IDCases最新文献

Background: Ecthyma is a deeper form of impetigo involving the epidermis and dermis causing ulcerative plaques. Pathogens commonly responsible for the disease (group A beta-hemolytic streptococcus and Staphylococcus aureus) typically afflicts children, presenting during early stages with skin lesions that can closely resemble other vesicular and ulcerative dermatoses, such as those observed in mpox infection. The ongoing global outbreak of monkeypox has escalated the urgency for clinicians to accurately differentiate between these conditions due to their overlapping dermatological manifestations. Through this series, we intend to demonstrate the diverse clinical presentations of ecthyma observed in non-endemic regions, which may closely mimic those of monkeypox.

Case presentation: The first case describes a 12- year-old male with a history of atopic dermatitis, presenting with a vesicular rash initially suspected to be monkeypox. However, diagnosis via skin punch biopsy and cultures revealed ecthyma. The second case involved an 18-year-old male with acute, rapidly progressing ulcerated lesions and systemic symptoms. Differential diagnosis included toxic shock syndrome and necrotizing fasciitis, but histopathological findings confirmed ecthyma. The third case featured a 55-year-old woman with rapidly developing skin lesions on her hand, resolved through empirical antibiotic therapy, further confirming the diagnosis.

Conclusion: misdiagnosis and thus, delayed treatment of ecthyma leads to severe unfavourable outcomes. Given its rare occurrence yet fatal potential, and the current global vigilance due to the monkeypox outbreak, it is vital for healthcare providers to include ecthyma in the differential diagnosis of necrotic and ulcerative skin lesions.

Osteomyelitis is a prevalent orthopedic condition. The most frequently associated pathogens are Staphylococcus aureus, coagulase-negative Staphylococci, and aerobic gram-negative bacilli. The treatment includes the administration of antibiotics targeting the pathogens and possible surgical debridement. Although Serratia fonticola has been isolated in various tissues, including the respiratory, gastrointestinal, urinary, and biliary tracts, as well as in wounds, human infections associated with S. fonticola have rarely been reported. Here, we present an uncommon case of osteomyelitis secondary to S. fonticola infection.

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.

Dematiaceous molds often cause noninvasive disease but have the potential to cause disseminated infection, particularly in immunosuppressed hosts. Cladophialophora bantiana is the most neurotropic of dematiaceous molds and is associated with brain abscesses, but disseminated infection is quite rare. Here we present a case of disseminated C. bantiana in a 67-year-old renal transplant recipient with multifocal soft tissue, bone and presumed central nervous system involvement. C. bantiana infections have been associated with significant mortality and our patient had progression of his disease despite intensive dual antifungal therapy with close therapeutic drug monitoring. There was a delay in diagnosis and initiation of antifungal therapy as the multifocal disease was presumed to represent a malignant process. This case review highlights the importance of having a high index of suspicion for disseminated fungal infection in immunocompromised patients and the need for tissue biopsy to aid in the prompt and timely diagnosis and initiation of empiric antifungal therapy, with concomitant surgical management whenever possible to improve patient outcomes.

Tropheryma whipplei (T. whipplei) is extensively known as the etiological bacterium of Whipple's disease (WD). Here, we reported a case of community-acquired pneumonia caused by T. whipplei in a young pregnant woman without predisposing medical conditions. This case indicated that T. whipplei might be also transmitted via respiratory droplet.

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.

Phaeohyphomycotic cyst is a common subcutaneous form of phaeohyphomycosis in which patients can present with subcutaneous plaques, nodules, etc., It is an infrequent presentation and is most reported in immunocompromised individuals. Diagnosis is confirmed by histopathological and mycological demonstration of the organism. The treatment is by surgical excision with systemic antifungals. We report a rare case of asymptomatic Mycotic cyst in an immunocompetent individual.

Tuberculosis is a transmissible disease caused by the bacterium Mycobacterium tuberculosis. It is the leading cause of mortality due to infectious diseases. Tuberculous pericarditis is one of the manifestations of extrapulmonary tuberculosis and represents the primary cause of pericardial effusion in developing countries. We present the case of a 71-year-old male patient with a history of 1 month of dyspnea, accompanied by paroxysmal nocturnal dyspnea and unintentional weight loss. An echocardiogram revealed the presence of severe pericardial effusion, for which pericardiocentesis was performed, and the pericardial fluid was analyzed using the Xpert MTB/RIF test, which confirmed the presence of Mycobacterium tuberculosis without resistance to Rifampicin. This is a case of Tuberculous Pericarditis as the cause of pericardial effusion, in which the etiological diagnosis was made possible through molecular biological analysis of the pericardial fluid. The importance of disseminating such cases lies in emphasizing that, even in the 21st century, in developing countries like Honduras, it is crucial not to dismiss tuberculosis infection, as it remains the leading cause of pericardial effusion in endemic regions.