Case Reports in Infectious Diseases最新文献

[This corrects the article DOI: 10.1155/2024/5581547.].

Background: Lemierre's syndrome is an uncommon yet potentially fatal infection, classically secondary to bacterial pharyngeal infections. It is typically characterized by bacteremia, most frequently due to Fusobacterium necrophorum and internal jugular vein thrombophlebitis. If untreated, septic embolization may result, potentially damaging the lungs, liver, brain, or other organs. This report describes a variant of Lemierre's syndrome in a young woman with streptococcal pharyngitis, who developed Fusobacterium nucleatum bacteremia and isolated facial vein thrombophlebitis, highlighting the importance of early diagnosis and treatment. Case Presentation: A 33-year-old woman with no significant past medical history presented with sore throat, chills, and right-sided facial and neck pain. Initially diagnosed with streptococcal pharyngitis at an urgent care clinic, she presented to the emergency department soon afterwards due to the development of severe rigors and fever. Blood cultures revealed growth of Fusobacterium nucleatum, raising suspicion for Lemierre's syndrome in the setting of worsening facial and neck pain despite negative initial imaging of the soft tissue of the neck. A subsequent CT venogram confirmed isolated thrombosis of the right facial vein. The patient was treated and discharged in stable condition on a 4 week course of metronidazole and 2 weeks of ceftriaxone. Conclusion: This case emphasizes the importance of maintaining suspicion for Lemierre's syndrome in patients with bacterial pharyngitis, especially when atypical symptoms such as facial pain occur. Although the internal jugular vein is most commonly affected, facial vein thrombosis may also occur. Early antibiotic treatment is critical for preventing severe complications including septic shock and embolization.

Introduction: Tuberculosis (TB), caused by Mycobacterium tuberculosis, primarily affects the lungs but can involve virtually any organ system, manifesting as extrapulmonary TB. While TB-related hypercoagulability and venous thromboembolism are recognized, such presentations remain uncommon and diagnostically challenging, especially in the absence of classical symptoms. Case Presentation: We report the case of a 24-year-old immunocompetent female who initially presented with painless right-sided neck swelling. Imaging revealed an acute thrombus in the right internal jugular vein (IJV), with no clear underlying cause. Further evaluation showed enlarged necrotic mediastinal lymph nodes, raising suspicion for lymphoma. However, the patient later developed a seizure episode, and subsequent neuroimaging revealed multiple intracranial ring-enhancing lesions. Ultimately, mediastinoscopic lymph node biopsy confirmed necrotizing granulomatous inflammation, with a positive TB polymerase chain reaction (PCR), consistent with disseminated TB involving both vascular and central nervous systems. The patient was started on antitubercular therapy, anticoagulation, and adjunctive corticosteroids, with multidisciplinary follow-up arranged. Discussion: This case highlights TB-induced hypercoagulability as a potential cause of isolated venous thrombosis and underscores the diagnostic challenges when TB mimics malignancy. It also emphasizes the importance of considering TB in the differential diagnosis of unexplained thrombosis and intracranial lesions, even in the absence of pulmonary symptoms. Conclusion: Clinicians should maintain a high index of suspicion for extrapulmonary TB in atypical thrombotic events. Early tissue diagnosis and a multidisciplinary approach are key to effective management and favorable outcomes.

Eikenella corrodens is a commensal bacterium of the buccal cavity and rarely causes lower respiratory infections in healthy children. Two young patients with persistent pleuropneumonia caused by E. corrodens are presented. In both cases, an obstructing endobronchial foreign body was found. Removal of the foreign bodies allowed complete recovery. A local and literature review demonstrated E. corrodens causing empyema in only four other cases, all with comorbidities. We conclude that in cases of persistent pneumonia in healthy children due to Eikenella corrodens, an aspirated foreign body should be suspected.

Linezolid, an oxazolidinone antibiotic, is commonly used to treat Gram-positive skin infections and has additional off-label success in treating bone and soft tissue infections. Linezolid has been associated with adverse effects, particularly those that are hematologic and neurologic in nature. However, we present three orthopedic patients who developed oral pain and swelling of the circumvallate papillae after a 10-day course of linezolid therapy, without the characteristic color changes associated with black hairy tongue as previously reported in the literature. All three patients were treated for superficial infections, and none exhibited signs of drug toxicity or neutropenia. Adverse side effects emerged despite short-term linezolid use, contrasting with previously reported cases involving long-term therapy. While black hairy tongue has been associated with linezolid and other antibiotics, these cases represent the first reported instance of generalized glossitis and papillitis without discoloration or noticeable alterations in the anterior portions of the tongue. The absence of coinfections or concurrent medications likely to cause similar symptoms suggests a unique set of side effects potentially correlated with linezolid. This case series emphasizes the importance of monitoring for atypical oral symptoms in patients on short-term linezolid therapy and adds to the growing body of literature on the side-effect profile. Further investigation into the mechanism of these reactions is necessary to better guide clinical practice in managing antibiotic-related oral adverse effects.

Central nervous system (CNS) tuberculosis (TB) is a severe manifestation of Mycobacterium tuberculosis (MTB) infection, characterized by high mortality. Contezolid, a novel oxazolidinone antibiotic, exhibits in vitro activity against MTB and may offer a safety advantage over linezolid, a first-generation oxazolidinone frequently linked to myelosuppression and neuropathy. Clinical data on contezolid in CNS tuberculosis remain scarce. We report a middle-aged man with chronic renal allograft dysfunction who was receiving long-term hemodialysis and subsequently developed severe CNS TB complicated by multiple coinfections, diabetes mellitus, and pancytopenia. An individualized multidrug regimen that included contezolid was successfully employed, suggesting its potential utility in complex CNS TB. This report highlights therapeutic considerations for similar patients and underscores the need for further research on the role of contezolid in TB treatment.

Introduction: Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection that primarily involves the fascia and subcutaneous tissues. While it typically affects the extremities, perineum, or trunk, NF of the breast remains an exceptionally rare and underdiagnosed entity, often leading to delayed intervention and high morbidity. Case Presentation: We report the case of a 57-year-old woman with poorly controlled Type 2 diabetes who presented to the emergency department with diabetic ketoacidosis and erythema of the left breast. Initial arterial blood gas analysis revealed profound metabolic acidosis (pH 6.89, PaCO₂ 12.8 mmHg, bicarbonate 2.5 mmol/L, and base excess -31.5 mmol/L). Despite initial antibiotic therapy, the breast symptoms worsened, raising concern for inflammatory breast cancer. Imaging revealed subcutaneous emphysema and extensive soft tissue inflammation. A diagnosis of NF was confirmed, prompting emergency surgical intervention. A left mastectomy was performed, with resection of necrotic fascia and pectoralis major. Microbiological cultures identified a polymicrobial infection with Escherichia coli, Citrobacter, and Actinotignum schaalii. The patient received targeted antibiotic therapy and supportive care, including pain management and fluid-electrolyte balance. Reconstruction was initiated 8 months later with contralateral breast reduction and fat grafting. Discussion: Breast NF poses significant diagnostic challenges due to the organ's unique vascular anatomy and the rarity of the condition. Delays in diagnosis can be fatal. This case underscores the importance of clinical vigilance, prompt imaging, and early surgical debridement. The synergistic effect of polymicrobial infections was evident in the rapid progression. Reconstruction remains an essential component of care, with satisfactory outcomes achievable through fat grafting and symmetry procedures. Conclusion: Breast NF requires rapid diagnosis and aggressive multidisciplinary management. This case illustrates the need for increased awareness to reduce diagnostic delays and improve survival and reconstructive outcomes.

Adenoviral infections significantly impact pediatric health, manifesting as respiratory, gastrointestinal, and ocular disorders. We report a 14-year-old male with adenoviral pharyngoconjunctival fever (PCF) complicated by subconjunctival hemorrhage and enlarged adenoids. The patient presented with high-grade fever, sore throat, bilateral conjunctivitis, and gastrointestinal symptoms, including vomiting and diarrhea. Initial laboratory findings suggested septicemia; however, an extended respiratory panel confirmed adenoviral infection. Notably, the patient also had left-sided undescended testes and scoliosis, raising questions about potential associations. This case underscores the complexity of adenoviral infections in children, highlighting the interplay of respiratory, gastrointestinal, and ocular symptoms. The presence of additional conditions warrants further investigation into possible correlations with adenoviral infection. Comprehensive evaluation is crucial for accurate diagnosis and management of adenoviral infections in pediatric patients, and future research should explore long-term implications and associations with cryptorchidism and scoliosis.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease with a high mortality rate which is endemic in Iran. Laboratory diagnosis of CCHF is routinely conducted using PCR and IgM ELISA tests. However, nucleotide variations within CCHF virus (CCHFV) may lead to false-negative PCR results. Case Presentation: A 51-year-old patient suspected to have CCHF was tested for CCHFV infection using two different molecular assays. The results were discrepant, as our homemade SYBR green-based real-time PCR yielded a strong positive result, while the RealStar CCHFV RT-PCR Kit returned a negative result. Due to the discrepancies in the real-time PCR tests, a homemade conventional RT-PCR method was performed, resulting in a positive result similar to the SYBR green-based real-time PCR assay. Partial sequencing of S segment of viral genome and phylogenetic analysis revealed that the strain clustered with a strain from Africa-3 genotype, which was isolated in Namibia in 1987. CCHF antigen and IgM ELISA also confirmed the CCHFV infection in this case. Conclusions: This report underlines the requirement of CCHFV genomic surveillance to update the molecular diagnostic assays. Moreover, the circulation of an African CCHFV strain in Iran supports previous data suggesting that Iran harbors the greatest CCHFV genetic diversity among endemic countries. Discrepancies in PCR results, likely due to this diversity, may hinder timely diagnosis and subsequently affect patient management and treatment measures.

Opportunistic fungal infections (OFIs) are common among human immunodeficiency virus (HIV) -positive patients, especially in those with delayed diagnosis and treatment. Patients with severe HIV/AIDS with clusters of differentiation 4 (CD4) counts less than 100 are significantly prone to develop multiple OFIs. In the current study, we present a case of co-infection of pulmonary aspergillosis and cryptococcal meningitis in a late-diagnosed HIV patient with a low CD4 count.