A Silent Threat Unveiled: Invasive Fungal Sinusitis in a High-Risk Hematologic Malignancy Patient.

Invasive fungal sinusitis (IFS) poses a fatal threat to patients with hematological malignancies or a history of allogeneic hematopoietic stem cell transplant (HSCT). While invasive aspergillosis, a subtype of IFS, remains rare in immunocompetent individuals, allogeneic HSCT recipients face a notable surge in incidence. Despite the rapid onset and progression of IFS, its clinical presentation is subtle, contributing to heightened mortality rates. Prompt surgical debridement and systemic antifungal therapy are required to yield positive results. Examining IFS cases in HSCT recipients is vital, providing insights into its clinical course, prevention strategies, and improved evaluation. We present a rare presentation of IFS with Aspergillus niger in a relapsed acute myeloid leukemia patient post-HSCT. Two weeks after chemotherapy, the patient developed headaches and blood-tinged sinus drainage in the setting of pancytopenia. Radiologic and pathological findings confirmed the diagnosis of IFS, necessitating weeks of intensive anti-fungal therapy. Despite the initial positive response, the disease ultimately progressed to a fatal outcome. This case emphasizes that early detection is required for a favorable treatment response. Furthermore, it underscores the importance of heightened clinical suspicion, risk stratification, multidisciplinary care, and ongoing research for optimal management of IFS in allogeneic HSCT recipients.

Vertebral discitis caused by Salmonella enterica serovar Montevideo infection.

Salmonellosis is a common cause of foodborne illness worldwide, manifesting as non-invasive non-typhoidal salmonellosis, invasive non-typhoidal salmonellosis, and typhoid fever. It also rarely presents as Salmonella osteomyelitis in children with hemoglobinopathies and immunocompromised adults and even rarer osteomyelitis in an immunocompetent host without significant risk factors. Our case is of a 38-year-old immunocompetent male without significant risk factors presented with biopsy proven Salmonella vertebral discitis due to exposure to contaminated and undercooked poultry. It illustrates the importance of thorough and complete history taking even in immunocompetent patients and early recognition with prompt targeted treatment of Salmonella osteomyelitis/discitis to prevent unfavorable outcomes.

De Novo Cytomegalovirus Colitis in a Donor-Seronegative/Recipient-Seronegative Kidney Transplant Recipient.

Cytomegalovirus (CMV) is one of the most frequent microbes linked with kidney transplant recipients. CMV infection is typically classified as CMV virus isolation in any body fluid or specimen. We present a 43-year-old man who underwent a deceased donor kidney transplant with CMV donor-seronegative and recipient-seronegative (CMV D-/R-) status and completed three months of CMV prophylaxis with high-dose acyclovir given his low-risk status. He was admitted for complaints of profuse watery diarrhea and persistent fevers lasting one week in duration. His infectious workup led to a CMV quantitative nucleic acid amplification test (QNAT) polymerase chain reaction (PCR) of 239,977 IU/mL with a biopsy-proven diagnosis of invasive CMV colitis. He was treated inpatient with intravenous ganciclovir for two weeks and then de-escalated to oral valganciclovir until achieving viremia resolution with undetectable CMV QNAT PCR as an outpatient. This case illustrates the importance of the changing epidemiology and clinical presentation of CMV disease in solid organ transplant (SOT) recipients in an era of new immunosuppression regimens and improved CMV disease detection in the early post-transplant period.

Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae.

Cat scratch disease (CSD) is caused by a bacterial infection due to Bartonella henselae and is associated with young cats and kittens. CSD commonly occurs as regional lymphadenitis in the setting of subacute regional lymphadenopathy predominantly in children and young adults. The prognosis for immunocompetent patients is favorable with complete recovery, however, immunocompromised adults can progress to life-threatening complications such as neuroretinitis, osteomyelitis, and bacillary angiomatosis. B. henselae is transmitted from cats to humans through scratching or biting when located on the cat's claws or oral cavity. In 1% of diagnosed cases, patients developed this disease without ever receiving an animal scratch.  We present a case of a 29-year-old immunocompetent male developing severe right inguinal pain with concern for an incarcerated inguinal hernia. He reported exposure to a vaccinated six-month-old kitten but denied any recent scratches or bites. His infectious workup revealed right inguinal lymphadenitis on CT imaging and subsequent lymph node biopsy confirmed a diagnosis of CSD. He was treated with a short course of oral doxycycline for CSD and opioids for pain management. This case illustrates the importance of thorough complete history and physical taking even in immunocompetent patients and early recognition with prompt targeted treatment of Bartonella lymphadenitis to prevent unfavorable outcomes.

Varicella Zoster Aseptic Meningitis Presenting as an Atypical Mucocutaneous Eruption Involving All Three Divisions of the Trigeminal Nerve.

Herpes zoster involving all three divisions of the trigeminal nerve is extremely rare and may pose a diagnostic challenge, especially in young and immunocompetent patients. We present a unique case of herpes zoster involving all three divisions of the trigeminal nerve and illustrate that this uncommon eruption can be a presenting sign of varicella zoster aseptic meningitis. This case emphasizes the importance of fundamental morphology recognition, particularly its ability to aid in clinical diagnosis and its potential to decrease patient morbidity and mortality by expediting the initiation of appropriate treatment.