A Case Series Demonstrating the Difficulties in Diagnosing COVID-19 Associated Pulmonary Aspergillus.

Many bacterial, viral, and fungal co-infections have been reported with COVID-19-associated acute respiratory distress syndrome (ARDS). Invasive Aspergillosis has been described with COVID-19 ARDS. However, it continues to evade diagnosis in critically ill patients admitted to the intensive care unit (ICU). The difficulty is discerning an actual infection from colonization. Unfortunately, a timely diagnosis is crucial since COVID-19-associated pulmonary Aspergillus (CAPA) has high morbidity and mortality. We present three ICU cases of CAPA to illustrate the difficulty in diagnosing and treating the disease. We hope to bring awareness and improve patient outcomes of CAPA.

Syphilis-Associated Proteinuria and Hepatitis in the Setting of Human Immunodeficiency Virus (HIV) Co-Infection.

Syphilis has long been known as "the great imitator", mimicking a wide variety of diseases, and often its diagnosis is delayed or missed. It remains an important public health issue that continues to occur at high rates among patients with HIV. We report a case of a 52-year-old man who presented with a constellation of unusual symptoms highlighting that syphilis should be included in the differential diagnosis in patients with HIV presenting with abnormal liver enzymes, rash, proteinuria, conjunctivitis, and/or sexual risk factors.

Mycoplasma pneumoniae-Induced Rash and Mucositis (MIRM) Mimicking Behçet's Disease and Paraneoplastic Pemphigus (PNP).

MIRM is an uncommon entity characterized by prominent mucositis, usually with sparse cutaneous involvement. The diagnosis of MIRM can be challenging due to the lack of awareness amongst clinicians. Patients with Behçet's disease usually present with recurrent and painful mucocutaneous ulcers, while other clinical manifestations of the disease are more variable. Here, we describe an interesting case of MIRM mimicking Behçet's disease and PNP highlighting the overlapping manifestations and diagnostic challenges.

Management dilemmas in restarting anticoagulation after gastrointestinal bleeding.

Systemic anticoagulants are widely prescribed to prevent and treat thromboembolism, among other indications. A common complication of using these agents is gastrointestinal bleeding. While early resumption of anticoagulants after the bleeding has resolved can increase the risk of rebleeding, delayed resumption puts the patient at increased risk of thromboembolic events and mortality. There is limited data on this topic to guide clinicians on resuming anticoagulation after hospitalization for gastrointestinal bleeding and to educate patients regarding the subsequent risks of recurrent gastrointestinal bleeding, thromboembolism, and mortality. The optimal time to resume anticoagulation is also unknown. This review summarizes the existing literature and available data on the commonly encountered dilemma of restarting anticoagulation therapy after hospitalization for gastrointestinal bleeding.

Calcium Carbonate (Tums)-Associated Hypercalcemic Crisis.

Hypercalcemic crisis due to severe decompensated hypercalcemia represents a life-threatening medical emergency leading to renal failure and altered mental status. Hypercalcemic crisis most commonly results from hypercalcemia of malignancy, undiagnosed primary hyperparathyroidism, granulomatous diseases, and medication-induced hypercalcemia. Commonly prescribed medications like thiazide diuretics, lithium therapy, and teriparatide are among the medications known to cause hypercalcemia. Here, we describe a case of the hypercalcemic crisis caused by excessive calcium carbonate ingestion emphasizing physicians to be aware of this potentially life-threatening adverse effect of a widely available over-the-counter acid reflux medication and educate patients regarding the same.

Actinomyces odontolyticus causing meningitis and cervical abscess.

Actinomyces spp. are filamentous gram-positive bacilli found in humans as a common flora of the oropharynx, gastrointestinal tract, and urogenital tract. Actinobacteria are normally present in the gums and are a common cause of infection in dental procedures and oral abscesses. To date, no cases of A. odontolyticus causing meningitis and cervical abscess have been reported in online databases. Therefore, we report the first case of A. odontolyticus meningitis and recurrent cervical abscess due to translocation from the oral cavity.

IgA negative immunofluorescence in diagnoses of adult-onset Henoch-Schönlein purpura.

We describe two cases of young adult men presenting with diffuse petechial rash and gastrointestinal disturbances. They were found to have leukocytoclastic vasculitis without immunoglobulin A findings under direct immunofluorescence on skin biopsy histopathology performed over a week after the appearance of lesions. Henoch Schönlein purpura (HSP) was diagnosed based upon the clinical presentation as well as the leukocytoclastic vasculitis biopsy findings.

Tick-borne disease (babesiosis).

Babesiosis is a tick-borne disease that shares the Lyme disease tick vector. Prompt microbiological smear examination and a parasitemia index guide further therapy. In severe cases with a parasitemia index >10%, exchange transfusion should be carried out quickly, along with administration of antibiotics, to prevent death and improve patient outcomes. A clinic follow-up should be advocated to check for relapse. Here we present a case of babesiosis requiring exchange transfusion.

Mycobacterium bovis epidural abscess following Bacillus Calmette-Guerin therapy for bladder cancer.

Bacillus Calmette-Guerin (BCG) is derived from attenuated Mycobacterium bovis. It is the most common intravesical immunotherapy for treating early stage bladder cancer. Pott's disease is a form of mycobacterial infection that involves the vertebrae. This case highlights an unusual presentation of epidural abscess infection with M. bovis following BCG therapy for bladder cancer.

Cardiovascular implantable electronic device infection with rapidly growing mycobacteria.

Cardiovascular implantable electronic devices, which are frequently utilized for many cardiovascular diseases, can become infected, leading to significant morbidity and mortality. This case highlights an unusual presentation of pacemaker generator pocket infection with Mycobacterium fortuitum.