Pub Date : 2026-01-01Epub Date: 2026-01-20DOI: 10.1016/j.idcr.2026.e02491
Fatema Juma , Sarah Alangari , Oqab AlMutairi , Talal AlMutairi , Khalifa Binkhamis
Weissella confusa, a gram-positive, facultative anaerobic bacterium, is typically associated with fermented foods. However, the bacterium is increasingly being linked to various human infections.
A 59-year-old woman with a history of type 2 diabetes mellitus, chronic anemia, multiple myeloma, and lymphoma presented with severe back pain, reduced appetite, and swelling. During hospitalization, she developed a fever and was diagnosed with a Weissella confusa infection. Despite antibiotic treatment, the patient’s health deteriorated, resulting in her death.
Although Weissella confusa is often regarded as a nonpathogenic bacterium, this case underscores the potential pathogenicity of the organism in immunocompromised patients. Adequate identification and understanding of this bacterium are vital to ensure appropriate treatment and management.
{"title":"Weissella confusa infection in an immunocompromised patient: A case report","authors":"Fatema Juma , Sarah Alangari , Oqab AlMutairi , Talal AlMutairi , Khalifa Binkhamis","doi":"10.1016/j.idcr.2026.e02491","DOIUrl":"10.1016/j.idcr.2026.e02491","url":null,"abstract":"<div><div><em>Weissella confusa</em>, a gram-positive, facultative anaerobic bacterium, is typically associated with fermented foods. However, the bacterium is increasingly being linked to various human infections.</div><div>A 59-year-old woman with a history of type 2 diabetes mellitus, chronic anemia, multiple myeloma, and lymphoma presented with severe back pain, reduced appetite, and swelling. During hospitalization, she developed a fever and was diagnosed with a <em>Weissella confusa</em> infection. Despite antibiotic treatment, the patient’s health deteriorated, resulting in her death.</div><div>Although <em>Weissella confusa</em> is often regarded as a nonpathogenic bacterium, this case underscores the potential pathogenicity of the organism in immunocompromised patients. Adequate identification and understanding of this bacterium are vital to ensure appropriate treatment and management.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02491"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037659","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 : 2026-01-01Epub Date: 2025-11-17DOI: 10.1016/j.idcr.2025.e02431
Rohan Mylavarapu , Moamen Al Zoubi
Anaerobic pathogens are uncommon etiologies of pericardial infections. Clostridium ramosum, an obligate anaerobic gram-positive bacillus and member of the normal gastrointestinal flora, is generally considered of low virulence but has been implicated in invasive infections in elderly or immunocompromised individuals. We report the first documented case of Clostridium ramosum pericarditis. An 85-year-old male with atrial fibrillation, hypertension, hyperlipidemia, splenomegaly with bicytopenia, and depression was found to have a moderate pericardial effusion on transthoracic echocardiography. Follow-up imaging revealed a reduced ejection fraction, progressive aortic dilation, and early tamponade physiology. Despite being asymptomatic, he underwent pericardiocentesis, which yielded 400 mL of fluid. Gram stain demonstrated gram-positive bacilli, later identified on anaerobic culture as Clostridium ramosum. Blood cultures remained negative. He was treated with intravenous ampicillin-sulbactam followed by oral metronidazole, with resolution of the effusion and no recurrence on follow-up. This case highlights that anaerobic pericarditis can occur in the absence of systemic symptoms or sepsis, particularly in elderly patients with comorbidities that predispose to bacterial translocation. Timely drainage and targeted antimicrobial therapy are essential for favorable outcomes. Importantly, routine anaerobic cultures of pericardial fluid should be considered to avoid missed diagnoses. Recognition of rare anaerobic pathogens in pericardial infections expands the understanding of their pathogenic potential and informs future diagnostic and therapeutic approaches.
{"title":"Anaerobic pericarditis due to Clostridium ramosum: First known case report","authors":"Rohan Mylavarapu , Moamen Al Zoubi","doi":"10.1016/j.idcr.2025.e02431","DOIUrl":"10.1016/j.idcr.2025.e02431","url":null,"abstract":"<div><div>Anaerobic pathogens are uncommon etiologies of pericardial infections. <em>Clostridium ramosum</em>, an obligate anaerobic gram-positive bacillus and member of the normal gastrointestinal flora, is generally considered of low virulence but has been implicated in invasive infections in elderly or immunocompromised individuals. We report the first documented case of <em>Clostridium ramosum</em> pericarditis. An 85-year-old male with atrial fibrillation, hypertension, hyperlipidemia, splenomegaly with bicytopenia, and depression was found to have a moderate pericardial effusion on transthoracic echocardiography. Follow-up imaging revealed a reduced ejection fraction, progressive aortic dilation, and early tamponade physiology. Despite being asymptomatic, he underwent pericardiocentesis, which yielded 400 mL of fluid. Gram stain demonstrated gram-positive bacilli, later identified on anaerobic culture as <em>Clostridium ramosum</em>. Blood cultures remained negative. He was treated with intravenous ampicillin-sulbactam followed by oral metronidazole, with resolution of the effusion and no recurrence on follow-up. This case highlights that anaerobic pericarditis can occur in the absence of systemic symptoms or sepsis, particularly in elderly patients with comorbidities that predispose to bacterial translocation. Timely drainage and targeted antimicrobial therapy are essential for favorable outcomes. Importantly, routine anaerobic cultures of pericardial fluid should be considered to avoid missed diagnoses. Recognition of rare anaerobic pathogens in pericardial infections expands the understanding of their pathogenic potential and informs future diagnostic and therapeutic approaches.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02431"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037652","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 : 2026-01-01Epub Date: 2026-01-20DOI: 10.1016/j.idcr.2026.e02501
Junais Koleri, Musaed Saad A. Al Samawi, Hasan Syed Ahmedullah, Sreethish Sasi, Ajithkumar V. Ittaman, Muna Al Maslamani
Neurosyphilis can affect multiple organ systems, but simultaneous involvement of the spinal cord and retinal vasculature is exceedingly rare. We report a 36-year-old man presenting first with unilateral branch retinal vein occlusion (BRVO) and, two weeks later, progressive paraparesis due to longitudinally extensive transverse myelitis. Serologic tests were positive for syphilis, and cerebrospinal fluid (CSF) VDRL confirmed neurosyphilis. Spinal MRI showed a longitudinal T2-hyperintense lesion from C4 to the conus. Intravenous penicillin led to clinical and radiographic improvement. This case highlights the clinical relevance of syphilis as a “great imitator” – manifesting concurrently as ocular vasculitis and spinal cord demyelination. This case highlights an exceedingly rare, concurrent presentation of BRVO and longitudinally extensive myelitis as the primary manifestation of neurosyphilis. We propose syphilitic vasculitis as the unified underlying mechanism. This report underscores the critical need for clinicians, particularly ophthalmologists and neurologists, to maintain a high index of suspicion for syphilis in patients with unexplained neurologic or vascular ophthalmologic findings.
{"title":"A rare case of concurrent longitudinally extensive myelitis and retinal vein occlusion","authors":"Junais Koleri, Musaed Saad A. Al Samawi, Hasan Syed Ahmedullah, Sreethish Sasi, Ajithkumar V. Ittaman, Muna Al Maslamani","doi":"10.1016/j.idcr.2026.e02501","DOIUrl":"10.1016/j.idcr.2026.e02501","url":null,"abstract":"<div><div>Neurosyphilis can affect multiple organ systems, but simultaneous involvement of the spinal cord and retinal vasculature is exceedingly rare. We report a 36-year-old man presenting first with unilateral branch retinal vein occlusion (BRVO) and, two weeks later, progressive paraparesis due to longitudinally extensive transverse myelitis. Serologic tests were positive for syphilis, and cerebrospinal fluid (CSF) VDRL confirmed neurosyphilis. Spinal MRI showed a longitudinal T2-hyperintense lesion from C4 to the conus. Intravenous penicillin led to clinical and radiographic improvement. This case highlights the clinical relevance of syphilis as a “great imitator” – manifesting concurrently as ocular vasculitis and spinal cord demyelination. This case highlights an exceedingly rare, concurrent presentation of BRVO and longitudinally extensive myelitis as the primary manifestation of neurosyphilis. We propose syphilitic vasculitis as the unified underlying mechanism. This report underscores the critical need for clinicians, particularly ophthalmologists and neurologists, to maintain a high index of suspicion for syphilis in patients with unexplained neurologic or vascular ophthalmologic findings.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02501"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077516","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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-12-07DOI: 10.1016/j.idcr.2025.e02455
Andrea S. Salcedo , Xosse Carreras , Nelson Diaz , Takaaki Kobayashi , Jorge Alave
Background
Extrapulmonary tuberculosis (EPTB) accounts for 15–20 % of TB, but necrotic retroperitoneal lymphadenopathy is exceptionally rare, particularly in immunocompetent hosts.
Case presentation
A 32-year-old immunocompetent man from Peru presented with two weeks of severe abdominal pain and intermittent fever. CT revealed conglomerate necrotic retroperitoneal lymph nodes encasing the pancreatic head and major vessels. Image-guided biopsy showed necrotizing granulomas; acid-fast bacilli smear and GeneXpert MTB/RIF confirmed Mycobacterium tuberculosis. Chest CT demonstrated additional necrotic mediastinal nodes without parenchymal disease. Standard therapy (2HRZE/4HR) was initiated; due to partial radiologic response at six months, isoniazid–rifampicin was extended to complete ten months, achieving full clinical and imaging resolution.
Literature review
A structured search identified seven additional immunocompetent adults with necrotic retroperitoneal lymphadenopathy. Abdominal pain predominated; CT consistently showed multiple necrotic nodes. Final diagnoses were tuberculosis (3/7), high-grade B-cell lymphoma (2/7), Kikuchi–Fujimoto disease (1/7), and metastatic esophageal carcinoma (1/7). All cases required tissue confirmation.
Conclusions
Necrotic retroperitoneal lymphadenopathy is an uncommon manifestation of TB that can mimic malignancy. In patients from TB-endemic settings, TB should remain high in the differential when CT demonstrates necrotic retroperitoneal nodes. Early image-guided biopsy with mycobacterial testing is decisive. Drug-susceptible disease generally responds to standard six-month therapy, although extended treatment may be warranted for delayed radiologic response
{"title":"Tuberculosis presenting with necrotic retroperitoneal lymphadenopathy in an immunocompetent patient: A case report and literature review","authors":"Andrea S. Salcedo , Xosse Carreras , Nelson Diaz , Takaaki Kobayashi , Jorge Alave","doi":"10.1016/j.idcr.2025.e02455","DOIUrl":"10.1016/j.idcr.2025.e02455","url":null,"abstract":"<div><h3>Background</h3><div>Extrapulmonary tuberculosis (EPTB) accounts for 15–20 % of TB, but necrotic retroperitoneal lymphadenopathy is exceptionally rare, particularly in immunocompetent hosts.</div></div><div><h3>Case presentation</h3><div>A 32-year-old immunocompetent man from Peru presented with two weeks of severe abdominal pain and intermittent fever. CT revealed conglomerate necrotic retroperitoneal lymph nodes encasing the pancreatic head and major vessels. Image-guided biopsy showed necrotizing granulomas; acid-fast bacilli smear and GeneXpert MTB/RIF confirmed <em>Mycobacterium tuberculosis</em>. Chest CT demonstrated additional necrotic mediastinal nodes without parenchymal disease. Standard therapy (2HRZE/4HR) was initiated; due to partial radiologic response at six months, isoniazid–rifampicin was extended to complete ten months, achieving full clinical and imaging resolution.</div></div><div><h3>Literature review</h3><div>A structured search identified seven additional immunocompetent adults with necrotic retroperitoneal lymphadenopathy. Abdominal pain predominated; CT consistently showed multiple necrotic nodes. Final diagnoses were tuberculosis (3/7), high-grade B-cell lymphoma (2/7), Kikuchi–Fujimoto disease (1/7), and metastatic esophageal carcinoma (1/7). All cases required tissue confirmation.</div></div><div><h3>Conclusions</h3><div>Necrotic retroperitoneal lymphadenopathy is an uncommon manifestation of TB that can mimic malignancy. In patients from TB-endemic settings, TB should remain high in the differential when CT demonstrates necrotic retroperitoneal nodes. Early image-guided biopsy with mycobacterial testing is decisive. Drug-susceptible disease generally responds to standard six-month therapy, although extended treatment may be warranted for delayed radiologic response</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02455"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738609","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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2026-01-20DOI: 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 : 2026-01-01Epub Date: 2026-01-19DOI: 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 : 2026-01-01Epub Date: 2026-02-20DOI: 10.1016/j.idcr.2026.e02525
Eunice Susan Thomson , Merlin Moni , Balu Chandrababu , Anil Kumar , Dipu T. Satyapalan , Nivedita Suresh , Anna Kurian , Kiran G. Kulirankal
A middle-aged woman with uncontrolled type 2 diabetes mellitus presented with pain in the right arm for 1 year, multiple gradually increasing painful swellings across her right wrist for 6 months, and intermittent fever of 3 months duration. She developed painful flexion and extension of the right ring and middle fingers as well as the right wrist. Physical examination revealed flexion contractures in the right and middle finger, mobile and non-tender axillary lymph nodes. Blood examination revealed an elevated erythrocyte sedimentation rate. An externally performed magnetic resonance imaging of the right wrist revealed multiple inflammatory swellings involving several tendon sheaths. A tendon sheath biopsy revealed multiple rice bodies within the tendon sheath. The tissue sample tested positive for acid-fast bacilli (AFB), and nucleic acid amplification test (NAAT/ Gene Xpert) result was positive. Chest radiography revealed bilateral infiltrates. The patient was initiated on anti-tubercular therapy with which she improved symptomatically.
{"title":"Tuberculous tenosynovitis as the initial presentation of disseminated tuberculosis in a patient with uncontrolled diabetes: A case report and review of literature","authors":"Eunice Susan Thomson , Merlin Moni , Balu Chandrababu , Anil Kumar , Dipu T. Satyapalan , Nivedita Suresh , Anna Kurian , Kiran G. Kulirankal","doi":"10.1016/j.idcr.2026.e02525","DOIUrl":"10.1016/j.idcr.2026.e02525","url":null,"abstract":"<div><div>A middle-aged woman with uncontrolled type 2 diabetes mellitus presented with pain in the right arm for 1 year, multiple gradually increasing painful swellings across her right wrist for 6 months, and intermittent fever of 3 months duration. She developed painful flexion and extension of the right ring and middle fingers as well as the right wrist. Physical examination revealed flexion contractures in the right and middle finger, mobile and non-tender axillary lymph nodes. Blood examination revealed an elevated erythrocyte sedimentation rate. An externally performed magnetic resonance imaging of the right wrist revealed multiple inflammatory swellings involving several tendon sheaths. A tendon sheath biopsy revealed multiple rice bodies within the tendon sheath. The tissue sample tested positive for acid-fast bacilli (AFB), and nucleic acid amplification test (NAAT/ Gene Xpert) result was positive. Chest radiography revealed bilateral infiltrates. The patient was initiated on anti-tubercular therapy with which she improved symptomatically.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02525"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349506","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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