Rare co-existance of disease or pathology Background: Histoplasmosis results from the inhalation of spores from the fungus, Histoplasma capsulatum. A case is presented of pulmonary histoplasmosis associated with altered mental state and hypercalcemia following allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia (AML). Case Report: A 75-year-old man with a five-day history of AML treated with allogeneic hematopoietic stem cell transplantation, presented with weakness, fatigue, and slow mentation. Computed tomography (CT) of the brain was unremarkable. Laboratory investigations showed serum albumin of 2.9 g/dL, calcium of 11.6 mg/dL, ionized calcium of 1.55 mmol/L, parathyroid hormone (PTH) <6.3 pg/mL, and 25-hydroxy vitamin D of 14.4 ng/mL. Treatment began with intravenous cefepime 1 gm bid, normal saline, and the bisphosphonate, pamidronate, administered as a single dose. Three days later, his clinical status declined. He developed a dry productive cough, his oxygen saturation (O 2 Sat) was 90%, and his mental status worsened. Chest CT showed diffuse bilateral lung infiltrates with ground glass opacities. Bronchioalveolar lavage and transbronchial biopsy were negative for Pneumocystis jiroveci pneumonia (PJP). The CMV viral load was 195 IU/mL. Urinalysis for Histoplasma antigen and the Fungitell ® assay were positive. Treatment commenced with intravenous voriconazole (250 mg, bid) and ganciclovir (5 mg/kg, bid). A left lower lobe transbronchial lung biopsy was positive for Histoplasma capsulatum and negative for CMV. Conclusions: This case report has highlighted the need for awareness of the diagnosis of histoplasmosis in patients with allogeneic hematopoietic stem cell transplantation who present with an altered mental state in the setting of hypercalcemia.

Patient: Male, 68Final Diagnosis: Echtyma gangrenosumSymptoms: Abdominal discomfort • fever • genital ulcerMedication: —Clinical Procedure: Antibiotic treatmentSpecialty: Infectious DiseasesObjective:Rare co-existance of disease or pathologyBackground:Ecthyma gangrenosum is an uncommon cutaneous infection commonly caused by Pseudomonas aeruginosa affecting typically immunocompromised patients. The presence of ecthyma gangrenosum can be associated with severe systemic infection often with a fatal prognosis. Most cases of ecthyma gangrenosum occur around the axilla, buttocks, and limbs; the scrotum is rarely affected.Case Report:A 68-year-old male with previously diagnosed acute myeloid leukemia, presented with left scrotal pain, fever, and rigors. Physical examination showed 2 ulcerating lesions with central black eschars surrounded by erythematous halos on the superior aspect of the left scrotum. Diagnosis of ecthyma gangrenosum was confirmed as both blood and lesion cultures showed growth of P. aeruginosa. After early empiric antibiotic treatment, the lesions significantly improved, and no sign of recurrence or new lesions was noticed.Conclusions:Ecthyma gangrenosum should be considered in the differential diagnosis of ulcerating lesions of the scrotum. An early diagnosis and aggressive antibiotic treatment are imperative for resolution of this infection.

Background. Coronavirus 2 (SARS-CoV-2) is the virus associated with the coronavirus disease (COVID-19) causing a pandemic worldwide in 2020. There are other noninfectious diseases that can present exactly as COVID-19, and the management and approach are completely different, hence the importance of understanding and having a wide differential in patients presenting with similar characteristics. Case Report. A 23-year-old male, with a history of childhood asthma, presented to the Emergency Department in a hospital in south Florida in the USA with complaints of a 2-day duration of subjective fever, chills, dry cough, dyspnea, and myalgia. His vital signs were blood pressure 135/65 mmHg, temperature 39°C, pulse 134 bpm, respiratory rate 22 breaths per minute, and saturation of oxygen 96% in room air. Laboratory analysis was significant for white blood cells 15.3 × 10 3 /μL, ALT 69 U/L, AST 66 U/L, ferritin 375.6 ng/mL, C-reactive protein 27.70 mg/dL, and procalcitonin 1.43 ng/mL. A respiratory pathogen panel (RPP) and a SARS-CoV-2 test were both negative. The patient was given empiric antibiotic treatment and hydroxychloroquine. Two more tests for SARS-CoV-2 were negative, and the patient reported that he smoked marijuana through an e-cigarette. The patient was started on high-dose steroids, and symptoms improved. Conclusion. COVID-19 is an emergent lung disease that is affecting the population worldwide; many other noninfectious diseases can mimic its presentations and laboratory characteristics; the importance of having a broad differential diagnosis especially in causing confusion during pandemic times is valuable in the management of patients with such presentations, such as EVALI, and glucocorticoids will be indicated in this circumstances.