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.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.2026.e02493
Carina Nørskov Naustdal , Marie Helleberg , Eva Fallentin , Lone Galmstrup Madsen
Humans can become accidental, intermediate hosts of Echinococcus granulosus leading to cystic disease. We present a patient with liver cysts without obvious exposure to E. granulosus. His travel activity was limited, and country of residence had a low incidence with all cases assumed to be imported. The patient initially presented with acute severe abdominal pain, but also loss of appetite, fatigue and unintentional weight loss over a longer period of time. CT (computed tomography) scan revealed two cystic hepatic lesions. On suspicion of malignancy, liver biopsy was performed causing an anaphylactic reaction. Thorough diagnostics with serological analysis and histological findings the diagnosis cystic echinococcosis was revealed. The genotype was G1, E. granulosus sensu stricto (GenBank accession number: PX806355). The patient was commenced on albendazole and underwent a minimal invasive percutaneous procedure. Repeated CT images months later detected decreased size of the lesions without evidence of recurrence. This case highlights the importance of considering E. granulosus as a differential diagnosis in cystic liver lesions, even in patients without obvious exposure.
{"title":"Hepatic cystic echinococcosis in a low-endemic region, Denmark","authors":"Carina Nørskov Naustdal , Marie Helleberg , Eva Fallentin , Lone Galmstrup Madsen","doi":"10.1016/j.idcr.2026.e02493","DOIUrl":"10.1016/j.idcr.2026.e02493","url":null,"abstract":"<div><div>Humans can become accidental, intermediate hosts of <em>Echinococcus granulosus</em> leading to cystic disease. We present a patient with liver cysts without obvious exposure to <em>E. granulosus</em>. His travel activity was limited, and country of residence had a low incidence with all cases assumed to be imported. The patient initially presented with acute severe abdominal pain, but also loss of appetite, fatigue and unintentional weight loss over a longer period of time. CT (computed tomography) scan revealed two cystic hepatic lesions. On suspicion of malignancy, liver biopsy was performed causing an anaphylactic reaction. Thorough diagnostics with serological analysis and histological findings the diagnosis cystic echinococcosis was revealed. The genotype was G1, <em>E. granulosus sensu stricto</em> (GenBank accession number: PX806355). The patient was commenced on albendazole and underwent a minimal invasive percutaneous procedure. Repeated CT images months later detected decreased size of the lesions without evidence of recurrence. This case highlights the importance of considering <em>E. granulosus</em> as a differential diagnosis in cystic liver lesions, even in patients without obvious exposure.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02493"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037656","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.e02500
N. Domènech-López, P. Marjalizo, I. Bourleau, A. Casablanca-Piñera, L. Moura, J. Rosinés-Fonoll, J. Torras-Sanvicens
Purpose
To describe a case of mpox-associated ocular disease in an HIV-infected patient.
Case report
A 50-year-old man presented with severe ocular inflammation including corneal ulceration, scleral involvement and anterior uveitis. Mpox infection was confirmed by PCR from ocular, pharyngeal, and cutaneous samples, with ocular positivity persisting the longest. Initial treatment with a subtherapeutic self-administered dose of tecovirimat failed to control inflammation. Clinical improvement was achieved after increasing the tecovirimat dose and introducing topical corticosteroids. Despite visual acuity recovery, permanent corneal damage remained.
Conclusions and Importance
This case highlights the importance of maintaining a high index of suspicion for ocular mpox. Although tecovirimat remains a compassionate-use therapy, it has demonstrated effectiveness in managing ocular manifestations. However, optimal dosing and treatment duration—particularly in cases with persistent inflammation or recurrence—are not yet well established. Our experience supports the short-term use of topical corticosteroids in combination with systemic antivirals, under close monitoring. Long-term follow-up is essential to assess recurrence, viral persistence, and late complications.
{"title":"Ocular mpox presenting as sclerokeratouveitis: A case report","authors":"N. Domènech-López, P. Marjalizo, I. Bourleau, A. Casablanca-Piñera, L. Moura, J. Rosinés-Fonoll, J. Torras-Sanvicens","doi":"10.1016/j.idcr.2026.e02500","DOIUrl":"10.1016/j.idcr.2026.e02500","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe a case of mpox-associated ocular disease in an HIV-infected patient.</div></div><div><h3>Case report</h3><div>A 50-year-old man presented with severe ocular inflammation including corneal ulceration, scleral involvement and anterior uveitis. Mpox infection was confirmed by PCR from ocular, pharyngeal, and cutaneous samples, with ocular positivity persisting the longest. Initial treatment with a subtherapeutic self-administered dose of tecovirimat failed to control inflammation. Clinical improvement was achieved after increasing the tecovirimat dose and introducing topical corticosteroids. Despite visual acuity recovery, permanent corneal damage remained.</div></div><div><h3>Conclusions and Importance</h3><div>This case highlights the importance of maintaining a high index of suspicion for ocular mpox. Although tecovirimat remains a compassionate-use therapy, it has demonstrated effectiveness in managing ocular manifestations. However, optimal dosing and treatment duration—particularly in cases with persistent inflammation or recurrence—are not yet well established. Our experience supports the short-term use of topical corticosteroids in combination with systemic antivirals, under close monitoring. Long-term follow-up is essential to assess recurrence, viral persistence, and late complications.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02500"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037657","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}
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.2026.e02502
Xiaoyan Ji , Mingyang Wang , Peng Jin , Lingyi Kong , Yongkang Xu , Weili Chen , Bin Liu , Qingquan Wang
Hepatitis B virus (HBV) infection is primarily associated with liver diseases but can also manifest with various extrahepatic complications. While numerous extrahepatic manifestations have been reported in acute or chronic hepatitis B patients, intracranial HBV infection remains clinically rare. A 43-year-old male had a pre-existing diagnosis of serologically negative occult HBV infection (OBI), which was initially diagnosed by detecting HBV DNA in serum while HBsAg, anti-HBs, anti-HBe, and anti-HBc were all negative. Following intracerebral hemorrhage, the patient's consciousness gradually restored through a course of rehabilitation therapy. Subsequently, the patient developed persistent fever and his level of consciousness progressively deteriorated. Serological testing confirmed the presence of HBsAg and HBeAg, the HBV loads in the serum was high, subsequent metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) revealed positivity for HBV. After 8 weeks of treatment with entecavir, the HBV loads in the serum and CSF decreased significantly, the patient's consciousness improved, and the patient's temperature returned to normal. This study first reported a seronegative OBI patient developing intracranial HBV infection following intracerebral hemorrhage and clarified the diagnostic value of mNGS in rare intracranial infections.
{"title":"Intracranial hepatitis B virus (HBV) infection following intracerebral hemorrhage in a patient with seronegative occult HBV infection","authors":"Xiaoyan Ji , Mingyang Wang , Peng Jin , Lingyi Kong , Yongkang Xu , Weili Chen , Bin Liu , Qingquan Wang","doi":"10.1016/j.idcr.2026.e02502","DOIUrl":"10.1016/j.idcr.2026.e02502","url":null,"abstract":"<div><div>Hepatitis B virus (HBV) infection is primarily associated with liver diseases but can also manifest with various extrahepatic complications. While numerous extrahepatic manifestations have been reported in acute or chronic hepatitis B patients, intracranial HBV infection remains clinically rare. A 43-year-old male had a pre-existing diagnosis of serologically negative occult HBV infection (OBI), which was initially diagnosed by detecting HBV DNA in serum while HBsAg, anti-HBs, anti-HBe, and anti-HBc were all negative. Following intracerebral hemorrhage, the patient's consciousness gradually restored through a course of rehabilitation therapy. Subsequently, the patient developed persistent fever and his level of consciousness progressively deteriorated. Serological testing confirmed the presence of HBsAg and HBeAg, the HBV loads in the serum was high, subsequent metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) revealed positivity for HBV. After 8 weeks of treatment with entecavir, the HBV loads in the serum and CSF decreased significantly, the patient's consciousness improved, and the patient's temperature returned to normal. This study first reported a seronegative OBI patient developing intracranial HBV infection following intracerebral hemorrhage and clarified the diagnostic value of mNGS in rare intracranial infections.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02502"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037658","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.e02468
Rie Anazawa, Takayuki Sakurai
Although uncommon, non-typhoidal Salmonella bacteremia is clinically challenging, especially in patients with prosthetic material. Infective endocarditis can occur as a complication of non-typhoidal Salmonella bacteremia, and management typically involves a six-week course of antibiotics in conjunction with surgery. However, the optimal management for patients with retained prosthetic material in the absence of a clear infectious focus remains uncertain. We report a case of recurrent non-typhoidal Salmonella bacteremia in a patient with a bioprosthetic valve. Imaging studies revealed no identifiable infectious focus. Initial two episodes were treated with ceftriaxone; the third was managed with levofloxacin and rifampin, followed by three years of levofloxacin. The patient was cured without surgery. This case highlights the therapeutic challenges of managing non-typhoidal Salmonella bacteremia in the presence of prosthetic material. In cases where extensive imaging studies reveal no infectious focus, long-term antimicrobial therapy without surgical intervention may be a feasible approach, provided that persistent negativity of blood cultures and clinical stability are achieved. Such cases may also enable clinicians to determine the appropriate timing of discontinuing long-term oral antimicrobial therapy.
{"title":"Successful three-year levofloxacin treatment for recurrent non-typhoidal Salmonella bacteremia in a patient with a bioprosthetic valve","authors":"Rie Anazawa, Takayuki Sakurai","doi":"10.1016/j.idcr.2025.e02468","DOIUrl":"10.1016/j.idcr.2025.e02468","url":null,"abstract":"<div><div>Although uncommon, non-typhoidal <em>Salmonella</em> bacteremia is clinically challenging, especially in patients with prosthetic material. Infective endocarditis can occur as a complication of non-typhoidal <em>Salmonella</em> bacteremia, and management typically involves a six-week course of antibiotics in conjunction with surgery. However, the optimal management for patients with retained prosthetic material in the absence of a clear infectious focus remains uncertain. We report a case of recurrent non-typhoidal <em>Salmonella</em> bacteremia in a patient with a bioprosthetic valve. Imaging studies revealed no identifiable infectious focus. Initial two episodes were treated with ceftriaxone; the third was managed with levofloxacin and rifampin, followed by three years of levofloxacin. The patient was cured without surgery. This case highlights the therapeutic challenges of managing non-typhoidal <em>Salmonella</em> bacteremia in the presence of prosthetic material. In cases where extensive imaging studies reveal no infectious focus, long-term antimicrobial therapy without surgical intervention may be a feasible approach, provided that persistent negativity of blood cultures and clinical stability are achieved. Such cases may also enable clinicians to determine the appropriate timing of discontinuing long-term oral antimicrobial therapy.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02468"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926298","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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