Olympia Akritidou

Background: Mucormycosis is an aggressive, angioinvasive mold infection that progresses rapidly and carries high mortality. Disease in non-classical hosts is readily mistaken for bacterial superinfection or the expected course of the underlying condition and the resulting delay in tissue biopsy and antifungal therapy may adversely affect outcome. Methods: We report a retrospective case series at a tertiary referral center in northern Greece over a seven-year period. Results: Nine patients (median age: 49 years, of whom 7 were male and 2 were female) with histopathologically confirmed mucormycosis were reviewed. Two previously healthy adolescents developed post-traumatic cutaneous disease and survived. Three patients reached craniofacial disease through the classic immunosuppressed route, one through poorly controlled type 1 diabetes, one through poorly controlled type 2 diabetes, and one through allogeneic transplantation for acute lymphoblastic leukemia (ALL). The remaining four developed infection on a background of barrier disruption or critical illness: two with major thermal burns (39% and 54% total body surface area), one with a cannulation-site eschar during high-dose corticosteroid therapy for dermatomyositis, and one intubated patient with prediabetes who developed forearm necrosis with local thrombosis. Rhizopus arrhizus predominated in the craniofacial and healthcare-associated cases, whereas the trauma and burn cases yielded a wider range of species. Liposomal amphotericin B (L-AmB) was the first-line agent in eight patients and one case with limited disease received isavuconazole monotherapy. Eight patients underwent surgery, ranging from debridement to orbital exenteration, maxillectomy, and in one case forequarter amputation. Eight of nine patients (89%) required admission to the Intensive Care Unit (ICU); among them, the median ICU stay was 37 days (IQR 7-57; range 2-123). Overall mortality was 67% (6/9). Conclusions: This series includes established metabolic and transplant-associated mucormycosis as well as trauma, burn, and healthcare-associated presentations. Only two patients had no documented systemic predisposition other than traumatic tissue disruption. While this small, heterogeneous patient sample cannot determine incidence, prognostic factors, or treatment effects, it may illustrate that this disease has the potential to affect patients beyond the classic host. Rapidly progressive necrosis or thrombosis should nevertheless prompt consideration of mucormycosis and tissue sampling for histopathology and culture.

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety.

Background and Clinical Significance: Acquired angioedema (AAE) is a rare and potentially life-threatening condition characterized by acquired deficiency of C1-inhibitor (C1-INH) resulting in hyperactivation of the classical complement pathway. AAE occurs in association with malignancies or autoimmune diseases. Infectious triggers are rarely encountered, and the underlying mechanisms have yet to be completely clarified. Case Presentation: This case involves a previously healthy 19-year-old male who was admitted with Mycoplasma pneumonia and oral ulcers, subsequently developing unilateral facial angioedema. Laboratory studies demonstrated reduced C4, decreased levels and activity of C1-INH, and reduced C1q, all consistent with acquired C1-INH deficiency. These findings were attributed to the presence of cold agglutinins, which are frequently observed in Mycoplasma pneumoniae infections. Following treatment with icatibant, a bradykinin B2 receptor antagonist, the patient’s angioedema resolved rapidly. An exhaustive workup found no evidence of underlying systemic disorders, and the patient did not experience any angioedema attacks following resolution of the infection. Conclusions: The presence of cold agglutinins, commonly associated with Mycoplasma infections, can precipitate a decline in C1-INH levels, resulting in complement pathway dysregulation. This disruption leads to an excess of bradykinin, followed by increased vascular permeability and localized edema.

Background/Objectives: Fungal endocarditis (FE), is a rare yet life-threatening disease, which predominantly affects immunocompromised individuals, prosthetic valve recipients, and injection drug users. The purpose of this review is to summarize the evolving epidemiological trends, diagnostic challenges, and treatment strategies, by identifying evidence that supports the optimal clinical approach. Methods: A literature search was performed, drawing from sources such as PubMed and Google Scholar and included articles published between January 2015 and March 2025. Clinical studies, case series, and meta-analyses reporting on FE epidemiology, diagnostics, or treatment were included. Results: The majority of FE cases is caused by Candida species, predominantly C. albicans, while Aspergillus accounted for a lesser percentage of cases. While blood cultures showed limited sensitivity, adjunctive diagnostic tools such as serum biomarkers (β-D-glucan, galactomannan) and advanced imaging modalities (18F-FDG PET/CT) are increasingly used to guide the diagnostic process. Early surgical intervention combined with antifungals improved survival, particularly for Aspergillus, although comprehensive data regarding this approach remains limited due to the rarity of the disease. Conclusions: Fungal endocarditis requires an aggressive treatment strategy, integrating early surgery, targeted antifungals, and long-term suppression, especially for prosthetic valves. Despite advances, the complexity of the condition and the variety of the pathogens involved, continue to impede progress towards effective management of FE. Future research must prioritize rapid diagnostics, standardized treatment protocols, and novel antifungals to address this critical condition.

Toxocariasis is a parasitic zoonosis caused by ascarid nematodes of dogs (Toxocara canis) or cats (Toxocara cati). Transmission to humans can occur in various ways, most commonly through the ingestion of infective embryonated eggs in soil or on vegetables or fruits and less frequently through ingestion of raw or undercooked meat contaminated with larvae. The disease manifestations span a broad clinical spectrum, ranging from asymptomatic seropositivity to severe systemic complications including sepsis and septic shock, with the presentation varying according to the affected organ systems. Cardiac involvement is a rare but potentially life-threatening complication and consists of myocarditis, pericarditis or Loeffler’s endocarditis (eosinophilic myocarditis). We present a case of eosinophilic myocarditis associated with Toxocara canis infection in a 54-year-old woman living in a rural area near the forest and provide a brief review of the literature.