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}
Isolated inguinal tuberculous lymphadenitis (TL) with no other pulmonary or extrapulmonary involvement is rare. A 74-year-old male patient presented with inguinal lymph node swelling at a primary care clinic. On palpation, the lymph node was polymorphic and soft in consistency, and ultrasonography revealed a hypoechoic node with the absence of the hilum and an intra-nodal strong echo. Referring to a tertiary care hospital, a computed tomography scan revealed multinodular inguinal lymph node without any active inflammatory lesions in the lung. The T-SPOT.TB assay was positive. An excisional biopsy of the lymph node revealed caseous necrosis on histopathological examination, and the patient was diagnosed with TL. Isolated inguinal lymphadenopathy, even in the absence of pulmonary involvement, necessitates consideration of TL in the diagnostic process.
{"title":"Isolated inguinal tuberculous lymphadenitis","authors":"Hiroaki Shibahara , Takayoshi Yamada , Yoshimasa Nakane , Shunsuke Nakagawa , Yoriko Yamashita","doi":"10.1016/j.idcr.2025.e02458","DOIUrl":"10.1016/j.idcr.2025.e02458","url":null,"abstract":"<div><div>Isolated inguinal tuberculous lymphadenitis (TL) with no other pulmonary or extrapulmonary involvement is rare. A 74-year-old male patient presented with inguinal lymph node swelling at a primary care clinic. On palpation, the lymph node was polymorphic and soft in consistency, and ultrasonography revealed a hypoechoic node with the absence of the hilum and an intra-nodal strong echo. Referring to a tertiary care hospital, a computed tomography scan revealed multinodular inguinal lymph node without any active inflammatory lesions in the lung. The T-SPOT.TB assay was positive. An excisional biopsy of the lymph node revealed caseous necrosis on histopathological examination, and the patient was diagnosed with TL. Isolated inguinal lymphadenopathy, even in the absence of pulmonary involvement, necessitates consideration of TL in the diagnostic process.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02458"},"PeriodicalIF":1.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738611","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}
Saccharomyces boulardii is a widely used probiotic for managing antibiotic-associated diarrhea and other gastrointestinal disorders. While considered safe in immunocompetent individuals, its use in critically ill patients has been increasingly associated with invasive fungal infections, particularly Saccharomyces cerevisiae fungemia.
Case presentation
We report the case of a 46-year-old male admitted with severe necrotizing biliary pancreatitis, complicated by pancreatic necrosis, portal vein thrombosis, and a suspected duodenal fistula. Following emergency necrosectomy, the patient required prolonged ICU care with enteral and parenteral nutrition via jejunostomy and central venous catheter. On postoperative day 7, he developed watery diarrhoea and was started on S. boulardii (Econorm) probiotics. By day 14, he developed high-grade fever, hypotension, and leucocytosis. Blood cultures from both central and peripheral lines grew S. cerevisiae, confirmed by MALDI-TOF. The isolate was sensitive to amphotericin B, fluconazole, and caspofungin. The probiotic was discontinued, central line removed, and caspofungin initiated, resulting in clinical improvement and sterile follow-up cultures.
Discussion and conclusion
Though rare, fungemia due to S. boulardii can be life-threatening, particularly in ICU settings where multiple risk factors coexist. Proposed mechanisms include gut translocation and catheter contamination during probiotic handling. This case underscores the need for caution in using yeast-based probiotics in critically ill patients. Lactobacillus-based formulations are safer alternatives. Strict infection control, microbiology communication, and heightened clinical awareness are essential to mitigate risk.
{"title":"Probiotic paradox: Saccharomyces cerevisiae fungemia after S. boulardii use in severe pancreatitis","authors":"Vidit Dholakia, Soumyadip Sain, Suvendu Sekhar Jena, Samiran Nundy","doi":"10.1016/j.idcr.2025.e02452","DOIUrl":"10.1016/j.idcr.2025.e02452","url":null,"abstract":"<div><h3>Background</h3><div>Saccharomyces boulardii is a widely used probiotic for managing antibiotic-associated diarrhea and other gastrointestinal disorders. While considered safe in immunocompetent individuals, its use in critically ill patients has been increasingly associated with invasive fungal infections, particularly Saccharomyces cerevisiae fungemia.</div></div><div><h3>Case presentation</h3><div>We report the case of a 46-year-old male admitted with severe necrotizing biliary pancreatitis, complicated by pancreatic necrosis, portal vein thrombosis, and a suspected duodenal fistula. Following emergency necrosectomy, the patient required prolonged ICU care with enteral and parenteral nutrition via jejunostomy and central venous catheter. On postoperative day 7, he developed watery diarrhoea and was started on S. boulardii (Econorm) probiotics. By day 14, he developed high-grade fever, hypotension, and leucocytosis. Blood cultures from both central and peripheral lines grew S. cerevisiae, confirmed by MALDI-TOF. The isolate was sensitive to amphotericin B, fluconazole, and caspofungin. The probiotic was discontinued, central line removed, and caspofungin initiated, resulting in clinical improvement and sterile follow-up cultures.</div></div><div><h3>Discussion and conclusion</h3><div>Though rare, fungemia due to S. boulardii can be life-threatening, particularly in ICU settings where multiple risk factors coexist. Proposed mechanisms include gut translocation and catheter contamination during probiotic handling. This case underscores the need for caution in using yeast-based probiotics in critically ill patients. Lactobacillus-based formulations are safer alternatives. Strict infection control, microbiology communication, and heightened clinical awareness are essential to mitigate risk.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02452"},"PeriodicalIF":1.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738711","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}
Brucellosis is one of the most common zoonotic diseases, presenting with a wide range of clinical manifestations. The most common symptoms include undulating fever and musculoskeletal issues. Frequent complications tend to involve osteoarticular surfaces, leading to spondylitis, osteomyelitis, and peripheral arthritis. Septic arthritis is another serious complication, the early diagnosis of which can be challenging, especially in the postpartum period, as the symptoms are often non-specific and easily misinterpreted. A 21-year-old female presented to our clinic in the fourth week of her postpartum period with severe unilateral buttock pain. She was sub febrile and had no apparent abnormalities on a pelvic X-ray. The pain was intense to the point that she could not walk properly. Sacroiliac MRI during the acute pain episode revealed mild bilateral sacroiliac (SI) joint effusion, predominantly on the right side, with bone marrow edema in the sacral and iliac aspects of the right SI joint, accompanied by some articular erosions and adjacent myofascial edema. The patient tested seropositive for brucellosis and completely recovered with antibiotic therapy. The patient was under follow-up for 3 months and she underwent a significant remission in symptoms with her pain substantially reduced. Brucella sacroiliitis should be considered in postpartum patients presenting with unilateral buttock pain that is unresponsive to analgesics and associated with difficulty walking.
{"title":"Unilateral septic sacroiliitis caused by Brucella Melitensis in the postpartum period: A rare case report","authors":"Sai Pavan lagishetty , Tarun Kumar Suvvari , Ridhinayani Nalam , Laxmi Supriya Yarrabathina , Greeshma Rangari , Navya Sree Keshetty","doi":"10.1016/j.idcr.2025.e02457","DOIUrl":"10.1016/j.idcr.2025.e02457","url":null,"abstract":"<div><div>Brucellosis is one of the most common zoonotic diseases, presenting with a wide range of clinical manifestations. The most common symptoms include undulating fever and musculoskeletal issues. Frequent complications tend to involve osteoarticular surfaces, leading to spondylitis, osteomyelitis, and peripheral arthritis. Septic arthritis is another serious complication, the early diagnosis of which can be challenging, especially in the postpartum period, as the symptoms are often non-specific and easily misinterpreted. A 21-year-old female presented to our clinic in the fourth week of her postpartum period with severe unilateral buttock pain. She was sub febrile and had no apparent abnormalities on a pelvic X-ray. The pain was intense to the point that she could not walk properly. Sacroiliac MRI during the acute pain episode revealed mild bilateral sacroiliac (SI) joint effusion, predominantly on the right side, with bone marrow edema in the sacral and iliac aspects of the right SI joint, accompanied by some articular erosions and adjacent myofascial edema. The patient tested seropositive for brucellosis and completely recovered with antibiotic therapy. The patient was under follow-up for 3 months and she underwent a significant remission in symptoms with her pain substantially reduced. Brucella sacroiliitis should be considered in postpartum patients presenting with unilateral buttock pain that is unresponsive to analgesics and associated with difficulty walking.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02457"},"PeriodicalIF":1.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738709","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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