This case report depicts a 39-year-old male with no significant past medical history who was admitted for fever of unknown origin and sepsis. He was then found to have Streptococcus intermedius bacteremia and pyogenic liver abscess. The treatment course was complicated by pleural empyema leading to readmission. The case presented here adds to the medical literature, where a clear underrepresentation has been noted, and outlines a unique case of S. intermedius liver abscess complicated by pleural empyema in a patient without significant medical history, risk factors, or typical physical exam findings.

Introduction: There are currently very few documented case reports of Aspergillus brain abscesses in the setting of persistent sinusitis symptoms and comorbid conditions of Type II Diabetes Mellitus and steroid treatment. Many cases of intracranial aspergillosis are secondary to a disseminated invasive Aspergillus infection or primary pulmonary aspergillosis. This case illustrates the importance and vitality of considering the rare but potentially lethal diagnosis of Aspergillus fumigatus brain abscess in the differential of persistent sinusitis, even in the absence of systemic symptoms. Case Report: A 73-year-old female with risk factors of Type II Diabetes Mellitus (T2DM) and steroid treatment presented to the hospital with persistent sinusitis symptoms lasting three months. She subsequently was diagnosed with Aspergillus brain abscess after bicoronal bifrontal craniotomy with pericranial flap. The patient was treated with voriconazole and amphotericin B for 3–6 months post-resection and follow-up with neurosurgery to monitor abscess reduction. She was admitted five more times after initial diagnosis for sequelae related to the brain abscess. The initial abscess did decrease in size but then began to worsen. The patient unfortunately passed away six months after initial presentation and diagnosis. Conclusion: Few cases of invasive rhino-orbito-cerebral Aspergillus brain abscesses secondary to Aspergillus sinus infections have been documented. If missed it can be lethal. Therefore, when a patient presents with persistent sinusitis, in the relevant context, Aspergillus brain abscesses are an important differential diagnosis that warrant consideration.

We present a novel case of de novo membranous nephropathy (DNMN) leading to transplant rejection in a 51-year-old female patient. The patient has a transplant history of two renal transplants for end-stage renal disease due to lupus nephritis. She had a prior unrelated, living donor kidney transplant that was subsequently replaced by a deceased donor kidney transplant due to graft failure. This patient's case is intriguing because DNMN is a rare cause of transplant rejection, and the literature demonstrates a scarcity of clinical examples. Interestingly, post-transplant DNMN has been suggested to be a separate disease from recurrent post-transplant MN and is associated with separate risk factors and diagnostic findings. As DNMN is considered a manifestation of antibody-mediated rejection, it should be treated with immunosuppressive therapy. As such, the presented case has received immunosuppressive therapy. In addition, DNMN is associated with humoral alloimmunity. Potentially other inflammatory processes (such as infection/potential UTI in our patient's case) could cause exposure to undetectable donor antigens on renal transplants leading to antibody-mediated rejection via DNMN.

A case of immunoglobulin A (IgA) nephropathy is presented here that demonstrates an unusual clinical presentation in multiple ways and is vitally important for clinicians to consider. The patient is a Hispanic female in her 7th decade of life that presented with nephrotic-range proteinuria without hematuria ultimately leading to a diagnosis of IgA nephropathy. After diagnosis, her clinical course was complicated by continued poorly controlled type II diabetes mellitus and hypertension, and ultimately her kidney disease progressed to chronic kidney disease IV and then end-stage renal disease requiring hemodialysis. Though IgA nephropathy predominantly presents as nephritic syndrome, it can also present as nephrotic range proteinuria and even rapidly progressive glomerulonephritis which should be considered even when the patient's ethnicity and age group carry a smaller risk.