Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2025.e02417
Jared Miguel Duldulao , Nina Modanlo , Sushma Boppana , Kristina Adachi , Huan Vinh Dong , Ishminder Kaur , Karin Nielsen-Saines , Jessica Terrell , Carol E. Cheng , Sanchi Malhotra
Coccidioidomycosis is predominantly a pulmonary disease, however dissemination can include unique cutaneous presentations. We report a previously healthy 11-year-old female with delayed diagnosis of cutaneous scalp coccidioidomycosis with disseminated disease with secondary wound myiasis and bacterial superinfection. She required extensive surgical debridement, eventually requiring a skin graft and prolonged hospitalization for antifungal therapy, experiencing a unique adverse effect.
{"title":"A scalp to make you squirm: Cutaneous myiasis hiding a unique presentation of disseminated coccidioidomycosis","authors":"Jared Miguel Duldulao , Nina Modanlo , Sushma Boppana , Kristina Adachi , Huan Vinh Dong , Ishminder Kaur , Karin Nielsen-Saines , Jessica Terrell , Carol E. Cheng , Sanchi Malhotra","doi":"10.1016/j.idcr.2025.e02417","DOIUrl":"10.1016/j.idcr.2025.e02417","url":null,"abstract":"<div><div>Coccidioidomycosis is predominantly a pulmonary disease, however dissemination can include unique cutaneous presentations. We report a previously healthy 11-year-old female with delayed diagnosis of cutaneous scalp coccidioidomycosis with disseminated disease with secondary wound myiasis and bacterial superinfection. She required extensive surgical debridement, eventually requiring a skin graft and prolonged hospitalization for antifungal therapy, experiencing a unique adverse effect.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02417"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2025.e02415
Yingchun Xiang, Biao Xiong, Li Qin, Hui Xu
Pulmonary tuberculosis (TB) remains a pressing global health issue, with atypical presentations complicating diagnosis, particularly in postpartum women who undergo significant immunological changes. This case report presents a postpartum woman experiencing persistent fever following spontaneous abortion, initially unresponsive to empirical antimicrobial therapy. Notably, the patient exhibited no classical respiratory symptoms, and traditional tests for diagnosing TB, including acid-fast staining and PCR, all showed negative results. Ultimately, through next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) clinicians identified Mycobacterium tuberculosis and Haemophilus influenzae, suggesting that the patient had a mixed infection. Following targeted anti-tubercular treatment, the patient demonstrated rapid clinical improvement, underscoring the therapeutic significance of accurate pathogen identification. This case highlights the limitations of traditional diagnostic modalities in detecting atypical TB presentations and the critical role of advanced molecular techniques in refractory postpartum infections. Remind clinicians of the necessity of expanding differential diagnosis and the criticality of incorporating NGS into diagnostic methods for postpartum fever cases that unresponsive to empirical treatment. Furthermore, the co-infection of Mycobacterium tuberculosis and Haemophilus influenzae indicates the complex infectious milieu in immunologically altered postpartum patients, necessitating multidisciplinary collaboration for optimal outcomes. Despite challenges in accessing advanced diagnostics, this report underscores the need to recognize non-classical TB presentations. The diagnosis of atypical TB was based on the following: (1) absence of classic symptoms, including chronic cough, night sweats, weight loss, or hemoptysis; (2) negative routine TB tests—acid-fast staining and PCR of respiratory samples; and (3) chest imaging showing bilateral lower-lobe consolidation without cavitation or upper-lobe predominance. These features diverged from those of typical TB pneumonia. Moreover, NGS co-detected Haemophilus influenzae, supporting a mixed infection and reinforcing the atypical presentation. This case offers valuable insight for improving diagnosis of complex postpartum infections and warrants further study into immune mechanisms of TB reactivation postpartum.
{"title":"Atypical pulmonary tuberculosis and haemophilus influenzae co-infection presenting as refractory postpartum fever: Diagnostic utility of next-generation sequencing","authors":"Yingchun Xiang, Biao Xiong, Li Qin, Hui Xu","doi":"10.1016/j.idcr.2025.e02415","DOIUrl":"10.1016/j.idcr.2025.e02415","url":null,"abstract":"<div><div>Pulmonary tuberculosis (TB) remains a pressing global health issue, with atypical presentations complicating diagnosis, particularly in postpartum women who undergo significant immunological changes. This case report presents a postpartum woman experiencing persistent fever following spontaneous abortion, initially unresponsive to empirical antimicrobial therapy. Notably, the patient exhibited no classical respiratory symptoms, and traditional tests for diagnosing TB, including acid-fast staining and PCR, all showed negative results. Ultimately, through next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) clinicians identified Mycobacterium tuberculosis and Haemophilus influenzae, suggesting that the patient had a mixed infection. Following targeted anti-tubercular treatment, the patient demonstrated rapid clinical improvement, underscoring the therapeutic significance of accurate pathogen identification. This case highlights the limitations of traditional diagnostic modalities in detecting atypical TB presentations and the critical role of advanced molecular techniques in refractory postpartum infections. Remind clinicians of the necessity of expanding differential diagnosis and the criticality of incorporating NGS into diagnostic methods for postpartum fever cases that unresponsive to empirical treatment. Furthermore, the co-infection of Mycobacterium tuberculosis and Haemophilus influenzae indicates the complex infectious milieu in immunologically altered postpartum patients, necessitating multidisciplinary collaboration for optimal outcomes. Despite challenges in accessing advanced diagnostics, this report underscores the need to recognize non-classical TB presentations. The diagnosis of atypical TB was based on the following: (1) absence of classic symptoms, including chronic cough, night sweats, weight loss, or hemoptysis; (2) negative routine TB tests—acid-fast staining and PCR of respiratory samples; and (3) chest imaging showing bilateral lower-lobe consolidation without cavitation or upper-lobe predominance. These features diverged from those of typical TB pneumonia. Moreover, NGS co-detected Haemophilus influenzae, supporting a mixed infection and reinforcing the atypical presentation. This case offers valuable insight for improving diagnosis of complex postpartum infections and warrants further study into immune mechanisms of TB reactivation postpartum.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02415"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2025.e02410
Thao D. Nguyen
Chronic bacterial prostatitis (CBP) presents diagnostic and therapeutic challenges, particularly in patients with drug allergies and atypical symptom profiles. This case describes a retired male healthcare professional with exclusive penile pain and urinary symptoms, diagnosed with CBP. Management involved sequential fluoroquinolone therapy—ciprofloxacin followed by moxifloxacin—over 6.5 weeks, guided by clinical condition and pharmacokinetic/ pharmacodynamic (PK/PD) considerations. To mitigate adverse drug reaction (ADR) risks, the patient incorporated probiotics, tendon support measures, and QT monitoring. The individualized approach resulted in significant symptomatic improvement without complications. Follow-up focused on prostate-specific antigen (PSA) monitoring, symptom tracking, and referral to pelvic floor physical therapy. This case’s approach combining sequential fluoroquinolone therapy with structured ADR-prevention strategies and a patient-engaged, shared decision-making model underscores the importance of individualized, multidisciplinary care in CBP.
{"title":"Tailored management of chronic bacterial prostatitis with sequential fluoroquinolones and adverse effect mitigation strategies: A case report","authors":"Thao D. Nguyen","doi":"10.1016/j.idcr.2025.e02410","DOIUrl":"10.1016/j.idcr.2025.e02410","url":null,"abstract":"<div><div>Chronic bacterial prostatitis (CBP) presents diagnostic and therapeutic challenges, particularly in patients with drug allergies and atypical symptom profiles. This case describes a retired male healthcare professional with exclusive penile pain and urinary symptoms, diagnosed with CBP. Management involved sequential fluoroquinolone therapy—ciprofloxacin followed by moxifloxacin—over 6.5 weeks, guided by clinical condition and pharmacokinetic/ pharmacodynamic (PK/PD) considerations. To mitigate adverse drug reaction (ADR) risks, the patient incorporated probiotics, tendon support measures, and QT monitoring. The individualized approach resulted in significant symptomatic improvement without complications. Follow-up focused on prostate-specific antigen (PSA) monitoring, symptom tracking, and referral to pelvic floor physical therapy. This case’s approach combining sequential fluoroquinolone therapy with structured ADR-prevention strategies and a patient-engaged, shared decision-making model underscores the importance of individualized, multidisciplinary care in CBP.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02410"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2024.e02124
Brenden Nago , Jeffrey E. Liu
The authors report a case of varicella zoster encephalitis, mimicking a glioblastoma on Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS). The limitations of MRI/MRS, may lead to delayed treatment with antiviral agents, which can result in increased morbidity and mortality. The possibility of viral encephalitis should remain in the differential diagnosis of all patients presenting with headaches and confusion, even when imaging results are indicative of a neoplastic process.
{"title":"An unusual case of varicella zoster encephalitis mimicking a glioblastoma on magnetic resonance imaging and magnetic resonance spectroscopy","authors":"Brenden Nago , Jeffrey E. Liu","doi":"10.1016/j.idcr.2024.e02124","DOIUrl":"10.1016/j.idcr.2024.e02124","url":null,"abstract":"<div><div>The authors report a case of varicella zoster encephalitis, mimicking a glioblastoma on Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS). The limitations of MRI/MRS, may lead to delayed treatment with antiviral agents, which can result in increased morbidity and mortality. The possibility of viral encephalitis should remain in the differential diagnosis of all patients presenting with headaches and confusion, even when imaging results are indicative of a neoplastic process.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02124"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2024.e02126
Alex Belote, Kassem Hammoud
A 55-year-old-male with a chronic left uretero-pelvic junction (UPJ) obstruction managed with intermittent stent exchanges presented with low midline back pain. CT Abdomen/Pelvis revealed spondylodiscitis at L4-L5, further demonstrated on MRI Lumbar spine. Imaging also revealed the left nephro-ureteral stent was mispositioned, with some mild wall thickening of the left ureter. He was not systemically ill, and antimicrobials were held. He underwent a L4/5 disc biopsy, and pathology revealed acute discitis. Blood and biopsy cultures remained negative through hospital day 5. He then underwent repeat L4/5 disc biopsy. Cultures of repeat biopsy resulted in Gardnerella vaginalis. IV antimicrobials were stopped, and oral Metronidazole was started. He completed 10 weeks of Metronidazole therapy, with significant clinical improvement.
G. vaginalis is a rare cause of bone and joint infections. It is difficult to culture and is less virulent than common bacteria associated with native vertebral osteomyelitis. There have been few case reports of G. vaginalis osteomyelitis or prosthetic joint infection, especially in males. G. vaginalis can rarely colonize the urethra in men and has been known to form biofilm on foreign material in the female genitourinary system. We suspect our patient had developed colonization of his ureteral stent, predisposing him to osteomyelitis. Were repeat biopsy not pursued in this case, our patient likely could have developed empiric treatment failure. Holding antibiotics after initial biopsy proved highly beneficial.
{"title":"A rare case of Gardnerella vaginalis spondylodiscitis","authors":"Alex Belote, Kassem Hammoud","doi":"10.1016/j.idcr.2024.e02126","DOIUrl":"10.1016/j.idcr.2024.e02126","url":null,"abstract":"<div><div>A 55-year-old-male with a chronic left uretero-pelvic junction (UPJ) obstruction managed with intermittent stent exchanges presented with low midline back pain. CT Abdomen/Pelvis revealed spondylodiscitis at L4-L5, further demonstrated on MRI Lumbar spine. Imaging also revealed the left nephro-ureteral stent was mispositioned, with some mild wall thickening of the left ureter. He was not systemically ill, and antimicrobials were held. He underwent a L4/5 disc biopsy, and pathology revealed acute discitis. Blood and biopsy cultures remained negative through hospital day 5. He then underwent repeat L4/5 disc biopsy. Cultures of repeat biopsy resulted in <em>Gardnerella vaginalis</em>. IV antimicrobials were stopped, and oral Metronidazole was started. He completed 10 weeks of Metronidazole therapy, with significant clinical improvement.</div><div><em>G. vaginalis</em> is a rare cause of bone and joint infections. It is difficult to culture and is less virulent than common bacteria associated with native vertebral osteomyelitis. There have been few case reports of <em>G. vaginalis</em> osteomyelitis or prosthetic joint infection, especially in males. <em>G. vaginalis</em> can rarely colonize the urethra in men and has been known to form biofilm on foreign material in the female genitourinary system. We suspect our patient had developed colonization of his ureteral stent, predisposing him to osteomyelitis. Were repeat biopsy not pursued in this case, our patient likely could have developed empiric treatment failure. Holding antibiotics after initial biopsy proved highly beneficial.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02126"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2024.e02134
Asbah Rahman, Aastha Randhawa, Yu Shia Lin
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.
{"title":"Unmasking tuberculous arthritis in a prosthetic joint: Diagnostic and therapeutic challenges","authors":"Asbah Rahman, Aastha Randhawa, Yu Shia Lin","doi":"10.1016/j.idcr.2024.e02134","DOIUrl":"10.1016/j.idcr.2024.e02134","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02134"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2024.e02136
Weibu Chen, Xueyan Chen
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.
{"title":"Diagnosis of disseminated cryptococcosis via iliac bone marrow aspirate analysis","authors":"Weibu Chen, Xueyan Chen","doi":"10.1016/j.idcr.2024.e02136","DOIUrl":"10.1016/j.idcr.2024.e02136","url":null,"abstract":"<div><div>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 <em>Cryptococcus</em> 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.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02136"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Emergence of Coccidioides posadasii in an asymptomatic Ecuadorian patient with diabetes: A case report","authors":"Zanny Bastidas , Jeannete Zurita , Gabriela Sevillano , Jesus-Elias Dawaher , Pablo Cáceres , César Delgado","doi":"10.1016/j.idcr.2024.e02137","DOIUrl":"10.1016/j.idcr.2024.e02137","url":null,"abstract":"<div><div>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 <em>Coccidioides posadasii</em> 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.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02137"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a rare case of sepsis caused by Raoultella ornithinolytica, a gram-negative, encapsulated bacterium. The patient, a 46-year-old male, was admitted to the intensive care unit with severe diabetic ketoacidosis, acute renal failure, and sepsis. Despite aggressive management, including continuous renal replacement therapy and high-dose inotropes, the patient's condition deteriorates rapidly, ultimately resulting in a fatal outcome. This case highlights the importance of considering Raoultella ornithinolytica in the differential diagnosis of sepsis, particularly in cases where the source of infection is unknown. The patient's clinical course underscores the challenges of managing sepsis in the intensive care unit and the need for continued research into the diagnosis, treatment, and prevention of sepsis caused by this rare opportunistic pathogen.
{"title":"Fatal case of sepsis caused by Raoultella ornithinolytica: A rare opportunistic pathogen","authors":"Rifah Anwar Assadi , Husain Abdulaziz AlAwadhi , Nageeb Hussein Abdulla Hasson , Rizah Anwar Assadi","doi":"10.1016/j.idcr.2025.e02156","DOIUrl":"10.1016/j.idcr.2025.e02156","url":null,"abstract":"<div><div>We present a rare case of sepsis caused by <em>Raoultella ornithinolytica</em>, a gram-negative, encapsulated bacterium. The patient, a 46-year-old male, was admitted to the intensive care unit with severe diabetic ketoacidosis, acute renal failure, and sepsis. Despite aggressive management, including continuous renal replacement therapy and high-dose inotropes, the patient's condition deteriorates rapidly, ultimately resulting in a fatal outcome. This case highlights the importance of considering <em>Raoultella ornithinolytica</em> in the differential diagnosis of sepsis, particularly in cases where the source of infection is unknown. The patient's clinical course underscores the challenges of managing sepsis in the intensive care unit and the need for continued research into the diagnosis, treatment, and prevention of sepsis caused by this rare opportunistic pathogen.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02156"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2024.e02139
Cole Royer , Matthew Owens , Kenrick Wysong , Michael Madrid , Katrina Moreau
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.
{"title":"A case of disseminated blastomycosis in New England","authors":"Cole Royer , Matthew Owens , Kenrick Wysong , Michael Madrid , Katrina Moreau","doi":"10.1016/j.idcr.2024.e02139","DOIUrl":"10.1016/j.idcr.2024.e02139","url":null,"abstract":"<div><div><em>Blastomyces</em> 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.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02139"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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