IDCases最新文献

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

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

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

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.

Gonococcal urethritis is a sexually transmitted infection caused by obligate gram-negative diplococci, Neisseria gonorrhoeae. In a patient complaining of dysuria and urethral discharge, the diagnosis is typically confirmed by identifying the bacteria in mucosal secretions. Inadequately treated or untreated cases are at a risk of developing epididymo-orchitis, prostatitis and serious complications like disseminated gonococcal infection, meningitis, and endocarditis.

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.