Year 2022, Volume 6 - Issue 5

Background: Bipolaris species are dematiaceous fungi that originally are plant pathogens but have been reported to cause a wide spectrum of diseases in both immunocompromised and immunocompetent human hosts. Case Presentation: We report a case of a young immunocompetent man who presented with fever, dry cough, and malaise. He had unilateral pleural effusion with mediastinal mass. Histopathology of pleura and mediastinal mass revealed granulomatous inflammation with fungal pseudohyphae. Tissue cultures grew Bipolaris species. He is on itraconazole with significant clinical improvement. Conclusion: This clinical presentation of Bipolaris infection has not been previously described. In Pakistan, where tuberculosis leuritis is frequently encountered, this case highlights that other rare causes of granulomatous pleuritis can also present in a similar fashion.

Background: Lyme disease is a common parasitic disease that can cause varied and potentially serious manifestations. The recommendations for treating some manifestations of Lyme are based on low-quality evidence, including for myocarditis. Treatment guidelines vary and are based on very low-quality evidence. IV ceftriaxone is typically recommended until the heart block resolves. Case Presentation: We report a case of a 31-year-old male admitted to our inpatient service with syncope and bradycardia. He was diagnosed with a third-degree heart block from Lyme disease. He was started on IV ceftriaxone, and his heart block improved. He had an ongoing second-degree atrioventricular block when he requested to be discharged on oral antibiotics rather than continuing IV ceftriaxone. Our patient received four doses of ceftriaxone before discharging from the hospital. He completed 2 weeks of oral doxycycline after discharge. In a follow-up phone call, he reported complete resolution of symptoms. Conclusion: This case supports the current Infectious Disease Society of America guideline of using intravenous ceftriaxone followed by oral doxycycline after the patient has improved. It also suggests that it may be safe to shorten the period of intravenous antibiotics and hospitalization. Shortening this period would reduce expenses and be more convenient for patients. More research is needed on the duration and preferred agent for treating the complications of Lyme.

Background: Pulmonary sequestration (PS) is defined as nonfunctional tissue within lung, has separate arterial supply from lung itself and does not have any communication with the tracheobronchial tree. PS is divided into two types which are intralobar pulmonary sequestration (ILS) and extralobar pulmonary sequestration (ELS). PS is a rare congenital malformation of the lungs which is composed of 0.15% to 6.4% of all congenital lung malformation. PS is commonly located in the left lobes and its incidence, especially the incidence of ILS, in the pediatric population is higher than in the adult population. Diagnosis of intralobar pulmonary sequestration which is in the right lower lobe in the third decade of life is a rare situation. We present a case of 37-year-old man diagnosed with ILS located in the right lower lobe which has its own arterial supply directly from descending aorta. This rare case was treated with right lower lobectomy just after the coil embolization of its arterial supply with the help of interventional radiology.