Case Reports in Infectious Diseases最新文献

Vibrio cholerae, the aetiological agent of cholera, is predominantly an imported pathogen in high-income countries. We report a case of a 49-year-old Nigerian male returning from Africa with abdominal pain and watery diarrhea, who rapidly developed acute kidney injury. The initial diagnosis was Clostridioides difficile enteritis, based on GDH antigen and toxin detection in stool samples. Microbiological cultures subsequently revealed concomitant growth of Vibrio cholerae. The patient required intensive care unit management, including aggressive fluid resuscitation and antimicrobial treatment with doxycycline and vancomycin. Surveillance cultures were performed on both patients and patients' contacts; no additional cholera cases were detected during follow-up. This case highlights the importance of considering cholera in patients presenting with diarrheal syndromes after returning from endemic regions, even when another, more common pathogen in high-income countries has already been identified. Coinfection may worsen clinical outcomes and has significant implications for both therapeutic decisions and infection control measures.

Cochlear implantation (CI) is a safe and well-established intervention for sensorineural hearing loss, with a low incidence of severe postoperative infections. We present the first reported case of cerebellar abscess and herniation due to CI infection. This unique case involves a 57-year-old man with recurrent cochlear implant infections, necessitating multiple debridements and eventual removal of the implant body while retaining the electrode array. This ultimately led to the formation of two right-sided cerebellar abscesses. His course was further complicated by cerebellar herniation due to mass effect, requiring urgent neurosurgical intervention and extensive antimicrobial therapy. Despite the grave prognosis, timely intervention led to significant clinical improvement. This case highlights the pathophysiology, implicated organisms, and management of cerebellar abscesses following CI/explantation, underscoring the importance of early recognition, aggressive infection control, and multidisciplinary management in this rare but serious complication.

Multicentric Castleman disease is a rare proliferative disease of lymphoid tissue. It has rarely been reported in Asian countries, particularly in HIV-positive patients. Here, we report a case of Kaposi's sarcoma herpesvirus-associated Multicentric Castleman disease (KSHV-MCD). A 44-year-old male HIV patient with a good response to antiretroviral therapy presented with recurrent fever and bilateral axillary masses. He was hospitalized for recurrent exacerbations, and it took 7 years from onset to definitive diagnosis. Lymph node biopsy suggested Castleman disease. Metagenomic next-generation sequencing (mNGS) of the blood showed that the patient was infected with KSHV (8327 sequence reads) and EBV (283 sequence reads). The patient was administered rituximab, thalidomide, sodium phosphonates, and ganciclovir. The patient's symptoms were completely relieved, and all indicators returned to normal, with no recurrence during follow-up. This case underlines that it is necessary to perform multiple lymph node biopsies or repeat the biopsies multiple times for the diagnosis of KSHV-MCD.

Actinomycosis is a rare bacterial infection caused by Actinomyces species, most commonly affecting the cervicofacial region. Posterior skull base involvement is extremely uncommon. We report a case of actinomycosis in a 44-year-old male with a 10-year history of chronic hepatitis B on tenofovir therapy, who presented with a 3-month history of progressive right-sided neck swelling, pain, occipital headaches, and a 10 kg weight loss. The patient initially experienced a sore throat and neck discomfort, partially relieved by medication, but gradually developed a foreign body sensation in the retropharynx and painful swelling in the lateral neck and behind the right ear, accompanied by fever and chills. Physical examination revealed swelling, erythema, warmth over the right lateral neck, and neck stiffness. MRI showed an ill-defined infiltrative lesion at the posterior skull base, involving the right occipital bone and upper cervical vertebrae, extending into adjacent soft tissues. Biopsy of the lesion demonstrated filamentous organisms with sulfur granules amid a mixed inflammatory response, confirming actinomycosis. The patient was treated with intravenous ceftriaxone followed by oral amoxicillin, along with surgical drainage from the right posterior cervical region. At the 11 week follow-up, he showed significant clinical improvement, with continued long-term antibiotics due to bone involvement. This case highlights the diagnostic challenges posed by atypical presentations of actinomycosis, particularly in patients with predisposing conditions such as chronic infections. Unlike typical cervicofacial actinomycosis, this patient lacked classical features such as discharging sinuses or lymphadenopathy. Recognition of sulfur granules in biopsy specimens was pivotal for diagnosis. Early diagnosis, prolonged high-dose antibiotic therapy, and surgical intervention when needed are crucial to achieving favorable outcomes. Clinicians should maintain a high index of suspicion for actinomycosis in patients presenting with unexplained neck masses and skull base lesions.

Background: Mastoiditis represents the most common complication of acute otitis media, particularly during the first years of life. Epidural haematomas refer to a life-threatening condition due to the extra-axial collection of blood between the dura matter and the inner table of the skull, more frequently caused by head trauma. In the absence of head trauma, the epidural haematoma is called spontaneous. Sigmoid sinus thrombosis is a rare complication of mastoiditis. A case of a child with an atypical presentation of acute otitis media and mastoiditis and a rare combination of complications, such as spontaneous epidural haematoma secondary to sigmoid sinus thrombosis, is presented.

Case report: We present a 4-year-old boy with high fever, vomiting, temporal headache and altered mental status. On repeat efforts to evaluate the tympanic membranes due to poor cooperation, a bulging, inflamed and opacified tympanic membrane alongside an attenuated light reflex were identified in the left ear, confirming the diagnosis of acute otitis media. No redness or swelling of the mastoid process was observed. Due to the worsening mental status, a CT head scan was performed, which revealed left sigmoid sinus thrombosis, an epidural collection and hydrocephalus. The patient underwent urgent extraventricular drain insertion, a left lateral suboccipital craniotomy and evacuation of the epidural collection, which was proven to be a haematoma. After 1 month of intravenous antibiotics and hospitalization, he was discharged home asymptomatic and with no neurological deficits.

Conclusion: We present a case of atypically presenting mastoiditis secondary to otitis media, further complicated by the development of sigmoid sinus thrombosis and epidural haematoma. We highlight the importance of regular physical evaluations in young patients with poor cooperation. Also, in the presence of mastoiditis and neurological symptoms, a brain image scan is crucial for the diagnosis of potentially fatal complications.

Typhoid fever, caused by Salmonella Typhi and Salmonella Paratyphi A, remains endemic in Nepal. Typhoid fever can affect nearly all systems of the body, leading to various complications; however, sensorineural hearing loss (SNHL) remains an exceptionally rare occurrence. This case report describes a 24-year-old female school teacher who presented with an 8-day history of fever, followed by a 6-day history of bilateral hearing loss and tinnitus. She was diagnosed with typhoid fever based on a positive Widal test and was treated with intravenous antibiotics, antipyretics, and oral steroids, but her hearing did not improve. She was referred to a tertiary center for further evaluation, where she was diagnosed with profound SNHL. A cochlear implant was recommended but declined by the patient due to financial constraints and uncertainty regarding the outcome. This case highlights the need for further research into the pathogenesis and treatment of SNHL associated with typhoid fever.

Purpura fulminans (PF) is an ominous, rapidly progressive cutaneous manifestation of intravascular thrombosis and hemorrhagic infarctions typically mediated by coagulopathy or bacterial infection. Neonatal PF is a rarely reported but potentially disabling disorder associated with a high mortality rate and severe long-term morbidity in survivors. We report an extremely low birth weight premature infant with PF associated with late-onset Group B streptococcal sepsis. The infant survived but suffered a severe brain injury and autoamputation of all four extremities. We present this case and a review of the literature.

Hemophagocytic lymphohistiocytosis (HLH) is a critical and life-threatening syndrome, which can rapidly progress to mortality without immediate or targeted therapeutic intervention. Human herpesvirus 8 (HHV-8, or Kaposi sarcoma-associated herpesvirus (KSHV)) is a rarely described viral cause of secondary HLH, especially in immunocompetent adults. Here, we report an uncommon case of HLH after HHV-8 infection, with no history of transplantation or HIV infection. The pathophysiological mechanisms of secondary HLH remain incompletely understood. There might be potential overlapping pathogenic pathways between HHV-8-associated HLH and KICS pathogenesis. E3 ubiquitin ligases may be a critical factor in the pathogenesis of HHV-8-associated secondary HLH. Ferritin testing, peripheral blood smears, and pathogenesis evaluations should be immediately implemented for patients presenting with fever and bicytopenia. Through our case report, we seek to advance clinical recognition of HHV-8-associated HLH, optimize diagnostic precision, and ultimately improve survival outcomes for patients.

Background: Malaria is a common and potentially deadly infection in Sub-Saharan Africa, causing nearly 600,000 deaths. Despite improvements in treatment and prevention, it continues to wreak havoc, particularly in this region, which accounts for more than 95% of cases. Individuals living in malaria-endemic areas traditionally have a lower risk of developing severe malaria.

Case presentation: We report a case of a 67-year-old woman with hypertension and bilateral knee osteoarthritis. She was referred from a health center due to confusion and abnormal movements in a febrile context. Findings upon admission revealed a patient with a poor general state, an inflammatory syndrome, a confusional syndrome, a cortical irritation syndrome, a hemolytic anemia, and a severe hypoglycemia. Both the rapid diagnostic test and the thick blood smear for malaria were positive. The clinical course was marked by persistent signs of hemolysis and hypoglycemia, status epilepticus, deep coma, the development of diffuse ecchymoses, digital ischemia and Stage 2 pressure ulcers, worsening of respiratory failure, hepatocellular failure, acute kidney injury, and hyperkalemia reaching 6.24 mmol/L. Therapeutic interventions led to significant improvements in the patient's level of consciousness, resolution of status epilepticus, correction of hypoglycemia, and attenuation of hemolysis, although acute kidney injury persisted, requiring extrarenal epuration. Despite improvements in consciousness and correction of respiratory, liver, and kidney function, the patient ultimately succumbed to sepsis before digital amputation could be performed.

Conclusion: This case serves as a reminder of the severe complications and potential fatality associated with malaria. Emphasis must be placed on prevention.

Amebiasis is a significant public health issue in tropical regions, with liver abscess as its most common extraintestinal complication. Budd-Chiari syndrome secondary to amoebic liver abscess is rare and seldom reported. We present a 37-year-old man with poorly controlled Type 1 diabetes who developed fever, abdominal pain and distension. Imaging identified a left lobe liver abscess with hepatic vein and inferior vena cava thrombosis, consistent with Budd-Chiari syndrome. The patient received image-guided drainage, broad-spectrum antimicrobials, and anticoagulation, leading to clinical improvement and vascular recanalization. We intend to bring to notice, the need to consider hepatic venous outflow obstruction in patients with amoebic liver abscess and ascites or lower extremity edema. Early diagnosis and combined medical and interventional management can help prevent irreversible liver damage.