No abstract

While the development of a fistulous tract from the kidney to the proximal adjacent organs is relatively common, a tract leading to the skin is a rare occurrence. The primary cause of a fistula is prior surgical intervention or malignancy leading to abscess formation. Our case involves Xanthogranulomatous pyelonephritis (XGP) causing a longstanding lobulated abscess, ultimately leading to the formation of a fistulous tract.

Legionella lung abscess (LLA) is known to develop from pneumonia and Legionnaires' disease in immunocompromised patients and aspiration. Literature review showed reports of aspiration pneumonia in immunocompetent patients; however, no such was found between LLA and immunocompetency. A 53-year-old male with history of depression and paraumbilical hernia presented for chest pain, which was right sided, started acutely, constant, radiated to the back, and exaggerated with taking deep breaths. The patient denied all other symptoms. Social history was only pertinent for being an active 35 pack-year smoker. The patient was recently admitted one month ago for viral meningitis from Echovirus. On physical exam, the patient was vitally stable, had absent breath sounds in the right middle lobe, and was significantly tender at the right anterior chest. Labs revealed elevated sedimentation rate and C-reactive protein. Imaging demonstrated a right middle lobe lung abscess. Throughout the hospital course, Legionella pneumophila serogroup 1 (LPS1) was found to be positive on urine antigen, sputum polymerase chain reaction, and sputum cultures. The patient was switched to intravenous levofloxacin and ampicillin-sulbactam. Upon symptomatic resolution, the patient was discharged home with recommendations for a follow-up chest computed tomography and diagnostic bronchoscopy. We hypothesize that smoking causes neutrophilic stasis within the lung and the development of the LLA. Treatment includes intravenous long term antibiotics and possibly drainage.

Objective: We conducted this study to investigate the effectiveness of platelet transfusion and/or intravenous tranexamic acid in the treatment of clinical bleeding in patients with dengue fever at a tertiary care hospital during a large outbreak (August and November, 2011) of dengue fever in Lahore, Pakistan. Methods: We reviewed data of patients with clinical bleeding and confirmed dengue fever at Jinnah Hospital Lahore, Pakistan. Based on the treatment, patients were classified into four groups: Baseline characteristics of patients and site and grade of bleeding were documented. A comparison of time to cessation of bleeding across four groups was made. Results: Out of 100 selected patients with clinical bleeding, 65 were male and median age was 28 years (range 13-80). There were 47 patients in group A, 12 in group B, 9 in group C, and 32 in group D. 75 patients had bleeding from a single site while 24 patients had bleeding from 2 different sites and 1 patient had bleeding from 3 sites. Median time from the initiation of treatment till the cessation of bleeding was not significantly difference across four groups (p value = 0.724, Kruskal-Wallis test). Adverse effects included abdominal pain in group A and pruritus in group A and C. Conclusion: Platelet transfusion and/or tranexamic acid do not provide significant benefit over standard of care treatment in patients with clinical bleeding in dengue fever and may be associated with adverse outcome.