An 89-year-old man was seen for worsening left hip pain. He had a history of bladder cancer status post-transurethral resection of bladder tumor followed by intravesicular instillations of bacillus Calmette-Guérin (BCG). About one year later, he developed worsening pain in his left prosthetic hip that continued to worsen over the next three months. A computed tomography scan of the hip revealed loosening hardware and periprosthetic fluid collection. Aspiration and operative cultures revealed Mycobacterium bovis BCG. Susceptibility testing revealed resistance to pyrazinamide. The patient underwent a surgical washout with retention of hardware. Treatment with isoniazid, rifampin, ethambutol, and pyridoxine was initiated. This case highlights an extremely rare and delayed complication of intravesicular BCG leading to prosthetic joint infection.

Legionella pneumophila is the most common cause of atypical pneumonia presenting with rhabdomyolysis. A case is reviewed involving a previously healthy 48-year-old man with Legionnaires’ Disease presenting with a peak CPK level of 1.07 million U/L, the highest degree of elevation that has been reported.

Herein, we report two additional cases of extreme pyrexia and rapid death due to Staphylococcus aureus infection. The organisms produced a variant superantigen, cross-reactive with toxic shock syndrome toxin-1 (TSST-1 cross-reactive superantigen SE-like X), which we purport to be the causative agent for this syndrome.

Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections. The current recommended treatment regimen for an initial episode of CDI is fidaxomicin (200 mg twice daily for 10 days) or vancomycin (125 mg, four times daily for 10 days) as an acceptable alternative [1]. Unfortunately, in approximately 25–35% of cases, CDI recurs within 1–2 months of the initial infection [2–5]. After a first recurrence, patients are substantially more likely to have a subsequent recurrence, with approximately 50–60% of these patients experiencing multiple recurrent CDI (rCDI) [2]. We report our early clinical experience in a multi-center community infectious disease private practice setting with the initial five patients who received the live biotherapeutic product, REBYOTA (RBL). Methods: Five patients who had experienced multiple recurrent episodes of C difficile infection and had failed the standard antibiotic therapy were prescribed the live biotherapeutic product REBYOTA (RBL). The product was administered as a single dose via the rectum. The patients were followed for eight weeks for clinical response and adverse events. Results: Patients included three males and two females, aged 20–86 years with recurrences ranging from 3 to 6 in the previous 18 months. Four patients received standard vancomycin, two patients had vancomycin taper, two had fidaxomicin and one had bezlotoxumab (Zinplava). RBL was administered easily and in less than 10 minutes. No new symptoms occurred within seven days. No recurrence was reported at eight weeks. No adverse events were reported, including no bacteremia or fungemia. No patient incurred expenses other than deductible costs. Conclusion: In a real-world setting, our initial five patients found that RBL was easy and convenient to administer with normalization of formed stools and an excellent overall clinical response at eight weeks. Furthermore, no adverse events were reported.

A seventy-year-old African American female with a past medical history of essential hypertension, type two diabetes mellitus, gout, and osteoarthritis presented to the hospital with complaints of pruritic skin rash around the eyes, diarrhea, and weakness. The patient was started on allopurinol a few weeks prior to presentation after an acute gout flare in the right foot. Patient had an oral temperature
of 103 ˝F, a maculopapular rash of the face, eyelids, torso, and extremities, and diffuse tenderness with palpation of the abdomen.