Splenic infarction as a complication in malaria is very sparsely reported despite having millions of cases of malaria every year. It appears to be an underreported complication and its recognition now can be attributed to the availability of better diagnostic and imaging modalities. It is important to look for splenic involvement in patients with malaria, especially in patients who complain of left hypochondrial pain as it might be associated with complications. Among the different species of malaria, like the case being reported here, it has been most commonly described with vivax malaria and outcomes have been almost always favorable with appropriate management of the infection.

We present the case of necrotizing pneumonia in a young patient without chronic comorbidities, who presented a torpid with subsequent death, highlighting in this case, subacute evolution, as well as the isolation of Staphylococcus epidermidis coagulase-negative resistant to vancomycin, acquired in the community, which finally resulted in a poor prognosis. The importance of the tomographic image is emphasized, as well as the evaluation for chest surgery, as it is important invasive surgical management or chest, coupled with broad-spectrum drugs according to targeted crops or pleuropulmonary expectoration secretions.

Hashimoto's encephalopathy is a controversial and under-recognized condition, associated with autoimmune thyroiditis. Presentation may be an insidious development of cognitive impairment or recurrent acute episodes of focal neurological deficit with confusion. Here, we present a case of middle-aged female that presented with headache, vomiting with alteration of sensorium and left side weakness and responded well to steroids. A negative microbiological screen of the cerebrospinal fluid (CSF) and serum along with raised CSF protein, elevated serum antithyroid antibodies, and characteristic electroencephalographic and neuroimaging findings yielded the diagnosis.

Strongyloides stercoralis is an intestinal nematode acquired primarily in the tropics, estimated to infect approximately 100 million people worldwide. Strongyloidiasis can be asymptomatic in many individuals or present in a variety of ways including acute infection, chronic infection, hyperinfection, and disseminated infection. We present a case where recurrent pneumonia was being evaluated and later found to be due to strongyloides hyperinfection syndrome and successfully treated with ivermectin. A 74-year-old female background of seasonal bronchitis, recurrent lower respiratory tract infections presented to us with Gram-negative bronchopneumonia which was treated but recurred after a few days. Investigations were ongoing for fungal infections when we picked up the S. stercoralis hyperinfection. In tropical regions, the regional prevalence of strongyloides infection may exceed 25%. Strongyloides hyperinfection describes the syndrome of accelerated autoinfection, generally the result of an alteration in immune status. Hyperinfection syndrome is estimated to happen in 1-2.5% of the patients with strongyloidiasis. Hyperinfections are often complicated, and gut flora gain access to extraintestinal sites, presumably through ulcers induced by the filariform larvae or by virtue of being carried on the surface or in the intestinal tract of the larvae themselves. Our patient did not have symptoms of strongyloides or reasons for immunosuppression. She only could have been immunosuppressed due to age or possible steroid use for seasonal bronchitis. We want to point out that strongyloides hyperinfection is a possible cause of recurrent Gram-negative pneumonia and sepsis. Parasitic infection screening must be done in all patients in our country who are admitted with severe sepsis.

Hemophagocytic lymphohistiocytosis (HLH) is an infrequent disorder occurring as a result of unrestrained immune activation. Tuberculosis (TB) is a catastrophic cause of secondary HLH if not treated appropriately. Here, we report an unusual case of secondary HLH associated with abdominal TB. Although rare, secondary HLH should be ruled out in patients with TB, especially in the presence of pancytopenia.

Cysticercosis is a preventable parasitic infection caused by the cestode (tapeworm) Taenia solium. In several countries of Africa, Asia, and Latin America, cysticercosis is endemic. In developed countries, cysticercosis is predominantly an imported disease or associated with poor regions and deprived sanitary resources. We present a case of a 94-year-old Spanish woman who was admitted to the emergency room due to a right leg trauma, edema, and superfi cial venous dilation of the same extremity. The patient came from a rural and remote area. With the suspected diagnosis of venous thromboembolism, x-ray and lower limb venous ultrasonography were performed, confi rming the presumptive diagnosis. As a casual fi nding, we discovered multiples “cigar-shaped” soft-tissue calcifications in both the legs and chest x-ray. Those fi ndings were compatible with muscular cysticercosis. The patient neither showed any symptom related to this pathology and nor were there neurological warning signs. Due to the age, basal conditions, and the family's request, no further studies or treatments were performed.

Neoscytalidium dimidiatum is a plant pathogen capable of causing infection in humans. The infections are generally indolent and found in the nails and skin. Corneal infection due to this fungus is rare. A case of keratitis caused by Neoscytalidium dimidiatum in an adult male resulting from trauma to the eye is reported.

Leptospirosis is one of the most common zoonotic diseases that are potentially fatal but it is quite under-diagnosed and under-reported. However, acute necrotizing pancreatitis, which is usually associated with high mortality rate, is a rare complication of leptospirosis. This is a report of leptospirosis case presenting with acute pancreatitis. A previously healthy 35-year-old male Indian farmer presented to the emergency department with chief complaints of high-grade fever, chills, and rigors but no rash for the last 3 days. There was no history of a cough, breathlessness, pain abdomen, vomiting, hemoptysis or hematemesis, altered sensorium, or burning micturition. There was no history of any addiction or previous hospitalization. Respiratory, cardiovascular and neurological system examination was normal. Leptospira IgM ELISA was undertaken on the 7 ^th day of admission, which was found to be positive. IgG negative and a Leptospira microagglutination test was also positive (at 1/200, Leptospira icterohemorrhagica) pyogenes. Severe leptospirosis may be fatal before IgM antibody is reliably produced; furthermore, leptospiremia may be difficult to detect due to negative serologic results and blood cultures. Therefore, repeat serology after the 1 ^st week of illness and empirical treatment prior to serologic results may be essential for improving outcome in patients with severe leptospirosis.

Tuberculosis (TB) is one of the known endemic diseases in this part of world; the most common organ involvement is lung. Among extrapulmonary involvements, tubercular lymphadenitis is the most common. Gastrointestinal TB is very uncommon, making up to 3.5% of extrapulmonary TB. Hepatosplenic TB with abdominal tubercular lymphadenitis is very rare form of TB, accounting <1%. We are describing a patient who had lymphoma-like presentation and at the end proved to be a rare form of TB.

Polymicrobial pneumonia may cause by combinations of respiratory viruses and bacteria in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection whereas the colonization by methicillin resistant Staphylococcus aureus coinfection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral coinfection and accounts approximately on 39% of microbiological diagnosed cases of CAP. The emergency of influenza virus H1N1 in 2009 caused the first pandemic in more than 40 years. Several studies found bacterial coinfection in a quarter and one-half of influenza infections, the pathogens more frequent isolates were S. pneumoniae and S. aureus mixed pneumonia in all patient groups. The high rate of viral bacterial infection in CAP, should suggest the consideration of new treatments, also during influenza season, the rapid detection of influenza virus (A or B) may allow physician the effective use of neuraminidase inhibitors within 36-48 h of symptoms onset, reducing the complication of secondary bacterial infection. On the other hand, prevention of mixed infection by influenza and pneumococcal vaccine should be addressed. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: No clinical signs or radiological findings help the clinician to suspicious the diagnosis. In this case series, we report five different cases of severe polymicrobial CAP: All of them required mechanical ventilation: Invasive the first two and noninvasive ventilation the last three cases.