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}
Pub Date : 2026-01-01DOI: 10.1016/j.idcr.2025.e02462
Mohammad Hadi Tajik Jalayeri , Narges Lashkarbolouk , Mahdi Mazandarani , Mohaddeseh Dankoub
Introduction
Lophomonas infection is a rare respiratory illness caused by parasites, mostly reported in immunocompromised patients. X-linked agammaglobulinemia (XLA), or Bruton's disease, is a primary immunodeficiency caused by a defective Bruton's tyrosine kinase (BTK) gene. This defect results in a deficiency or absence of functional BTK protein, leading to significantly reduced or absent B lymphocytes and serum immunoglobulin levels.
Case presentation
A 21-year-old male patient was admitted to our service exhibiting a six-week history of fever, dyspnea, and productive cough. The patient's condition deteriorated despite prior outpatient management. Following abnormal laboratory values and computed tomography, bronchoscopy was performed. Microscopic evaluation of the bronchoalveolar lavage fluid revealed the presence of viable, oval-shaped, flagellated Lophomonas protozoa.
Conclusion
In evaluating immunocompromised patients with sustained respiratory symptoms, clinicians should consider opportunistic infections, such as pulmonary lophomoniasis, in their differential diagnosis. Delayed intervention in this patient population may lead to irreversible adverse sequelae.
{"title":"Insights into pulmonary lophomoniasis infection in a Bruton's disease patient; A case report study and literature review","authors":"Mohammad Hadi Tajik Jalayeri , Narges Lashkarbolouk , Mahdi Mazandarani , Mohaddeseh Dankoub","doi":"10.1016/j.idcr.2025.e02462","DOIUrl":"10.1016/j.idcr.2025.e02462","url":null,"abstract":"<div><h3>Introduction</h3><div>Lophomonas infection is a rare respiratory illness caused by parasites, mostly reported in immunocompromised patients. X-linked agammaglobulinemia (XLA), or Bruton's disease, is a primary immunodeficiency caused by a defective Bruton's tyrosine kinase (BTK) gene. This defect results in a deficiency or absence of functional BTK protein, leading to significantly reduced or absent B lymphocytes and serum immunoglobulin levels.</div></div><div><h3>Case presentation</h3><div>A 21-year-old male patient was admitted to our service exhibiting a six-week history of fever, dyspnea, and productive cough. The patient's condition deteriorated despite prior outpatient management. Following abnormal laboratory values and computed tomography, bronchoscopy was performed. Microscopic evaluation of the bronchoalveolar lavage fluid revealed the presence of viable, oval-shaped, flagellated Lophomonas protozoa.</div></div><div><h3>Conclusion</h3><div>In evaluating immunocompromised patients with sustained respiratory symptoms, clinicians should consider opportunistic infections, such as pulmonary lophomoniasis, in their differential diagnosis. Delayed intervention in this patient population may lead to irreversible adverse sequelae.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02462"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926140","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.e02480
Nurul 'Aifaa Mohd Azmi , Shao Keong Koeh , Tuan Sharifah Syuwaibah Tuan Zainal , Mohd Zulfakar Mazlan
Introduction
Necrotizing pneumonia is a severe lung infection characterized by pulmonary necrosis and high mortality rates of up to 50 %. It is typically caused by toxin-producing pathogens, such as Staphylococcus aureus and Klebsiella pneumoniae. Limited guidelines exist for its management, making its treatment challenging. Case report: We discuss a case of a 58-year-old Malay woman with no significant comorbidity but developed necrotizing pneumonia. The diagnosis was confirmed using computed tomography (CT) of the thorax. Treatment with carbapenem, oxazolidinone and corticosteroid led to significant recovery. Conclusion: To date, no specific anti-inflammatory treatments exist for severe necrotizing pneumonia. Since systemic inflammation and multi-organ failure drive mortality, management focuses on supportive care aimed at maintaining oxygenation and hemodynamic stability to improve outcomes in critically ill patients.
{"title":"A case of necrotizing pneumonia leading to respiratory failure and tracheostomy","authors":"Nurul 'Aifaa Mohd Azmi , Shao Keong Koeh , Tuan Sharifah Syuwaibah Tuan Zainal , Mohd Zulfakar Mazlan","doi":"10.1016/j.idcr.2025.e02480","DOIUrl":"10.1016/j.idcr.2025.e02480","url":null,"abstract":"<div><h3>Introduction</h3><div>Necrotizing pneumonia is a severe lung infection characterized by pulmonary necrosis and high mortality rates of up to 50 %. It is typically caused by toxin-producing pathogens, such as <em>Staphylococcus aureus</em> and <em>Klebsiella pneumoniae</em>. Limited guidelines exist for its management, making its treatment challenging. Case report: We discuss a case of a 58-year-old Malay woman with no significant comorbidity but developed necrotizing pneumonia. The diagnosis was confirmed using computed tomography (CT) of the thorax. Treatment with carbapenem, oxazolidinone and corticosteroid led to significant recovery. Conclusion: To date, no specific anti-inflammatory treatments exist for severe necrotizing pneumonia. Since systemic inflammation and multi-organ failure drive mortality, management focuses on supportive care aimed at maintaining oxygenation and hemodynamic stability to improve outcomes in critically ill patients.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02480"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926282","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.e02505
Stéphanie M.L.M. Looijaard , Hetty Jolink , Nathalie M. Delfos , Fanny N. Lauw
We discuss two cases of severe leptospirosis, in which the most concerning symptoms affected the nervous system. These cases illustrate the wide range of neurological symptoms that can be seen in patients with leptospirosis, which can affect both the central and peripheral nervous system. These symptoms are thought to be caused by an inflammatory reaction to Leptospira, rather than by the infection itself. Both patients experienced a variety of neurological symptoms that prolonged and altered their course of treatment. The first patient developed radicular pain secondary to polyradiculitis, which was confirmed by spinal MRI. He was treated with antibiotics but continued to experience bilateral leg pain following treatment. He was referred to a rehabilitation clinic to help him deal with his persisting complaints. The second patient was admitted to the intensive care unit and failed to regain consciousness after sedation was discontinued. Neuroimaging revealed multiple intracranial microhemorrhages. He was treated with antibiotics in combination with corticosteroids. Following extensive rehabilitation, he recovered without residual neurological deficits.
{"title":"Severe neurological complications of leptospirosis, presentation of two cases","authors":"Stéphanie M.L.M. Looijaard , Hetty Jolink , Nathalie M. Delfos , Fanny N. Lauw","doi":"10.1016/j.idcr.2026.e02505","DOIUrl":"10.1016/j.idcr.2026.e02505","url":null,"abstract":"<div><div>We discuss two cases of severe leptospirosis, in which the most concerning symptoms affected the nervous system. These cases illustrate the wide range of neurological symptoms that can be seen in patients with leptospirosis, which can affect both the central and peripheral nervous system. These symptoms are thought to be caused by an inflammatory reaction to <em>Leptospira</em>, rather than by the infection itself. Both patients experienced a variety of neurological symptoms that prolonged and altered their course of treatment. The first patient developed radicular pain secondary to polyradiculitis, which was confirmed by spinal MRI. He was treated with antibiotics but continued to experience bilateral leg pain following treatment. He was referred to a rehabilitation clinic to help him deal with his persisting complaints. The second patient was admitted to the intensive care unit and failed to regain consciousness after sedation was discontinued. Neuroimaging revealed multiple intracranial microhemorrhages. He was treated with antibiotics in combination with corticosteroids. Following extensive rehabilitation, he recovered without residual neurological deficits.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02505"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077518","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}
Symmetrical peripheral gangrene (SPG) is an uncommon clinical entity characterized by bilateral ischemic damage resulting in gangrene, typically occurring in the absence of large-vessel occlusion or vasculitis. This case report describes a 14-year-old Ethiopian girl who developed SPG of the lower limbs in the context of severe Plasmodium falciparum malaria. She initially presented with fever, vomiting, and diarrhea, and despite prompt initiation of antimalarial therapy, progressive darkening of both feet was observed. Clinical evaluation revealed stable vital signs, preserved organ function, and palpable peripheral pulses, supporting the diagnosis of severe malaria complicated by peripheral gangrene. Management was conservative, relying on continued antimalarial treatment. This case highlights the importance of early recognition and timely intervention in SPG, underscoring the need to address underlying etiologies to optimize patient outcomes.
{"title":"Symmetrical lower extremity gangrene in a patient with severe malaria: a case report and literature review","authors":"Sudi Temam Aman , Endrias Habte Belay , Tolasa Dibisa Jirata , Sherefudin Hassen Hussen , Siham Faris Isa , Abduletif Haji-Ababor Abagojam , Merid Lemma Kebede , Kidus Tesfaye Bezabih , Kedir Negesso Tukeni","doi":"10.1016/j.idcr.2025.e02466","DOIUrl":"10.1016/j.idcr.2025.e02466","url":null,"abstract":"<div><div>Symmetrical peripheral gangrene (SPG) is an uncommon clinical entity characterized by bilateral ischemic damage resulting in gangrene, typically occurring in the absence of large-vessel occlusion or vasculitis. This case report describes a 14-year-old Ethiopian girl who developed SPG of the lower limbs in the context of severe Plasmodium falciparum malaria. She initially presented with fever, vomiting, and diarrhea, and despite prompt initiation of antimalarial therapy, progressive darkening of both feet was observed. Clinical evaluation revealed stable vital signs, preserved organ function, and palpable peripheral pulses, supporting the diagnosis of severe malaria complicated by peripheral gangrene. Management was conservative, relying on continued antimalarial treatment. This case highlights the importance of early recognition and timely intervention in SPG, underscoring the need to address underlying etiologies to optimize patient outcomes.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02466"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926295","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.e02478
Asteway M. Haile , Biruk T. Mengistie , Chernet T. Mengistie , Elezer B. Zewde , Addis H. Bekele , Bezawit M. Haile
Introduction
Immune reconstitution inflammatory syndrome (IRIS) can unmask autoimmune disease after antiretroviral therapy (ART), and Graves’ disease has been reported as a late autoimmune manifestation, though pediatric cases are exceptionally rare.
Case presentation
A 9-year-old Ethiopian boy with vertically acquired HIV, diagnosed at age 6 during an acute illness, had presented at that time with profound immunosuppression (CD4 23 cells/mm³, HIV RNA ∼150,000 copies/mL) and was started on combination ART. He achieved sustained virologic suppression and marked immune recovery (CD4 >1800 cells/mm³). Thirty-three months after ART initiation he developed a six-month history of weight loss, palpitations, increased appetite, night sweats and progressive bilateral proptosis. Examination showed tachycardia, lid retraction, lid lag and a diffusely enlarged, soft, non-tender goitre. Laboratory testing revealed suppressed TSH and elevated free T4; thyroid ultrasound demonstrated a diffusely enlarged, hypervascular gland. Thyroid autoantibodies were not available. A clinical diagnosis of Graves’ disease in the context of IRIS was made.
Management and outcome
ART was continued. He was treated with carbimazole and propranolol with close endocrine and infectious-disease follow-up. Symptoms resolved, heart rate normalized and thyroid function tests returned to the euthyroid range, allowing down-titration of carbimazole to a maintenance dose.
Conclusion
This case illustrates that Graves’ hyperthyroidism may present as a late IRIS manifestation in children with profound immune recovery after ART. Early recognition, standard antithyroid therapy and continuation of ART can achieve good outcomes.
{"title":"Grave’s disease as a manifestation of immune reconstitution inflammatory syndrome in an HIV-infected child on highly active antiretroviral therapy: A case report","authors":"Asteway M. Haile , Biruk T. Mengistie , Chernet T. Mengistie , Elezer B. Zewde , Addis H. Bekele , Bezawit M. Haile","doi":"10.1016/j.idcr.2025.e02478","DOIUrl":"10.1016/j.idcr.2025.e02478","url":null,"abstract":"<div><h3>Introduction</h3><div>Immune reconstitution inflammatory syndrome (IRIS) can unmask autoimmune disease after antiretroviral therapy (ART), and Graves’ disease has been reported as a late autoimmune manifestation, though pediatric cases are exceptionally rare.</div></div><div><h3>Case presentation</h3><div>A 9-year-old Ethiopian boy with vertically acquired HIV, diagnosed at age 6 during an acute illness, had presented at that time with profound immunosuppression (CD4 23 cells/mm³, HIV RNA ∼150,000 copies/mL) and was started on combination ART. He achieved sustained virologic suppression and marked immune recovery (CD4 >1800 cells/mm³). Thirty-three months after ART initiation he developed a six-month history of weight loss, palpitations, increased appetite, night sweats and progressive bilateral proptosis. Examination showed tachycardia, lid retraction, lid lag and a diffusely enlarged, soft, non-tender goitre. Laboratory testing revealed suppressed TSH and elevated free T4; thyroid ultrasound demonstrated a diffusely enlarged, hypervascular gland. Thyroid autoantibodies were not available. A clinical diagnosis of Graves’ disease in the context of IRIS was made.</div></div><div><h3>Management and outcome</h3><div>ART was continued. He was treated with carbimazole and propranolol with close endocrine and infectious-disease follow-up. Symptoms resolved, heart rate normalized and thyroid function tests returned to the euthyroid range, allowing down-titration of carbimazole to a maintenance dose.</div></div><div><h3>Conclusion</h3><div>This case illustrates that Graves’ hyperthyroidism may present as a late IRIS manifestation in children with profound immune recovery after ART. Early recognition, standard antithyroid therapy and continuation of ART can achieve good outcomes.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02478"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926301","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.e02475
Edward Tubberville, Seth Conley, Madison Karabinus, Mhorys Pickmans
Blastomycosis is the clinical manifestation of infection caused by the yeast phase of the thermally dimorphic fungus Blastomyces dermatitidis, an environmentally poorly understood endemic North American mycosis that can progress to severe pulmonary disease in immunocompromised patients. We present a case of a 77-year-old male with a past medical history of cutaneous follicular non-Hodgkin lymphoma, renal cell carcinoma requiring total right nephrectomy, insulin dependent type 2 diabetes, and pulmonary chromoblastomycosis with left upper lobe lobectomy who presented to the emergency room for a week and a half of shortness of breath with pink tinged sputum and lethargy. He was admitted for community acquired pneumonia and initially treated with ceftriaxone and azithromycin. However, he continued to clinically deteriorate and developed acute respiratory distress syndrome (ARDS) and septic shock with secondary renal failure, requiring intubation and renal replacement therapy. Microbial cell-free DNA testing of the serum returned with 253 molecules/100 nanoliters of Blastomyces dermatitidis DNA, pulmonary blastomycosis was later confirmed by bronchoalveolar lavage cytology which directly visualized Blastomyces dermatitidis yeast. Initial treatment with Itraconazole was suspended due to suspected pulmonary toxicity and was transitioned to Isavuconazonium after completion of lipid amphotericin. He was successfully extubated after 8 days and was discharged on day 51 of admission without any supplemental oxygen requirements. This case underscores the value of rapid, noninvasive diagnostics like cfDNA testing for non-resolving pneumonia and raises the question if fungal surveillance in those who required lobectomy from prior fungal infection would mitigate future severe infections.
{"title":"Necrotizing pneumonia due to blastomycosis: Diagnostic challenges and the emerging role of cell-free DNA testing","authors":"Edward Tubberville, Seth Conley, Madison Karabinus, Mhorys Pickmans","doi":"10.1016/j.idcr.2025.e02475","DOIUrl":"10.1016/j.idcr.2025.e02475","url":null,"abstract":"<div><div>Blastomycosis is the clinical manifestation of infection caused by the yeast phase of the thermally dimorphic fungus <em>Blastomyces dermatitidis</em>, an environmentally poorly understood endemic North American mycosis that can progress to severe pulmonary disease in immunocompromised patients. We present a case of a 77-year-old male with a past medical history of cutaneous follicular non-Hodgkin lymphoma, renal cell carcinoma requiring total right nephrectomy, insulin dependent type 2 diabetes, and pulmonary chromoblastomycosis with left upper lobe lobectomy who presented to the emergency room for a week and a half of shortness of breath with pink tinged sputum and lethargy. He was admitted for community acquired pneumonia and initially treated with ceftriaxone and azithromycin. However, he continued to clinically deteriorate and developed acute respiratory distress syndrome (ARDS) and septic shock with secondary renal failure, requiring intubation and renal replacement therapy. Microbial cell-free DNA testing of the serum returned with 253 molecules/100 nanoliters of <em>Blastomyces dermatitidis</em> DNA, pulmonary blastomycosis was later confirmed by bronchoalveolar lavage cytology which directly visualized <em>Blastomyces dermatitidis</em> yeast. Initial treatment with Itraconazole was suspended due to suspected pulmonary toxicity and was transitioned to Isavuconazonium after completion of lipid amphotericin. He was successfully extubated after 8 days and was discharged on day 51 of admission without any supplemental oxygen requirements. This case underscores the value of rapid, noninvasive diagnostics like cfDNA testing for non-resolving pneumonia and raises the question if fungal surveillance in those who required lobectomy from prior fungal infection would mitigate future severe infections.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02475"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977809","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.e02492
Anping Hong , Xiaowei He , Min Ju , Xiaobo Sun
Legionella Ltongbeachae is ubiquitously found in both aqueous environments and moist soils worldwide, sometimes causing severe pneumonia. Legionella longbeachae pneumonia can cause severe lower respiratory tract illness leading to fatal outcomes. But Legionella longbeachae is rarely reported in China. Here we present a case of Legionella longbeachae pneumonia detected by NGS in a 73-year-old woman, who was a farmer working in a vegetable greenhouse and was diagnosed as diabetes 2 before. The patient experienced severe chills and fever when she was transfer to our hospital. Anyway, the symptoms resolved after targeted anti-infection treatment and low-dose hormone therapies plus insulin treatment. Besides that, we reviewed the Legionella longbeachae pneumonia in China and type 2 diabetes is a possible risk factor that could facilitate Legionnaires' disease. The case reported herein may serve as a warning to public health and a cue for the successful management of diseases associated with Legionella longbeachae.
{"title":"Type 2 diabetes patient infected by soil-derived Legionella Longbeachae in China: A case report","authors":"Anping Hong , Xiaowei He , Min Ju , Xiaobo Sun","doi":"10.1016/j.idcr.2026.e02492","DOIUrl":"10.1016/j.idcr.2026.e02492","url":null,"abstract":"<div><div><em>Legionella Ltongbeachae</em> is ubiquitously found in both aqueous environments and moist soils worldwide, sometimes causing severe pneumonia. <em>Legionella longbeachae</em> pneumonia can cause severe lower respiratory tract illness leading to fatal outcomes. But <em>Legionella longbeachae</em> is rarely reported in China. Here we present a case of <em>Legionella longbeachae</em> pneumonia detected by NGS in a 73-year-old woman, who was a farmer working in a vegetable greenhouse and was diagnosed as diabetes 2 before. The patient experienced severe chills and fever when she was transfer to our hospital. Anyway, the symptoms resolved after targeted anti-infection treatment and low-dose hormone therapies plus insulin treatment. Besides that, we reviewed the <em>Legionella longbeachae</em> pneumonia in China and type 2 diabetes is a possible risk factor that could facilitate Legionnaires' disease. The case reported herein may serve as a warning to public health and a cue for the successful management of diseases associated with <em>Legionella longbeachae</em>.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02492"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077512","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}
Pneumocystis jirovecii pneumonia (PJP), an opportunistic fungal infection, typically occurs in immunocompromised patients, such as those with human immunodeficiency virus (HIV) infection or those receiving prolonged immunosuppressive therapy. Recently, PJP in non-HIV patients treated with novel immunomodulatory agents, including Janus kinase (JAK) inhibitors, has been increasingly reported. Here, we report a case of PJP in a 53-year-old HIV-negative Japanese man with no recognized immunosuppressive comorbidities. The patient, a veterinarian, had been self-administering oclacitinib (16–64 mg/day), a selective JAK1 inhibitor approved for the treatment of atopic dermatitis in dogs, daily for approximately 2 years to manage atopic dermatitis. He presented with progressive exertional dyspnea and fever. Chest computed tomography revealed bilateral ground-glass opacities with patchy consolidations. The diagnosis of PJP was confirmed by polymerase chain reaction of bronchoalveolar lavage fluid and Grocott’s methenamine silver staining of transbronchial lung biopsy specimens. He was initially treated with trimethoprim-sulfamethoxazole and corticosteroids; however, the regimen was switched to atovaquone owing to hepatotoxicity. The patient recovered fully and remained recurrence-free at 1-year follow-up. No other causes of immunosuppression were identified, and oclacitinib use was considered the likely precipitating factor. To our knowledge, this is the first reported case of PJP associated with oclacitinib use in humans. As JAK inhibitors are increasingly being used, clinicians should be aware of their potential to cause opportunistic infections, even with veterinary formulations without approved human indications.
{"title":"Pneumocystis jirovecii pneumonia in a human caused by long-term use of veterinary drug oclacitinib: A case report","authors":"Keisuke Oshima , Ryo Koyama , Takashi Akimoto , Toshihiko Nishioki , Tomohito Takeshige , Junko Watanabe , Daisuke Usuda , Kazuhisa Takahashi","doi":"10.1016/j.idcr.2025.e02459","DOIUrl":"10.1016/j.idcr.2025.e02459","url":null,"abstract":"<div><div><em>Pneumocystis jirovecii</em> pneumonia (PJP), an opportunistic fungal infection, typically occurs in immunocompromised patients, such as those with human immunodeficiency virus (HIV) infection or those receiving prolonged immunosuppressive therapy. Recently, PJP in non-HIV patients treated with novel immunomodulatory agents, including Janus kinase (JAK) inhibitors, has been increasingly reported. Here, we report a case of PJP in a 53-year-old HIV-negative Japanese man with no recognized immunosuppressive comorbidities. The patient, a veterinarian, had been self-administering oclacitinib (16–64 mg/day), a selective JAK1 inhibitor approved for the treatment of atopic dermatitis in dogs, daily for approximately 2 years to manage atopic dermatitis. He presented with progressive exertional dyspnea and fever. Chest computed tomography revealed bilateral ground-glass opacities with patchy consolidations. The diagnosis of PJP was confirmed by polymerase chain reaction of bronchoalveolar lavage fluid and Grocott’s methenamine silver staining of transbronchial lung biopsy specimens. He was initially treated with trimethoprim-sulfamethoxazole and corticosteroids; however, the regimen was switched to atovaquone owing to hepatotoxicity. The patient recovered fully and remained recurrence-free at 1-year follow-up. No other causes of immunosuppression were identified, and oclacitinib use was considered the likely precipitating factor. To our knowledge, this is the first reported case of PJP associated with oclacitinib use in humans. As JAK inhibitors are increasingly being used, clinicians should be aware of their potential to cause opportunistic infections, even with veterinary formulations without approved human indications.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02459"},"PeriodicalIF":1.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798471","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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