Afroditi Ziogou

Background: Polycystic liver disease is a genetic pathology characterized by the formation of numerous cysts in the liver. This case is notable for the rare presentation of isolated polycystic liver disease leading to secondary obstructive uropathy. Unlike the more common association with autosomal dominant polycystic kidney disease, this patient exhibited no evidence of bilateral polycystic kidney disease; the only renal finding was a solitary simple cyst in the contralateral kidney, considered an incidental finding, highlighting an unusual extrinsic mechanism of urinary tract obstruction due to massive hepatomegaly. In adults, polycystic liver disease often manifests as an extra-renal complication of autosomal dominant polycystic kidney disease. In rare cases, however, it may present solely as autosomal dominant polycystic liver disease without renal involvement. Case Presentation: In this study, we describe a patient with isolated polycystic liver disease, in whom marked hepatomegaly progressively compressed and displaced the kidney, obstructing the ureter at the pyeloureteral junction. Imaging studies, including abdominal ultrasound and computed tomography, confirmed the extent of cystic involvement and the resulting mass effect. This led to the gradual development of severe hydronephrosis, evident both on palpation and during clinical examination of the abdomen. Hydronephrosis, in turn, exerted pressure on adjacent organs such as the liver, pancreas, stomach, and large vessels, causing symptoms including abdominal distension, dysphagia, gastroesophageal reflux, early satiety, reduced mobility, as well as abdominal and lumbar pain. Conclusion: Clinicians should consider the possibility of mass effect complications in patients with isolated polycystic liver disease, as early recognition and intervention may help prevent severe secondary organ dysfunction.

Background: Candida albicans constitutes part of the normal human gastrointestinal (GI) microbiome(GM). Alterations inthe GM induced by antibiotics may disrupt colonization resistance and promote fungal overgrowth. This review summarizes the effects of antibiotics on GI C. albicans colonization in experimental animal models and humans. Methods: A narrative review was conducted using data from the PubMed/MEDLINE and Scopus databases. Studies evaluating changes in GI C. albicans populations following antibiotic administration in mice or humans were included. Results: Twenty-six articles met the inclusion criteria, comprising 16 murine and 10 human studies. Across all studies, antibiotics were consistently associated with increased GI C. albicans colonization. The greatest increases were observed with broad-spectrum agents with activity against anaerobic bacteria. Elevated fungal concentrations frequently persisted after treatment discontinuation. Human studies largely reproduced findings from murine models. Despite substantial increases in GI colonization, dissemination beyond the GI tract was uncommon. Conclusions: Available evidence demonstrates that antibiotic-induced disruption of the GM promotes GI overgrowth of C. albicans. Hence, C. albicans concentration can serve as an indicator of antibiotics’ impact on the GM. While increased colonization alone rarely results in invasive disease, antibiotic-associated yeast expansion may represent an important step in the pathogenesis of disseminated candidiasis.

Upper tract urothelial carcinoma (UTUC) accounts for approximately 5–10% of diagnosed urothelial carcinoma (UC). Due to advanced initial presentation or aggressive progression of UTUC, the majority of patients will need systematic treatment in the neo-adjuvant or adjuvant setting. The management of patients with UTUC is complicated due to the lack of published data and only limited studies addressing immunotherapy in UTUC patients are available. The perioperative scenario in localized high-risk disease is still evolving. For metastatic disease, two monoclonal antibodies targeting PD-1 (pembrolizumab and nivolumab) and three to its ligand PD-L1 (atezolizumab, avelumab and durvalumab) have obtained approval for the second-line treatment of platinum-pretreated patients. Atezolizumab and pembrolizumab are currently approved in the first-line setting for cisplatin ineligible patients, with PD-L1- positive tumors. The aim of this review was to highlight the role of immunotherapy in locally advanced and metastatic UTUC and provide the safety profile of these regimens.

Background/Objectives: Butyricimonas species constitute a genus of Gram-negative, anaerobic bacteria that are part of the human gut microbiota. Infections caused by these organisms are extremely rare in clinical practice. While uncommon in the general population, their occurrence is higher among immunocompromised individuals or patients with significant underlying health conditions. This review aims to compile and analyze all reported cases of human Butyricimonas infections, focusing on epidemiology, microbiological characteristics, antimicrobial resistance patterns, treatment strategies, and associated mortality. Methods: This review was conducted using data retrieved from the PubMed/MEDLINE and Scopus databases. Results: A total of 14 publications described Butyricimonas infections affecting 14 patients. The mean age of those affected was 66.46 years, and 10 (71.4%) were male. The most frequently reported predisposing factor was a history of malignancy, observed in almost one-third of cases (30.8%). Clinically, fever, organ dysfunction, and shock were the most common presentations (fivecases), followed by sepsis and the need for ICU in fourpatients. In vitro studies indicated that the isolates were generally susceptible to carbapenems and metronidazole, with only high resistance levels observed to penicillin. Among the antimicrobial therapies used, carbapenems were the most commonly administered (50%), followed by piperacillin/tazobactam (41.7%) and metronidazole (33.3%). The overall mortality rate across the cohort was 16.7%, with infection-attributable deaths representing 8.3% of cases. Conclusions: Given the potential of Butyricimonas species to cause severe infections, clinicians should consider this organism in patients presenting with unexplained bacteremia or intra-abdominal infections, particularly in the setting of mucosal disruption or immune dysfunction.

Nocardiosis is an infection caused by Gram-positive, saprophytic bacteria most often affecting immunocompromised hosts. The lungs, central nervous system, and skin are the sites most typically involved, although any organ may be affected. Skeletal involvement, particularly osteomyelitis, remains uncommon. This study is a review of all published cases of Nocardia osteomyelitis in humans, emphasizing epidemiology, microbiology, clinical features, management, and patient outcomes. A narrative review was performed using data from the PubMed/MedLine and Scopus databases. Fifty studies describing 55 patients were included. The median age was 54 years, and 65.5% were male. The main risk factors were immunosuppression (21.8%) and trauma (18.2%). The vertebrae constituted the most commonly affected site (25.5%), followed by the lower limb bones (20%); 23.6% had multifocal disease. Nocardia asteroides accounted for the majority of cases (34.8%). Trimethoprim-sulfamethoxazole was the most frequently administered agent (81.5%), followed by cephalosporins (29.6%) and carbapenems (27.8%). Overall mortality was 9.3%, with 5.6% of reported deaths directly attributed to the infection. Although uncommon, osteomyelitis due to Nocardia spp. should be considered when Gram-positive, filamentous microorganisms are detected in bone specimens, particularly in immunocompromised or post-trauma patients, as early suspicion and targeted therapy may improve survival.

Background: Exophiala spp. are dematiaceous fungi with opportunistic pathogenic potential and a widespread environmental presence. Clinical cases of Exophiala spp. fungemia are uncommon. Although rarely encountered in the general population, these organisms are increasingly reported in immunocompromised individuals or those with complex underlying health conditions. Objectives: This review seeks to examine all documented human cases of Exophiala spp. fungemia, with particular focus on aspects such as epidemiology, microbiological features, resistance patterns, therapeutic approaches and associated mortality rates. Methods: A narrative review was conducted using data sourced from the PubMed/MedLine and Scopus databases. Results: A total of 19 articles described infections in 32 patients involving Exophiala spp. fungemia. The mean patient age was 49.2 years, and 65.6% were male. Central venous catheters emerged as the leading predisposing factor (96.9%). Fever represented the most frequent clinical presentation (50%), followed by organ dysfunction (21.9%). The yeast generally demonstrated susceptibility to voriconazole and itraconazole. Voriconazole was also the most frequently administered antifungal (62.5%), followed by amphotericin (31.3%) and micafungin (28.1%). Overall mortality reached 34.4%, with 25% of deaths specifically caused by the infection. Conclusions: Given the potential of Exophiala spp. to cause severe fungemia, healthcare professionals, particularly clinicians and microbiologists, should consider this pathogen in the differential diagnosis when black yeast is detected in blood cultures, especially in patients with immunodeficiency or significant comorbidities, to ensure timely and accurate identification.

Background: Cryptococcus species constitute opportunistic fungi that seldom cause infections in individuals with competent immune systems. In the rare case of cryptococcal endocarditis, the fungus infiltrates the endocardium. This disease occurs almost exclusively in patients with active immunosuppression, implanted cardiac devices, or prosthetic valves. Objectives: This study aims to analyze all documented cases of Cryptococcus spp. endocarditis in humans, emphasizing the epidemiology, microbiology, clinical manifestations, therapeutic approaches, and infection outcomes. Methods: A comprehensive review was performed by searching the PubMed and Scopus databases. Results: A total of 16 studies reported data on 16 patients diagnosed with cryptococcal endocarditis. The mean patient age was 46.6 years, with males comprising 81.25% of cases. Immunosuppression was the most prevalent predisposing factor (31.25%), followed by a history of end-stage renal disease and prosthetic cardiac valves (25%). The most commonly affected intracardiac sites were the mitral (60%) and aortic valve (46.6%), while in 33.3% of cases, multiple-valve infection was observed. Cryptococcus neoformans was detected as the causative organism in the majority of cases (87.5%). The most frequently administered antifungal treatments included amphotericin B (87.5%) and fluconazole (43.75%), with combination therapy used in 62.5% of cases. Overall mortality was relatively high at 56.25%, with 50% of deaths directly attributed to the infection. Conclusions: Considering the ability of Cryptococcus spp. to induce severe systemic infections, healthcare providers should consider this pathogen in the differential diagnosis when yeast microorganisms are identified in microbiological samples. This is particularly crucial for patients with underlying comorbidities or immunodeficiency, as early recognition is crucial to ensure precise diagnosis and treatment.

Introduction: Wernicke Encephalopathy (W.E.) is an acute neurological disorder induced by thiamine deficiency. Alcohol abuse is considered to be the leading cause of the disease; however, numerous other conditions, such as malnutrition or cancer, have been identified as potential risk factors. Case Presentation: Clinical manifestations include a typical triad of mental status alteration, nystagmus, and ataxia and are attributed to damage in brain regions of high thiamine demand. The diagnosis is mainly clinical and further supported by the immediate response of neurological signs to parenteral thiamine administration. Among paraclinical examinations, brain MRI is considered substantial for diagnosis and is supported by the determination of thiamine blood levels. Conclusion: Non-alcoholic W.E. is trickier to diagnose due to its atypical clinical course and risk factors. We herein describe a case of non-alcoholic W.E. in a woman with colon cancer who gradually developed the classic symptoms of thiamine deficiency.

Background: Ovarian torsion comprises a challenging gynecologic emergency, predominantly concerning women of reproductive age and its occurrence during pregnancy is considered particularly demanding. Despite being characterized by non-specific clinical manifestations, the majority of cases typically present with acute abdominal pain. Pelvic ultrasonography provides useful preclinical information and remains an integral component of the diagnostic approach. Early diagnosis and surgical treatment are imperative in order to preserve ovarian viability and fertility, especially in women of reproductive age. Case Presentation: We herein report a rare case of ovarian torsion in a 24-year-old pregnant woman presenting with acute lower abdominal pain. Pelvic ultrasonography revealed a right ovarian mass as well as an absence of blood flow to the right ovary. Exploratory laparotomy confirmed the clinical suspicion of right ovarian torsion and oophorectomy was performed; histopathological examination revealed a corpus luteum cyst of the right ovary and confirmed the diagnosis. Following surgery, the patient miscarried. Conclusion: Ovarian torsion during pregnancy is a challenging condition that necessitates immediate medical intervention.

Background/Objectives: Primary gastric actinomycosis is extremely rare and only a limited number of cases are published in the literature. Actinomycosis is caused by anaerobic Gram-positive bacteria; these microorganisms are members of the normal human microbiome and occasionally lead to infection, especially in immunocompromised patients or patients subjected to abdominal surgery. Advances in personalized medicine, including tailored antimicrobial therapy based on individual patient profiles, may enhance treatment efficacy and reduce unnecessary interventions. Methods: A review was performed through a literature search of the PubMed/MedLine and Scopus databases. Results: A total of 27 patients were included, 15 males (55.56%) and 12 (44.44%) females, with a mean age of 55.11 ± 17.48 years. Among the included patients, 25.93% had a history of abdominal surgery. Abdominal pain (73.08%), weight loss (40.74%), nausea or vomiting (30.77%) and fever (19.23%) constitute the most commonly reported clinical manifestations. Endoscopy (59.26%), computed tomography (48.15%), ultrasonography (22.22%) and magnetic resonance imaging (11.11%) assisted in indicating the primary lesion. Diagnosis was achieved preoperatively in 66.66% of patients, via endoscopy and biopsy (51.85%) or via cultures (14.81%), while nine cases (33.33%) were diagnosed postoperatively. The therapeutic approaches included antimicrobial administration (32%), surgery (24%) or both (44%). The most widely used antimicrobial was penicillin (77.78%) and the mean duration of antimicrobial treatment was 5.85 months. The protocol for this review was registered in Prospero (ID:CRD42025649532). Conclusions: Due to the divergent clinical presentation of primary gastric actinomycosis, clinicians should be aware of this rare entity in order to establish diagnosis in a timely manner and provide prompt and effective treatment.