Background Multiplexed molecular rapid diagnostic tests (RDTs) may allow for rapid and accurate diagnosis of the microbial etiology of pneumonia. However, little data are available on multiplexed RDTs in pneumonia and their impact on clinical practice. Methods This retrospective study analyzed 659 hospitalized patients for microbiological diagnosis of suspected pneumonia. Results The overall sensitivity of the Unyvero LRT Panel was 85.7% (95% CI 82.3–88.7) and the overall specificity was 98.4% (95% CI 98.2–98.7) with a negative predictive value of 97.9% (95% CI 97.6–98.1). The LRT Panel result predicted no change in antibiotics in 12.4% of cases but antibiotic de-escalation in 65.9% (405/615) of patients, of whom 278/405 (69%) had unnecessary MRSA coverage and 259/405 (64%) had unnecessary P. aeruginosa coverage. Interpretation In hospitalized adults with suspected pneumonia, use of an RDT on respiratory samples can allow for early adjustment of initial antibiotics, most commonly de-escalation.

Infective endocarditis is an uncommon, but potentially lethal complication of bacteremia. This case discusses infective endocarditis secondary to subcutaneous injection of illicit drugs, also known as "skin popping." In addition to this we will review diagnostic and management recommendations set forth by the American Heart Association (AHA) and the Infectious Disease Society of America (IDSA). Case Presentation: The patient is a 34-year-old obese female that is G9P5 with a past medical history of opiate use disorder, who presented to the emergency department with fever, left leg swelling, and severe chest pain that was 10/10 in severity, right sided, and worse on inspiration. The patient denies any dizziness, lightheadedness, falls, headaches, photo or phonophobia, costovertebral angle tenderness, neck rigidity or pain. Presenting vital signs were temperature 38.1°, heart rate 134, respiratory rate 24, blood pressure 110/55, and oxygen saturation of 99% on room air. She appeared anxious. Examination pertinent for regular sinus tachycardia and no murmurs. She had decreased breath sounds in the right lower lobe, left lower extremity calf and upper leg enlargement when compared to the right leg. Numerous 0.5-1 cm non-erythematous, nontender, healed circular lesions were appreciated throughout the arms and chest. Presenting labs included hemoglobin 8.1, WBC 17.2, platelets 97, and sodium of 122. Urine toxicology was positive for opiates, fentanyl, and methadone. Ultrasound of the left lower extremity showed a deep vein thrombosis (DVT). CTA revealed multiple bilateral cavitary lesions with nodules in the lungs representing septic emboli. She was admitted to the medicine unit. Transesophageal echocardiography revealed a large, 1.1 cm x 1.1 cm mobile vegetation on the tricuspid valve with mild to moderate regurgitation. Blood cultures grew Pseudomonas aeruginosa, Streptococcus mitis, and Enterobacter cloacae complex E. and the patient's antibiotics were narrowed to Zosyn for a 6-week course. The patient's fever and DVT subsided. Repeat imaging after 2 weeks showed interval improvement in septic emboli and tricuspid valve vegetation size. Discussion: Skin popping, as a route of illicit drug use, is usually associated with a range of soft skin tissue infections, but also poses risks of bacteremia and infective endocarditis. It should also be considered an intravenous drug use equivalent that meets a minor criterion of the modified Duke Criteria. It is also important to obtain early transthoracic and transesophageal echocardiography for evaluation of the extent of the disease and whether cardiothoracic intervention is required to minimize systemic embolization.

Cancer immunotherapies have been revolutionary treatments in oncological disease. Such therapies include immune checkpoint inhibitors that target programmed cell death protein, ligands, and cytotoxic T-lymphocyte-associated antigen (CTLA-4). Increased use has led to recognition of immune-related adverse events. Such events are often distinct from the typical adverse events of traditional cancer therapies. Immune-related adverse events are more commonly found to affect the skin, gastrointestinal tract, and endocrine system. The incidence of these adverse events remains low for central nervous system effects. This article describes a case of atezolizumab-associated encephalitis in a patient with metastatic small cell lung cancer.

Sclerosing mesenteritis (SM) is a rare inflammatory condition with unknown etiology that affects the mesenteric adipose tissue. We present a case of a 49-year-old male with severe abdominal pain who underwent abdominal biopsy confirming the presence of adipose inflammation and necrosis. The diagnosis of SM was made, and the patient was treated with prednisone and tamoxifen. As this condition is rare, there are no standard guidelines for management. This case aims to outline a possible treatment plan.