Infectious Disease & Sepsis

62-year-old male with history of IgM myeloma with significant extramedullary disease complicated by renal failure, previously on daratumumab and lenalitomide with progression, now status post hyperCVAD. Presented with respiratory distress, neutropenic sepsis, streptococcus agalactiea, oral thrush, and bilateral pulmonary infiltrates. Patient was initially placed on BiPAP but required to be intubated and placed on mechanical ventilation with protective lung strategy 🫁.

Chest x-ray is shown below:

Bronchoscopy was done and BAL was sent for PJP and other tests. There were multiple mucosal white spots scattered in trachea and throughout the bronchial tree bilaterally as shown in these images:

What do you think?

A very good review article on prevention of Central Line Associated Bloodstream Infections (CLABSI) was published last week in NEJM at Prevention of Central Line–Associated Bloodstream Infections | NEJM

Risk factors for CLABSIs and strategies to prevent them are discussed in detail.

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Staphylococcal Scalded Skin Syndrome (SSSS) is a serious skin disorder caused by infection with certain strains of Staphylococcus bacteria. These bacteria release exotoxins, specifically exfoliative toxins, which target the protein desmoglein-1 that helps cells in the outer layer of the skin (the epidermis) stick together. When these toxins disrupt the protein, they cause the skin cells to separate, leading to widespread blistering and the appearance of scalded skin.

The symptoms of SSSS typically begin with fever, irritability, and redness of the skin. The skin then becomes tender and forms fluid-filled blisters, which can easily rupture, leaving areas that look like burns or scalds. It's important to note that the mucous membranes, such as those in the mouth and eyes, are typically not involved in SSSS, which can help differentiate it from other similar-looking conditions.