IDCases最新文献

{"title":"Streptobacillus moniliformis bacteremia in an afebrile patient: A rare case report","authors":"Zirong Wu ,&nbsp;Lin Zhang ,&nbsp;Li Shi ,&nbsp;Chunhua Wang ,&nbsp;Weiliang Cao","doi":"10.1016/j.idcr.2026.e02632","DOIUrl":"10.1016/j.idcr.2026.e02632","url":null,"abstract":"<div><div>Rat-bite fever (RBF), caused by <em>Streptobacillus moniliformis</em>, typically presents with fever, rash, and polyarthralgia, but we report an atypical afebrile case in a 36-year-old woman who presented with severe arthralgia and purpuric rash without fever. Laboratory findings revealed leukocytosis, elevated inflammatory markers (CRP 118.77 mg/L, ESR 64 mm/h), and acute kidney injury. Two sets of blood cultures grew <em>Streptobacillus moniliformis</em>, identified by Gram stain, colony morphology, and MALDI-TOF mass spectrometry (Bruker system, score 2.50). Antimicrobial susceptibility testing, performed according to CLSI M100 guidelines, demonstrated sensitivity to penicillin (MIC 0.032 mg/L), ceftriaxone, and other antibiotics. The patient was treated with intravenous penicillin (1.6 million units every 8 h for 14 days) and showed clinical improvement before discharge. This case underscores that fever may be absent in RBF and highlights that, in patients with compatible symptoms (e.g., rash, arthralgia) and potential rodent exposure, blood cultures should be considered even in the absence of fever, especially when other infectious or inflammatory causes are being evaluated, to avoid diagnostic delay.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"45 ","pages":"Article e02632"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148183603","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":"Isolation of Burkholderia cepacia complex from pericardial fluid in a patient with lung adenocarcinoma with metastasis: A rare case report","authors":"K. Mirlekar,&nbsp;M. Saraf,&nbsp;A. Sarage","doi":"10.1016/j.idcr.2026.e02613","DOIUrl":"10.1016/j.idcr.2026.e02613","url":null,"abstract":"<div><h3>Background</h3><div>Burkholderia cepacia complex (BCC) comprises environmental non-fermenting Gram-negative bacilli that primarily cause opportunistic infections in immunocompromised individuals. Pericardial infection due to BCC is exceedingly rare, particularly in patients with malignancy. Differentiating infectious from malignant effusions remains a diagnostic challenge, especially in tuberculosis-endemic regions.</div></div><div><h3>Case presentation</h3><div>We report a case of a 50-year-old female presenting with chronic cough, fever, and progressive Grade III dyspnoea requiring oxygen support. Imaging revealed right pleural effusion and pericardial effusion. Cytological examination of pleural fluid demonstrated malignant cells, and immunohistochemistry confirmed lung adenocarcinoma with metastasis. The patient was also HBsAg positive with detectable viral load, representing an additional immunocompromised state.</div><div>Pericardial fluid culture isolated Burkholderia cepacia complex, while pleural fluid cultures remained sterile. Tuberculosis workup, including Ziehl–Neelsen staining, GeneXpert testing, and adenosine deaminase levels, was negative. Antimicrobial susceptibility testing performed using CLSI 2024 interpretative criteria demonstrated susceptibility to trimethoprim–sulfamethoxazole, levofloxacin, and meropenem; intermediate susceptibility to minocycline; and resistance to ceftazidime. The patient received targeted antimicrobial therapy along with chemotherapy and showed symptomatic improvement with reduced oxygen requirement.</div></div><div><h3>Discussion</h3><div>Isolation of BCC from a sterile site without prior cardiac intervention raises important questions regarding pathogenesis. Dual immunocompromised states—lung adenocarcinoma with metastasis and chronic hepatitis B infection—likely facilitated opportunistic infection through hematogenous or contiguous spread. Clinical correlation and therapeutic response supported true infection rather than contamination.</div></div><div><h3>Conclusions</h3><div>BCC can rarely cause pericardial infection in patients with malignancy. Comprehensive microbiological evaluation of pericardial fluid is essential even in confirmed malignant effusions to enable accurate diagnosis and targeted therapy</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"45 ","pages":"Article e02613"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148246009","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":"Vascular prosthetic infection by Francisella tularensis: a unique case report","authors":"Roger Frigola Castro,&nbsp;Leopoldo Fernández Alonso,&nbsp;Margarita Atienza Pascual,&nbsp;Irantzu Unzaga Rubio,&nbsp;Esther Martínez Aguilar","doi":"10.1016/j.idcr.2026.e02556","DOIUrl":"10.1016/j.idcr.2026.e02556","url":null,"abstract":"<div><h3>Introduction</h3><div>Tularemia is a rare zoonosis caused by <em>Francisella tularensis</em>. Clinical presentation is variable and typically associated with people living in rural areas with compatible epidemiological exposure. Vascular prosthetic infections by this microorganism are exceptionally uncommon. We report a unique case of a vascular prosthetic infection by <em>F. tularensis</em>, a previously undescribed complication.</div></div><div><h3>Case report</h3><div>We describe a 76-year-old male, with multiple femoro-femoral cross bypass procedures, presented with progressively enlarging painful left femoral mass and one week of malaise, low-grade fever, and anorexia. Angio-CT demonstrated inflammatory/infectious collections around the bypass graft. Periprosthetic samples grew <em>Francisella tularensis,</em> confirmed by PCR and serology<em>,</em> while blood cultures remained negative. Given the patient’s stable condition, deferred surgery was performed. The procedure consisted of explantation of the previous femoro-femoral bypass, a new left-to-right profunda femoro-femoral bypass, and an additional bypass from the cross to the left profunda femoral artery, all using cryopreserved arterial grafts. Cultures from the prosthesis, anastomosis, fluid, and subcutaneous tissue were uniformly positive for <em>F. tularensis</em>.</div><div>Antibiotic therapy was initiated in collaboration with internal medicine, consisting of intravenous gentamicin and ciprofloxacin for two weeks during hospitalization, followed by four additional weeks of intravenous ciprofloxacin via a home-hospitalization program. At six-month follow-up, the patient remained asymptomatic with no evidence of infection.</div></div><div><h3>Discussion</h3><div>Prosthetic infections caused by <em>F. tularensis</em> are exceedingly rare. Reported cases in the literature are limited to joint prostheses, cardiac valves, and a single aortic endograft. Optimal management requires complete graft removal, wide surgical debridement, and targeted antimicrobial therapy.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"44 ","pages":"Article e02556"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147543734","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":"Isolated ovarian tuberculosis in a hemodialysis patient: An incidental pre-transplant discovery with diagnostic and management implications","authors":"Ayyoub Hormatallah,&nbsp;Ikram Asakak,&nbsp;Loubna Slama,&nbsp;Mahmoud Aberkane,&nbsp;Mohamed Harmouche,&nbsp;Zainab Chatbi,&nbsp;Ibtissam Bellajdel,&nbsp;Hafsa Taheri,&nbsp;Hanane Saadi,&nbsp;Ahmed Mimouni","doi":"10.1016/j.idcr.2026.e02551","DOIUrl":"10.1016/j.idcr.2026.e02551","url":null,"abstract":"<div><div>Female genital tuberculosis remains a rare extrapulmonary manifestation, particularly when presenting as isolated ovarian involvement mimicking malignancy. We report a case discovered incidentally during pre-transplant screening in an immunocompromised patient on hemodialysis. A 37-year-old woman with end-stage renal disease on hemodialysis for 5 years underwent routine pre-kidney transplant evaluation. Computed tomography revealed a multiloculated left adnexal mass (38 × 33 mm). She was asymptomatic without tuberculosis exposure history. Transvaginal ultrasound demonstrated a thin-septated avascular cystic lesion, while magnetic resonance imaging showed hyperintensity with fluid-fluid levels and no suspicious enhancement. Laboratory findings revealed mild anemia, elevated inflammatory markers, and mildly elevated cancer antigen 125 with normal human epididymis protein 4. Tuberculosis screening showed positive tuberculin skin test (12 mm) and positive interferon-gamma release assay, with normal chest radiography. Laparoscopic cystectomy was performed. Histopathology demonstrated epithelioid granulomas with Langhans giant cells, caseous necrosis, and rare acid-fast bacilli. Molecular testing and culture confirmed Mycobacterium tuberculosis without rifampin resistance. Anti-tuberculous therapy adapted to renal failure was initiated with favorable outcome. At 6-month follow-up, complete resolution was documented on pelvic ultrasound. At 12 months, with no recurrence and normalized inflammatory markers, the patient was successfully relisted for kidney transplantation. This case emphasizes the importance of maintaining high clinical suspicion for tuberculosis in immunocompromised patients presenting with adnexal masses, particularly those awaiting transplantation. Early microbiological diagnosis enabled conservative surgical management and timely treatment, preventing potentially life-threatening post-transplant reactivation.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"44 ","pages":"Article e02551"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147543814","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":"Tularemia from a cat bite: Case report and review of the literature","authors":"Matthew Enriquez,&nbsp;Anne-Marie Leuck","doi":"10.1016/j.idcr.2026.e02546","DOIUrl":"10.1016/j.idcr.2026.e02546","url":null,"abstract":"<div><h3>Background</h3><div>Patients frequently present to primary care or urgent care with infections related to cat bites. First-line treatment includes antibiotics targeting traditional cat-associated pathogens such as <em>Pasteurella multocida</em>.</div><div><em>Francisella tularensis</em> is increasingly recognized in cat-associated infections but does not respond to first-line antibiotics. <em>F. ularensis</em> may also relapse after treatment. This case highlights the need for clinicians to be aware that <em>F. tularensis</em> could be present in cat-related infections not responding to usual first-line antibiotics.</div></div><div><h3>Case presentation</h3><div>A 64-year-old woman presented to the hospital with fevers and finger swelling two weeks after sustaining a cat bite to her finger. Prior to admission, she had been treated with ceftriaxone and clindamycin without improvement. She failed to improve on vancomycin and piperacillin-tazobactam. She underwent debridement with intraoperative cultures growing <em>F. tularensis</em>. Her antibiotics were switched to ciprofloxacin (for <em>F. tularensis</em>) and oral amoxicillin-clavulanate (for coverage of other feline oral flora) with improvement. Antibiotics were stopped after three weeks but she developed clinical relapse. She was then treated with six weeks of doxycycline with complete resolution. This case occurred during an increase of tularemia in the local cat population identified by the health department.</div></div><div><h3>Conclusions</h3><div>This case illustrates the importance of considering <em>F. tularensis</em> in cat-related infections not improving with standard antibiotic therapy. The case also underscores the importance of recognizing relapse of <em>F. tularensis</em> infection as a common complication, as well as the importance of engaging with public health authorities to be aware of changes in epidemiology that may affect patient care.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"44 ","pages":"Article e02546"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515702","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":"Tuberculosis on two fronts: A case report of liver and stomach involvement in a patient","authors":"Mojtaba Khademi Bafrooei ,&nbsp;Arash Rahimi ,&nbsp;Ali Atashabparvar ,&nbsp;Narjes Seddighi","doi":"10.1016/j.idcr.2026.e02516","DOIUrl":"10.1016/j.idcr.2026.e02516","url":null,"abstract":"<div><h3>Introduction</h3><div>Tuberculosis (TB) is a chronic disease caused by Mycobacterium tuberculosis, primarily affecting the lungs but can also affect other organs. In 2021, 10.6 million people became ill with TB, and 1.6 million died. Abdominal TB is rare, accounting for 1–3 % of cases, and often involves the ileocecal region. Stomach and duodenal TB are uncommon and challenging to diagnose as they mimic other conditions. Hepatic TB is rarer, accounting for &lt; 1 % of TB cases, and has non-specific symptoms such as fever, hepatomegaly, and weight loss.</div></div><div><h3>Case presentation</h3><div>A 26-year-old female healthcare worker experienced fatigue and abdominal pain in the epigastric and right upper quadrant areas, prompting her visit to a gastroenterology clinic. She did not have any other accompanying symptoms, such as nausea, vomiting, weight loss, fever, or night sweats, and upon examination, she exhibited mild epigastric tenderness without any mass. Laboratory tests revealed anemia, mild thrombocytosis, and elevated erythrocyte sedimentation rate. Upper endoscopy uncovered multiple small, clean-based ulcers in the antrum and bulb, and biopsies confirmed chronic granulomatous gastritis in the stomach and duodenum. Abdominopelvic ultrasonography showed heterogeneous liver parenchymal echogenicity and multiple small, ill-defined hyperechoic areas in both liver lobes. At the same time, CT scans of the chest, abdomen, and pelvis exhibited multiple hypodense lesions with peripheral rim enhancement in the liver and clear lungs. The patient was given anti-tuberculosis drugs and responded well. Follow-up after six months revealed no significant findings.</div></div><div><h3>Conclusions</h3><div>Clinicians in TB-endemic regions should maintain a high index of suspicion for gastrointestinal and liver TB in patients presenting with some abdominal and constitutional symptoms. The most sensitive imaging modality for hepatic TB is a CT scan, while the most specific diagnostic modality is a CT or Sono- guided liver biopsy.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"44 ","pages":"Article e02516"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147543815","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":"Necrotizing fasciitis in an immunocompetent child with a recent history of varicella-zoster virus infection: A case report from a resource-limited setting","authors":"Abdullahi Hassan Elmi,&nbsp;Fahma Hussein Ibrahim","doi":"10.1016/j.idcr.2026.e02653","DOIUrl":"10.1016/j.idcr.2026.e02653","url":null,"abstract":"<div><div>Necrotizing fasciitis is a rare but life-threatening soft-tissue infection characterized by rapid progression, extensive tissue destruction, and high morbidity and mortality. Secondary bacterial infections may occur after varicella-zoster virus infection; however, the timing and clinical context are essential when interpreting causality. We report the case of an 8-year-old previously healthy girl who presented with high-grade fever, severe pain, and rapidly progressive necrotic soft-tissue infection involving the right leg and buttock. She had a documented history of chickenpox two months before presentation, with residual healed scars noted on examination. Given the prolonged interval and absence of active varicella lesions, a direct causal relationship between varicella and necrotizing fasciitis could not be confirmed. Laboratory investigations showed leukocytosis, severe anemia, hyponatremia, markedly elevated C-reactive protein, and a Laboratory Risk Indicator for Necrotizing Fasciitis score of 10, supporting a high-risk diagnosis. Wound culture grew Proteus mirabilis, an uncommon organism in necrotizing fasciitis, and treatment was guided by culture sensitivity. The patient improved following prompt supportive care, intravenous antibiotics, urgent surgical debridement, and continued wound management. This case highlights the importance of cautious interpretation of remote varicella history, early recognition of necrotizing fasciitis, timely surgical intervention, culture-guided antimicrobial therapy, and multidisciplinary care, particularly in resource-limited settings.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"45 ","pages":"Article e02653"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369894","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":"Coccidioidal peritonitis: A rare manifestation of disseminated coccidioidomycosis","authors":"Nicholas Cheung,&nbsp;Rhett Harmon,&nbsp;Robin L. Dietz Jr.,&nbsp;Shaun Chandna,&nbsp;Sherif Shoucri","doi":"10.1016/j.idcr.2026.e02674","DOIUrl":"10.1016/j.idcr.2026.e02674","url":null,"abstract":"<div><div>Coccidioidomycosis (CM) is primarily a pulmonary disease but can also present with significant extrapulmonary disease. Extrapulmonary manifestations vary across organ systems, but most frequently presents as infection of the bone, brain and skin. Due to the variety of clinical presentations in disseminated disease, CM can be underrecognized, resulting in a diagnostic conundrum. We report a case of a non-immunocompromised patient initially presenting for weight loss with imaging findings mimicking peritoneal carcinomatosis, ultimately found to have CM with peritoneal involvement.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"45 ","pages":"Article e02674"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431278","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":"Your friendly neighborhood spider bite – Or not: A fishy case of Mycobacterium marinum","authors":"Briccio Cadiz,&nbsp;Katherine Raymer,&nbsp;Zackary Houghton,&nbsp;Riley Bricker,&nbsp;Marlon C. Torrento,&nbsp;Nickolas A. Bacon,&nbsp;Vikram Oke,&nbsp;Karthik V. Iyer","doi":"10.1016/j.idcr.2026.e02671","DOIUrl":"10.1016/j.idcr.2026.e02671","url":null,"abstract":"<div><div><em>Mycobacterium marinum</em> is a slow-growing nontuberculous mycobacterium, most commonly causing cutaneous infection after prolonged or repeated exposure to contaminated aquatic environments. Diagnosis is frequently delayed because of its indolent course, nonspecific clinical features, and frequent misattribution to more common dermatologic conditions. We report the case of a 51-year-old immunocompromised woman who developed a progressive ulcerative lesion on the right wrist after a presumed spider bite following a farm visit. Despite multiple emergency department encounters and empiric antibacterial therapy, the lesion failed to improve. Acid-fast bacilli culture from a wound specimen ultimately grew <em>M. marinum</em> several weeks after initial presentation. Subsequent history revealed a previously undisclosed history of exposure to a home aquarium. Management was complicated by impaired oral antimicrobial absorption following prior bariatric surgery and incomplete clinical response to initial therapy, necessitating prolonged outpatient parenteral antimicrobial treatment, with eventual clinical resolution. This case underscores the impact of diagnostic anchoring bias, highlights the importance of thorough environmental exposure assessment beyond classic aquatic settings, and emphasizes early consideration of nontuberculous mycobacterial infection in chronic, nonhealing cutaneous lesions.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"45 ","pages":"Article e02671"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498029","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 disseminated VZV in an immunocompromised host temporally associated with recent recombinant adjuvanted herpes zoster vaccination","authors":"Raphaël Clement,&nbsp;Ewa Wierzbicka-Hainaut,&nbsp;Julien Mahe,&nbsp;Damien Boutin","doi":"10.1016/j.idcr.2026.e02673","DOIUrl":"10.1016/j.idcr.2026.e02673","url":null,"abstract":"<div><h3><u>Background</u><u>:</u></h3><div>Recombinant adjuvanted herpes zoster vaccine (Shingrix) effectively prevents varicella-zoster virus (VZV) reactivation and is recommended for older and immunocompromised adults.</div></div><div><h3><u>Case presentation</u></h3><div>We report a severe early disseminated VZV reactivation occurring 14 days after primary Shingrix vaccination in an 80-year-old man with a history of lymphocytic lymphoma in biological relapse and secondary hypogammaglobulinemia. Initial presentation featured multimetameric necrotic and hemorrhagic thoracic lesions, which progressed despite oral valaciclovir to a diffuse cephalocaudal vesicular eruption with fever and severe pain, prompting hospitalization. Workup identified VZV-associated bone marrow involvement with acute anemia requiring transfusion; PET imaging excluded lymphoma transformation. The patient improved under intravenous acyclovir (10 mg/kg every 8 h) with daily local care, followed by extended valaciclovir prophylaxis. Given the severity and timing, the second Shingrix dose was withheld.</div></div><div><h3><u>Discussion</u></h3><div>Causality is difficult to establish: primary varicella could not be fully excluded, and vaccine-induced immunity would not yet be established after a single early dose. Nonetheless, the short latency, immunocompromised status, and concordance with rare reports of early post-vaccination zoster suggest a possible association. This case highlights the importance of reporting to pharmacovigilance systems and differentiating adverse events from vaccine failure, without undermining the overall favorable safety profile of Shingrix in high-risk populations.</div></div>","PeriodicalId":47045,"journal":{"name":"IDCases","volume":"45 ","pages":"Article e02673"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498054","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}