Dual intestinal parasitosis unmasked by treatment for gastrointestinal sarcoidosis.

The symptoms and complications of intestinal parasitosis can occur with long-term corticosteroid therapy. We highlight the case of a young man who developed chronic gastrointestinal (GI) symptoms of diarrhea, crampy abdominal pain, and vomiting while on treatment for multisystemic sarcoidosis with corticosteroids. His symptoms were initially thought to be related to the gastrointestinal manifestations of sarcoidosis, but further evaluation revealed a combined case of intestinal strongyloidiasis and giardiasis as well as previously undiagnosed human T-cell lymphotropic virus (HTLV -1) infection. This distinctive case of dual intestinal parasitosis highlights the need for clinicians to maintain a high level of awareness to screen for intestinal parasites, particularly Strongyloides when prescribing corticosteroids in the long term given the potential risk of hyperinfection in the setting of immunosuppression..

Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis.

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

Pneumocystis pneumonia causing cavitating lung nodules in an immunocompetent individual.

Pneumocystis jirovecii pneumonia (PCP) is a potential life-threatening pulmonary infection which commonly manifests in immunosuppressed patients especially with HIV, with underlying malignancies, severe malnutrition as well as those on immunosuppressive treatments. There have been case reports of symptomatic PCP in individuals with a normally functioning immune system with typical clinical features and radiologic findings of bilateral and diffuse interstitial opacities. However, PCP in immunocompetent individuals presenting with lung nodules had been rarely reported. We report a 53-year-old immunocompetent gentleman who presented with subacute cough, progressive shortness of breath and radiographic findings of multiple lung nodules with central cavitation. The diagnosis of PCP was made by detection of PCP DNA PCR in bronchoalveolar lavage sample following fibreoptic bronchoscopy. This case also highlights the atypical radiographic findings of multiple cavitating lung nodules as a presentation of PCP in an immunocompetent patient.