Primary pulmonary sarcomas (PPS) are a rare tumor entity in general and tend to be low grade tumors (1). Most sarcomas diagnosed in the lung are due to metastasis and follow an aggressive course (2,3,4,5). This case presents an aggressive, high grade, primary lung spindle cell sarcoma with myxoid features.

No abstract

No abstract

The Capnocytophaga spp. are fusiform, gram-negative rods with gliding motility and grow best in capnophilic environments. There has been concern for antimicrobial resistance among the Capnocytophaga spp. The purpose of this case is to present a patient with isolated C. canimorsus bacteremia causing septic shock and to discuss antimicrobial treatments. CASE PRESENTATION:The patient is a 63-year-old male with a past medical history of Epstein Barr Virus infection resulting in a splenectomy however, his vaccinations were up to date. The patient presented with fatigue for one day and had petechiae on his abdomen, lower extremities and nose. He was febrile at 38.9 degrees Celsius and was started on vancomycin, azithromycin and piperacillin-tazobactam. He then became hypotensive and received the sepsis fluid bolus with no change in his blood pressure. The patient required vasopressor support and then became hypoxic requiring endotracheal intubation. Due to worsening acidosis and vasopressor support the patient was started on continuous renal replacement therapy. The patient's initial blood cultures revealed gram negative rods however, the Biofire BCID (Biomérieux) molecular probe was negative. C. canimorsus was isolated from blood cultures. The antibiotic was then de-escalated to ceftriaxone. Literature review showed the possibility of betalactamase production in this bacterium. Given the overall critical illness of the patient, his antibiotic was changed to a combination of ampicillin-sulbactam and clindamycin. He finished a 7-day course of clindamycin and 14-day course of ampicillin-sulbactam. He received a total of 21 days of antibiotic therapy. DISCUSSION:The Capnocytophaga spp. found in the oral cavity of cats and dogs can cause wound infections, endocarditis, sepsis and meningitis. Capnocytophaga spp. have been known to cause more severe infections in immunocompromised patients. The Capnocytophaga spp. have been susceptible to many different classes of antibiotics including penicillins, macrolides, fluoroquinolones, cephalosporins and clindamycin. Recent literature has shown that there are strains of Capnocytophaga that produce beta-lactamase. Other literature has shown some Capnocytophaga spp. to be resistant to 3rd generation cephalosporins and fluoroquinolones. There was one report of a strain of C. sputigena with production of an extended spectrum beta-lactamase. CONCLUSIONS:The patient presented had C. canimorsus bacteremia. Sensitivities were unable to be done as there are no clear Clinical Laboratory and Standards Institute breakpoints for this organism. Literature had shown that C. canimorsus to be sensitive to penicillins. However, there have also been reports of beta-lactam production among other Capnocytophaga spp. Since the patient was critically ill and, sensitivities were unable to be done, the patient was switched to ampicillin-sulbactam and clindamycin.

No abstract