IDCases最新文献

Scrub typhus (tsutsugamushi disease) is an acute febrile illness caused by Orientia tsutsugamushi, often found in Asia and Oceania. The presence of an eschar, characterized by a crust, is a key diagnostic finding. Many symptoms of this disease are already known, however reactive arthritis following scrub typhus is very rare. Here, we present a case of 79-year-old man who was referred to our hospital because of continuous fever and left shoulder pain. We found 4-fold rise in Orientia tsutugamushi-specific IgG titer using paired serum samples and Orientia sp. genes by real-time PCR from a crust of right thigh. And the left shoulder joint image was consistent with aseptic arthritis; thus we diagnosed as scrub typhus with reactive arthritis. This case highlights the importance of recognizing reactive arthritis as a symptom of scrub typhus. In this report, we also review published cases of reactive arthritis associated with scrub typhus, and we suppose that this arthritis related to this infection may recover after antibiotic use and have a good prognosis. Physicians' awareness of newly appeared arthritis may contribute to facilitate early diagnosis, and may improve the course of such patients.

Blastomyces infections are classified as dimorphic fungal infections commonly seen geographically throughout the Mississippi and Ohio River Valleys, St. Laurence Seaways, as well as the Canadian providences of Ontario Manitoba, and Saskatchewan. Although primarily endemic in the Midwestern United States, there has been a rise in cases throughout New England. Factors that could contribute to this rise of blastomycosis include a changing climate, increasing use of immunosuppressive medications as well as a greater recognition of this disease. Initial presentation of blastomycosis follows the inhalation of fungal spores which can cause flu-like symptoms or mimic acute pneumonia. Blastomycosis can also present as a disseminated infection through extrapulmonary spread in both immunocompromised and immunocompetent hosts and cases present at similar rates within the population. Here we present a case of disseminated blastomycosis in a patient from New England with no reported pre-existing risk factors. The patient developed blastomycosis osteomyelitis in the left elbow which prompted surgical intervention as well as a 12-month regimen of voriconazole therapy. This case outlines the need to adopt better surveillance practices for blastomycosis in non-endemic areas as well as highlights the imperative role of healthcare staff in implementing proper reporting measures to track the spread of blastomycosis.

Dalbavancin is a novel long acting lipoglycopeptide antibiotic with a favorable safety profile approved for treating Acute Bacterial Skin and Skin Structure Infections (ABSSSI) caused by Gram-positive organisms. Given its long half-life, a two-dose regimen can provide effective systemic therapy for up to six weeks, making it an appealing option to avoid prolonged intravenous antibiotic therapy. Herein, we report a case of a 27-year-old male who developed dalbavancin-induced fever while treating Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. Despite being inconsistently reported, our case highlights fever as a possible side effect of dalbavancin therapy, and the challenging management of this adverse event given its prolonged half-life.

Bispecific antibody is a new treatment for hematological disease, especially for lymphoma, myeloma and acute lymphoblastic leukemia. This class of treatment presents the same kind of side effect as CAR-T cell which are immune-mediated. Nevertheless, infectious complication remains a major concerns with related mortality. Fungal infection are rarely reported in clinical trial but remains a major concern. We report a case of a co-infection of Aspergillus and Mucorales in a patient with diffuse large B-cell lymphoma (DLBCL) following treatment with the bispecific antibody epcoritamab. The patient developed severe cytokine release syndrome (CRS) and subsequent fungal infections, which were challenging to diagnose and treat due to the complexities of managing immunocompromised patients and co-infection. Advanced diagnostics, including PET-CT, and a combination of antifungal therapies were crucial in achieving remission. The case underscores the need for early diagnosis, multidisciplinary management, and innovative treatment strategies in similar high-risk patients.

An 85-year-old woman with a history of total knee replacements for osteoarthritis in the past, presented with left knee swelling and pain that persisted for 14 months. An initial diagnosis of synovial cyst was made, and she underwent multiple aspirations and symptomatic treatments without improvement. Repeat arthrocentesis showed a WBC of 56,000/μL with 61 % neutrophils and 34 % lymphocytes. Synovial fluid bacterial and fungal cultures were negative. The acid-fast bacilli (AFB) culture revealed the Mycobacterium tuberculosis complex and was confirmed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) Mass Spectrometry. This case highlights the challenges of diagnosing tuberculous prosthetic joint infection in an elderly individual with knee pain.

HIV infection frequently affects multiple systems, with hematological manifestations being the most prevalent. In some cases, cryptococcosis serves as the initial manifestation and a cause of infection involving HIV-positive patients. This case report describes a patient with thrombocytopenia who incidentally discovered Cryptococcus infiltrating the bone marrow upon bone marrow smear examination, highlighting that examining bone marrow is essential in diagnosing pancytopenia resulting from opportunistic fungal infections like cryptococcosis, especially in individuals with compromised immune systems.

Coccidioidomycosis is a potentially serious but poorly studied mycosis in Ecuador. It is not a notifiable infection; therefore, its true incidence and prevalence in Ecuador remain unknown. Because primary lung disease due to coccidioidomycoses is typically self-limiting, it does not usually require treatment. Here, we present the first case of Coccidioides posadasii infection in an asymptomatic patient with diabetes without a history of travel to an endemic area. This is the first case reported in Ecuador in the last half-century.

Hydatid disease is endemic in Tunisia. Whereas uncomplicated pulmonary hydatid cysts are easily diagnosed on radiological findings, complicated and atypical forms may be misdiagnosed and confused with other pulmonary lesions, mainly lung malignancies. We report a case of a 47-year-old woman, who presented with a 3-month history of hemoptysis. Physical examination was normal. Chest x-ray and CT scan of the chest revealed a mass with speculated margins and central necrosis, located in the apical segment of the right lower lobe moderately contrast-enhanced. The scan guided biopsy showed inflammatory pulmonary parenchyma with no signs of malignancy. Fiberoptic bronchoscopy revealed significant bleeding from the superior segmental bronchus of right lower lobe. Pathology examination of the bronchial aspiration revealed a suggestive aspect of malignant cells. Regarding those findings, lung carcinoma was highly suspected and the importance of hemoptysis motivated an urgent hemostasis lobectomy. The patient underwent a right lower lobectomy with radical lymph node dissection via a right posterolateral thoracotomy. Histological examination showed a laminated membrane lined by a proligerous membrane made up of a layer of eosinophilic cells confirming the diagnosis of pulmonary hydatid cyst. It should be kept in mind that pulmonary hydatid disease can clinically, radiologically mimic lung cancer. Exceptionally, even cytology can lead to a diagnosis pitfall.

Human Parvovirus B19 (B19V) is rarely observed in patients with Guillain-Barré syndrome. We report the case of a patient with rapidly progressive functional impotence of the limbs. B19V was detected in both blood and CSF samples. The patient improved clinically after plasma exchanges, but mild functional impotence persisted 2 months later.

Mycobacterium Chelonae is a rapidly growing nontuberculous mycobacterium (NTM) that is ubiquitous in the environment and is associated with skin and soft tissue infections (1). Because Mycobacterium Chelonae is an opportunistic infection, it can present as skin abscess, cellulitis, osteomyelitis, pulmonary infection or disseminated infections, particularly in individuals with compromised immune systems or underlying lung conditions such as cystic fibrosis or bronchiectasis. M.Chelonae is one of the most pathogenic rapidly growing mycobacteria (RGM). Diagnosing RGM and distinguishing it from Mycobacterium tuberculosis is important because public health tracking and management is different in these two organisms. Antibiotic susceptibility testing can also provide valuable clues to the species identification of RGM as each species has a specific in vitro antibiotic susceptibility pattern (2). Although incidence of M. Chelonae is increasing, these infections often remain misdiagnosed. This case report discusses the clinical presentation, diagnostic challenges, the rationale for early empiric treatment, and therapeutic options for M. Chelonae infection, emphasizing the importance of timely intervention in immunocompromised individuals.