Pub Date : 2025-01-01DOI: 10.1016/j.idcr.2025.e02315
John Jairo Cardeño-Sánchez , Mariana Montoya-Castillo , Juan Ricardo Cadavid-Castrillón , Luis Felipe Higuita-Gutiérrez
Coinfections by cytomegalovirus and Clostridioides difficile are rare and can be life-threatening, especially in immunosuppressed patients. Their symptoms often overlap, thus generating a great diagnostic challenge, with the need for multiple diagnostic aids. Under certain conditions, combined antiviral treatment, requiring the addition of foscarnet, is necessary to control cytomegalovirus. The latter drug is relatively safe; however, adverse reactions should always be considered for proper management. We present a case of a patient with a history of Burkitt's lymphoma in complete remission, who received chemotherapy in the past, and currently is living with HIV with undetectable viral load and CD4+ count of 141 cells/mm3, who presented with cytomegalovirus coinfection with suspected resistance to ganciclovir and Clostridioides difficile colitis. The patient required treatment with foscarnet and developed a genital ulcer, secondary to this drug, and therefore it was necessary to suspend it.
{"title":"Foscarnet-induced penile ulcer in a patient with cytomegalovirus coinfection refractory to ganciclovir and Clostridioides difficile: A case report","authors":"John Jairo Cardeño-Sánchez , Mariana Montoya-Castillo , Juan Ricardo Cadavid-Castrillón , Luis Felipe Higuita-Gutiérrez","doi":"10.1016/j.idcr.2025.e02315","DOIUrl":"10.1016/j.idcr.2025.e02315","url":null,"abstract":"<div><div>Coinfections by cytomegalovirus and <em>Clostridioides difficile</em> are rare and can be life-threatening, especially in immunosuppressed patients. Their symptoms often overlap, thus generating a great diagnostic challenge, with the need for multiple diagnostic aids. Under certain conditions, combined antiviral treatment, requiring the addition of foscarnet, is necessary to control cytomegalovirus. The latter drug is relatively safe; however, adverse reactions should always be considered for proper management. We present a case of a patient with a history of Burkitt's lymphoma in complete remission, who received chemotherapy in the past, and currently is living with HIV with undetectable viral load and CD4+ count of 141 cells/mm3, who presented with cytomegalovirus coinfection with suspected resistance to ganciclovir and <em>Clostridioides difficile</em> colitis. The patient required treatment with foscarnet and developed a genital ulcer, secondary to this drug, and therefore it was necessary to suspend it.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02315"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579732","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02314
Sarah Alqhtani , Hala Danish , Raghad Alkharouby , Hadeel Altayeb
Syphilitic alopecia is a rare cutaneous manifestation of secondary syphilis. It is described as a non-scarring hair loss which usually presents as the pathognomonic moth-eaten pattern. Syphilis-associated alopecia often mimics that of other types of hair loss, which may lead to misdiagnosis or delay in treatment. Herein, we present a case of a 29-year-old man who presented with hair loss and pruritic painless scalp lesions. His history was unremarkable except for another sexually transmitted infection two years ago, along with sexual contact two months prior to his current presentation. Diagnosis of secondary syphilis was confirmed through serological tests. Hair regrowth was achieved within approximately three months following penicillin treatment. The present case highlights the strong clinical acumen required to diagnose secondary syphilis in a patient presenting with alopecia, particularly when it is the only initial presenting symptom.
{"title":"Alopecia as the initial presentation of secondary syphilis: A case report and review of literature","authors":"Sarah Alqhtani , Hala Danish , Raghad Alkharouby , Hadeel Altayeb","doi":"10.1016/j.idcr.2025.e02314","DOIUrl":"10.1016/j.idcr.2025.e02314","url":null,"abstract":"<div><div>Syphilitic alopecia is a rare cutaneous manifestation of secondary syphilis. It is described as a non-scarring hair loss which usually presents as the pathognomonic moth-eaten pattern. Syphilis-associated alopecia often mimics that of other types of hair loss, which may lead to misdiagnosis or delay in treatment. Herein, we present a case of a 29-year-old man who presented with hair loss and pruritic painless scalp lesions. His history was unremarkable except for another sexually transmitted infection two years ago, along with sexual contact two months prior to his current presentation. Diagnosis of secondary syphilis was confirmed through serological tests. Hair regrowth was achieved within approximately three months following penicillin treatment. The present case highlights the strong clinical acumen required to diagnose secondary syphilis in a patient presenting with alopecia, particularly when it is the only initial presenting symptom.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02314"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588018","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02295
Yuji Toyota, Akihiro Ito, Tadashi Ishida
Isolated splenic tuberculosis (TB) is rare. Here, we report a case of isolated splenic TB in a 70-year-old man with rheumatoid arthritis (RA). The patient presented to the emergency department with a 3-day history of epigastric pain and hematemesis. For RA treatment, a combination of methotrexate (8 mg) and baricitinib (4 mg) had been initiated 2 years prior. Abdominal computed tomography (CT) scan revealed upper gastrointestinal hemorrhage and intrasplenic involvement. Following endoscopic hemostasis, we performed endoscopic ultrasound-guided fine-needle aspiration via the stomach due to suspected pancreatic cancer. At an outpatient follow-up visit 1 month later, fever and elevated C-reactive protein (9.02 mg/dL) levels were observed. CT imaging showed enlarged necrotic lymph nodes near the gastroesophageal junction, left mesentery of the colon, and the greater curvature of the pylorus, along with an increased low-density area in the spleen. Subsequently, upper gastrointestinal endoscopy and ultrasound-guided percutaneous fine-needle aspiration cytology were performed. Cultures from the abscesses tested positive for Mycobacterium tuberculosis, which was susceptible to isoniazid, rifampicin, ethambutol, and pyrazinamide. No lesions were identified, thus confirming a diagnosis of isolated splenic TB. Oral anti-TB treatment with four drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) was initiated. After 6 months of treatment, the splenic lesions had shrunk. Nine months after completing therapy, RA treatment was resumed without relapse. Therefore, early diagnosis and anti-TB treatment can successfully manage splenic TB without requiring splenectomy.
{"title":"Isolated splenic tuberculosis in a patient with rheumatoid arthritis","authors":"Yuji Toyota, Akihiro Ito, Tadashi Ishida","doi":"10.1016/j.idcr.2025.e02295","DOIUrl":"10.1016/j.idcr.2025.e02295","url":null,"abstract":"<div><div>Isolated splenic tuberculosis (TB) is rare. Here, we report a case of isolated splenic TB in a 70-year-old man with rheumatoid arthritis (RA). The patient presented to the emergency department with a 3-day history of epigastric pain and hematemesis. For RA treatment, a combination of methotrexate (8 mg) and baricitinib (4 mg) had been initiated 2 years prior. Abdominal computed tomography (CT) scan revealed upper gastrointestinal hemorrhage and intrasplenic involvement. Following endoscopic hemostasis, we performed endoscopic ultrasound-guided fine-needle aspiration via the stomach due to suspected pancreatic cancer. At an outpatient follow-up visit 1 month later, fever and elevated C-reactive protein (9.02 mg/dL) levels were observed. CT imaging showed enlarged necrotic lymph nodes near the gastroesophageal junction, left mesentery of the colon, and the greater curvature of the pylorus, along with an increased low-density area in the spleen. Subsequently, upper gastrointestinal endoscopy and ultrasound-guided percutaneous fine-needle aspiration cytology were performed. Cultures from the abscesses tested positive for <em>Mycobacterium tuberculosis</em>, which was susceptible to isoniazid, rifampicin, ethambutol, and pyrazinamide. No lesions were identified, thus confirming a diagnosis of isolated splenic TB. Oral anti-TB treatment with four drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) was initiated. After 6 months of treatment, the splenic lesions had shrunk. Nine months after completing therapy, RA treatment was resumed without relapse. Therefore, early diagnosis and anti-TB treatment can successfully manage splenic TB without requiring splenectomy.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02295"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680343","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 nodules present a diagnostic dilemma, particularly in differentiating tuberculous nodules from malignant lesions. Misdiagnosis may lead to unnecessary surgery or delayed treatment. We report two cases where solitary pulmonary nodules were initially suspected as malignancies but were ultimately diagnosed as pulmonary tuberculosis. In Case #1, a diabetic patient with a left lower lobe nodule underwent resection, and postoperative pathology and molecular tests confirmed tuberculosis. In Case #2, a patient with prior pulmonary surgery developed a new right upper lobe nodule. Despite malignant imaging features, CT-guided biopsy and GeneXpert plus nanopore sequencing confirmed Mycobacterium tuberculosis, and anti-tuberculosis therapy led to lesion absorption without repeat surgery. CT imaging alone is insufficient to distinguish tuberculosis from malignancy. Integrating percutaneous biopsy with molecular diagnostics is essential for accurate diagnosis. In high-risk patients, postoperative anti-tuberculosis treatment should be considered. An individualized, multidisciplinary approach is critical to avoid overtreatment and improve outcomes.
{"title":"Diagnostic and therapeutic strategies for solitary pulmonary nodules mimicking malignancy: Insights from two cases of pulmonary tuberculosis","authors":"Xianlei Wang , Ying Zhang , Huan Zhang , Zhihua Zhang , Weile Xu","doi":"10.1016/j.idcr.2025.e02302","DOIUrl":"10.1016/j.idcr.2025.e02302","url":null,"abstract":"<div><div>Pulmonary nodules present a diagnostic dilemma, particularly in differentiating tuberculous nodules from malignant lesions. Misdiagnosis may lead to unnecessary surgery or delayed treatment. We report two cases where solitary pulmonary nodules were initially suspected as malignancies but were ultimately diagnosed as pulmonary tuberculosis. In Case #1, a diabetic patient with a left lower lobe nodule underwent resection, and postoperative pathology and molecular tests confirmed tuberculosis. In Case #2, a patient with prior pulmonary surgery developed a new right upper lobe nodule. Despite malignant imaging features, CT-guided biopsy and GeneXpert plus nanopore sequencing confirmed Mycobacterium tuberculosis, and anti-tuberculosis therapy led to lesion absorption without repeat surgery. CT imaging alone is insufficient to distinguish tuberculosis from malignancy. Integrating percutaneous biopsy with molecular diagnostics is essential for accurate diagnosis. In high-risk patients, postoperative anti-tuberculosis treatment should be considered. An individualized, multidisciplinary approach is critical to avoid overtreatment and improve outcomes.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02302"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365694","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02412
Wen Sun , Lili Ma , Hongmin Xi, Miao Qin, Liangliang Li, Lulu Zhang, Ping Yang, Xiangyun Yin, Xianghong Li
Cytomegalovirus (CMV) infection is a common perinatal viral infection. Most CMV infections are asymptomatic; only a part of them present with symptoms, particularly in infants fed fresh breast milk. This article reports a case of two extremely preterm twins who simultaneously developed severe breast milk-acquired CMV infection. By reviewing the medical records of two infants, observing their clinical symptoms, collecting laboratory test results (including blood routine, biochemistry, inflammatory indicators, etc.), and conducting continuous monitoring of CMV-DNA in blood, urine, and breast milk, the research results were obtained. Both infants presented with sepsis-like syndrome: fever, apnea, pneumonia with respiratory failure, neutropenia, and thrombocytopenia, but antibiotic treatment was ineffective. Finally, the diagnosis of breast milk-acquired CMV infection was confirmed by testing of CMV DNA. Severe breast milk-acquired CMV infection occurring simultaneously in preterm twins was extremely rare. In clinical practice, early detection, timely diagnosis, and positive intervention are key points for breast milk-acquired CMV infection.
{"title":"Breast milk-acquired cytomegalovirus (aCMV) infection with sepsis-like syndrome in extremely preterm twins","authors":"Wen Sun , Lili Ma , Hongmin Xi, Miao Qin, Liangliang Li, Lulu Zhang, Ping Yang, Xiangyun Yin, Xianghong Li","doi":"10.1016/j.idcr.2025.e02412","DOIUrl":"10.1016/j.idcr.2025.e02412","url":null,"abstract":"<div><div>Cytomegalovirus (CMV) infection is a common perinatal viral infection. Most CMV infections are asymptomatic; only a part of them present with symptoms, particularly in infants fed fresh breast milk. This article reports a case of two extremely preterm twins who simultaneously developed severe breast milk-acquired CMV infection. By reviewing the medical records of two infants, observing their clinical symptoms, collecting laboratory test results (including blood routine, biochemistry, inflammatory indicators, etc.), and conducting continuous monitoring of CMV-DNA in blood, urine, and breast milk, the research results were obtained. Both infants presented with sepsis-like syndrome: fever, apnea, pneumonia with respiratory failure, neutropenia, and thrombocytopenia, but antibiotic treatment was ineffective. Finally, the diagnosis of breast milk-acquired CMV infection was confirmed by testing of CMV DNA. Severe breast milk-acquired CMV infection occurring simultaneously in preterm twins was extremely rare. In clinical practice, early detection, timely diagnosis, and positive intervention are key points for breast milk-acquired CMV infection.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02412"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519689","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02348
Smadar Goldfarb , Maya Korem , Limor Rubin
Group A Strep (GAS) infection associated with intrauterine devices (IUDs) is rare and only sporadically described following IUDs removal. We present a unique case of toxic shock syndrome presenting with pyogenic ascites following IUD removal in a 29 year old otherwise healthy woman. Upon admission, the patient primarily complained of abdominal pain and diarrhea and was found to have acute kidney injury. Despite empiric antibiotic therapy, her condition deteriorated, developing acute respiratory distress syndrome (ARDS), worsening renal failure, ascites, and a desquamating rash on her palms. All cultures obtained from blood, urine, stool, and peritoneal fluid were negative. However, 16S rRNA PCR testing of the peritoneal fluid confirmed the diagnosis of GAS. Source control and full recovery were achieved following an exploratory laparotomy with abdominal washouts in addition to antibiotics administration. This report adds to the limited literature on GAS infections associated with IUDs and demonstrates the need for heightened clinical suspicion and advanced diagnostic techniques in similar scenarios.
{"title":"A unique case of IUD associated group A Streptococci pyogenic ascites","authors":"Smadar Goldfarb , Maya Korem , Limor Rubin","doi":"10.1016/j.idcr.2025.e02348","DOIUrl":"10.1016/j.idcr.2025.e02348","url":null,"abstract":"<div><div>Group A Strep (GAS) infection associated with intrauterine devices (IUDs) is rare and only sporadically described following IUDs removal. We present a unique case of toxic shock syndrome presenting with pyogenic ascites following IUD removal in a 29 year old otherwise healthy woman. Upon admission, the patient primarily complained of abdominal pain and diarrhea and was found to have acute kidney injury. Despite empiric antibiotic therapy, her condition deteriorated, developing acute respiratory distress syndrome (ARDS), worsening renal failure, ascites, and a desquamating rash on her palms. All cultures obtained from blood, urine, stool, and peritoneal fluid were negative. However, 16S rRNA PCR testing of the peritoneal fluid confirmed the diagnosis of GAS. Source control and full recovery were achieved following an exploratory laparotomy with abdominal washouts in addition to antibiotics administration. This report adds to the limited literature on GAS infections associated with IUDs and demonstrates the need for heightened clinical suspicion and advanced diagnostic techniques in similar scenarios.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02348"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867450","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02364
Liqin Meng , Ling Guo , Xin Huang , Jinghan Li , Jinli Bi , Taijie Li
This report presents two cases of human infection caused by Wohlfahrtiimonas chitiniclastica, a pathogen associated with chronic osteomyelitis and soft tissue infections. Case 1 involves a 75-year-old male with a long-standing, chronic wound following a right lower leg fracture, which worsened due to inappropriate treatments like "moxibustion" and leech therapy, leading to a severe infection. Despite initial antibiotic therapy with cefoxitin sodium, the infection progressed, resulting in amputation. Case 2 describes a patient with a refractory right plantar ulcer complicated by calcaneal osteomyelitis, who was treated with surgical debridement, followed by antimicrobial therapy based on bacterial culture and susceptibility testing. Both cases were associated with polymicrobial infections, including W. chitiniclastica, and required targeted antibiotic therapy. The diagnosis was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing, highlighting the importance of advanced diagnostic techniques. W. chitiniclastica is capable of causing life-threatening infections, including osteomyelitis and myiasis, particularly in patients with poor hygiene or chronic wounds. This study underscores the challenges in identifying emerging pathogens and the necessity for comprehensive diagnostic approaches, including whole-genome sequencing, to improve clinical outcomes and develop effective therapeutic strategies.
{"title":"Wohlfahrtiimonas chitiniclastica Infections in two patients with osteomyelitis, China","authors":"Liqin Meng , Ling Guo , Xin Huang , Jinghan Li , Jinli Bi , Taijie Li","doi":"10.1016/j.idcr.2025.e02364","DOIUrl":"10.1016/j.idcr.2025.e02364","url":null,"abstract":"<div><div>This report presents two cases of human infection caused by <em>Wohlfahrtiimonas chitiniclastica</em>, a pathogen associated with chronic osteomyelitis and soft tissue infections. Case 1 involves a 75-year-old male with a long-standing, chronic wound following a right lower leg fracture, which worsened due to inappropriate treatments like \"moxibustion\" and leech therapy, leading to a severe infection. Despite initial antibiotic therapy with cefoxitin sodium, the infection progressed, resulting in amputation. Case 2 describes a patient with a refractory right plantar ulcer complicated by calcaneal osteomyelitis, who was treated with surgical debridement, followed by antimicrobial therapy based on bacterial culture and susceptibility testing. Both cases were associated with polymicrobial infections, including <em>W. chitiniclastica</em>, and required targeted antibiotic therapy. The diagnosis was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing, highlighting the importance of advanced diagnostic techniques. <em>W. chitiniclastica</em> is capable of causing life-threatening infections, including osteomyelitis and myiasis, particularly in patients with poor hygiene or chronic wounds. This study underscores the challenges in identifying emerging pathogens and the necessity for comprehensive diagnostic approaches, including whole-genome sequencing, to improve clinical outcomes and develop effective therapeutic strategies.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02364"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099929","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02378
Jessica Hinh , Cindy Ho , Joshua Haron Abasszade , Keat Yee Low , Sasha Hall , Jacqueline Fraser , Michael Patrick Swan , Michael Braude , Sally Jane Bell
Streptococcus anginosus group is increasingly being recognised as a cause of invasive infections with a propensity to cause pyogenic abscesses. The most common sites of infection described include intra-abdominal, skin and soft tissues and bloodstream. Prompt identification of this bacteria as a cause of pyogenic disease is needed to appropriately commence antibiotic therapy, usually with beta-lactams. We describe an atypical case of Streptococcus anginosus infection with pylephlebitis, widespread infective thromboembolism and presumed mycotic pseudoaneurysm related to an appendiceal rupture. In this case, a blood culture was requested for investigation due to suspicion of sepsis which confirmed Streptococcus anginosus bacteremia. There was evidence of a distended cystic structure within the right iliac fossa, with extensive expansive portal mesenteric occlusive thrombi and mucinous deposits in the mesorectum and liver concerning for pseudomyxoma peritonei (PMP) with hepatic metastases on computed tomography scan of the abdomen and pelvis, and on magnetic resonance imaging of the liver. Further attempts of obtaining histopathology to investigate the concerns of malignancy were undertaken including a diagnostic laparoscopy, and various endoscopic interventions, however this was negative for malignancy. After receiving two weeks of intravenous antibiotics, the patient showed marked clinical, biochemical and radiological improvement. This case highlights the need to consider sepsis as a rare but significant cause of widespread thrombotic disease.
{"title":"Widespread pylephlebitis and infective thromboembolism due to Streptococcus anginosus-related appendiceal rupture: A case report","authors":"Jessica Hinh , Cindy Ho , Joshua Haron Abasszade , Keat Yee Low , Sasha Hall , Jacqueline Fraser , Michael Patrick Swan , Michael Braude , Sally Jane Bell","doi":"10.1016/j.idcr.2025.e02378","DOIUrl":"10.1016/j.idcr.2025.e02378","url":null,"abstract":"<div><div><em>Streptococcus anginosus</em> group is increasingly being recognised as a cause of invasive infections with a propensity to cause pyogenic abscesses. The most common sites of infection described include intra-abdominal, skin and soft tissues and bloodstream. Prompt identification of this bacteria as a cause of pyogenic disease is needed to appropriately commence antibiotic therapy, usually with beta-lactams. We describe an atypical case of <em>Streptococcus anginosus</em> infection with pylephlebitis, widespread infective thromboembolism and presumed mycotic pseudoaneurysm related to an appendiceal rupture. In this case, a blood culture was requested for investigation due to suspicion of sepsis which confirmed <em>Streptococcus anginosus</em> bacteremia. There was evidence of a distended cystic structure within the right iliac fossa, with extensive expansive portal mesenteric occlusive thrombi and mucinous deposits in the mesorectum and liver concerning for pseudomyxoma peritonei (PMP) with hepatic metastases on computed tomography scan of the abdomen and pelvis, and on magnetic resonance imaging of the liver. Further attempts of obtaining histopathology to investigate the concerns of malignancy were undertaken including a diagnostic laparoscopy, and various endoscopic interventions, however this was negative for malignancy. After receiving two weeks of intravenous antibiotics, the patient showed marked clinical, biochemical and radiological improvement. This case highlights the need to consider sepsis as a rare but significant cause of widespread thrombotic disease.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02378"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099936","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02318
Fang Xingyan , Ou Xingkun , Hu Yonglin , Daimin Xiao
Brevibacterium ravenspurgense infections are exceptionally rare and frequently necessitate sophisticated laboratory analyses for precise identification. In this report, we detail a case of Brevibacterium ravenspurgense bacteremia in a patient suffering from adrenoleukodystrophy, a rare hereditary metabolic disorder. The diagnosis was validated using 16S rRNA gene sequencing, emphasizing the pivotal role of advanced molecular methodologies in pinpointing uncommon pathogens.Vancomycin was the preferred antibiotic for the treatment of Brevibacterium ravenspurgense infection. This case accentuates the importance of considering rare pathogens, particularly in patients with intricate medical backgrounds.
{"title":"Brevibacterium ravenspurgense bacteremia","authors":"Fang Xingyan , Ou Xingkun , Hu Yonglin , Daimin Xiao","doi":"10.1016/j.idcr.2025.e02318","DOIUrl":"10.1016/j.idcr.2025.e02318","url":null,"abstract":"<div><div><em>Brevibacterium ravenspurgense</em> infections are exceptionally rare and frequently necessitate sophisticated laboratory analyses for precise identification. In this report, we detail a case of <em>Brevibacterium ravenspurgense</em> bacteremia in a patient suffering from adrenoleukodystrophy, a rare hereditary metabolic disorder. The diagnosis was validated using 16S rRNA gene sequencing, emphasizing the pivotal role of advanced molecular methodologies in pinpointing uncommon pathogens.Vancomycin was the preferred antibiotic for the treatment of <em>Brevibacterium ravenspurgense</em> infection. This case accentuates the importance of considering rare pathogens, particularly in patients with intricate medical backgrounds.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02318"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614688","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 : 2025-01-01DOI: 10.1016/j.idcr.2025.e02286
Margaret Kaszycki , Olayemi Sokumbi , Jason Sluzevich
Syphilis, caused by Treponema pallidum, progresses through distinct stages, with secondary syphilis often being the first presentation within 6–11 weeks after exposure. Although referred to as the “great mimicker”, secondary syphilis has typical clinic and histopathological features. This report presents a case of secondary syphilis with absent palmoplantar involvement and unusual granulomatous pathological manifestations. Our patient presented with a diffuse headache and a spreading non-pruritic rash, which progressed to involve the chest, abdomen, upper extremities, and face. Diagnostic workup, including serology and biopsy, confirmed secondary syphilis with granulomatous inflammation. Histopathological examination revealed vacuolar interface dermatitis, neutrophilic mounds, and granulomatous inflammation, while a Treponema pallidum immunohistochemical stain identified spirochetes located primarily in the dermis. This case, representing the earliest documented instance of secondary granulomatous syphilis, challenges the typical association of granulomatous inflammation with tertiary syphilis and delayed hypersensitivity reactions. Instead, we propose that granuloma formation and the lack of palmoplantar involvement are an interrelated phenomena that occur concurrently in this rare subtype of secondary syphilis. We hypothesize that the sparing of the palms and soles, areas with thickened epidermis, may indicate a dermal-based granulomatous response. The patient responded well to IV penicillin therapy, highlighting the importance of early detection and treatment in managing syphilis with atypical histopathological features. With the recent increase in syphilis cases, this highlights the importance of recognizing both clinical and histopathological changes for prompt diagnosis and treatment.
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