Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 20, Issue 6, 2020

Cytomegalovirus retinitis is a rare complication in kidney transplant patients with only one other reported incidence. A 70-year-old female with a previous history of kidney transplant began experiencing a decreased vision of her right eye and was diagnosed with CMV retinitis and started on ganciclovir treatment. After completing the treatment, the patient has had no signs of recurrence or any other complaints. There is only one other published case report of CMV retinitis in a kidney transplant patient, therefore appropriate treatment and predictability of recurrence are unknown.

Background: Non-tuberculous mycobacterial (NTM) infections have been drawing interest recently because of their rising incidence not only in immunocompromised but also in immunocompetent individuals. These are underdiagnosed in India, due to the lack of awareness and a low index of suspicion. In regions endemic for tuberculosis (TB) such as India, presumptive anti-tubercular treatment (ATT) is often prescribed. Non-response of NTM to the treatment may be wrongly ascribed to multidrug-resistant tuberculosis. This emphasizes the need to correctly identify them before initiating therapy. Case Study: We describe the case of a young, healthy female patient who developed cervical lymphadenitis and was given presumptive ATT. Microbiological examination of aspirate revealed M. fortuitum. This not only rectified the course of treatment resulting in complete cure, but also spared the patient from significant side effects of ATT. This case is an awakening call for clinicians to avoid presumptive ATT.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a multisystem autoimmune disease of unknown etiology often misdiagnosed as pneumonia. The hallmark features include necrotizing granulomatous inflammation and pauci-immune vasculitis in small and medium-sized blood vessels. We described a 15-year-old female with a history of six months of acne-like facial and peri-auricular lesions. She had received conventional treatment for acne (antibiotics + topical corticosteroid) with no response. She also had a history of chronic coughs, which always diagnosed and treated as sinusitis. In addition, she had a history of frequent dysuria, which always diagnosed and treated as a urinary tract infection. Given the history, with suspicion of a multi-systemic disease such as vasculitis; we performed some diagnostic laboratory and radiologic tests in order to rule out the possible etiologies. The results were positive for cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA). The urine analysis suggested the involvement of kidney micro-vasculature. In addition, two nodular lesions with the cystic pattern were observed in the CT scan of the lungs. However, the skin and nasal biopsies revealed no evidence of chronic necrotizing vasculitis or granulomatous lesion. Nonetheless, treatment was initiated with a strong suspicion of GPA. Following the treatment, the patient's symptoms completely disappeared, and the diagnosis of GPA was confirmed.