A 60-year-old man with granulomatous interstitial nephritis followed by neurologic disease

Article Abstract:

A 60-year-old man with a history of weight loss, lethargy, nausea, loss of appetite, diarrhea and vomiting was admitted to the hospital. Partial facial paralysis, staggering walk and left-sided sensory loss were noted on examination. The patient developed poor kidney function and had a kidney biopsy which revealed granulomatous nephritis (abnormal tissue growth in the kidney). He was treated with prednisone and discharged. The patient was well until a persistent productive cough, double vision, numbness on his left side, hoarseness, nausea and vomiting developed. He was readmitted to the hospital for further evaluation. Severe headache, vomiting, light sensitivity in his eyes and rigidity of the neck indicated brain involvement; a CT (computerized tomography) scan revealed a brain abscess (collection of pus). Wegener's granulomatosis (which is characterized by abnormal tissue granuloma and associated with kidney disease, sinus pain and pus, cough and weakness) was considered. However, sarcoidosis (which causes abnormal tissue growths on organs, particularly the kidneys) was probably the initial disease. Cultures of the brain abscess and meningeal infection revealed Listeria monocytogenes bacteria. Antibiotics and prednisone were administered to the patient with a successful outcome. His condition remained stable for eight years until his death.

Listeriosis, Kidney diseases, Brain diseases, Sarcoidosis, Wegener's granulomatosis

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A 47-year-old Cape Verdean man with pericardial disease

Article Abstract:

The case is reported of a 47-year-old man who awoke one morning with severe pain on the left side of the neck, which moved to the left side of the chest by mid-afternoon. Upon deep breathing, the pain grew worse and breathing became difficult. A fever developed, and abnormal lung sounds were heard when the patient first consulted the hospital. The patient was black and had immigrated to the US seven years earlier from the Cape Verde Islands. Abnormal heart sounds were detected, and the patient's urine tested positive for protein. The patient's course in the hospital is described; on the fourth day, after a stable course, signs of cardiac compression (increased pressure on the heart) developed. These were treated. The clinical diagnosis was acute infectious pericarditis (inflammation of the pericardium, the sac that surrounds the heart). Another possible diagnosis was acute tuberculous pericarditis. A discussion is presented of pericarditis and its possible causes. Surgery was performed to remove infected fluid and diseased pericardium, and the patient recovered. The final diagnosis was purulent pericarditis as a result of infection with Streptococcus pneumoniae. Similar symptoms in an immigrant patient should always raise the possibility of tuberculosis, however. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, Physiological aspects, Pericarditis, Olds, G. Richard, Harmon, James V., Jr

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