IF 1.1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02319

Meilani Yevista Debora Br Pasaribu , Hermina Novida

{"title":"Secondary adrenal insufficiency in a young man with HIV and pulmonary tuberculosis, complicated by cerebral toxoplasmosis and seizure","authors":"Meilani Yevista Debora Br Pasaribu , Hermina Novida","doi":"10.1016/j.idcr.2025.e02319","DOIUrl":"10.1016/j.idcr.2025.e02319","url":null,"abstract":"<div><div>Secondary adrenal insufficiency (SAI) presents with non-specific clinical symptoms, which may overlap with those of HIV and tuberculosis, making diagnosis challenging. We report a case of a 22-year-old Indonesian man, presented with fatigue, intermittent dyspnea, intermittent nocturnal fever, and a significant weight loss of 5 kg over one month. He also reported having unprotected sex with a casual partner. Physically, he presented pale and weak with hypotension . Laboratory examination showed cortisol levels of 28.46 nmol/L and adrenocorticotropic hormone (ACTH) levels of 5.6 µg/dL. Chest x-ray and GeneXpert confirmed pulmonary tuberculosis. Despite an initial negative HIV examination, repeat testing was recommended due to the possibility of a false-negative result. Therefore, the initial diagnosis was SAI due to HIV and tuberculosis. He was treated with hydrocortisone and supportive therapy. Following outpatient discharge, he was re-admitted due to severe headaches, vomiting, and a generalized tonic-clonic seizure. Neuroimaging revealed ring-enhancing lesions, and serology testing was positive for toxoplasmosis IgG and IgM. Repeat testing of HIV was positive with very lowCD4 count. The final diagnosis was cerebral toxoplasmosis, newly diagnosed HIV, and disseminated tuberculosis infection. He responded well to the treatment for 20 days without any complaints and was discharged with anti-retroviral (ARV) and anti-tuberculosis drug (ATD) alongside toxoplasmosis treatment. He remained clinically stable at a 5-months follow-up. Early recognition and treatment of SAI to prevent life-threatening complications, particularly in patients with HIV and tuberculosis co-infection. Thus, early recognition and management are critical to minimize severe complications, particularly cerebral toxoplasmosis.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"41 ","pages":"Article e02319"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604618","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}

引用次数: 0

Isolated splenic tuberculosis in a patient with rheumatoid arthritis 类风湿性关节炎患者孤立性脾结核1例

IF 1.1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02295

Yuji Toyota, Akihiro Ito, Tadashi Ishida

{"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}

引用次数: 0

A unique case of IUD associated group A Streptococci pyogenic ascites 一例与宫内节育器相关的A组链球菌化脓性腹水

IF 1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02348

Smadar Goldfarb , Maya Korem , Limor Rubin

引用次数: 0

Spontaneous sub-amputation from atypical critical limb ischemia in a patient without classical risk factors 无典型危险因素的非典型危重肢体缺血患者自发性亚截肢

IF 1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02368

Alsadig Suliman , Shorouq Mohammed Ali , Mohamed Saadeldein , Alkhansa Alkhider , Abubakr Muhammed

{"title":"Spontaneous sub-amputation from atypical critical limb ischemia in a patient without classical risk factors","authors":"Alsadig Suliman , Shorouq Mohammed Ali , Mohamed Saadeldein , Alkhansa Alkhider , Abubakr Muhammed","doi":"10.1016/j.idcr.2025.e02368","DOIUrl":"10.1016/j.idcr.2025.e02368","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous sub-amputation is a rare manifestation of critical limb ischemia (CLI), most often associated with advanced vascular disease and comorbidities. We present a case of spontaneous foot sub-amputation in an elderly patient without major lifestyle-related risk factors, managed in a resource-limited setting.</div></div><div><h3>Case Report</h3><div>A 76-year-old male with no history of diabetes, hypertension, or smoking presented after his left foot detached spontaneously during sleep, following two months of leg pain and two days of worsening discoloration and fever. On examination, he was septic, with absent left femoral and popliteal pulses and advanced gangrene. Imaging was not performed due to systemic and facility constraints. Emergency above-knee amputation was performed. Intraoperatively, thrombus removal was achieved using a Foley catheter in place of a Fogarty catheter. Postoperatively, the patient stabilized and showed good wound healing. Further diagnostics, including histopathology and thrombophilia screening, were not feasible due to financial and systemic limitations.</div></div><div><h3>Discussion</h3><div>This case highlights an atypical CLI presentation in a patient without conventional lifestyle-associated risk factors, but with overlooked contributors such as prediabetes. The absence of imaging and vascular tools required improvisation for timely limb removal. The use of a Foley catheter for thrombectomy demonstrates adaptable practice in low-resource environments. Although the underlying etiology could not be fully confirmed, acute-on-chronic arterial occlusion was the most plausible diagnosis.</div></div><div><h3>Conclusion</h3><div>Early recognition, sound clinical judgment, and surgical adaptability are vital in underserved settings. This case demonstrates that even with limited diagnostics and resources, effective outcomes can still be achieved.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"42 ","pages":"Article e02368"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061270","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}

引用次数: 0

Wohlfahrtiimonas chitiniclastica Infections in two patients with osteomyelitis, China 2例骨髓炎患者的几丁粒虫感染

IF 1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02364

Liqin Meng , Ling Guo , Xin Huang , Jinghan Li , Jinli Bi , Taijie Li

{"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}

引用次数: 0

Widespread pylephlebitis and infective thromboembolism due to Streptococcus anginosus-related appendiceal rupture: A case report 广泛性肾盂炎和感染性血栓栓塞，由血管炎链球菌相关的阑尾破裂：1例报告

IF 1

IDCases Pub Date : 2025-01-01 DOI: 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

{"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}

引用次数: 0

Severe Legionnaires’ disease refractory to azithromycin: Are quinolones superior to macrolides? 阿奇霉素难治性严重军团病：喹诺酮类药物优于大环内酯类药物吗？

IF 1.1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02242

Luqman Croal-Abrahams, Folasade Arinze

引用次数: 0

When herpes zoster is not herpes: A case of statin-induced myopathy complicated by drug allergies 当带状疱疹不是疱疹：他汀类药物引起的肌病合并药物过敏1例

IF 1.1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02164

Hira Khalid Kareem , Muhammad Fawad Ashraf , Muhammad Shehryar , Hafsa Fayyaz , Shreyas Patil

{"title":"When herpes zoster is not herpes: A case of statin-induced myopathy complicated by drug allergies","authors":"Hira Khalid Kareem , Muhammad Fawad Ashraf , Muhammad Shehryar , Hafsa Fayyaz , 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 (>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}

引用次数: 0

Severe dual fungal infection after bispecific antibody therapy: A case of invasive aspergillosis and mucormycosis in immunocompromised patient 双特异性抗体治疗后严重双重真菌感染：免疫功能低下患者侵袭性曲霉病和毛霉病1例。

IF 1.1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2024.e02140

Sarah Sakalihasan , Frédéric Lifrange , Mathieu Czajkowski , Veronique Goncette , Bernard Duysinx , Pierre Lovinfosse , Damla Can , Raphael Schils , Marie-Pierre Hayette , Adrien De Voeght

{"title":"Severe dual fungal infection after bispecific antibody therapy: A case of invasive aspergillosis and mucormycosis in immunocompromised patient","authors":"Sarah Sakalihasan , Frédéric Lifrange , Mathieu Czajkowski , Veronique Goncette , Bernard Duysinx , Pierre Lovinfosse , Damla Can , Raphael Schils , Marie-Pierre Hayette , Adrien De Voeght","doi":"10.1016/j.idcr.2024.e02140","DOIUrl":"10.1016/j.idcr.2024.e02140","url":null,"abstract":"<div><div>Bispecific antibody is a new treatment for hematological disease, especially for lymphoma, myeloma and acute lymphoblastic leukemia. This class of treatment presents the same kind of side effect as CAR-T cell which are immune-mediated. Nevertheless, infectious complication remains a major concerns with related mortality. Fungal infection are rarely reported in clinical trial but remains a major concern. We report a case of a co-infection of <em>Aspergillus</em> and <em>Mucorales</em> in a patient with diffuse large B-cell lymphoma (DLBCL) following treatment with the bispecific antibody epcoritamab. The patient developed severe cytokine release syndrome (CRS) and subsequent fungal infections, which were challenging to diagnose and treat due to the complexities of managing immunocompromised patients and co-infection. Advanced diagnostics, including PET-CT, and a combination of antifungal therapies were crucial in achieving remission. The case underscores the need for early diagnosis, multidisciplinary management, and innovative treatment strategies in similar high-risk patients.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02140"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984932","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}

引用次数: 0

Varicella zoster virus triggering Henoch–Schonlein Purpura in an adult: A case report 水痘带状疱疹病毒引发成人过敏性紫癜1例报告

IF 1.1

IDCases Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02174

Kevin Chung , Natasha Priya Dyal , Sandhya Nagarakanti

{"title":"Varicella zoster virus triggering Henoch–Schonlein Purpura in an adult: A case report","authors":"Kevin Chung , Natasha Priya Dyal , Sandhya Nagarakanti","doi":"10.1016/j.idcr.2025.e02174","DOIUrl":"10.1016/j.idcr.2025.e02174","url":null,"abstract":"<div><div>This case reports highlights a 37-year-old woman who was transferred to Mayo Clinic Arizona for care after development of seizures, altered mental status, and a diffuse petechial rash, along with vesicular lesions near the groin. She received broad-spectrum antimicrobial therapy. CSF testing showed lymphocytic pleocytosis and elevated protein levels, and PCR testing confirmed varicella zoster virus (VZV) infection. MRI of the brain demonstrated chronic microhemorrhages, indicative of vasculitis secondary to disseminated VZV. Dermatology consultation and subsequent biopsy of the skin lesions revealed leukocytoclastic vasculitis with IgA deposition, consistent with Henoch-Schonlein Purpura (HSP). A VZV-positive PCR from the rash further corroborated the diagnosis. This case highlights the first reported instance of VZV induced HSP in an adult. Although this patient had no complications from HSP, early recognition and targeted treatment are necessary in some cases to prevent severe conditions. This case underscores the importance of maintaining a broad differential diagnosis and the importance of biopsy lesions for prompt recognition of uncommon conditions in high-risk patients.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"39 ","pages":"Article e02174"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157740","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}

引用次数: 0

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