Primary Cutaneous Cryptococcosis in a Patient on Fingolimod: A Case Report.

Primary cutaneous cryptococcosis is an uncommon condition. Patients with immunosuppression and those of older age are more susceptible to infection, warranting investigations into underlying systemic disease. We report the case of a 49-year-old male with multiple sclerosis in remission on fingolimod who presented with a non-healing skin lesion on his upper thigh for a duration of two years. Skin biopsy showed dermal parasitized histiocytes, and serum antigens for histoplasmosis and Cryptococcus were negative. Further investigation with polymerase chain reaction (PCR) demonstrated cutaneous cryptococcal infection, with no associated systemic signs or symptoms. This case report highlights an uncommon presentation of cutaneous cryptococcosis on an unexposed skin surface with successful and rapid improvement following fluconazole therapy without fingolimod discontinuation.

A Case of Morganella morganii-induced Fetal Demise.

Morganella morganii is a rare opportunistic pathogen that is known to cause urinary tract and intra-abdominal infections. Per our literature review, there are few case reports of neonatal sepsis associated with this organism but to our knowledge, there are no case reports of Morganella morganii causing fetal demise in published literature in the Englishlanguage. In this case report, we present a case of a 34-year-old pregnant woman who had a hospital course complicated by Morganella morganii, which eventually led to stillbirth.

Unusual Liver Mass in an Immunocompetent Adult: A Case Report and Literature Review.

A hepatic abscess is a rare disease, especially in developed countries, and usually results from microbial contamination of liver parenchyma via an arterial or portal system or from a direct spread by contiguity. Pyogenic liver abscesses (PLA) are polymicrobial with Staphylococcus aureus accounting for less than 10% of the cases and methicillin-resistant Staphylococcus aureus (MRSA) accounting for even fewer. Colonic and hepatobiliary pathologies are often associated with reported MRSA abscesses. We report a case of MRSA bacteremia and liver abscess in an immunocompetent patient with no significant risk factors. Our patient presented with fever and abdominal pain of four days' duration. Laboratory studies revealed neutrophilic leukocytosis, elevated creatinine, c-reactive protein, and transaminitis. Blood culture was positive for MRSA. Computed tomography (CT) of the abdomen showed multiple areas of hypodensities over the left hepatic lobe that placed malignancy and abscess into the main differentials. A liver biopsy was consistent with liver abscess. Drainage was performed after a month of treatment with intravenous (IV) daptomycin and microbial analysis of the abscess was negative. Our case signifies the association of liver abscess and MRSA bacteremia in a patient with no significant risk factors and highlights the importance of prompt antibiotic treatment as first-line therapy.

A Case of Drug-induced Linear IgA Bullous Dermatosis.

Linear immunoglobulin A (IgA) bullous dermatosis (LABD) presents as a rare autoimmune disease that can either occur spontaneously or induced by certain drugs, the most common of which is vancomycin. LABD is a subepidermal blistering disease that is diagnosed by detecting linear IgA bands along the basement membrane. We present a case of a 59-year-old man with worsening blistering skin rash who was treated with vancomycin and piperacillin-tazobactam for pneumonia.