First Report of Fatal Disseminated Blastomyces percursus Infection in a Liver Transplant Recipient in Iran, a Non-endemic Country: A Case Report

Primary Cutaneous Aspergillosis Caused by Aspergillus fumigatus in an Immunocompetent Host: A Rare Case Report with Diagnostic and Therapeutic Insights

Blastocystis species in hepatic abscesses: innocent bystander or hidden culprit? A case report and literature review

The case of a 65-year-old man with a history of recent travel to a tropical country who was found to have multiple hepatic abscesses is presented and the clinical and microbiological picture was most consistent with amoebic liver abscess secondary to E. histolytica; however, the presence of Blastocystis species introduces uncertainty around its clinical significance.

Tintelnotia destructans invasive rhinosinusitis in an immunocompromised child: A case-report and review of the literature

Tintelnotia destructans is a recently described fungus within the family Phaeosphaeriaceae, previously reported only in superficial human infections such as keratitis, onychomycosis, and non-invasive sinus fungus ball. We describe the first case of invasive rhinosinusal infection due to this pathogen in a child with severe aplastic anemia. Diagnosis was established by histopathology showing submucosal fungal invasion and broad-range fungal PCR targeting 18S rRNA identifying T. destructans. Combined endoscopic surgical debridement, antifungal therapy (liposomal amphotericin B and isavuconazole) and immune reconstitution after emergency haplo-identical hematopoietic stem cell transplant ultimately led to complete recovery without recurrence 18 months after treatment, despite continued therapeutic immunosuppression for GvHD. This case expands the known pathogenic spectrum of T. destructans, demonstrating its potential to cause invasive disease in severely immunocompromised hosts. Advances in molecular diagnostic tools may expand the spectrum of fungi causing invasive fungal infections by identification of novel pathogenic species.

Disseminated Nocardia farcinica with multiple cerebral abscesses in a patient receiving induction immunosuppression for autoimmune hepatitis: case report

Background Nocardiosis is an opportunistic infection caused by aerobic, Gram-positive actinomycetes of the genus Nocardia that most often affects patients with impaired cell-mediated immunity, including those receiving corticosteroids or other immunosuppressive therapies. Disseminated disease frequently involves the central nervous system, where a systematic review reported an overall case fatality rate of 22.8%, and Nocardia farcinica is the most commonly identified species. We report a case of disseminated Nocardia farcinica with multiple cerebral abscesses in a patient receiving induction immunosuppressive therapy for autoimmune hepatitis. Case report A 55-year-old man with a history of autoimmune hepatitis and occupational soil exposure presented with 4–5 week history of progressive cognitive impairment, dysarthria, and right upper extremity weakness. Two months earlier, he had been treated with high-dose corticosteroids and azathioprine and prescribed trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, which had been interrupted for an estimated 2–4 weeks before presentation during ongoing corticosteroid therapy. Upon admission, laboratory tests demonstrated neutrophil-predominant leukocytosis with lymphopenia, and liver function tests showed substantial improvement compared to his initial presentation of autoimmune hepatitis. Neuroimaging revealed multiple ring-enhancing intracerebral lesions with surrounding vasogenic edema. Stereotactic aspiration of a cerebral abscess and drainage of a concurrent retroperitoneal collection grew Nocardia farcinica, confirming disseminated nocardiosis. Antimicrobial therapy was transitioned to imipenem-cilastatin and TMP-SMX based on susceptibility testing. During infection management, azathioprine was paused, and prednisone was continued at a dose of 25 mg/day, followed by a biochemical autoimmune hepatitis flare requiring hepatology-guided monitoring. The patient demonstrated gradual neurologic improvement and was discharged to inpatient rehabilitation after an 18-day hospitalization. Conclusion Disseminated nocardiosis should be considered for immunosuppressed patients with autoimmune hepatitis presenting with subacute neurological decline and ring-enhancing brain lesions, particularly during outpatient immunosuppression transitions when antimicrobial prophylaxis may be interrupted or incompletely reconciled. The patient demonstrated progressive neurological improvement and radiographic abscess reduction after 3 months of susceptibility-guided combination therapy, reinforcing the importance of early tissue diagnosis and neurosurgical intervention in this population.

Disseminated Phaeohyphomycosis Due to Alternaria alternata in a Liver Transplant Recipient: Successful Treatment With Isavuconazole, a Case Report and Literature Review

Phaeohyphomycoses are a heterogeneous group of diseases caused by several genera of pigmented fungi, also called dematiaceous fungi. These organisms are increasingly recognized as emerging opportunistic pathogens in immunocompromised patients, particularly solid organ transplant recipients. Among them, Alternaria is the most frequently associated genus, with clinical manifestations ranging from superficial to disseminated infections. Treatment options are limited and often complicated by toxicity and drug interactions, particularly in the posttransplant setting. We report what is, to our knowledge, the first case of disseminated alternariosis in a liver transplant recipient in Uruguay, successfully treated with isavuconazole. This case highlights the importance of early recognition and tailored antifungal therapy in transplant patients presenting with unusual cutaneous and pulmonary manifestations.

A case report of a patient with chronic granulomatous disease complicated by invasive aspergillosis and disseminated Burkholderia multivorans infection

Chronic granulomatous disease (CGD) is a rare inborn error of immunity characterized by defective phagocyte oxidative burst, leading to recurrent, life-threatening infections with catalase-positive bacteria and fungi. Co-infections with Aspergillus and Burkholderia species in CGD are exceedingly rare and often fatal due to synergistic pathogenic mechanisms and limited therapeutic options. We report a fatal case of X-linked CGD in a 14-year-old male with a history of recurrent infections, who presented with severe pneumonia, respiratory failure, and profound growth retardation. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) identified Aspergillus flavus complex, Burkholderia multivorans , and subsequent cultures confirmed disseminated B. multivorans infection and invasive aspergillosis. Whole-exome sequencing revealed a novel missense mutation, c.1514T>A (p.Leu505Gln), in the CYBB gene, predicted to result in loss of NADPH oxidase function, which is consistent with the severe infectious phenotype observed. Despite aggressive antimicrobial therapy and intensive supportive care, the patient developed refractory septic shock and multiorgan failure, and died on day 14 of hospitalization. This case underscores the lethal potential of concurrent Aspergillus and Burkholderia infections in X-linked CGD and highlights the critical importance of early diagnosis, which can be achieved through functional assays such as the DHR test or NBT test, followed by genetic confirmation when available. The novel CYBB mutation expands the known genotype-phenotype spectrum of severe X-CGD. Prompt recognition of primary immunodeficiencies in children with recurrent infections caused by typical pathogens is essential to enable timely prophylaxis and curative interventions such as hematopoietic stem cell transplantation before irreversible infectious complications occur.