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Case Report
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| Escherichia coli sepsis and pyomyositis following allogeneic stem cell transplant | ||||||
| Folusakin Ayoade1, Mohammed Alam2, Amy Bozeman3, Breanne Peyton-Thomas4, Richard Mansour5, Nebu Koshy6 | ||||||
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1MD, Folusakin Ayoade, Clincal Fellow, Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA 71103, USA.
2MD, Mohammed Alam, Assistant Professor, Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA 71103, USA. 3PA, Amy Bozeman, Physician Assistant, Bone Marrow Transplant Unit, University Health, Shreveport, LA 71103, USA. 4Pharm D, Breanne Peyton-Thomas, Clinical Pharmacist, University Health, Shreveport, LA 71103, USA. 5MD, Richard Mansour, Associate Professor, Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA 71103, USA. 6MD, Nebu Koshy, Associate Professor, Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA 71103, USA. | ||||||
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| How to cite this article |
| Ayoade F, Alam M, Bozeman A, Peyton-Thomas B, Mansour R, Koshy N. Escherichia coli sepsis and pyomyositis following allogeneic stem cell transplant. Int J Case Rep Images 2017;8(1):57–61. |
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Abstract
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Introduction:
Manifestation of infections in hematopoietic stem cell transplant patients tend to be subtle, with subsequent delay in diagnosis and effective therapy. Traditionally, in both normal and immunocompromised hosts, pyomyositis is often attributable to gram positive pathogens such as Staphylococcus aureus. Pyomyositis due to Escherichia coli is quite rare in the hematopoietic stem cell transplant host, often with uncharacteristic or atypical presentations.
Case Report: A 53-year-old male with relapsed acute myelogenous leukemia received allogeneic stem cell transplant. After eight days post-transplantation, he developed fever and other non-specific symptoms, followed by progressive left calf swelling and pain. The first two ultrasound studies of the affected leg showed no drainable collections despite obvious signs of local infection. The third ultrasound study, done after seven days of onset of symptoms, however, revealed a developing abscess with extensive surrounding cellulitis. Lower extremity computed tomography scan confirmed a 3.4x2.5 cm lesion with a central necrotic portion measuring approximately 1.8x1 cm within the lateral head of the gastrocnemius muscle. Blood cultures and drained pus from the affected calf muscle grew quinolone-resistant Escherichia coli which was sensitive to beta-lactamase antibiotics. Successful treatment was accomplished with three weeks of intravenous meropenem and abscess drainage. Conclusion: This case illustrates the unique peculiarities of infection manifestations in the immunocompromised host, especially recipients of stem cell transplant. The causative pathogen could be atypical, and the clinical and expected imaging findings may be delayed or even absent. | |
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Keywords:
Abscess, Escherichia coli, Hematopoietic stem cell transplant, Pyomyositis, Quinolone
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Author Contributions
Folusakin Ayoade – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Mohammed Alam – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Amy Bozeman – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Breanne Peyton-Thomas – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Richard Mansour – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Nebu Koshy – |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2017 Folusakin Ayoade et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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