal region. Biopsy revealed reactive lymphoid hyperplasia with lipogranulomatous changes, but no evidence of malignancy. The patient was started on therapeutic Lovenox. Upon further investigation he revealed to having recurrent mouth and genital ulcers. A skin biopsy was positive for erythema nodosum. He had a right eye retinal detachment. The patient met criteria for Behcet disease with 8 points on International Criteria for Behcet Disease (ICBD) score. He was referred to a rheumatologist for further workup and initiation of immunomodulators. Discussion: VTE is a well-known complication of Behcet disease but can reoccur without proper treatment. In order to start the correct treatment, in this case immunomodulators, the right diagnosis must be made. Recognizing the signs and symptoms, as well as knowing the ICBD scoring criteria for Behcet disease, may help other patients with similar presentation.
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