Hydatid disease, or cystic echinococcosis, is a zoonotic infection caused mainly by Echinococcus granulosus, transmitted through ingestion of parasite eggs from contaminated sources or contact with infected canines. Humans become accidental hosts, typically developing cysts in the liver and lungs, with rare dissemination to other organs. We report a case of a 65-year-old female with disseminated hydatid disease involving the left kidney, head of the pancreas, pelvic sidewall, right gluteal region, and left proximal medial thigh. The disease had spread extensively, affecting a large segment of the descending thoracic aorta and causing embolization into the mesenteric, iliac, and lower limb arteries. This case highlights the diagnostic challenges we faced, radiologic features, and management considerations in an advanced presentation of disseminated hydatidosis, particularly in a resource-limited setting where infectious disease specialists and vascular surgeons are not readily available.
{"title":"The wandering hydatid cyst with arterial embolization: Diagnostic pitfalls and management strategies in resource-limited healthcare – A case report","authors":"Yegzeru Belete , Abdulkerim Girma , Amanuel Anegagregn , Biruh Alemu Ashine , Ermiyas Sintayehu","doi":"10.1016/j.idcr.2025.e02465","DOIUrl":"10.1016/j.idcr.2025.e02465","url":null,"abstract":"<div><div>Hydatid disease, or cystic echinococcosis, is a zoonotic infection caused mainly by <em>Echinococcus granulosus</em>, transmitted through ingestion of parasite eggs from contaminated sources or contact with infected canines. Humans become accidental hosts, typically developing cysts in the liver and lungs, with rare dissemination to other organs. We report a case of a 65-year-old female with disseminated hydatid disease involving the left kidney, head of the pancreas, pelvic sidewall, right gluteal region, and left proximal medial thigh. The disease had spread extensively, affecting a large segment of the descending thoracic aorta and causing embolization into the mesenteric, iliac, and lower limb arteries. This case highlights the diagnostic challenges we faced, radiologic features, and management considerations in an advanced presentation of disseminated hydatidosis, particularly in a resource-limited setting where infectious disease specialists and vascular surgeons are not readily available.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02465"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926296","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}
Nephrotic syndrome (NS) is a disease characterized by heavy protein loss in the urine due to increased permeability of the glomerular membrane, leading to low levels of albumin in the blood. Several studies have shown that primary or secondary kidney disease, congenital infections, diabetes, lupus, cancer, or the use of certain medications can cause it. Therefore, this study aims to present a case of NS in a 9-year-old boy complicated by spontaneous bacterial peritonitis and herpes zoster. The patient presented to the emergency department with a 2-day history of worsening abdominal pain accompanied by fever, nausea, vomiting, and facial oedema. Assessment showed a previous diagnosis of NS at the age of 7, but the condition remained poorly controlled due to irregular medication compliance. As the condition worsened, lavage drainage was performed, and the patient was later diagnosed with septic shock. Antibiotics therapies were administered to address the underlying infection. During hospitalization, the patient developed skin lesions that appeared to be herpes zoster, which was related to an immunocompromised condition. The patient was discharged after clinical improvement, and treatment was continued through outpatient monitoring. This current study emphasized the importance of early and aggressive intervention, particularly in immunocompromised pediatric patients with double burdens, to achieve better clinical outcomes.
{"title":"Managing concurrent nephrotic syndrome, spontaneous bacterial peritonitis, and herpes zoster in an immunocompromised child: Diagnostic difficulties and treatment outcomes","authors":"Riyadi Adrizain , Ismiana Modjaningrat , Winyarti , Fadila Dyah Trie Utami , Wilson Surya Lesmana , Vita Indriasari , Dedi Rachmadi Sjambas","doi":"10.1016/j.idcr.2026.e02489","DOIUrl":"10.1016/j.idcr.2026.e02489","url":null,"abstract":"<div><div>Nephrotic syndrome (NS) is a disease characterized by heavy protein loss in the urine due to increased permeability of the glomerular membrane, leading to low levels of albumin in the blood. Several studies have shown that primary or secondary kidney disease, congenital infections, diabetes, lupus, cancer, or the use of certain medications can cause it. Therefore, this study aims to present a case of NS in a 9-year-old boy complicated by spontaneous bacterial peritonitis and herpes zoster. The patient presented to the emergency department with a 2-day history of worsening abdominal pain accompanied by fever, nausea, vomiting, and facial oedema. Assessment showed a previous diagnosis of NS at the age of 7, but the condition remained poorly controlled due to irregular medication compliance. As the condition worsened, lavage drainage was performed, and the patient was later diagnosed with septic shock. Antibiotics therapies were administered to address the underlying infection. During hospitalization, the patient developed skin lesions that appeared to be herpes zoster, which was related to an immunocompromised condition. The patient was discharged after clinical improvement, and treatment was continued through outpatient monitoring. This current study emphasized the importance of early and aggressive intervention, particularly in immunocompromised pediatric patients with double burdens, to achieve better clinical outcomes.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02489"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926293","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 : 2026-01-01DOI: 10.1016/j.idcr.2026.e02490
Carta A. Gunawan, Henry P. Mangiri
The incidence of malaria has decreased significantly in East Kalimantan Province, a tropical forest area in Indonesia since the last 2 decades. Although malaria cases now are rare in most parts of this province, they do not disappear. Less experience with malaria cases could cause misdiagnosis or late diagnosis of malaria and severe malaria, a life-threatening disease.
It was reported a severe falciparum malaria in a 31-year-old male patient treated at a hospital in Samarinda, East Kalimantan Province, Indonesia. This patient was admitted to hospital with several complications including acute kidney injury, impaired consciousness, jaundice and liver dysfunction, high parasitemia, and severe thrombocytopenia. This patient was treated with artesunate injection and symptomatic and supportive treatments. Although the prognosis was poor due to many complications, this patient had full recovery. Early diagnosis and prompt and proper treatment play important role in managing severe malaria cases.
{"title":"Severe falciparum malaria remains a threat in East Kalimantan: A case report","authors":"Carta A. Gunawan, Henry P. Mangiri","doi":"10.1016/j.idcr.2026.e02490","DOIUrl":"10.1016/j.idcr.2026.e02490","url":null,"abstract":"<div><div>The incidence of malaria has decreased significantly in East Kalimantan Province, a tropical forest area in Indonesia since the last 2 decades. Although malaria cases now are rare in most parts of this province, they do not disappear. Less experience with malaria cases could cause misdiagnosis or late diagnosis of malaria and severe malaria, a life-threatening disease.</div><div>It was reported a severe falciparum malaria in a 31-year-old male patient treated at a hospital in Samarinda, East Kalimantan Province, Indonesia. This patient was admitted to hospital with several complications including acute kidney injury, impaired consciousness, jaundice and liver dysfunction, high parasitemia, and severe thrombocytopenia. This patient was treated with artesunate injection and symptomatic and supportive treatments. Although the prognosis was poor due to many complications, this patient had full recovery. Early diagnosis and prompt and proper treatment play important role in managing severe malaria cases.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02490"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037653","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 : 2026-01-01DOI: 10.1016/j.idcr.2026.e02497
Seyed Reza Mirbadie , Mohammad Ali Mohaghegh , Fateme Skandary , Eissa Soleymani , Fatemeh Nikbin , Alireza Sazmand
Chrysomya bezziana can potentially cause myiasis, a condition in which fly larvae infest living tissue in humans and animals. Contributing factors to this rare ailment include poor oral hygiene, alcohol abuse, and infected wounds. Hospital-acquired myiasis, a rare type of myiasis, occurs in patients following hospital admission. Herein, we report a case of C. bezziana oral myiasis in an 89-year-old female patient hospitalized in northeastern Iran. In this article, we also present an updated review of reported human myiasis cases in Iran up to 2025. According to our findings, C. bezziana has been responsible for 13 documented cases of myiasis in Iran. Most nosocomial myiasis cases in the country are related to pharyngeal and nasal infestations and are primarily observed in the ICU patients.
{"title":"Nosocomial oral myiasis caused by Chrysomya bezziana in Iran: A new case and review of human myiasis in the country","authors":"Seyed Reza Mirbadie , Mohammad Ali Mohaghegh , Fateme Skandary , Eissa Soleymani , Fatemeh Nikbin , Alireza Sazmand","doi":"10.1016/j.idcr.2026.e02497","DOIUrl":"10.1016/j.idcr.2026.e02497","url":null,"abstract":"<div><div><em>Chrysomya bezziana</em> can potentially cause myiasis, a condition in which fly larvae infest living tissue in humans and animals. Contributing factors to this rare ailment include poor oral hygiene, alcohol abuse, and infected wounds. Hospital-acquired myiasis, a rare type of myiasis, occurs in patients following hospital admission. Herein, we report a case of <em>C. bezziana</em> oral myiasis in an 89-year-old female patient hospitalized in northeastern Iran. In this article, we also present an updated review of reported human myiasis cases in Iran up to 2025. According to our findings, <em>C. bezziana</em> has been responsible for 13 documented cases of myiasis in Iran. Most nosocomial myiasis cases in the country are related to pharyngeal and nasal infestations and are primarily observed in the ICU patients.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02497"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037660","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 : 2026-01-01DOI: 10.1016/j.idcr.2025.e02471
Chandan Kumar Baranwal , Manish Thakur , Kanika Soni
Summary
This case report describes a rare instance of simultaneous typhoid hepatitis and splenic abscess in a 27-year-old immunocompetent male from India. The patient presented with high fever, jaundice, abdominal pain, and vomiting, and was mimicking acute viral hepatitis or disseminated tuberculosis finally diagnosed with Salmonella typhi infection following extensive diagnostic & therapeutic evaluations. Despite the seriousness of hepatic and splenic involvement, especially in the absence of underlying immunodeficiency, the patient responded well to appropriate antibiotic therapy. The report highlights the diagnostic challenges and clinical significance of atypical typhoid complications, emphasizing the importance of timely recognition and treatment to improve outcomes.
Introduction
In India, infection with Salmonella typhi, causing typhoid fever, is quite common. This may sometimes mimic other infectious diseases, complicating the diagnosis and management of these patients. Typhoid fever is a multisystem illness transmitted by the Feco-oral route, primarily through contaminated water and undercooked food, caused by Salmonella typhi and Salmonella paratyphi. It carries an important health concern, especially in tropical and developing countries. [1], [2] The gastrointestinal complications related to Salmonella typhi infection are Ileal perforation/ulceration, and may lead to obstruction and have been commonly reported. [1] Apart from that, involvement of the liver and spleen in typhoid fever is a serious concern. Here we are representing a case that presented with typhoid hepatitis and typhoid splenic abscess.
{"title":"Typhoid Fever goes rogue: A rare & unusual case of concurrent typhoid hepatitis and splenic abscess in an immunocompetent adult","authors":"Chandan Kumar Baranwal , Manish Thakur , Kanika Soni","doi":"10.1016/j.idcr.2025.e02471","DOIUrl":"10.1016/j.idcr.2025.e02471","url":null,"abstract":"<div><h3>Summary</h3><div>This case report describes a rare instance of simultaneous typhoid hepatitis and splenic abscess in a 27-year-old immunocompetent male from India. The patient presented with high fever, jaundice, abdominal pain, and vomiting, and was mimicking acute viral hepatitis or disseminated tuberculosis finally diagnosed with Salmonella typhi infection following extensive diagnostic & therapeutic evaluations. Despite the seriousness of hepatic and splenic involvement, especially in the absence of underlying immunodeficiency, the patient responded well to appropriate antibiotic therapy. The report highlights the diagnostic challenges and clinical significance of atypical typhoid complications, emphasizing the importance of timely recognition and treatment to improve outcomes.</div></div><div><h3>Introduction</h3><div>In India, infection with <em>Salmonella typhi</em>, causing typhoid fever, is quite common. This may sometimes mimic other infectious diseases, complicating the diagnosis and management of these patients. Typhoid fever is a multisystem illness transmitted by the Feco-oral route, primarily through contaminated water and undercooked food, caused by Salmonella typhi and <em>Salmonella paratyphi.</em> It carries an important health concern, especially in tropical and developing countries. <span><span>[1]</span></span>, <span><span>[2]</span></span> The gastrointestinal complications related to <em>Salmonella typhi</em> infection are Ileal perforation/ulceration, and may lead to obstruction and have been commonly reported. <span><span>[1]</span></span> Apart from that, involvement of the liver and spleen in typhoid fever is a serious concern. Here we are representing a case that presented with typhoid hepatitis and typhoid splenic abscess.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02471"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977806","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 : 2026-01-01DOI: 10.1016/j.idcr.2025.e02487
Afra Mohammed Alkaabi, Aadi Gupta, Maithah Mohammed Alkaabi, Mohammad Ilyas Bader
Background
Necrotizing fasciitis (NF) is a rare but life-threatening soft tissue infection in neonates, associated with high morbidity and mortality. Perineal involvement in female neonates is particularly uncommon and may lead to devastating complications.
Case presentation
A 5-week-old previously healthy female infant presented with a 10-day history of a generalized rash that later localized to the perianal region and limbs, developing into ulceration. The condition evolved into extensive perineal necrosis complicated by rectovulvar and rectovaginal fistulae. Initial clinical features were suggestive of eczema herpeticum with secondary bacterial infection, and empirical antiviral and broad-spectrum antibiotic therapy was initiated. HSV PCR was not performed, however, HSV-1/2 IgG levels were markedly elevated. Blood and peritoneal swab cultures were negative, while ulcer biopsy and wound swab cultures grew Klebsiella pneumoniae. Despite medical therapy, the infant deteriorated and required urgent surgical intervention. Management included superficial perineal debridement and a diverting sigmoid colostomy. Advanced immunological evaluation, including functional testing and whole-exome and whole-genome sequencing did not identify an underlying immunodeficiency. The perineal wounds healed with fecal diversion and local wound care, and the colostomy was successfully reversed six weeks later with good functional outcome.
Conclusion
This case highlights that severe perineal necrotizing fasciitis can occur in immunocompetent neonates and may be complicated by rare rectovulvar and rectovaginal fistulae. Early recognition, multidisciplinary care, and timely fecal diversion are critical to achieving favorable outcomes, even in the absence of identifiable immunodeficiency.
{"title":"Extensive necrotizing fasciitis in an immunocompetent neonate leading to rectovulvar and rectovaginal fistulae: A case report","authors":"Afra Mohammed Alkaabi, Aadi Gupta, Maithah Mohammed Alkaabi, Mohammad Ilyas Bader","doi":"10.1016/j.idcr.2025.e02487","DOIUrl":"10.1016/j.idcr.2025.e02487","url":null,"abstract":"<div><h3>Background</h3><div>Necrotizing fasciitis (NF) is a rare but life-threatening soft tissue infection in neonates, associated with high morbidity and mortality. Perineal involvement in female neonates is particularly uncommon and may lead to devastating complications.</div></div><div><h3>Case presentation</h3><div>A 5-week-old previously healthy female infant presented with a 10-day history of a generalized rash that later localized to the perianal region and limbs, developing into ulceration. The condition evolved into extensive perineal necrosis complicated by rectovulvar and rectovaginal fistulae. Initial clinical features were suggestive of eczema herpeticum with secondary bacterial infection, and empirical antiviral and broad-spectrum antibiotic therapy was initiated. HSV PCR was not performed, however, HSV-1/2 IgG levels were markedly elevated. Blood and peritoneal swab cultures were negative, while ulcer biopsy and wound swab cultures grew <em>Klebsiella pneumoniae.</em> Despite medical therapy, the infant deteriorated and required urgent surgical intervention. Management included superficial perineal debridement and a diverting sigmoid colostomy. Advanced immunological evaluation, including functional testing and whole-exome and whole-genome sequencing did not identify an underlying immunodeficiency. The perineal wounds healed with fecal diversion and local wound care, and the colostomy was successfully reversed six weeks later with good functional outcome.</div></div><div><h3>Conclusion</h3><div>This case highlights that severe perineal necrotizing fasciitis can occur in immunocompetent neonates and may be complicated by rare rectovulvar and rectovaginal fistulae. Early recognition, multidisciplinary care, and timely fecal diversion are critical to achieving favorable outcomes, even in the absence of identifiable immunodeficiency.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02487"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977807","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 : 2026-01-01DOI: 10.1016/j.idcr.2026.e02503
Douglas Jaxon Vadner , Monica Bailey , Sidney Smith
Introduction
Mpox is an Orthopoxvirus infection with evolving clinical presentations, including genital-dominant disease that can resemble common sexually transmitted infections (STIs). Secondary bacterial superinfection is uncommon but may alter lesion morphology and delay diagnosis.
Case Presentation
A 64-year-old unhoused heterosexual male presented with a two-week history of painful, malodorous groin ulcers after unprotected intercourse. Lesions began as groin-confined vesicles and later spread to the face and peri-auricular area. Because of ulceration, purulence, and sexual exposure, initial evaluation focused on more common sexually transmitted infections, all of which tested negative. Dermatology was consulted when the eruption showed umbilicated vesiculopustules at uniform developmental stages. Punch biopsies demonstrated neutrophilic pustules consistent with Orthopoxvirus infection, and PCR confirmed mpox. During hospitalization, several lesions became purulent with foul odor; culture grew methicillin-sensitive Staphylococcus aureus. Linezolid therapy produced rapid improvement.
Discussion
This case demonstrates genital-dominant mpox in a heterosexual male, a less commonly reported demographic, and highlights how lesion morphology may mimic bacterial or viral STIs. Bacterial superinfection can obscure classic diagnostic features, contribute to malodor and purulence, and delay recognition. PCR remains essential for confirmation, particularly when presentation overlaps with other genital ulcer etiologies.
Conclusion
Clinicians should include mpox in the differential diagnosis of genital ulcer disease regardless of sexual orientation and maintain vigilance for bacterial superinfection in non-healing or purulent lesions. Early PCR testing and culture-directed therapy are essential for accurate diagnosis and optimal management.
{"title":"Atypical genital mpox mimicking a sexually transmitted infection with secondary Staphylococcus aureus infection: A case report","authors":"Douglas Jaxon Vadner , Monica Bailey , Sidney Smith","doi":"10.1016/j.idcr.2026.e02503","DOIUrl":"10.1016/j.idcr.2026.e02503","url":null,"abstract":"<div><h3>Introduction</h3><div>Mpox is an Orthopoxvirus infection with evolving clinical presentations, including genital-dominant disease that can resemble common sexually transmitted infections (STIs). Secondary bacterial superinfection is uncommon but may alter lesion morphology and delay diagnosis.</div></div><div><h3>Case Presentation</h3><div>A 64-year-old unhoused heterosexual male presented with a two-week history of painful, malodorous groin ulcers after unprotected intercourse. Lesions began as groin-confined vesicles and later spread to the face and peri-auricular area. Because of ulceration, purulence, and sexual exposure, initial evaluation focused on more common sexually transmitted infections, all of which tested negative. Dermatology was consulted when the eruption showed umbilicated vesiculopustules at uniform developmental stages. Punch biopsies demonstrated neutrophilic pustules consistent with Orthopoxvirus infection, and PCR confirmed mpox. During hospitalization, several lesions became purulent with foul odor; culture grew methicillin-sensitive <em>Staphylococcus aureus</em>. Linezolid therapy produced rapid improvement.</div></div><div><h3>Discussion</h3><div>This case demonstrates genital-dominant mpox in a heterosexual male, a less commonly reported demographic, and highlights how lesion morphology may mimic bacterial or viral STIs. Bacterial superinfection can obscure classic diagnostic features, contribute to malodor and purulence, and delay recognition. PCR remains essential for confirmation, particularly when presentation overlaps with other genital ulcer etiologies.</div></div><div><h3>Conclusion</h3><div>Clinicians should include mpox in the differential diagnosis of genital ulcer disease regardless of sexual orientation and maintain vigilance for bacterial superinfection in non-healing or purulent lesions. Early PCR testing and culture-directed therapy are essential for accurate diagnosis and optimal management.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02503"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077513","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}
Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, with a predilection for cooler areas of the body such as the external ear. We report a man in his late thirties with lepromatous leprosy, presenting with an eight-month history of facial and auricular nodules that progressed to erythema, ulceration, and sensory impairment. The clinical examination revealed infiltrated, nodular pinnae, a cheek ulcer, and bilateral ulnar neuritis. Slit-skin smear revealed abundant acid-fast bacilli (BI 6 +), and histopathology confirmed the multibacillary spectrum. The acute erythema, painful tender nodules, and neuritis were consistent with a Type 2 lepra reaction (erythema nodosum leprosum, ENL). The patient was treated with the WHO-recommended multidrug therapy for multibacillary leprosy (MB-MDT) and oral corticosteroids, showing progressive clinical improvement. This case underscores that external ear involvement, though a recognized feature of multibacillary leprosy, may be easily overlooked, particularly when complicated by lepra reactions. Timely recognition and prompt management of lepra reactions are essential to prevent irreversible neuropathy and disfigurement.
{"title":"Nodular and abscessed pinna in lepromatous leprosy with Type 2 lepra reaction","authors":"Naga Nitya Vangala , Manisha Gedam , Adarshlata Singh , Bhushan Madke , Varun H","doi":"10.1016/j.idcr.2026.e02506","DOIUrl":"10.1016/j.idcr.2026.e02506","url":null,"abstract":"<div><div>Leprosy is a chronic granulomatous infection caused by <em>Mycobacterium leprae</em>, with a predilection for cooler areas of the body such as the external ear. We report a man in his late thirties with lepromatous leprosy, presenting with an eight-month history of facial and auricular nodules that progressed to erythema, ulceration, and sensory impairment. The clinical examination revealed infiltrated, nodular pinnae, a cheek ulcer, and bilateral ulnar neuritis. Slit-skin smear revealed abundant acid-fast bacilli (BI 6 +), and histopathology confirmed the multibacillary spectrum. The acute erythema, painful tender nodules, and neuritis were consistent with a Type 2 lepra reaction (erythema nodosum leprosum, ENL). The patient was treated with the WHO-recommended multidrug therapy for multibacillary leprosy (MB-MDT) and oral corticosteroids, showing progressive clinical improvement. This case underscores that external ear involvement, though a recognized feature of multibacillary leprosy, may be easily overlooked, particularly when complicated by lepra reactions. Timely recognition and prompt management of lepra reactions are essential to prevent irreversible neuropathy and disfigurement.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02506"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077514","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}
Hypersensitivity pneumonitis (HP) due to nontuberculous mycobacteria (NTM) is an uncommon phenotype of NTM pulmonary disease, classically linked to hot tub or pool exposure. We report a steroid-dependent case of HP-type Mycobacterium avium lung disease likely triggered by outdoor water aerosol exposure.
Case presentation
A 79-year-old man with a 16-pack-year smoking history presented with progressive dyspnea on exertion. High-resolution CT showed bilateral peripheral ground-glass opacities, and serum Krebs von den Lungen-6 was markedly elevated. Bronchoalveolar lavage fluid demonstrated lymphocytic predominance with an increased CD4/CD8 ratio, fulfilling criteria for probable HP. Prednisolone induced clinical and radiological improvement; however, repeated attempts at tapering resulted in relapse with new ground-glass opacities in the right middle lobe and rising biomarkers. Although Mycobacterium avium had been isolated from bronchoalveolar lavage culture, the initial absence of respiratory symptoms and radiographic improvement led to observation alone. Given the difficulty tapering corticosteroids and the positive culture, chronic antigen exposure to environmental NTM was suspected. Further environmental assessment identified a long-standing habit of golfing on a riverside course, where ongoing inhalation of water aerosols was deemed the most likely source of antigenic exposure.
Conclusion
Antigen avoidance combined with azithromycin and ethambutol led to sustained clinical and radiological improvement and successful steroid tapering without restrictive ventilatory impairment. This case underscores the importance of routinely sending mycobacterial cultures from bronchoalveolar lavage in suspected HP and of carefully reassessing environmental exposures, even in outdoor settings, as identifying NTM as the causative antigen can substantially modify management.
{"title":"A case of Mycobacterium avium-associated hypersensitivity pneumonitis","authors":"Akinari Atsumi , Takahiro Asami , Takuya Ozawa , Takanori Asakura , Ho Namkoong , Takashi Inoue","doi":"10.1016/j.idcr.2025.e02464","DOIUrl":"10.1016/j.idcr.2025.e02464","url":null,"abstract":"<div><h3>Background</h3><div>Hypersensitivity pneumonitis (HP) due to nontuberculous mycobacteria (NTM) is an uncommon phenotype of NTM pulmonary disease, classically linked to hot tub or pool exposure. We report a steroid-dependent case of HP-type <em>Mycobacterium avium</em> lung disease likely triggered by outdoor water aerosol exposure.</div></div><div><h3>Case presentation</h3><div>A 79-year-old man with a 16-pack-year smoking history presented with progressive dyspnea on exertion. High-resolution CT showed bilateral peripheral ground-glass opacities, and serum Krebs von den Lungen-6 was markedly elevated. Bronchoalveolar lavage fluid demonstrated lymphocytic predominance with an increased CD4/CD8 ratio, fulfilling criteria for probable HP. Prednisolone induced clinical and radiological improvement; however, repeated attempts at tapering resulted in relapse with new ground-glass opacities in the right middle lobe and rising biomarkers. Although <em>Mycobacterium avium</em> had been isolated from bronchoalveolar lavage culture, the initial absence of respiratory symptoms and radiographic improvement led to observation alone. Given the difficulty tapering corticosteroids and the positive culture, chronic antigen exposure to environmental NTM was suspected. Further environmental assessment identified a long-standing habit of golfing on a riverside course, where ongoing inhalation of water aerosols was deemed the most likely source of antigenic exposure.</div></div><div><h3>Conclusion</h3><div>Antigen avoidance combined with azithromycin and ethambutol led to sustained clinical and radiological improvement and successful steroid tapering without restrictive ventilatory impairment. This case underscores the importance of routinely sending mycobacterial cultures from bronchoalveolar lavage in suspected HP and of carefully reassessing environmental exposures, even in outdoor settings, as identifying NTM as the causative antigen can substantially modify management.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02464"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926284","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}
We report the case of an immunocompetent adult presenting with acute febrile illness during a dengue outbreak in the Peruvian Amazon. The patient developed rapidly progressive respiratory compromise and hemodynamic instability, requiring admission to the intensive care unit for management of septic shock, necrotizing pneumonia, and multiorgan dysfunction. Despite full supportive care, he experienced refractory cardiorespiratory failure and died within 24 h of admission. Blood cultures later identified Burkholderia cepacia, and the association of bacteremia with necrotizing pulmonary involvement was consistent with cepacia syndrome. This case highlights a severe and uncommon presentation of B. cepacia infection in an immunocompetent host within a complex tropical epidemiological context.
{"title":"Necrotizing pneumonia and septic shock caused by Burkholderia cepacia in an immunocompetent adult","authors":"Jorge Luis Hurtado-Alegre , Jhonatan Mauricio Crispin-Ayala , Débora Rocío Mananita-Terrones , Jhosef Franck Quispe-Pari","doi":"10.1016/j.idcr.2025.e02470","DOIUrl":"10.1016/j.idcr.2025.e02470","url":null,"abstract":"<div><div>We report the case of an immunocompetent adult presenting with acute febrile illness during a dengue outbreak in the Peruvian Amazon. The patient developed rapidly progressive respiratory compromise and hemodynamic instability, requiring admission to the intensive care unit for management of septic shock, necrotizing pneumonia, and multiorgan dysfunction. Despite full supportive care, he experienced refractory cardiorespiratory failure and died within 24 h of admission. Blood cultures later identified Burkholderia cepacia, and the association of bacteremia with necrotizing pulmonary involvement was consistent with cepacia syndrome. This case highlights a severe and uncommon presentation of B. cepacia infection in an immunocompetent host within a complex tropical epidemiological context.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02470"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926285","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号