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Spinal epidural abscess due to coinfection of bacteria and tuberculosis:A case report

World Journal of Clinical Cases 2021年第16期9卷 4072-4080页

作者： Choonghyo Kim seungkoo lee Jiha Kim Department of Neurosurgery Kangwon National University School of MedicineChuncheon 24341GangwonSouth Korea Department of Neurosurgery Kangwon National University HospitalChuncheon 24289GangwonSouth Korea Department of Anatomic Pathology Kangwon National University School of MedicineChuncheon 24341GangwonSouth Korea Department of Anatomic Pathology Kangwon National University HospitalChuncheon 24289GangwonSouth Korea

BACKGROUND Spinal epidural abscess(SEA)is a rare condition that mostly results from infection with either bacteria or tuberculosis.However,coinfection with bacteria and tuberculosis is extremely rare,and it results in delays in diagnosis and antimicrobial treatment causing unfavorable outcomes.CASE SUMMARY A 75-year-old female visited the hospital with low back pain,and magnetic resonance imaging(MRI)revealed an SEA at the lumbosacral segment.Staphylococcus hominis and methicillin-resistant Staphylococcus epidermidis were identified from preoperative blood culture and intraoperative abscess culture,respectively.Thus,the patient underwent treatment with vancomycin medication for 9 wk after surgical drainage of the SEA.However,the low back pain recurred 2 wk after vancomycin treatment.MRI revealed an aggravated SEA in the same area in addition to erosive destruction of vertebral bodies.Second surgery was performed for SEA removal and spinal instrumentation.The microbiological study and pathological examination confirmed Mycobacterium tuberculosis as the pathogen concurrent with the bacterial SEA.The patient improved completely after 12 mo of antitubercular medication.CONCLUSION We believe that the identification of a certain pathogen in SEAs does not exclude coinfection with other pathogens.Tubercular coinfection should be suspected if an SEA does not improve despite appropriate antibiotics for the identified pathogen.

关键词： Bacteremia Coinfection Epidural abscess Tuberculosis Case report

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Cholecystoduodenal fistula presenting with upper gastrointestinal bleeding: A case report

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World Journal of Clinical Cases 2021年第2期9卷 410-415页

作者： Jin Myung Park Chang Don Kang Ji Hyun Kim Sang Hoon lee Seung-Joo Nam Sung Chul Park Sung Joonlee seungkoo lee Department of Internal Medicine Kangwon National University School of MedicineChuncheon 24289Kangwon DoSouth Korea Department of Gastroenterology Kangwon National University HospitalChuncheon 24289Kangwon DoSouth Korea Anatomy and Pathology Kangwon National University School of MedicineChuncheon 200947Kangwon DoSouth Korea Department of Pathology Kangwon National University HospitalChuncheon 24289Kangwon DoSouth Korea

BACKGROUND Cholecystoduodenal fistula is a rare complication of cholelithiasis.Symptoms are usually non-specific and often indistinguishable from those of etiologic diseases,but it rarely presents as severe gastrointestinal bleeding.Bleeding associated with cholecystoduodenal fistula usually requires surgery because significant bleeding from the cystic artery is unlikely to be resolved by conservative management or endoscopic hemostasis.CASE SUMMARY We report a case of cholecystoduodenal fistula that presented with hematemesis which was diagnosed by endoscopy and computed tomography.Endoscopic hemostasis could not be achieved,but surgical treatment was successful.Additionally,we have presented a literature review.CONCLUSION Cholecystoduodenal fistula should be considered as differential diagnosis when a patient with history of gallstone disease presents with gastrointestinal bleeding.

关键词： Biliary fistula Hematemesis Cholecystitis Gallstones Cholecystectomy Case report

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