A 56-year-old female patient with carcinoma of the pancreas on chemotherapy with gemcitabine, presented with a short history of fever, cough, and breathlessness. She was found to be hypoxic on admission and there were diffuse ground glass opacities with peripheral and basal sparing on high-resolution computed tomography (HRCT). Serum lactate dehydrogenase (LDH) and serum β-D-glucan (BDG) were high, and gomori methamine silver (GMS) staining from the throat gargle specimen showed typical cysts of Pneumocystis pneumonia (PCP). Therefore, she received treatment with trimethoprim/sulfamethoxazole (TMP/SMX) and steroids at first, which was later changed to primaquine + clindamycin in view of TMP/SMX-related toxicity. However, despite all measures, she succumbed to the illness. This case highlights the importance of PCP in immunocompromised hosts other than human immunodeficiency virus (HIV), the role of serum markers like LDH and BDG,⁶ and the use of throat gargle samples⁵ for microscopy and polymerase chain reaction (PCR). An unmet clinical need is a guide to prophylaxis, therapy, and adjuvant steroids in non-HIV patients.⁹

Cardiovascular manifestations of hypothyroidism include bradycardia, diastolic hypertension and increased peripheral vascular resistance. Pericardial effusion occurs in about 30% of hypothyroid individuals, but cardiac tamponade is rare because fluid accumulation occurs slowly, allowing the pericardium to stretch. Here we report a case of a young female who presented with cardiac tamponade, which on evaluation, was diagnosed as autoimmune thyroiditis. The patient was managed with emergency echocardiography directed pericardiocentesis and levothyroxine supplementation.

Yeasts such as Trichosporon are being increasingly reported in catheterized urine of hospitalized patients. However, guidelines to interpret their clinical significance are lacking. The following case highlights the need for research and evidence-based recommendations for the management of funguria, especially for Trichosporon in urine for critically ill patients with nonresolving sepsis. This is a case of metastatic carcinoma lung on immunotherapy, which developed nonresolving sepsis along with repeated isolation of Trichosporon from urine. Patient had shown clinical response only after treatment with voriconazole.

We hereby report the first case in the Indian subcontinent to the best of our knowledge of dual infection of disseminated histoplasmosis in an immunocompetent host with coronavirus disease 2019 (COVID-19) infection. We herein report a case of a 22-year-old COVID-19-positive immunocompetent male who presented with fever, breathing difficulty, pancytopenia, and skin exanthem. The bone marrow and skin biopsy established the diagnosis of disseminated histoplasmosis. The case was successfully treated with amphotericin and itraconazole. Diagnosis of opportunistic or coinfection infection in COVID-19 patients requires a high-index of suspicion, especially in immunocompetent patients.

Background: Despite recent advancements, patients with sepsis and septic shock continue to have high morbidity and mortality. Appropriate empiric antimicrobials form the cornerstone of therapeutic interventions and are vital for improving patient outcomes. Rare infections may sometimes complicate clinical diagnosis and make a choice of empiric antimicrobials challenging. Hence, recognition of rare infections and their antimicrobial susceptibility pattern is imperative for the management of such cases. Case description: Comamonas spp. are common environmental nonfermentative gram-negative bacilli that occasionally cause human disease. Human infections are not usually life-threatening. We present a case of bacteremia secondary to Comamonas testosteroni (C. testosteroni) in a 35 years old patient with chronic liver disease (CLD). Conclusion: Comamonas testosteroni (C. testosteroni) is an emerging human pathogen and may rarely cause sepsis and septic shock, especially in immunocompromised patients. The sensitivity pattern and choice of antibiotics need to be further evaluated for this rare infection, as early appropriate therapy may affect outcomes.

Introduction: Patients with scrub typhus usually present with constitutional symptoms and respond to the standard treatment. However, ongoing clinical deterioration warrants consideration for other associated conditions. Case description: Here, we describe a patient diagnosed with scrub typhus with rare but life-threatening immune dysfunction. Conclusion: Hemophagocytic lymphohistiocytosis (HLH) syndrome is due to an atypical immune response commonly triggered by infection. An alarm should be raised, and HLH should be considered in patients with scrub typhus who are nonresponsive to standard treatment. Quick and timely treatment had shown to have a better outcome. Hence physicians should be aware of this rare association and its management for better patient outcomes.

Introduction: Dengue is one of the commonest causes of fever in India. Also known as “break-bone fever” and “7-day fever,” dengue most often causes fever lasting for a few days, severe body aches, and thrombocytopenia. Although rare, viral infections, including dengue, can trigger another autoimmune, life-threatening condition called hemophagocytic lymphohistiocytosis (HLH). Clinical case: We describe one such case of dengue complicated by HLH, which was diagnosed and treated successfully. Conclusion: Diagnosis of HLH in the critically ill requires a high degree of suspicion, as it mimics sepsis, severe dengue etc. One clue to suspect HLH-complicating dengue is a recurrent fever after initial defervescence and a new fever occurring beyond 7 days of onset.

Fever of unknown origin (FUO) in the intensive care unit can often be elusive and lead to diagnostic dilemmas. It could be an uncommon presentation of a common disease or could be an index presentation of an uncommon disease. It requires a thorough history, physical examination, and syndrome-based diagnostic testing with a systematic approach. Catastrophic antiphospholipid syndrome (CAPS) presenting as FUO is rare, and we present here one such case report of a patient who presented to our center.