Exophiala pneumonia requiring pneumonectomy in a post-renal transplant patient.

Exophiala is a rare fungus that can cause fatal infections in patients who are immunocompromised. This case describes a 55-year-old post-renal transplant patient undergoing active treatment for multiple myeloma who presented to the emergency room with complaints of cough and dyspnea. She was found to have a cavitary lesion in the left upper lobe of her lung, and direct sampling via bronchoscopy revealed an invasive fungal infection with an Exophiala species. Despite initial improvement on antifungal therapy, her clinical course deteriorated requiring pneumonectomy and formation of brain abscess. This case emphasizes the challenge of invasive fungal infections and the importance of broad differentials in patients who are immunocompromised.

Scurvy in a patient with a restrictive diet.

Scurvy is a historically significant disease whose incidence has declined significantly with advancements in nutrition and access to varied foods. It is classically characterized by gingival bleeding, corkscrew hairs, and petechiae. In cases of severe deficiency, as seen in patients with years of a restricted diet, impaired connective tissue formation can lead to symptomatic, life-threatening bleeding diathesis. Risk factors for a restrictive diet in patients with unidentified bleeding diathesis should be recognized early to prevent significant morbidity.

Candida parapsilosis endocarditis in an immunocompetent host.

This case describes an 83-year-old immunocompetent woman who presented to the emergency department with complaints of nausea, vomiting, and dizziness. She was found to have evidence of embolic stroke secondary to Candida parapsilosis endocarditis. This case emphasizes the challenge of diagnosing fungal endocarditis, as it can be difficult to culture, and the importance of broad differentials even in patients with no obvious risk factors.

Disseminated cryptococcal infection in a patient with glioblastoma multiforme on treatment with lomustine and bevacizumab.

This case describes a 48-year-old Hispanic man with a history of glioblastoma multiforme on active chemotherapy treatment and corticosteroids who presented to the emergency room with complaints of cough, fever, chills, fatigue, confusion, and somnolence. Workup yielded evidence of disseminated cryptococcal disease. The case highlights the importance of a broad differential in patients with a history of being immunocompromised.