IDCases最新文献

Purpose

Immunizations have long been pivotal in preventing diseases like HZ (herpes zoster), caused by VZV (varicella zoster virus). This study aims to evaluate the efficacy and safety of the RZV (recombinant zoster vaccine) compared to the ZVL (zoster vaccine live) and to report rare adverse events following RZV administration.

Observation

Herein, we report an unusual case of a 59-year-old man who developed a V1-limited rash with a positive HZ PCR (polymerase chain reaction) test following administration of RZV in the United States.

Conclusion

The development of RZV has significantly improved the prevention of HZ compared to ZVL. Nevertheless, rare adverse events, such as dermatomal reactions, underscore the importance of ongoing monitoring and research into the immunomodulatory effects of RZV. Physicians should continue to administer the RZV to patients but be cognizant that reactivation may rarely subsequently occur.

Case Presentation

The patient with a history of benign prostatic hyperplasia was treated at an outside hospital two days after receiving the RZV complaining of paresthesia and a rash on his nasolacrimal area and forehead. The patient presented to the ED (emergency department), 9 days post-vaccination due to persistence of his symptoms despite use of amoxicillin, valacyclovir, and an unidentified eye drop. The dose of valacyclovir was increased, and he completed 1 g TID (three times a day) PO (per orally) for 10 days with subsequent resolution of symptoms. A positive PCR test confirmed the diagnosis of HZ. Topical mupirocin ointment was initiated and the patient was referred for ophthalmologic evaluation.

Given the high mortality rate of invasive pneumococcal disease (IPD) in hematopoietic stem cell transplant (HSCT) recipients, vaccination is recommended. These recipients respond to most vaccines; however, their immune response is typically weaker during the first months or years after transplantation, compared with that of healthy individuals. Here, we report a case of IPD with serotype 3 pneumonia and empyema in an HSCT recipient who had received three doses of the 13-valent pneumococcal conjugate vaccine (PCV) and one dose of the 23-valent pneumococcal polysaccharide vaccine; furthermore, the recipient had no relapse, graft-versus-host disease, or use of immunosuppressive agents after allogeneic HSCT for acute myeloid leukemia. Moreover, we discussed the characteristics of serotype 3 Streptococcus pneumoniae, a case series of breakthrough infections with S. pneumoniae in HSCT recipients who received pneumococcal vaccines, and the potential implications for the upcoming PCV15 and PCV20 vaccines for serotype 3.

Background

Listeria monocytogenes, a Gram-positive bacillus, primarily affects immunocompromised individuals. Endocarditis is a rare but severe complication of L. monocytogenes bacteremia, irrespective of native or prosthetic valves. While there is no standardized treatment, the use of ampicillin proves effective in most cases. Surgical intervention is reserved for cases involving valve dehiscence, heart failure, or myocardial abscess.

Case presentation

A 54-year-old female, with mitral valve replacement, presented with fever, chest pain and dyspnea at rest. Patient was initially diagnosed with bacterial pneumonia; however, subsequent evaluation revealed L. monocytogenes bacteremia, resulting in endocarditis. Surgical management was contraindicated due to multiple prior valve replacement surgeries. Symptoms resolution, along with improvements in echocardiographic and clinical parameters, was achieved through extended antibiotic treatment only with no surgical intervention.

Conclusion - key takeaways

This case underscores the critical importance of individualized treatment approaches in endocarditis, particularly in patients with surgery approach contraindication, and emphasized the success achieved through ampicillin-based management.

Rhinosporidiosis is one of the granulomatous diseases endemic in Asia, Africa, and Europe, with Southern India and Sri Lanka having the greatest prevalence rates. It is typically understood to affect the upper respiratory system. Involvement of the lungs beyond the trachea is infrequent as compared to the upper respiratory tract. We revealed an uncommon case of disseminated rhinosporidiosis in a diabetic patient, who initially presented with shortness of breath associated with cough and fever. Two months prior to these symptoms, he was having oral ulcer and dysphagia and, subsequently, loss of weight. Chest radiograph and CT thorax revealed military nodules with multiple suppurative neck and mediastinal lymphadenopathy and bilateral adrenal lesions. He was initially investigated for tuberculosis, metastatic malignancy, or lymphangitic carcinomatosis before a biopsy revealed Rhinosporidiosis. Hence, histopathological or laboratory evidence is frequently crucial to back up imaging concerns so the appropriate treatment can be given.

Kaposi sarcoma is an indolent angio-proliferative spindle- cell tumor derived from endothelial and immune cells infected with Human herpes virus type 8(HHV-8). In the era of highly active antiretroviral (HAART), Kaposi sarcoma is a rare form of initial presentation of HIV infection [1]. The author presents a case of diffuse gingival hypertrophied Kaposi sarcoma in 18-year-old male newly diagnosed RVI patient. After confirming the diagnosis patient started on HAART and mouth care. Surgical excision is the first line of treatment with HAART, since this patient has low CD4 count of 30 cells/mm3 which will complicate the surgery. So, we are waiting for CD4 count to increase above 200 cells/mm3 to undergo surgical excision. The case is representative of HIV complexity and aimed to bring awareness of unusual presentation of HIV.This case also reminds us how important early initiation of HAART is.

Bacillus cereus (B. cereus) is commonly found in the environment and is often considered a blood culture contaminant. However, in patients with specific risk factors such as intravenous drug use, central venous access catheters, immunosuppression, or prosthetic valves, B. cereus can cause severe infections. Herein, we present a case of prosthetic valve endocarditis (PVE) caused by B. cereus in an 84-year-old woman with a history of aortic valve replacement for aortic stenosis five years earlier. She presented with anorexia, and her physical examination revealed tenderness in the left upper quadrant of the abdomen. Blood culture grew B. cereus, and a CT scan showed splenic infarction, raising suspicion of PVE. Transesophageal echocardiogram (TEE) revealed an abscess around the left coronary cusp of the aortic valve and a 15 mm vegetation. Due to the patient's high risk for post-operative complications and her unwillingness to undergo surgery, the surgery was deferred. Instead, she was successfully treated with six weeks of intravenous vancomycin and discharged home. Follow-up TEE demonstrated resolution of the vegetation and valvular abscess. At her six-month post-discharge evaluation, no signs of active infection were noted including fever or worsening heart failure. Although surgery is typically recommended for most cases of PVE, conservative treatment can be considered as an alternative option for selected patients.

Lactococcus garvieae is a Gram-positive coccus that can be easily misidentified as Enterococcus spp. or streptococci. Infection with L. garvieae is associated with the consumption of raw fish and unpasteurized dairy products. Although rare, it can cause infective endocarditis (IE). Herein, we report a case in which aortic valve replacement (AVR) was required for IE caused by L. garvieae.

A 79-year-old Japanese man with a history of hypertension, myocardial infarction, gastroesophageal reflux disease (GERD), and abdominal aortic aneurysm presented with loss of appetite, myalgia, and difficulty in moving. Physical examination revealed a diastolic murmur, an Osler’s node on the right first toe, dental caries, and a palpable spleen, suggesting IE. Transthoracic echocardiography revealed a large, mobile vegetation on the aortic valve, which was associated with severe aortic regurgitation. Blood cultures revealed L. garvieae. The patient received antibiotic therapy, underwent AVR, and recovered without major complications. To date, 30 cases of L. garvieae-associated IE have been reported. We reviewed and summarized all cases of L. garvieae-associated IE including our case.

Introduction

Rabies is a zoonosis caused by viruses of the family Rhabdoviridae. Prophylaxis with the rabies vaccine and immunoglobulins, depending on the severity of the case, is recommended. After vaccination, mild, moderate, or severe adverse events (AE) are described. Although rare, severe skin reactions may occur, increasing the risk of anaphylaxis.

Case report

An 84-year-old woman was attacked by a stray unknown cat, leaving her with bites and scratches in the neck region and multiple injuries. The case was classified as severe. About 3 h after the first dose of the rabies vaccine, disseminated purplish spots appeared on her lower limbs, worsening significantly after the second dose, requiring hospitalization for the application of the third dose under observation, dermatology evaluation, and collection of skin tissue for biopsy. She was discharged 24 h after the third vaccination, and the purple spots cleared gradually. The biopsy suggested an adverse reaction to the vaccine components. Immunohistochemistry of the rabies virus antigen in dermal nerve fillets was negative. The seroconversion post rabies vaccine showed IgG antibody values below the reference levels.

Conclusion

Vaccination against rabies is extremely important; however, AEs may occur. Our patient developed an important AE and required hospitalization. After complete vaccination, the serum was not converted. A similar case was not previously described, and the case report is important for the creation of jurisprudence on rabies vaccination in elderly patients in Brazil.

Human fascioliasis, caused by Fasciola hepatica and Fasciolagigantica, is a neglected tropical disease of increasing public health significance. Reported cases are rare, with only one serologically confirmed instance in Ethiopia to date. We present the case of a male patient in his late twenties, without identified risk factors, who presented with bilateral upper quadrant pain persisting for a year and a history of repeated treatment for H. pylori gastritis. Initial ultrasound findings prompted further investigation with abdominal CT, contrast-enhanced MRI, and MRCP, leading to a diagnostic shift confirmed by a positive enzyme-linked assay for Fasciola hepatica. This case highlights the diagnostic challenges and the critical role of radiological imaging—ultrasound, CT, and MRIin identifying key features such as biliary dilation and parenchymal abnormalities, crucial for early detection and effective management of human fascioliasis.

In humans, solitary renal involvement or primary renal echinococcosis is rare, accounting for about 2–4 % of cases. Usually, patients shpw no obvious symptoms, but they can manifest as renal pain, renal mass, gross hematuria, and hydatiduria in rare cases. We report a case of primary renal cystic echinococcosis, which was originally misdiagnosed as a tuberculous renal abscess.