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}
Pub Date : 2026-01-01DOI: 10.1016/j.idcr.2025.e02473
Huda Aldhanhani , Nourhan Elsayed , Eyman Shebani
We present a rare case of neonatal bone infection caused by Bacteroides fragilis without predisposing risk factors in an otherwise healthy newborn. The infant initially presented with symptoms of sepsis, including fever, irritability, and reduced limb movement, prompting an extensive workup that eventually revealed Bacteroides fragilis in joint fluid PCR analysis. Treatment involved multi-agent antibiotics targeting anaerobic organisms and a joint washout procedure. This case highlights the importance of molecular diagnostics in detecting uncommon pathogens in neonatal bone infections and guiding effective antibiotic therapy. This report contributes valuable knowledge to understanding and managing bone and joint infections in neonatal populations.
{"title":"Bacteroides fragilis as an unusual cause of neonatal pyogenic arthritis: A case report","authors":"Huda Aldhanhani , Nourhan Elsayed , Eyman Shebani","doi":"10.1016/j.idcr.2025.e02473","DOIUrl":"10.1016/j.idcr.2025.e02473","url":null,"abstract":"<div><div>We present a rare case of neonatal bone infection caused by Bacteroides fragilis without predisposing risk factors in an otherwise healthy newborn. The infant initially presented with symptoms of sepsis, including fever, irritability, and reduced limb movement, prompting an extensive workup that eventually revealed Bacteroides fragilis in joint fluid PCR analysis. Treatment involved multi-agent antibiotics targeting anaerobic organisms and a joint washout procedure. This case highlights the importance of molecular diagnostics in detecting uncommon pathogens in neonatal bone infections and guiding effective antibiotic therapy. This report contributes valuable knowledge to understanding and managing bone and joint infections in neonatal populations.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02473"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977808","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.e02485
Yuma Takeda , Takaaki Kobayashi , Nicholas Van Sickels , Akihito Yoshida
Pyogenic liver abscess (PLA) is a rare but potentially life-threatening condition. Streptococcus constellatus, part of the Streptococcus anginosus group, is an uncommon causative agent of PLA, though its incidence has been increasingly reported. We present the case of a 68-year-old man with a history of hypertension, type 2 diabetes, and dyslipidemia, who was admitted after a traffic accident. Medical evaluation revealed bacteremia and liver abscesses caused by S. constellatus, and the patient was treated successfully with drainage and antibiotics. While the patient denied gastrointestinal symptoms, a colonoscopy was performed to investigate a possible portal of entry for the organism, which revealed an inflammatory lesion at the ileocecal valve. This case underscores the importance of colonoscopy in identifying potential sources of infection in cryptogenic PLA and highlights the need for thorough evaluation of gastrointestinal lesions in patients with S. constellatus bacteremia. The patient's loss of consciousness during the traffic accident was attributed to sepsis, reinforcing the critical role of comprehensive internal investigations in trauma patients with unexplained symptoms.
{"title":"Liver abscess and bacteremia caused by Streptococcus constellatus with suspected ileocecal valve lesion as the entry point","authors":"Yuma Takeda , Takaaki Kobayashi , Nicholas Van Sickels , Akihito Yoshida","doi":"10.1016/j.idcr.2025.e02485","DOIUrl":"10.1016/j.idcr.2025.e02485","url":null,"abstract":"<div><div>Pyogenic liver abscess (PLA) is a rare but potentially life-threatening condition. <em>Streptococcus constellatus</em>, part of the <em>Streptococcus anginosus</em> group, is an uncommon causative agent of PLA, though its incidence has been increasingly reported. We present the case of a 68-year-old man with a history of hypertension, type 2 diabetes, and dyslipidemia, who was admitted after a traffic accident. Medical evaluation revealed bacteremia and liver abscesses caused by <em>S. constellatus</em>, and the patient was treated successfully with drainage and antibiotics. While the patient denied gastrointestinal symptoms, a colonoscopy was performed to investigate a possible portal of entry for the organism, which revealed an inflammatory lesion at the ileocecal valve. This case underscores the importance of colonoscopy in identifying potential sources of infection in cryptogenic PLA and highlights the need for thorough evaluation of gastrointestinal lesions in patients with <em>S. constellatus</em> bacteremia. The patient's loss of consciousness during the traffic accident was attributed to sepsis, reinforcing the critical role of comprehensive internal investigations in trauma patients with unexplained symptoms.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02485"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926286","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.e02456
Jao Jarro B. Garcia, Liamuel Giancarlo V. Untalan, Veeda Michelle M. Anlacan
Angiostrongylus cantonensis is the leading parasitic cause of eosinophilic meningitis but there have been no cases of human infection reported from the Philippines. We report a 25-year-old female, with a dietary preference for raw lettuce, who presented with a two-week history of low-grade fever, malaise, progressive holocranial headache, and myalgia. She had Grade 2 papilledema, nuchal catch, and peripheral eosinophilia. Lumbar puncture eventually revealed eosinophilic meningitis. Extensive diagnostics were completed to exclude all potential infectious, hematologic, and rheumatologic causes of central and peripheral eosinophilia eventually leading to the conclusion of Probable Neuroangiostrongyliasis. She was managed conservatively until discharge and remained headache-free one year later. This case highlights important challenges in the diagnosis and management of this extremely rare zoonosis in the Philippine setting and demonstrates the need for increased public and medical awareness regarding this condition.
{"title":"Neuroangiostrongyliasis (Rat Lungworm Disease) in a Philippine Tertiary Center: Clinical experience, diagnostic challenges and review of literature","authors":"Jao Jarro B. Garcia, Liamuel Giancarlo V. Untalan, Veeda Michelle M. Anlacan","doi":"10.1016/j.idcr.2025.e02456","DOIUrl":"10.1016/j.idcr.2025.e02456","url":null,"abstract":"<div><div><em>Angiostrongylus cantonensis</em> is the leading parasitic cause of eosinophilic meningitis but there have been no cases of human infection reported from the Philippines. We report a 25-year-old female, with a dietary preference for raw lettuce, who presented with a two-week history of low-grade fever, malaise, progressive holocranial headache, and myalgia. She had Grade 2 papilledema, nuchal catch, and peripheral eosinophilia. Lumbar puncture eventually revealed eosinophilic meningitis. Extensive diagnostics were completed to exclude all potential infectious, hematologic, and rheumatologic causes of central and peripheral eosinophilia eventually leading to the conclusion of Probable Neuroangiostrongyliasis. She was managed conservatively until discharge and remained headache-free one year later. This case highlights important challenges in the diagnosis and management of this extremely rare zoonosis in the Philippine setting and demonstrates the need for increased public and medical awareness regarding this condition.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02456"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926300","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.e02463
Brian P. Epling , Maura Manion , Elizabeth Laidlaw , Michael S. Abers , Irini Sereti
Disseminated nocardiosis is an opportunistic infection seen primarily in patients with impaired phagocyte function, and less frequently in people with advanced HIV. Nocardia pseudobrasiliensis is a species that exhibits high rates of antimicrobial resistance, including to carbapenems, co-trimoxazole, and aminoglycosides. In this article, we present a case of an individual with advanced HIV infection and disseminated N. pseudobrasiliensis. Prior to completion of antimicrobial susceptibility testing, he was treated empirically with imipenem, co-trimoxazole, and amikacin, but demonstrated radiologic progression. Directed therapy with linezolid and azithromycin was ultimately initiated, resulting in marked symptomatic and radiologic improvement after one year of treatment alongside suppressive antiretroviral therapy.
{"title":"Disseminated drug-resistant nocardiosis in a patient with advanced HIV","authors":"Brian P. Epling , Maura Manion , Elizabeth Laidlaw , Michael S. Abers , Irini Sereti","doi":"10.1016/j.idcr.2025.e02463","DOIUrl":"10.1016/j.idcr.2025.e02463","url":null,"abstract":"<div><div>Disseminated nocardiosis is an opportunistic infection seen primarily in patients with impaired phagocyte function, and less frequently in people with advanced HIV. <em>Nocardia pseudobrasiliensis</em> is a species that exhibits high rates of antimicrobial resistance, including to carbapenems, co-trimoxazole, and aminoglycosides. In this article, we present a case of an individual with advanced HIV infection and disseminated <em>N. pseudobrasiliensis</em>. Prior to completion of antimicrobial susceptibility testing, he was treated empirically with imipenem, co-trimoxazole, and amikacin, but demonstrated radiologic progression. Directed therapy with linezolid and azithromycin was ultimately initiated, resulting in marked symptomatic and radiologic improvement after one year of treatment alongside suppressive antiretroviral therapy.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02463"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926297","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.e02474
Eden Belay Tilahun , Denis Oluka , Abraham Sisay Abie , Ayuel Isaac Abiel nyok , Lubega Ronald , Felix Oyania
Cysticercosis is an infection caused by the tapeworm Taenia solium and most commonly affects the brain. Cysticercosis presenting as a chest wall mass is rare and can pose a diagnostic challenge. We report the case of a 4-year-old female child who presented with a 3-month history of a progressively increasing, painless swelling on the right lateral chest wall. Examination revealed a 2 × 3 cm, well-defined, cystic mass in the anterior axillary line. Ultrasound suggested a subcutaneous epidermoid cyst; however, histopathology showed the presence of scolices within the cyst, lined by giant cells, lymphocytes, and eosinophils, revealing the diagnosis of cysticercosis. The patient was treated with albendazole and is clinically stable. This case report highlights the importance of considering cysticercosis in the differential diagnosis of chest wall masses, particularly in endemic countries.
{"title":"An unusual presentation of cysticercosis as a chest wall mass: A case report","authors":"Eden Belay Tilahun , Denis Oluka , Abraham Sisay Abie , Ayuel Isaac Abiel nyok , Lubega Ronald , Felix Oyania","doi":"10.1016/j.idcr.2025.e02474","DOIUrl":"10.1016/j.idcr.2025.e02474","url":null,"abstract":"<div><div>Cysticercosis is an infection caused by the tapeworm Taenia solium and most commonly affects the brain. Cysticercosis presenting as a chest wall mass is rare and can pose a diagnostic challenge. We report the case of a 4-year-old female child who presented with a 3-month history of a progressively increasing, painless swelling on the right lateral chest wall. Examination revealed a 2 × 3 cm, well-defined, cystic mass in the anterior axillary line. Ultrasound suggested a subcutaneous epidermoid cyst; however, histopathology showed the presence of scolices within the cyst, lined by giant cells, lymphocytes, and eosinophils, revealing the diagnosis of cysticercosis. The patient was treated with albendazole and is clinically stable. This case report highlights the importance of considering cysticercosis in the differential diagnosis of chest wall masses, particularly in endemic countries.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02474"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926299","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.e02479
Ting Li , Qi Wang , Yuying Lin , Yuhan Li , Zhiyin Luo , Wenyong Zhang , Nana Sun , Hangming Dong , Weizhen Zhang , Ying Meng
Nontuberculous mycobacteria (NTM) are increasingly recognized as significant opportunistic pathogens in humans, yet they remain rarely implicated in cardiac conditions. Here, we report a rare case of Mycobacterium avium complex (MAC) infection in the transverse pericardial sinus, an unusual site previously undocumented for NTM infection. The patient, a 68-year-old male with prior cardiac surgery, presented with recurrent fever lasting for over 10 days. Positron emission tomography/computed tomography demonstrated a hypermetabolic mass-like lesion within the transverse pericardial sinus, radiologically suggestive of an infectious process. Empirical broad-spectrum antimicrobial therapy failed to achieve clinical response. Following surgical intervention to remove lesion tissue from the transverse pericardial sinus, histopathological analysis revealed granulomatous inflammation and acid-fast bacilli, indicating NTM infection. Metagenomic next-generation sequencing (mNGS) identified MAC in the tissue sample. After starting antimycobacterial therapy, the patient's body temperature gradually returned to normal, and no recurrence was noted during a 7-month follow-up via serial surveillance imaging. This case suggests that, in patients with a history of cardiac surgery who present with unexplained pericardial or mediastinal lesions and non-diagnostic routine cultures and examinations, atypical pathogens such as NTM may warrant consideration within a broad differential diagnosis. It also illustrates the potential value of surgical intervention and mNGS in diagnosing and managing such rare infections.
{"title":"Mycobacterium avium complex causing transverse pericardial sinus infection: A case report","authors":"Ting Li , Qi Wang , Yuying Lin , Yuhan Li , Zhiyin Luo , Wenyong Zhang , Nana Sun , Hangming Dong , Weizhen Zhang , Ying Meng","doi":"10.1016/j.idcr.2025.e02479","DOIUrl":"10.1016/j.idcr.2025.e02479","url":null,"abstract":"<div><div>Nontuberculous mycobacteria (NTM) are increasingly recognized as significant opportunistic pathogens in humans, yet they remain rarely implicated in cardiac conditions. Here, we report a rare case of <em>Mycobacterium avium</em> complex (MAC) infection in the transverse pericardial sinus, an unusual site previously undocumented for NTM infection. The patient, a 68-year-old male with prior cardiac surgery, presented with recurrent fever lasting for over 10 days. Positron emission tomography/computed tomography demonstrated a hypermetabolic mass-like lesion within the transverse pericardial sinus, radiologically suggestive of an infectious process. Empirical broad-spectrum antimicrobial therapy failed to achieve clinical response. Following surgical intervention to remove lesion tissue from the transverse pericardial sinus, histopathological analysis revealed granulomatous inflammation and acid-fast bacilli, indicating NTM infection. Metagenomic next-generation sequencing (mNGS) identified MAC in the tissue sample. After starting antimycobacterial therapy, the patient's body temperature gradually returned to normal, and no recurrence was noted during a 7-month follow-up via serial surveillance imaging. This case suggests that, in patients with a history of cardiac surgery who present with unexplained pericardial or mediastinal lesions and non-diagnostic routine cultures and examinations, atypical pathogens such as NTM may warrant consideration within a broad differential diagnosis. It also illustrates the potential value of surgical intervention and mNGS in diagnosing and managing such rare infections.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02479"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977817","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.e02483
Marta Anioł-Borkowska , Aleksandra Niemczyk , Marcin Masalski , Krzysztof Morawski
Tuberculous otitis media (TOM) represents a rare extrapulmonary manifestation of tuberculosis, typically presenting with nonspecific early symptoms that make diagnosis challenging. The aim of this report is to present three cases of TOM and to review their clinical manifestations, diagnostic work-up, therapeutic management, and complications. We describe two patients with isolated TOM and a third who developed pulmonary tuberculosis during the course of the disease. In all three cases, symptoms followed a similar progression: Eustachian tube dysfunction, conductive hearing loss, and recurrent, painless otorrhea refractory to antibiotic therapy, accompanied by tympanic membrane (TM) perforations. Facial nerve palsy (FP) developed in two patients, either as a complication of untreated infection or following antromastoidectomy. Household exposure to Mycobacterium tuberculosis was confirmed in two of the three patients. The time from symptom onset to diagnosis was 6, 11, and 14 months, with the shortest delay observed in the patient who developed concurrent pulmonary symptoms. All patients received the standard four-drug regimen recommended by the WHO. Despite treatment, permanent complications persisted, including hearing loss, TM perforations, FP, postauricular fistula, and skin defects of the external auditory canal. These cases underscore that recurrent, painless otorrhea unresponsive to antibiotic therapy should prompt evaluation for TOM, particularly when accompanied by FP. Intraoperative identification of necrotic tissue in such cases warrants not only histopathological examination but also smear microscopy for acid-fast bacilli (AFB). The nonspecific clinical presentation and rarity of TOM contribute to initial misdiagnoses, leading to delays in establishing the correct diagnosis and initiating appropriate treatment.
{"title":"Tuberculous otitis media: Clinical challenges and long-term complications in three cases","authors":"Marta Anioł-Borkowska , Aleksandra Niemczyk , Marcin Masalski , Krzysztof Morawski","doi":"10.1016/j.idcr.2025.e02483","DOIUrl":"10.1016/j.idcr.2025.e02483","url":null,"abstract":"<div><div>Tuberculous otitis media (TOM) represents a rare extrapulmonary manifestation of tuberculosis, typically presenting with nonspecific early symptoms that make diagnosis challenging. The aim of this report is to present three cases of TOM and to review their clinical manifestations, diagnostic work-up, therapeutic management, and complications. We describe two patients with isolated TOM and a third who developed pulmonary tuberculosis during the course of the disease. In all three cases, symptoms followed a similar progression: Eustachian tube dysfunction, conductive hearing loss, and recurrent, painless otorrhea refractory to antibiotic therapy, accompanied by tympanic membrane (TM) perforations. Facial nerve palsy (FP) developed in two patients, either as a complication of untreated infection or following antromastoidectomy. Household exposure to <em>Mycobacterium tuberculosis</em> was confirmed in two of the three patients. The time from symptom onset to diagnosis was 6, 11, and 14 months, with the shortest delay observed in the patient who developed concurrent pulmonary symptoms. All patients received the standard four-drug regimen recommended by the WHO. Despite treatment, permanent complications persisted, including hearing loss, TM perforations, FP, postauricular fistula, and skin defects of the external auditory canal. These cases underscore that recurrent, painless otorrhea unresponsive to antibiotic therapy should prompt evaluation for TOM, particularly when accompanied by FP. Intraoperative identification of necrotic tissue in such cases warrants not only histopathological examination but also smear microscopy for acid-fast bacilli (AFB). The nonspecific clinical presentation and rarity of TOM contribute to initial misdiagnoses, leading to delays in establishing the correct diagnosis and initiating appropriate treatment.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02483"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926283","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.e02482
Xingyu Wu , Yuyao Yin , Yifan Guo , Lingxiao Sun , Qianyu Shi , Tao Ji , Hui Wang
Cat scratch disease (CSD) is a common zoonotic infection caused by Bartonella henselae (B. henselae) and typically presents with fever and regional lymphadenopathy. However, skeletal involvement, including osteomyelitis and arthritis, is rare. We report a 28-year-old immunocompetent female who presented with a five‑month history of persistent right knee swelling without fever or lymphadenopathy. She had previously undergone distal femoral tumor resection with prosthetic joint replacement, and this episode of chronic knee swelling together with the imaging findings was highly suggestive of prosthetic joint infection. Approximately one month before the onset of knee swelling, she had sustained a scratch from a cat. Conventional microbiological tests, including joint effusion and drainage fluid cultures, were negative. Metagenomic next‑generation sequencing (mNGS) of joint effusion identified B. henselae with 27 specific sequence reads, 0.1 % genome coverage and an RPM ratio of 1.9. This result was subsequently confirmed by a quantitative PCR assay targeting the nuoG gene. The patient underwent surgical debridement followed by oral minocycline and rifampin for 8 weeks, resulting in marked clinical improvement. This case underscores that B. henselae infection should be considered in culture‑negative bone and joint, particularly prosthetic joint, infections with a history of cat exposure, and that mNGS can provide valuable etiological evidence in atypical CSD.
{"title":"A case of atypical cat scratch disease with bone and joint infection diagnosed through clinical metagenomics","authors":"Xingyu Wu , Yuyao Yin , Yifan Guo , Lingxiao Sun , Qianyu Shi , Tao Ji , Hui Wang","doi":"10.1016/j.idcr.2025.e02482","DOIUrl":"10.1016/j.idcr.2025.e02482","url":null,"abstract":"<div><div>Cat scratch disease (CSD) is a common zoonotic infection caused by <em>Bartonella henselae</em> (<em>B. henselae</em>) and typically presents with fever and regional lymphadenopathy. However, skeletal involvement, including osteomyelitis and arthritis, is rare. We report a 28-year-old immunocompetent female who presented with a five‑month history of persistent right knee swelling without fever or lymphadenopathy. She had previously undergone distal femoral tumor resection with prosthetic joint replacement, and this episode of chronic knee swelling together with the imaging findings was highly suggestive of prosthetic joint infection. Approximately one month before the onset of knee swelling, she had sustained a scratch from a cat. Conventional microbiological tests, including joint effusion and drainage fluid cultures, were negative. Metagenomic next‑generation sequencing (mNGS) of joint effusion identified <em>B. henselae</em> with 27 specific sequence reads, 0.1 % genome coverage and an RPM ratio of 1.9. This result was subsequently confirmed by a quantitative PCR assay targeting the <em>nuoG</em> gene. The patient underwent surgical debridement followed by oral minocycline and rifampin for 8 weeks, resulting in marked clinical improvement. This case underscores that <em>B. henselae</em> infection should be considered in culture‑negative bone and joint, particularly prosthetic joint, infections with a history of cat exposure, and that mNGS can provide valuable etiological evidence in atypical CSD.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02482"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926294","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}
Hydatid disease caused by Echinococcus granulosus primarily affects the liver and lungs. Pelvic localization is rare, and cysts in the Douglas pouch are exceptional. Urinary tract involvement through extrinsic compression leading to hydronephrosis and pyelonephritis is exceedingly uncommon.
Case presentation
We report a 47-year-old Tunisian male with mental retardation who presented with fever, flank pain, and dysuria. Laboratory workup revealed leukocytosis and positive urine culture for Escherichia coli. Contrast-enhanced CT showed multiple hepatic and peritoneal hydatid cysts, the largest measuring 13 × 11 cm in the liver, and a 12 × 10 cm cyst in the Douglas pouch compressing the right ectopic ureter. This caused marked uretero-pyelo-calyceal dilatation and secondary acute pyelonephritis of the right kidney. The patient was treated with intravenous antibiotics and urinary decompression by double-J stenting, followed by albendazole and elective surgery including excision of the pelvic cyst and partial pericystectomy of hepatic lesions. Postoperative recovery was uneventful, and at 6-month follow-up the patient remained asymptomatic without recurrence
Discussion
Hydatid cysts of the Douglas pouch are extremely rare and may mimic other pelvic pathologies. Involvement of the urinary tract by extrinsic compression is exceptional and can present as recurrent urinary infections or acute pyelonephritis. Imaging plays a crucial role in diagnosis, while surgery remains the mainstay of treatment, supported by antiparasitic therapy.
Conclusion
Hydatid cysts in the Douglas pouch should be considered in the differential diagnosis of pelvic cystic lesions in endemic regions, particularly when associated with urinary tract obstruction.
{"title":"Secondary pelvic hydatid cyst of the Douglas pouch causing ureteral obstruction and acute pyelonephritis: A rare case report","authors":"Ghazi Lâamiri , Hazem Alouani , Houda Gazzah , Amine Abdelhedi , Mahdi Bouassida , Hassen Touinsi","doi":"10.1016/j.idcr.2025.e02477","DOIUrl":"10.1016/j.idcr.2025.e02477","url":null,"abstract":"<div><h3>Introduction</h3><div>Hydatid disease caused by <em>Echinococcus granulosus primarily affects the liver and lungs. Pelvic localization is rare, and cysts in the Douglas pouch are exceptional. Urinary tract involvement through extrinsic compression leading to hydronephrosis and pyelonephritis is exceedingly uncommon.</em></div></div><div><h3>Case presentation</h3><div>We report a 47-year-old Tunisian male with mental retardation who presented with fever, flank pain, and dysuria. Laboratory workup revealed leukocytosis and positive urine culture for <em>Escherichia coli</em>. Contrast-enhanced CT showed multiple hepatic and peritoneal hydatid cysts, the largest measuring 13 × 11 cm in the liver, and a 12 × 10 cm cyst in the Douglas pouch compressing the right ectopic ureter. This caused marked uretero-pyelo-calyceal dilatation and secondary acute pyelonephritis of the right kidney. The patient was treated with intravenous antibiotics and urinary decompression by double-J stenting, followed by albendazole and elective surgery including excision of the pelvic cyst and partial pericystectomy of hepatic lesions. Postoperative recovery was uneventful, and at 6-month follow-up the patient remained asymptomatic without recurrence</div></div><div><h3>Discussion</h3><div>Hydatid cysts of the Douglas pouch are extremely rare and may mimic other pelvic pathologies. Involvement of the urinary tract by extrinsic compression is exceptional and can present as recurrent urinary infections or acute pyelonephritis. Imaging plays a crucial role in diagnosis, while surgery remains the mainstay of treatment, supported by antiparasitic therapy.</div></div><div><h3>Conclusion</h3><div>Hydatid cysts in the Douglas pouch should be considered in the differential diagnosis of pelvic cystic lesions in endemic regions, particularly when associated with urinary tract obstruction.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02477"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926130","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}
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