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We describe the first case of multisystem inflammatory syndrome in an adult patient after coronavirus disease-19 (COVID-19) A 34-year-old Hispanic man, who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) 1 month before presentation, was admitted for fever, abdominal pain, headache, and myalgia The patient deteriorated, developing multisystem organ failure He required intensive care unit admission, mechanical ventilation, vasopressors, and continuous renal replacement therapy Laboratory workup showed depletion of serum complement levels After immunosuppressive therapy with intravenous immunoglobulin and corticosteroids, complement levels improved, and the patient made a full recovery © Wolters Kluwer Health, Inc All rights reserved

In a study of 34 human immunodeficiency virus (HIV)-seropositive and 12 HIV-seronegative intravenous drug users with 40 and 14 episodes, respectively, of infective endocarditis (IE), there were no differences between groups in the presentation of IE. Staphylococcus aureus was the infecting microorganism in 75% of the HIV-positive patients and 86% of the HIV-negative patients. Overall survival for the HIV-positive patients was 85% compared with 93% for the HIV-negative patients. Ninety percent of patients with asymptomatic HIV infection survived, whereas 60% of patients in CDC group IV survived (P = .052). In contrast to New Jersey seroprevalence surveys showing HIV antibody in 10%-50% of intravenous drug users, HIV antibody seroprevalence rate in this selected population was 75%. IE in the HIV-seropositive intravenous drug user is essentially the same as in the seronegative user. However, patients with symptomatic HIV infection may be more likely to die from their IE. Intravenous drug users with IE have a greater-than-expected seroprevalence of HIV; the reason remains to be determined.

During a 5-month period, we evaluated the sensitivity, specificity, and predictive value of qualitative cultures of intravenous catheters submitted to a university hospital microbiology laboratory. Of 36 catheters submitted for culture from nonseptic patients, 10 (28%) grew one or more microorganisms on qualitative culture. Of 44 catheters cultured from septic patients, 20 (45%) grew one or more microorganisms, but only 5 grew microorganisms that also were isolated from blood cultures. The sensitivity, specificity, and positive predictive values for catheter-related bacteremia were 71%, 96%, and 17%, values similar to those reported for quantitative methods. Although acceptable in terms of sensitivity and specificity, the very low positive predictive value suggests that catheter-related bacteremia cannot be predicted reliably by this test. We conclude, therefore, that nonstandardized qualitative IV catheter cultures have minimal value as predictors of bacteremia and recommend that they not be performed in clinical microbiology laboratories.

The special article by Sigal 1 entitled "The Lyme Disease [LD] Controversy" crystallizes the issues associated with the problem of LD in New Jersey. As a group of private practice physicians specializing in infectious diseases in an area in New Jersey where LD is hyperendemic, we have similar concerns. We would like to emphasize several of his points and make some suggestions. As Sigal suggests, more physician education is needed. However, in our community some physicians are reluctant to accept the facts reported by Sigal despite repeated personal contacts and exposure to educational programs. The misconceptions described by Sigal are strongly held by these physicians, who view them as necessary to accommodate patient needs and concerns. This is similar to the common practice of prescribing antibiotics for viral upper respiratory tract infections. Patients have developed certain expectations, and the physicians wish to accommodate their customers for fear of losing business.

• Actinomycosis is typically a chronic infection of the cervicofascial, thoracic, or abdominal region. Involvement of the heart occurs but is unusual. We present a case of chronic constrictive pericarditis caused by actinomycetes. The actinomycosis infection was present for 20 years, thereby representing the longest duration reported in the literature, to our knowledge. ( Arch Intern Med . 1989;149:1202-1203)