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}
Pub Date : 2025-12-08DOI: 10.1016/j.idcr.2025.e02454
Parthiban Palaniappan , Sivakumar K
Background
Central nervous system (CNS) tuberculosis is one of the most severe extrapulmonary manifestations of TB, associated with high morbidity and mortality if not diagnosed and treated early. In India, which bears the highest global burden of TB, the challenge is compounded by resource limitations. Even in apex government medical colleges serving millions, advanced imaging such as Magnetic Resonance Imaging (MRI) may take several days, and molecular or histopathological confirmation is often delayed. In such settings, clinicians must rely on high clinical suspicion and pragmatic use of available resources.
Case presentations
We describe six patients with atypical manifestations of CNS tuberculosis encountered at a government medical college hospital in South India. Presentations included parenchymal tuberculomas, extraparenchymal lesions, and radiological mimics of neoplasm and demyelinating disease. Diagnostic challenges were heightened by limited access to advanced imaging and delays in confirmatory testing. Management strategies were tailored to available resources, combining antitubercular therapy with steroids and supportive interventions. Clinical outcomes varied, with some patients demonstrating marked improvement, while others had residual neurological deficits.
Conclusion
This case series underscores the protean nature of CNS tuberculosis and the diagnostic dilemmas it creates in resource-constrained settings. Awareness of atypical presentations and timely initiation of empirical therapy, even in the absence of definitive imaging or laboratory confirmation, can be lifesaving. Our experience highlights the importance of clinical acumen and decision-making in high-burden, low-resource environments where delays in investigation are common.
{"title":"Atypical presentations of CNS tuberculosis: A case series from South India in a high-burden, resource-limited setting","authors":"Parthiban Palaniappan , Sivakumar K","doi":"10.1016/j.idcr.2025.e02454","DOIUrl":"10.1016/j.idcr.2025.e02454","url":null,"abstract":"<div><h3>Background</h3><div>Central nervous system (CNS) tuberculosis is one of the most severe extrapulmonary manifestations of TB, associated with high morbidity and mortality if not diagnosed and treated early. In India, which bears the highest global burden of TB, the challenge is compounded by resource limitations. Even in apex government medical colleges serving millions, advanced imaging such as Magnetic Resonance Imaging (MRI) may take several days, and molecular or histopathological confirmation is often delayed. In such settings, clinicians must rely on high clinical suspicion and pragmatic use of available resources.</div></div><div><h3>Case presentations</h3><div>We describe six patients with atypical manifestations of CNS tuberculosis encountered at a government medical college hospital in South India. Presentations included parenchymal tuberculomas, extraparenchymal lesions, and radiological mimics of neoplasm and demyelinating disease. Diagnostic challenges were heightened by limited access to advanced imaging and delays in confirmatory testing. Management strategies were tailored to available resources, combining antitubercular therapy with steroids and supportive interventions. Clinical outcomes varied, with some patients demonstrating marked improvement, while others had residual neurological deficits.</div></div><div><h3>Conclusion</h3><div>This case series underscores the protean nature of CNS tuberculosis and the diagnostic dilemmas it creates in resource-constrained settings. Awareness of atypical presentations and timely initiation of empirical therapy, even in the absence of definitive imaging or laboratory confirmation, can be lifesaving. Our experience highlights the importance of clinical acumen and decision-making in high-burden, low-resource environments where delays in investigation are common.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02454"},"PeriodicalIF":1.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698129","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 : 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":"2025-12-07","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}
Pub Date : 2025-12-07DOI: 10.1016/j.idcr.2025.e02453
Georges Khalil , Alexia Khoury , Marina Antoinette Khalil , Noura Abbas , Mitchelle Issa , Youssef El Toum , Giovanni Yanni
Background
In regions where hepatitis A virus (HAV) is endemic, the COVID-19 pandemic has introduced new challenges. While liver involvement in SARS-CoV-2 is well documented, the impact of HAV–COVID-19 coinfection remains unclear.
Objective
Evaluate whether COVID-19 coinfection worsens clinical outcomes or liver injury in patients with HAV infection.
Methods
We conducted a retrospective observational study at a tertiary care hospital in Lebanon, including 15 patients with confirmed HAV infection: 7 individuals were infected with COVID-19 (HAV–COVID coinfection group) and 8 with HAV alone (HAV-only group). Clinical characteristics, liver function tests, inflammatory markers, and recovery trends were assessed at admission (Day 1) and follow-up (Day 10) and remote follow-up extended up to 30 days. Group comparisons were made using Mann–Whitney U tests with effect sizes reported as rank-biserial correlations.
Results
All patients experienced a mild disease course without hepatic complications or ICU admissions. CRP levels were significantly higher in the HAV–COVID group at both time points (Day 1 p = 0.04; Day 10 p < 0.001), but no statistically significant differences were seen in liver enzymes or recovery rates between the groups.
Conclusion
HAV–COVID-19 coinfection in otherwise healthy individuals does not appear to worsen liver injury or delay recovery compared to HAV alone. However, given isolated reports of fulminant hepatitis, clinicians should continue to screen for coinfection in patients presenting with liver injury during with COVID-19, especially in HAV-endemic regions. Larger studies are needed to confirm these findings and explore potential risk modifiers.
{"title":"Benign course of hepatitis A and COVID-19 coinfection: A retrospective observational case series with comparative analysis","authors":"Georges Khalil , Alexia Khoury , Marina Antoinette Khalil , Noura Abbas , Mitchelle Issa , Youssef El Toum , Giovanni Yanni","doi":"10.1016/j.idcr.2025.e02453","DOIUrl":"10.1016/j.idcr.2025.e02453","url":null,"abstract":"<div><h3>Background</h3><div>In regions where hepatitis A virus (HAV) is endemic, the COVID-19 pandemic has introduced new challenges. While liver involvement in SARS-CoV-2 is well documented, the impact of HAV–COVID-19 coinfection remains unclear.</div></div><div><h3>Objective</h3><div>Evaluate whether COVID-19 coinfection worsens clinical outcomes or liver injury in patients with HAV infection.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study at a tertiary care hospital in Lebanon, including 15 patients with confirmed HAV infection: 7 individuals were infected with COVID-19 (HAV–COVID coinfection group) and 8 with HAV alone (HAV-only group). Clinical characteristics, liver function tests, inflammatory markers, and recovery trends were assessed at admission (Day 1) and follow-up (Day 10) and remote follow-up extended up to 30 days. Group comparisons were made using Mann–Whitney U tests with effect sizes reported as rank-biserial correlations.</div></div><div><h3>Results</h3><div>All patients experienced a mild disease course without hepatic complications or ICU admissions. CRP levels were significantly higher in the HAV–COVID group at both time points (Day 1 <em>p</em> = 0.04; Day 10 <em>p</em> < 0.001), but no statistically significant differences were seen in liver enzymes or recovery rates between the groups.</div></div><div><h3>Conclusion</h3><div>HAV–COVID-19 coinfection in otherwise healthy individuals does not appear to worsen liver injury or delay recovery compared to HAV alone. However, given isolated reports of fulminant hepatitis, clinicians should continue to screen for coinfection in patients presenting with liver injury during with COVID-19, especially in HAV-endemic regions. Larger studies are needed to confirm these findings and explore potential risk modifiers.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02453"},"PeriodicalIF":1.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738710","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}
Pulmonary actinomycosis is a rare, indolent infection that frequently mimics pulmonary tuberculosis, malignancy, or chronic fungal disease, resulting in delayed diagnosis—particularly in regions where tuberculosis and aspergillosis are endemic.
Case Presentation
A 33-year-old immunocompetent male presented with four months of fever, night sweats, weight loss, and progressive dry cough, followed by massive hemoptysis. Chest CT showed a cavitary right upper lobe lesion with an intracavitary ball-like component suggesting aspergilloma. Extensive microbiological investigations for tuberculosis, fungal infection, and other pathogens were negative. Due to massive hemoptysis and diagnostic uncertainty, the patient underwent VATS resection. Histopathology confirmed pulmonary actinomycosis, showing PAS-D–positive filamentous aggregates consistent with Actinomyces. He was treated with amoxicillin–clavulanate for six months, with complete radiological resolution.
Conclusions
This case highlights the diagnostic complexity of pulmonary actinomycosis in young immunocompetent individuals, the importance of considering it among TB and fungal mimics, and the crucial role of surgical biopsy for definitive diagnosis in complex presentations.
{"title":"Unmasking pulmonary actinomycosis: A diagnostic challenge in a young immunocompetent male","authors":"Ramez Othman , Diaa Shosha , Lina Alansari , Fares Aljohani , Nabih Alansari , Abdukhaliq Alghamdi , Yousef Alsharhan , Mikqdad Alsaeed , Alaa Alibrahim , Shahad Alshehri , Sirine Ahmad , Mohammed Alsaeed","doi":"10.1016/j.idcr.2025.e02450","DOIUrl":"10.1016/j.idcr.2025.e02450","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary actinomycosis is a rare, indolent infection that frequently mimics pulmonary tuberculosis, malignancy, or chronic fungal disease, resulting in delayed diagnosis—particularly in regions where tuberculosis and aspergillosis are endemic.</div></div><div><h3>Case Presentation</h3><div>A 33-year-old immunocompetent male presented with four months of fever, night sweats, weight loss, and progressive dry cough, followed by massive hemoptysis. Chest CT showed a cavitary right upper lobe lesion with an intracavitary ball-like component suggesting aspergilloma. Extensive microbiological investigations for tuberculosis, fungal infection, and other pathogens were negative. Due to massive hemoptysis and diagnostic uncertainty, the patient underwent VATS resection. Histopathology confirmed pulmonary actinomycosis, showing PAS-D–positive filamentous aggregates consistent with <em>Actinomyces</em>. He was treated with amoxicillin–clavulanate for six months, with complete radiological resolution.</div></div><div><h3>Conclusions</h3><div>This case highlights the diagnostic complexity of pulmonary actinomycosis in young immunocompetent individuals, the importance of considering it among TB and fungal mimics, and the crucial role of surgical biopsy for definitive diagnosis in complex presentations.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02450"},"PeriodicalIF":1.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738708","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}
Rat bite fever (RBF) is a rare but potentially fatal zoonotic disease caused by Streptobacillus moniliformis or Spirillum minus. In Asia, it is often caused by Spirillum minus and may present with atypical clinical features that complicate diagnosis.
Case presentation
A 35-year-old female from Far-Western Nepal developed fever and progressive localized swelling of the right hand eight days after a rat bite. Classic systemic features like rash, polyarthritis, and lymphadenopathy were absent. Laboratory tests showed neutrophilia, thrombocytopenia, and elevated CRP, while blood culture was negative. Despite negative microbiological result, a presumptive diagnosis of S. minus RBF was made based on epidemiological context, incubation period, and clinical presentation. She was treated with a combination of intravenous ampicillin, doxycycline and surgical wound debridement. She completed a course of oral antibiotics and recovered fully.
Conclusion
This case represents the first documented presumptive case of Spirillum minus RBF in Nepal, which presented atypically. It underscores the importance of clinical suspicion over microbiological confirmation in diagnosing RBF and emphasizes considering RBF in the differential diagnosis of febrile patients with cellulitis and a history of rodent exposure. Early initiation of empiric antibiotic therapy and timely surgical intervention can prevent serious complications. This case highlights RBF as an under-recognized zoonotic disease in Nepal and the need for greater clinical awareness and strengthened public health measures focused on rodent control.
{"title":"Rat bite fever presenting as localized cellulitis: The first documented presumptive case from Nepal and a call for clinical awareness","authors":"Suman Chaudhary , Shankar Adhikari , Kaushal Sharma","doi":"10.1016/j.idcr.2025.e02440","DOIUrl":"10.1016/j.idcr.2025.e02440","url":null,"abstract":"<div><h3>Background</h3><div>Rat bite fever (RBF) is a rare but potentially fatal zoonotic disease caused by Streptobacillus moniliformis or Spirillum minus. In Asia, it is often caused by Spirillum minus and may present with atypical clinical features that complicate diagnosis.</div></div><div><h3>Case presentation</h3><div>A 35-year-old female from Far-Western Nepal developed fever and progressive localized swelling of the right hand eight days after a rat bite. Classic systemic features like rash, polyarthritis, and lymphadenopathy were absent. Laboratory tests showed neutrophilia, thrombocytopenia, and elevated CRP, while blood culture was negative. Despite negative microbiological result, a presumptive diagnosis of S. minus RBF was made based on epidemiological context, incubation period, and clinical presentation. She was treated with a combination of intravenous ampicillin, doxycycline and surgical wound debridement. She completed a course of oral antibiotics and recovered fully.</div></div><div><h3>Conclusion</h3><div>This case represents the first documented presumptive case of Spirillum minus RBF in Nepal, which presented atypically. It underscores the importance of clinical suspicion over microbiological confirmation in diagnosing RBF and emphasizes considering RBF in the differential diagnosis of febrile patients with cellulitis and a history of rodent exposure. Early initiation of empiric antibiotic therapy and timely surgical intervention can prevent serious complications. This case highlights RBF as an under-recognized zoonotic disease in Nepal and the need for greater clinical awareness and strengthened public health measures focused on rodent control.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"43 ","pages":"Article e02440"},"PeriodicalIF":1.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738610","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}
Echinococcosis, commonly referred to as hydatid disease, is a prevalent condition in regions where sheep and cattle farming flourishes, representing a significant public health challenge in endemic areas. As one of the most neglected tropical diseases worldwide, this zoonotic infection caused by Echinococcus tapeworms often forms cysts in the liver and lungs. Cardiac involvement, a rare condition, can be insidious with vague symptoms or even remain asymptomatic until acute complications or fatal outcomes arise. The occurrence of silent, solitary cardiac hydatid cysts is exceptionally uncommon. This case report presents a rare and potentially life-threatening situation in which a substantial hydatid cyst nestled within the right ventricle of a healthy adult's heart culminating swiftly in sudden death. Postmortem findings revealed an outward bulge in the right ventricle, housing a fluid-filled cystic cavity. Histological evaluation confirmed the presence of a hydatid cyst, and death was attributed to cardiac arrhythmias. This case highlights the ubiquitous potential of hydatid cysts to manifest at various bodily sites, accentuating their silent but life-threatening nature. Sudden death, a recurrent feature of this disease in endemic settings, emphasizes the importance of timely diagnosis and intervention to avoid fatal repercussions. Increased awareness of this infrequent presentation among healthcare providers, particularly in endemic regions, can help save lives by fostering early recognition and prompt management.
{"title":"Sudden death related to an unrecognized solitary cardiac hydatid cyst: A case report and literature review.","authors":"Alemayehu Shiferaw Lema, Tesfaye Kidane Habtewold, Beza Tasew Degefu, Suresh Kumar Rajamani Sekar, Selamawit Tadesse Wendimagegn","doi":"10.1016/j.idcr.2025.e02339","DOIUrl":"10.1016/j.idcr.2025.e02339","url":null,"abstract":"<p><p>Echinococcosis, commonly referred to as hydatid disease, is a prevalent condition in regions where sheep and cattle farming flourishes, representing a significant public health challenge in endemic areas. As one of the most neglected tropical diseases worldwide, this zoonotic infection caused by Echinococcus tapeworms often forms cysts in the liver and lungs. Cardiac involvement, a rare condition, can be insidious with vague symptoms or even remain asymptomatic until acute complications or fatal outcomes arise. The occurrence of silent, solitary cardiac hydatid cysts is exceptionally uncommon. This case report presents a rare and potentially life-threatening situation in which a substantial hydatid cyst nestled within the right ventricle of a healthy adult's heart culminating swiftly in sudden death. Postmortem findings revealed an outward bulge in the right ventricle, housing a fluid-filled cystic cavity. Histological evaluation confirmed the presence of a hydatid cyst, and death was attributed to cardiac arrhythmias. This case highlights the ubiquitous potential of hydatid cysts to manifest at various bodily sites, accentuating their silent but life-threatening nature. Sudden death, a recurrent feature of this disease in endemic settings, emphasizes the importance of timely diagnosis and intervention to avoid fatal repercussions. Increased awareness of this infrequent presentation among healthcare providers, particularly in endemic regions, can help save lives by fostering early recognition and prompt management.</p>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"e02339"},"PeriodicalIF":1.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05eCollection Date: 2025-01-01DOI: 10.1016/j.idcr.2025.e02337
Rahma Aldhaheri, Caitlin A Trottier, Treeva Jassim, Zoe Freeman Weiss
Strongyloides stercoralis can complete its entire life cycle within the human host, allowing infections to persist for years. While it may cause chronic, often asymptomatic infection in immunocompetent individuals, it can lead to life-threatening hyperinfection syndrome or disseminated disease in those who are immunocompromised. We report a case of Strongyloides hyperinfection syndrome in a heart transplant recipient who had tested negative on conventional serologic screening as part of his pretransplant workup three years prior to transplantation. The patient developed severe disease characterized by ileus and respiratory failure, and was treated with a combination of oral, rectal, and veterinary-formulated subcutaneous ivermectin. The patient demonstrated a favorable response and achieved full recovery. This case contributes to the growing literature supporting the use of subcutaneous ivermectin as a viable treatment option in patients with compromised gastrointestinal absorption.
{"title":"Strongyloidiasis in a heart transplant recipient: Exploring the use of veterinary-formulated subcutaneous ivermectin and a review of the literature.","authors":"Rahma Aldhaheri, Caitlin A Trottier, Treeva Jassim, Zoe Freeman Weiss","doi":"10.1016/j.idcr.2025.e02337","DOIUrl":"10.1016/j.idcr.2025.e02337","url":null,"abstract":"<p><p><i>Strongyloides stercoralis</i> can complete its entire life cycle within the human host, allowing infections to persist for years. While it may cause chronic, often asymptomatic infection in immunocompetent individuals, it can lead to life-threatening hyperinfection syndrome or disseminated disease in those who are immunocompromised. We report a case of <i>Strongyloides</i> hyperinfection syndrome in a heart transplant recipient who had tested negative on conventional serologic screening as part of his pretransplant workup three years prior to transplantation. The patient developed severe disease characterized by ileus and respiratory failure, and was treated with a combination of oral, rectal, and veterinary-formulated subcutaneous ivermectin. The patient demonstrated a favorable response and achieved full recovery. This case contributes to the growing literature supporting the use of subcutaneous ivermectin as a viable treatment option in patients with compromised gastrointestinal absorption.</p>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"e02337"},"PeriodicalIF":1.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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