Title: Necrotizing pancreatitis with invasive candidiasis and candidemia due to Candida albicans and pan-echinocandin-resistant Candida glabrata Submitted by: Laman Rahimli MD, Jon Salmanton-García PhD, Prof. Oliver A. Cornely MD, Jannik Stemler MD Institution: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany andUniversity of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany. Email: laman.rahimli@uk.koeln.de Date Submitted:  13 March 2023 History:  A 64-year-old man presented to the central emergency department (day 0) with weakness and loss of sensation in his left […]

A 58-year-old male presented to our health system’s walk-in orthopedic clinic complaining of worsening pain and swelling of the third 3rd digit of his left hand.

A 41-year-old man with past medical history of diabetes mellitus type II, osteomyelitis s/p right above knee amputation, myocardial infarction s/p AICD placement, and hypertension presented with a three-day history of worsening headaches, photophobia, fever, and right hip pain.

A 39-year-old female with a past medical history of HTN, morbid obesity, chronic rhinosinusitis, s/p bilateral functional endoscopic sinus surgery (FESS) 8 months ago, presented with a 2-month history of worsening frontal headaches, accentuated by standing position and were accompanied by altered sense of smell and nausea. 

A 70-year-old gentleman was admitted to a German Military Hospital in early January 2022 with multiple lacerations of the head and retrograde amnesia following a fall at his nursing home.

A 59-year-old man was admitted for orthotopic heart transplantation. His past medical history was notable for non-ischemic cardiomyopathy status post implantable cardiac defibrillator (ICD) and prior sternotomy for implantation of a left ventricular assist device (LVAD).

A 54-year-old man status post remote orthotopic heart transplantation for non-ischemic cardiomyopathy complicated by cardiac allograft vasculopathy was admitted for redo orthotopic heart transplantation. 

A 36 year old man presented with progressively worsening headache, associated emesis and new onset altered mental status a few days after being discharged following a prolonged and complex hospitalization for cocaine overdose.

56-year-old man was admitted to an outside hospital with fever, short of breath and hypoxia. COVID-19 was diagnosed in the emergency room. He was treated with remdesivir and dexamethasone along with ceftriaxone and azithromycin. 

A 59-year-old man was admitted to a different hospital in Maryland, USA in January 2021 with bilateral pneumonia and diagnosed with COVID-19

Case #5: COVID-19 and Pulmonary Aspergillus

66-year-old white male admitted to the hospital for COVID-19 pneumonia with a two-week history of worsening shortness of breath, fevers, myalgias, anosmia, nausea and poor oral intake.

Case #4: Covid-19 and Candidemia

 A 63-year-old male who was transferred from an outside Hospital for acute hypoxic respiratory failure secondary to COVID-19 initially to the regular hospital floor service then later to the medical intensive care unit (MICU) within 24 hours of arrival. For 10 days prior to admission the patient has been experiencing generalized body aches, subjective intermittent fever with associated cough and progressively worsening shortness of breath. 

78 yo male, COVID+, worsening SOB. Recent hx: Transferred from OSH for worsening SOB, +CoVID 8 days prior to transfer.

Case #2: COVID-19 and Aspergillosis.

50-year-old male, shortness of breath, dry cough, fever and worsening hypoxia

 Case #1: COVID-19 and Pulmonary Aspergillus.

63-year-old male, presents with shortness of breath and positive SARS-CoV 2 (Covid).

A 66-year-old woman presented with exertional dyspnea, leg edema, pretibial skin hemorrhages and subjectively perceived deterioration of her general condition. The medical history included hypothyroidism. The peripheral blood analysis at admission to hospital showed pancytopenia (Hgb 8.4 g/dl, WBC 3.03 x 10*9/l, platelets 28 x 10*9/l) as well as the presence of 46% of blasts. The results of the bone marrow puncture on the following day confirmed the diagnosis of acute myeloid leukemia (AML). The baseline CT of the thorax five days after admission to hospital showed a small round focus within the right lower lung lobe.

63 year old male, presents with shortness of breath and positive SARS-CoV 2 (COVID-19).

A previously healthy 63-year-old male with no significant PMH presented to the emergency department as a level 2 trauma transfer from an outside hospital after sustaining a tree trunk injury to his left lower extremity earlier in the afternoon, resulting in significant swelling.

A 59-year-old man was admitted with five days of diffuse body pain involving shoulders, arms, legs, chest, and back associated with fatigue and generalized weakness.

A 70-year-old female with acute myeloid leukemia (AML) and prolonged neutropenia, status post 5 cycles of azacitidine and venetoclax, presented to the emergency department with two days of swelling around the left eye and progressively worsening pain of the eye, especially with eye movement.

60 yo white male has experienced largely non-productive cough for over 2 years. He reports occasional sputum production and streaky hemoptysis. Has severe DOE with 20 yds walking before becoming SOB.

A 48-year-old female with type 2 diabetes mellitus and stage IV diffuse large B cell lymphoma complicated by secondary hemophagocytic lymphohistiocytosis (HLH) was admitted to a tertiary care center for management of neutropenic fever.

A 59-year-old male in-patient developed persistent fever and cough after 11 days of neutropenia following two cycles of chemotherapy for Hodgkins Lymphoma. The patient’s Hodgkins Lymphoma developed as Richters-Transformation (RT) from an underlying Chronic Lymphocytic Leukemia (CLL). The latter was treated with ibrutinib as third line therapy until the diagnosis of RT. During in-hospital treatment, the patient developed a skin-lesion on the left lower leg and, simultaneously, fever and cough.

A 57-year-old male with hypertension and hypercholesterolemia underwent tissue aortic valve replacement for bicuspid aortic valve. Six months later, he presented to an outside hospital with sudden acute abdominal pain and lower extremity pain and weakness. He reported a four-month history of right neck pain, and two months of low-grade fevers, sweats, malaise and dysphagia. He was born in Mexico and migrated to the United States 14 years prior. He lived in an urban area of South Carolina and worked as a landscaper.

A 75-year old women presented with fever and an unproductive cough which had been present for seven days. She had chronic lymphatic leukemia which was currently successfully treated with ibrutinib for almost one year.

A 40-year-old man brought to the emergency department by the EMS with altered mental status of 4 days, hypothermia, an area of pain and swelling on his left hand.

A 23-year-old man with Stage IV nodular sclerosing Hodgkin’s lymphoma was admitted with fever and erythema of his left leg that had not responded to standard antibiotic therapy.

A 68 year old male was admitted for ultrasonic lithotripsy. He had developed chronic renal stones in the setting of suprapubic catheter placement for neurogenic bladder. Subsequent recurrent urinary tract infections were managed with trimethoprim-sulfamethoxazole suppressive therapy. Medical history was notable for multiple sclerosis, and diabetes mellitus managed with oral hypoglycemic agents.

A 65-year-old man with FLT3-mutated and complex aberrant karyotype acute myelogenous leukemia presented himself in the outpatient clinic for follow-up after allogeneic stem cell transplantation. The patients’ wife reported a slight character change and memory loss over a period of one week.