Our patient initially presented with multiple systemic disseminating infections and, after extensive work-up, was diagnosed with HIV infection with low CD4 count of 4 cells/μl.
Furthermore, during severe systemic inflammation, disseminated intravascular coagulation occurs because of the pro-adhesive endothelial environment and tissue factor expression on monocytes with consecutive intravascular thrombin formation [3], [4].
KP was able to exert a very effective therapeutic activity in experimental models of vaginal and systemic candidiasis, disseminated cryptococcosis and paracoccidioidomycosis as well as Influenza A virus infection [8], [9], [10].
In terms of presentation, often these cases present as isolated endophthalmitis infections without any other systemic evidence of disseminated disease.
We recently reported one case of bilateral KPEE with widespread disseminated systemic infection with confirmed K1 capsular serotype in the USA (see the 'Clinical experience' section) [26].
For example, our previously published case report [26] as well as a few other studies have noted disseminated systemic infection within the first few days of presentation [13, 36].
Complications from cutaneous-subcutaneous nocardiosis in companion animals are represented by invasion of adjacent structures, leading to pulmonary, neurologic and/or disseminated (systemic) forms [ 1, 4].
However, it has recently been demonstrated that intravenous administration of the tumor suppressor gene FUS1/TUSC2 in DOTAP nanoparticles is capable of systemic delivery to disseminated disease [ 47], and this approach is undergoing further investigation.
In fact, the dampening in early recurrence demonstrated in Figure 1 due to chemotherapy may be due to the effect of systemic chemotherapy upon disseminated non-dormant or 'awakened' micrometastatic cell clusters alone [ 10], with no impact upon either dormant isolated tumour cells or cancer stem cells.
In addition, metastases to the pancreas from other organs are typically associated with disseminated systemic disease, but in the case of RCC, the pancreas is the only metastatic site in about half of cases and is referred to as isolated pancreatic metastasis [ 1- 3, 6- 8].
