METHODS: An 18-year-old immunocompetent man presented with symptomatic lumbar canal stenosis, discharging sinuses, and cold abscess for 3 years treated with multiple incision drainage procedures with cottonoid packing antibiotic therapy. Radiographic imaging showed a soft tissue mass in the canal causing bony destruction. Postoperative histopathological examination showed an Aspergillus fungal ball. Patient showed improvement at 6-month follow-up with medical management.
CONCLUSIONS: As far as we know, this is the first case report showing an aspergilloma involving the vertebral column. Inadequate antibiotic treatment and blind introduction of a foreign body into sinus tracts can lead to fungal infections mimicking tuberculosis, causing disastrous outcomes. Fungal cultures are recommended routinely.

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Background and Objectives: Alveolar echinococcosis (AE) is a highly variable disease able to present as structurally diverse cysts in different organs based on the host\'s immunological state as well as the time between diagnosis and the primary infection. Bacterial superinfections, especially with anaerobic pathogens from the Clostridiaceae genus, can further alter the radiological findings due to pneumobilia, newly formed abscess formations, and inflammatory changes. Materials and Methods: We present a case of a 71-year-old Caucasian male admitted to our intensive care unit with septic shock, pneumobilia, and a complex cyst of the liver with calcification, as shown by an initial CT. Because of the septic shock, the patient was started on broad-band antibiotics. Clostridiaceae infection was considered an important differential diagnosis due to the presence of pneumobilia observed in the initial CT, without a history of previous endoscopy. Furthermore, serology for echinococcus was positive, and blood cultures showed growth of C. perfringens. Therefore, the patient was additionally treated with albendazole. After recovery, further staging was conducted, showing complete remission of the cyst and a left-over lesion classified as Alveolar Echinococcosis Ulm Classification (AEUC) V. In summary, the patient had a pre-existing, controlled AE infection that became superinfected with C. perfringens, likely attributable to the anaerobic necrotic tissue, leading to septicemia. Results: The anaerobic tissue within the AE cyst provided an ideal medium for C. perfringens to replicate, leading to cyst infection, which subsequently caused septic shock and pneumobilia. The initial findings from CT and MRI were confounded by the superinfection, demonstrating the diagnostic challenges of AE, especially when presenting with complications. Conclusions: Diagnosing AE remains a demanding task, even with the excellent tools available through serology, coupled with CT, FDG-PET-CT, and MRI. Notably, older superinfected cysts can pose difficulties when integrated into the appropriate diagnostic context. Prompt diagnosis is critical for the accurate treatment of echinococcosis and its complications, such as bacterial superinfections. From a clinical perspective, septicemia from Clostridiaceae and infections with C. perfringens-pathogens capable of inducing pneumobilia-should be regarded as significant differential diagnoses for pneumobilia in the absence of a recent history of endoscopy.

Clostridium septicum (C. septicum) is a zoonotic bacillus found in 2.8% of healthy human stools. In humans, it can cause serious infections such as bacteremia, myonecrosis, and encephalitis by spreading through the bloodstream. Reports of Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome complicated by C. septicum superinfection are rare, likely because colonic microangiopathic lesions by Shiga toxin-producing Escherichia Coli facilitate bacterial dissemination. Only 13 cases of Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome with C. septicum superinfection have been reported to date, according to our litterature review, with a 50% mortality rate. The lack of clinico-laboratory clues suggesting this condition makes the diagnosis challenging. For these reasons C. septicum superinfection usually goes undiagnosed in patients with Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome, and results in unfavorable outcomes. In this paper, we describe the case of a 5-year-old girl admitted for Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome who developed C. septicum coinfection leading to a fatal outcome. We carried out a review of the available literature on C. septicum infection complicating Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome and we compared the clinical features of the observed cases with those of an historical cohort of uncomplicated Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome. The mechanisms of superinfection are still unclear and clinical features are indistinguishable from those of uncomplicated Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome. However, rapid deterioration of clinical conditions and evidence of neurological involvement, associated with abnormal radiological findings, require immediate management. Although therapeutic approaches have not been directly compared, neurosurgical treatment of amenable lesions may improve the clinical outcome of patients with C. septicum-hemolytic-uremic syndrome.

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Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration.

Libman-Sacks endocarditis is an uncommon cardiac manifestation of lupus, characterized by noninfective heart valve vegetations. Most patients are asymptomatic. However, clinical manifestations of acute forms can mimic infectious endocarditis and complicate both differential diagnosis and treatment. We here report the case of a 28-year-old female patient with lupus erythematosus followed up from 2018. She had signs and symptoms supporting the diagnosis of infective endocarditis. Assessments allowed for the diagnosis of superinfection Libman-Sacks endocarditis. The patient died despite the combination of bi-antibiotic therapy and corticosteroids.

A young man, a recent coronavirus patient, was readmitted with hypoesthesia and dysarthria following a rapid deterioration of respiratory symptoms. The brain and lung CT scans revealed ischemia and cavitary lung lesions. Clinical suspicion for aspergillus leads to prompt treatment, confirmed by biopsy. Neurologic and pulmonary symptoms resolved ultimately.

UNASSIGNED: The consequences of SARS-CoV-2 infection in patients with primary (now called \"inborn errors of immunity\") or secondary immunodeficiencies is still a matter of debate. There are few reports in the literature of patients with Good\'s syndrome and SARS-CoV-2 infection with variable outcomes.
UNASSIGNED: A 51-year-old male with diagnosis of Good\'s syndrome treated with intravenous human immunoglobulin (IVIG) at a replacement dose with application every 21 days and prophylaxis for P. jirovecii with trimethoprim/ sulfamethoxazole due to profound lymphopenia at expense of T CD4+ lymphocytes who presented initially mild disease (RT-PCR+) that progressed to pneumonia with acute respiratory failure and required advanced airway management and admission to the ICU with a fatal outcome due to superinfection after 14 days hospitalized.
UNASSIGNED: It has been documented in patients with humoral immunodeficiencies a better prognosis for developing less intense cytokine release syndrome. The alteration in cellular immunity, especially lymphopenia at the expense of CD4+ T lymphocytes, may be associated with a worse prognosis as the response against viruses is compromised as well as high susceptibility to superinfection by opportunistic agents such as P. aeruginosa and Mucor sp. For this reason, we must maintain close surveillance in patients with inborn errors of immunity with cellular defects, as is the case of patients with Good\'s syndrome who present with COVID-19.
UNASSIGNED: las consecuencias de la infección por SARS-CoV-2 en pacientes con inmunodeficiencias primarias (ahora llamadas errores innatos de la inmunidad) o secundarias aún es un tema de debate. Existe en la literatura pocos reportes de pacientes con síndrome de Good e infección por SARS-CoV-2 con desenlaces variables.
UNASSIGNED: paciente masculino de 51 años de edad con diagnóstico de síndrome de Good en tratamiento con inmunoglobulina humana intravenosa (IGIV) a dosis de sustitución con aplicación cada 21 días y profilaxis para P. jirovecii con trimetoprim/sulfametoxazol por linfopenia profunda a expensas de linfocitos T CD4+, que presentó infección por SARS-CoV-2 (RT-PCR+) leve, que progresó a neumonía con falla respiratoria aguda y que requirió manejo avanzado de la vía aérea e ingreso a UCI con desenlace fatal por sobreinfección luego de 14 días hospitalizado.
UNASSIGNED: se ha documentado en pacientes con inmunodeficiencias humorales mejor pronóstico por desarrollar síndrome de liberación de citocinas de menor intensidad. La alteración en la inmunidad celular, sobre todo linfopenia a expensas de linfocitos T CD4+, puede estar asociado con un peor pronóstico al verse comprometida la respuesta contra virus, así como la alta susceptibilidad a sobreinfección por agentes oportunistas como P. aeruginosa y Mucor sp. Por esta razón, debemos mantener una estrecha vigilancia en los pacientes con errores innatos de la inmunidad con defectos celulares como es el caso de los pacientes con síndrome de Good que presenten COVID-19.

Appendiceal mucocele is an uncommon entity that may arise due to benign or malignant processes. The radiologic exploration of this entity is necessary for diagnosis, and its imaging manifestations vary, with some findings being more common than others. More specifically, the radiological findings of a superinfected mucocele are rare, with few reports in the literature. Herein we present the case of a 68-year-old male patient with a superinfected appendiceal obstructive mucocele caused by a fecalith, which was diagnosed by abdominal CT evaluation.