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Brain stem encephalitis is an unusual form of CNS listeriosis that is associated with a high mortality. This is a case of a 46 year-old male with a history of dermatomyositis on methotrexate who presented with fever, headache, assymetrical cranial nerve palsy and right hemiparesis. MRI showed a ring-enhancing lesions in medulla oblongata. CSF cultures grew Listeria monocytogenes. Despite treatment with ampicillin and gentamicin, the patient developed three rare manifestations of neurolisteriosis namely rhombencephalitis, hydrocephalus and brainstem hemorrhage and did not survive. Early detection and treatment is vital in preventing adverse outcomes.We report a clinical picture of a mowed meadow pattern of the tongue in a 29-year-old sexually active man who has sex with men. The painful lesions also called "Plaques en prairie fauchée", occur in the context of the discovery of a postive HIV serology. NVP-CGM097 The diagnosis of secondary syphilis was confirmed by a positive syphilis serology (nontreponemal RPR test title of 64) and a positive Treponema pallidum PCR, amplifying the tpp47 gene, on a tongue swab. The lesions completely resolve with a penicillin treatment.A 56-year-old female with a history of poor dental hygiene and aortic insufficiency status post aortic valve replacement in 2015 presented with chest pain and fevers. She was found to have portal vein thrombosis, colitis, and infective endocarditis with aortic valve thickening. Blood cultures were positive for Actinomyces odontolyticus and Gemella morbillorum. Transesophageal echocardiogram was positive for aortic root thickening. Patient was treated with ceftriaxone and apixaban with full recovery.Primary cutaneous nocardiosis accounts for 5-8 % of all nocardiosis cases and represents a diagnostic dilemma among immunocompetent and immunocompromised hosts. Herein, we present a case of a 30-year-old male with history of psoriasis with recent addition of Apremilast. Patient received intralesional triamcinolone injections for psoriatic plaques on the hands and abdomen prior to traveling to warm climate vacation. While on vacation, patient developed hand swelling and painful, red nodules on the dorsal hands and abdomen, sites where he received intralesional injections. Patient was empirically given doxycycline, but continued to develop new nodules. An abdominal lesion was biopsied for H&E and tissue culture. Tissue culture revealed beaded gram-positive rods identified as Nocardia nova by MALDI-TOF. Patient was switched to trimethoprim-sulfamethoxazole with significant improvement. This case represents an atypical primary cutaneous nocardiosis with Nocardia nova most likely in the setting of intralesional steroid injections and possible contribution of Apremilast.

Paragonimus, is a globally distributed trematode, with human disease limited to endemic regions. It can be transmitted to humans through ingestion of intermediate hosts that are crustaceans. Most symptomatic infections consist of pulmonary disease, and in aberrant migration of immature flukes, extrapulmonary manifestations may occur. These presentations are relatively uncommon and may affect various organs with atypical Clinico-radiological pathologies that are often challenging to diagnose. Pericardial involvement has scarcely been reported before. Furthermore, the management, clinical outcomes and potential complications of this involvement remain unclear.

Our patient is a 31-year-old Nepalese male who presented with abdominal distension and lower limb oedema. Initial work up revealed pericardial effusion, and analysis was suggestive of exudative lymphocytic effusion. Supported by positive QuantiFERON result along with his demographic data, the patient was treated presumptively as a case of tuberculous her infectious aetiologies. Pericardial involvement is seldom reported in the literature and clinical suspicion should be raised particularly when dealing with atypical presentations and relevant demographic data.

Anaplasmosis is a tick-borne illness caused by

. A review of CDC reports showed an increase in Anaplasmosis, with 1,193 cases reported in 2009 compared to 5,672 cases reported in 2017, with the majority of cases between May and October. Neurologic manifestations are uncommon.

A 72-year-old male presented in August with acute left-sided weakness. Patient was found to have an acute kidney injury (creatinine 5.3 mg/dL), thrombocytopenia (platelet count 25,000/mL), and rhabdomyolysis (CPK 25,000 units/L). Workup for an acute stroke was negative. Peripheral blood smears showed

neutrophil inclusions in >30 % of the buffy coat prep. PCR testing was positive for Anaplasmosis. He was treated with doxycycline for 10 days, with improvement within 48 h. He was discharged home after a 13-day hospital course with no residual neurological deficits.A review of our medical system between January 1st, 2016 and December 31st, 2018 revealed 20 cases of Anaplasmosis. All cases presented between May and December and had fever of unclear etiology, but only our case presented with stroke-like symptoms. All cases involved people living in heavily wooded areas, with a mean age of 70 years.

The typical presentation of Anaplasmosis is a nonspecific febrile illness with leukopenia and thrombocytopenia. Although headache is common, stroke-like symptoms are a rare but known complication. Elderly and immunocompromised patients living in heavily wooded areas are at higher risk for Anaplasmosis. Delayed diagnosis was common (55 % of case review) and associated with worse prognosis.

The typical presentation of Anaplasmosis is a nonspecific febrile illness with leukopenia and thrombocytopenia. Although headache is common, stroke-like symptoms are a rare but known complication. Elderly and immunocompromised patients living in heavily wooded areas are at higher risk for Anaplasmosis. Delayed diagnosis was common (55 % of case review) and associated with worse prognosis.Multiple ring-enhancing lesions on brain MRI in an immunocompromised patient are frequently associated with opportunistic infections such as toxoplasmosis. In this report, we describe the case of a patient with HIV/AIDS who was found to having multiple ring-enhancing lesions and was diagnosed with a primary central nervous system lymphoma.