IDCases最新文献

{"title":"Emphysematous osteomyelitis: A rare case report","authors":"Siddartha Guru ,&nbsp;Navami Guru ,&nbsp;Rezhan Hussein","doi":"10.1016/j.idcr.2025.e02168","DOIUrl":"10.1016/j.idcr.2025.e02168","url":null,"abstract":"<div><div>Emphysematous osteomyelitis is a rare entity that characteristically presents with intraosseous gas and positive bone cultures with gas-forming bacteria. We present a case of a 63-year-old woman who presented with lower back pain, decreased appetite, and unintentional weight loss over three weeks. Thoracic spine Computerized tomography image showed an ill-defined lytic lesion containing gas in the T12 vertebral body with anaerobic bone cultures, which grew <em>Clostridium septicum.</em> There was concern for possible complication of meningitis with abnormal CSF studies but no bacterial growth, though lumber puncture was done after being on antibiotics for five days. She was found to have underlying metastatic colon cancer as well. She was treated with six weeks of ceftriaxone and metronidazole and then transitioned to oral amoxicillin-clavulanic acid while on chemotherapy.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02168"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157745","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}

{"title":"Severe invasive streptococcal infection in a patient with COVID-19: A case report","authors":"Yuki Matsuura ,&nbsp;Mone Murashita ,&nbsp;Takayoshi Oyasu ,&nbsp;Akira Kodate ,&nbsp;Yoshihiro Sadamoto ,&nbsp;Akio Endo ,&nbsp;Hisako Sageshima ,&nbsp;Takumi Tsuchida","doi":"10.1016/j.idcr.2025.e02169","DOIUrl":"10.1016/j.idcr.2025.e02169","url":null,"abstract":"<div><div>A 63-year-old male with a history of hypertension had contracted Coronavirus Disease-2019 (COVID-19) five days before visiting our hospital and was recovering at home. He was brought to the hospital for emergency care because of bilateral leg pain, diarrhea, and shortness of breath. On arrival to the hospital, the patient was already suffering from multiple organ failure and was admitted to the intensive care unit. <em>Streptococcus dysgalactiae</em> subsp<em>. equisimilis</em> (SDSE) was detected in blood and sputum cultures, and we started antimicrobial therapy for septic shock/streptococcal toxic shock syndrome. However, multiple organ failure progressed, and the patient died one day after admission. This case suggests the possibility of immunosuppression due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient had no history of immunodeficiency, and COVID-19 may have contributed to the poor outcome. COVID-19 combined with SDSE sepsis has not been previously reported. Therefore, this case was considered rare.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02169"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157747","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}

{"title":"Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient","authors":"Matthew Alexander Stack ,&nbsp;John-Paul Lavik ,&nbsp;Jack G. Schneider ,&nbsp;Brynne E. Cross","doi":"10.1016/j.idcr.2025.e02171","DOIUrl":"10.1016/j.idcr.2025.e02171","url":null,"abstract":"<div><h3>Introduction</h3><div>Cryptococcal infections are typically thought of as occurring in immunocompromised patients, such as patients with HIV/AIDS, solid organ transplant recipients, or patients with rheumatologic diseases that require immunomodulatory therapy. Moreover, <em>Cryptococcus</em> spp. classically appear as variably-sized yeasts with narrow-based budding surrounded by a thick polysaccharide capsule. However, cryptococcal infections are being increasingly reported in atypical hosts, at times with non-characteristic histochemical staining appearances. Herein, we report a case of cryptococcal osteomyelitis in an otherwise immunocompetent individual that had a “speckled-egg” staining appearance on direct-smear Gram stain.</div></div><div><h3>Case</h3><div>The patient is an otherwise healthy 89-year-old male with a past medical history notable only for hypertension who presented with progressive left-sided neck pain that became worse despite lidocaine trigger point injections; imaging was obtained and revealed a C1-C2 prevertebral abscess, C2-C4 osteomyelitis, and a small C2-C4 abscess. An aspiration biopsy from one of the cervical abscesses grew <em>Cryptococcus neoformans.</em> Despite prompt initiation of liposomal amphotericin B as soon as the organism was suspected, the patient’s mentation declined with associated progression of weakness in his upper and lower extremities. The patient was ultimately transitioned to comfort care.</div></div><div><h3>Conclusions</h3><div>Unconventional presentations of cryptococcal disease are becoming increasingly recognized in seemingly immunocompetent patients. Our case was unique given that it occurred in a patient who appeared to be immunocompetent and the Gram stain showed a speckled-egg staining pattern that alone was not distinctive for cryptococcal yeasts. Despite the patient’s lack of any classic comorbidities associated with invasive cryptococcal disease, his advanced age was likely a risk factor.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02171"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158152","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}

{"title":"Severe symptomatic hypocalcemia due to Cyclospora cayetanensis infestation: A rare case","authors":"Ali Ajmal ,&nbsp;Camelia Chirculescu ,&nbsp;Tariq Alyamani ,&nbsp;Gregory J. Hiett ,&nbsp;Dhan Bahadur Shrestha","doi":"10.1016/j.idcr.2025.e02157","DOIUrl":"10.1016/j.idcr.2025.e02157","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe hypocalcemia can affect multiple systems, causing a wide variety of symptoms ranging from muscle weakness to twitching. In severe cases, it can lead to heart rhythm disturbances and seizures. A rare cause of hypocalcemia is due to malabsorption associated with prolonged gastroenteritis.</div></div><div><h3>Case presentation</h3><div>We present a 35-year-old female with persistent watery diarrhea of eight weeks presented with neuromuscular symptoms. Trousseau sign and Chvostek sign were positive bilaterally. Laboratory test results revealed severe hypokalemia, hypocalcemia, and anemia, with prolonged QT interval in electrocardiogram (EKG). Her stool polymerase chain reaction (PCR) revealed <em>Cyclospora cayetanensis</em>. Her electrolytes were appropriately replaced during her hospital stay. The patient was successfully treated with trimethoprim-sulfamethoxazole, calcium, and oral iron supplementation.</div></div><div><h3>Conclusion</h3><div>This case demonstrates a unique presentation of a healthy young female with symptomatic hypocalcemia resulting from malabsorption due to <em>Cycolospora cayetanensis</em>. This case emphasizes the importance of early diagnosis using newer techniques, such as polymerase chain reaction (PCR) for parasite DNA, which can result in appropriate diagnosis and timely treatment.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02157"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158934","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}

{"title":"Mumps-associated hepatitis: A rare clinical presentation","authors":"Mikiyas G. Teferi ,&nbsp;Abel K. Gulma ,&nbsp;Meron T. Akalu ,&nbsp;Getaw W. Hassen ,&nbsp;Elias M. Gashaw ,&nbsp;Nahom D. Gerer","doi":"10.1016/j.idcr.2025.e02207","DOIUrl":"10.1016/j.idcr.2025.e02207","url":null,"abstract":"<div><h3>Introduction</h3><div>Mumps is a viral infection that principally affects the salivary glands, but it results in a range of complications, including orchitis, pancreatitis, and meningoencephalitis. Hepatic involvement is exceedingly rare and underreported in adults. Here, we present a peculiar case of mumps-associated hepatitis, highlighting its diagnostic challenges, clinical course, and management.</div></div><div><h3>Case presentation</h3><div>An unvaccinated 20-year-old male presented with a two-week history of fever, malaise, and bilateral parotid gland swelling, along with nausea, anorexia, and right upper quadrant discomfort. Tender parotid gland enlargement, scleral icterus, and bilateral testicular tenderness were noted on examination. The laboratory results revealed that the liver enzymes were significantly high, with a positive mumps virus IgM serology test; the following conditions were excluded: hepatitis A, B, C, Epstein–Barr, and cytomegalovirus. The patient was treated conservatively through hydration maintenance, pain relief, and rest. Consistent with a self-limiting course of mumps associated with hepatitis, liver functions normalized over four weeks.</div></div><div><h3>Discussion</h3><div>Mumps virus is an RNA paramyxovirus that affects glandular tissues. Although rare, case reports suggest that transient hepatitis can result from direct viral invasion or immune-mediated injury. The diagnosis requires high clinical suspicion, as symptoms overlap with other causes of viral hepatitis. The main treatment focuses on providing constant supportive care, which is usually sufficient, and the prognosis tends to be favorable.</div></div><div><h3>Conclusion</h3><div>Hepatitis is a rare but possible complication of mumps, especially in patients who have elevated liver enzymes. This case serves as a reminder that all healthcare professionals must be vigilant in atypical presentations of mumps to guarantee appropriate treatment and avoid unnecessary tests.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"40 ","pages":"Article e02207"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697277","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}

{"title":"When herpes zoster is not herpes: A case of statin-induced myopathy complicated by drug allergies","authors":"Hira Khalid Kareem ,&nbsp;Muhammad Fawad Ashraf ,&nbsp;Muhammad Shehryar ,&nbsp;Hafsa Fayyaz ,&nbsp;Shreyas Patil","doi":"10.1016/j.idcr.2025.e02164","DOIUrl":"10.1016/j.idcr.2025.e02164","url":null,"abstract":"<div><div>Statins are commonly prescribed to reduce cardiovascular risk, but statin-induced myopathy is a leading cause for therapy discontinuation. This case report discusses a 69-year-old female with multiple comorbidities, including smoldering multiple myeloma, who presented with myalgias and a vesicular rash initially suspected to be herpes zoster due to her immunocompromised status. Elevated creatine kinase (CK) levels were noted (&gt;9000 U/L) while the patient was on high-dose atorvastatin. Despite initial suspicions of herpes zoster, the rash’s atypical progression led to further evaluation, revealing a more complex picture. The patient had a significant history of drug allergies, complicating the diagnosis, particularly following recent clindamycin treatment for a dental issue. After discontinuing atorvastatin and clindamycin, her CK levels improved, and subsequent testing confirmed the presence of anti-HMG-CoA reductase antibodies, establishing a diagnosis of statin-induced autoimmune necrotizing myopathy. This case underscores the importance of detailed patient histories and the need to consider drug-induced hypersensitivity reactions in immunocompromised individuals. The resolution of symptoms after stopping the offending medications emphasizes the critical role of careful monitoring and diagnosis in managing patients with complex medical backgrounds.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02164"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377982","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}

{"title":"Therapeutic role of fluconazole in immunocompetent patients with pulmonary cryptococcosis: A case report","authors":"Huimin Yu ,&nbsp;Shuang Hua ,&nbsp;Qifei Sha ,&nbsp;Tang Tang ,&nbsp;Yuzhu Cao","doi":"10.1016/j.idcr.2025.e02188","DOIUrl":"10.1016/j.idcr.2025.e02188","url":null,"abstract":"<div><div>The present investigation examines the potential for customized treatment of pulmonary cryptococcosis using fluconazole in an immunocompetent individual. Therapeutic drug monitoring (TDM) was utilized throughout treatment to assess fluconazole levels. Research indicated that the MIC₉₀ for cryptococcus in China is around 8 mg/L. We evaluated the area under the curve (AUC) relative to the minimal inhibitory concentration (MIC), focusing on the AUC from 0 to 24 h (AUC0–24 h/MIC). Fluconazole's dosage was adjusted according to pharmacokinetics/pharmacodynamics (PK/PD) principles to enhance therapeutic efficacy. Post-treatment evaluation showed marked improvement in the patient's condition, with lesions exhibiting partial absorption.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"40 ","pages":"Article e02188"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611256","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}

{"title":"Pulmonary mass with actinomyces infection mimicking malignancy: A case illustrated","authors":"Hidenori Takahashi ,&nbsp;Satomi Fujihara ,&nbsp;Saori Shimizu","doi":"10.1016/j.idcr.2025.e02264","DOIUrl":"10.1016/j.idcr.2025.e02264","url":null,"abstract":"<div><div>We encountered a case of pulmonary actinomycosis diagnosed through bronchoscopy, initially suspected as lung cancer originating from the bullae, and the PET-CT findings did not rule out malignancy. Pulmonary actinomycosis is a rare lung infection that often mimics cancer. Its anaerobic nature and prolonged culture time make diagnosis challenging without strong clinical suspicion.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"40 ","pages":"Article e02264"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941180","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}

{"title":"Transmission of human herpesvirus-8 through liver transplantation and development of post-transplantation Kaposi sarcoma: A case report","authors":"Julius Leander Ross Clemmesen ,&nbsp;Nicoline Arentoft ,&nbsp;Nicolai Aagaard Schultz ,&nbsp;Moises Alberto Suarez-Zdunek ,&nbsp;Annika Loft ,&nbsp;Nikolai Kirkby ,&nbsp;Jens Georg Hillingsø ,&nbsp;Gro Linno Willemoe ,&nbsp;Michael Perch ,&nbsp;Christian Ross Pedersen ,&nbsp;Susanne Dam Nielsen","doi":"10.1016/j.idcr.2025.e02263","DOIUrl":"10.1016/j.idcr.2025.e02263","url":null,"abstract":"<div><h3>Introduction</h3><div>Kaposi sarcoma is a vascular tumour associated with human herpesvirus-8 (HHV-8) infection. Due to immunosuppressive treatment, solid organ transplant recipients infected with HHV-8 have increased risk of Kaposi sarcoma. The risk of being infected with HHV-8 is associated with higher age, male sex, non-White ethnicity, being a man who has sex with men (MSM) and use of recreational drugs. Post-transplant Kaposi sarcoma is rare in HHV-8 low-prevalence areas. We report the first case of a liver transplant recipient developing Kaposi sarcoma following donor-transmitted HHV-8 infection in Denmark.</div></div><div><h3>Case presentation</h3><div>A 51-year-old male underwent uncomplicated liver transplantation at Copenhagen University Hospital – Rigshospitalet, and received standard immunosuppressive treatment with tacrolimus, mycophenolate mofetil and prednisolone. Five months post-transplantation the patient was admitted with abdominal pain, diarrhoea, and dehydration. Ultrasound imaging and PET/CT scan revealed multiple liver tumours. Biopsy from liver tumour diagnosed visceral post-transplantation Kaposi sarcoma. Kaposi sarcoma was successfully treated with reduction of immunosuppressive treatment and conversion from tacrolimus to everolimus, resulting in viral clearance and complete metabolic and structural tumour response. A review of the donor post-transplantation revealed multiple risk factors for being infected with HHV-8, with subsequent analysis confirming the donor was positive for HHV-8.</div></div><div><h3>Discussion</h3><div>Even in low-prevalence areas, there are benefits of targeted screening for HHV-8 in high-risk organ donors and recipients described in the literature and highlighted in the current case. Post-transplantation Kaposi sarcoma due to HHV-8 may be managed with reduction in immunosuppressive treatment and conversion from calcineurin inhibitors to mTOR inhibitors.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"40 ","pages":"Article e02263"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068646","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}

{"title":"Severe Legionnaires’ disease refractory to azithromycin: Are quinolones superior to macrolides?","authors":"Luqman Croal-Abrahams,&nbsp;Folasade Arinze","doi":"10.1016/j.idcr.2025.e02242","DOIUrl":"10.1016/j.idcr.2025.e02242","url":null,"abstract":"<div><div>Legionnaires’ disease is typically treated with either a macrolide or fluoroquinolone. Antimicrobial sensitivity testing of clinical samples is not routinely done because <em>Legionella</em> is difficult to culture. Controlled trials to suggest non-inferiority of either class are limited. We present a case of a 43-year-old immunosuppressed man with severe <em>Legionella</em> pneumonia whose clinical course was complicated by persistent fevers, acute metabolic encephalopathy, septic shock, rhabdomyolysis, and acute kidney injury while on azithromycin. He rapidly improved after a switch to levofloxacin. The current guidelines recommend either using a quinolone or macrolide for <em>Legionella</em> pneumonia. However, there are conflicting data suggestive of a benefit of quinolones over macrolides. Our case prompts the question of optimal antibiotic choice in cases of severe Legionnaires’ disease in immunocompromised patients and highlights the need for randomized controlled trials for further guidance.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"40 ","pages":"Article e02242"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935044","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}