A 70-year-old woman presented to the emergency department with a 3-week history of prolonged fever, asthenia and anorexia, denying other symptoms. Physical examination was unremarkable and the patient admitted for further investigation. Initial laboratory testing showed leucocytosis, elevated C-reactive protein and cholestasis, without hyperbilirubinemia or cytolysis. Abdominal ultrasonography found no abnormalities. Viral serologies, autoimmune tests and blood cultures were collected for further investigation of causes of prolonged fever with hepatic involvement. After two days, Citrobacter koseri was isolated in blood cultures and intravenous (IV) piperacillin-tazobactam initiated. Computed tomography (CT) scan of the abdomen showed a left lobe hepatic abscess with gas and a linear hyperdense image, possibly a foreign body, piercing through the gastric antrum into the abscess. Surgical exploration was done for source control. The abscess was drained and the foreign body, a 3.5 cm long fishbone, was removed. The patient’s condition rapidly improved. Gastrointestinal perforation due to the ingestion of sharp and elongated foreign bodies usually occur in ileal loops, where the intestinal wall is thinner, causing extravasation of fluids and air into the peritoneum and typically presents with an acute abdomen. The uncommon location of perforation masked these symptoms leading to the unusual presentation with prolonged fever.Pyomyositis is an infection of the skeletal muscle that involves intramuscular abscess formation. It is typically caused by gram-positive bacteria, especially Staphylococcus aureus. Few cases of Escherichia coli pyomyositis have been reported in immunocompromised adult patients, while none have been reported in children. We present a case of a 4-year-old boy with Down syndrome who developed Escherichia coli pyomyositis. The patient presented to our hospital with a fever and right forearm swelling. The magnetic resonance imaging findings suggested pyomyositis of the right forearm muscle and osteomyelitis of the distal radius. Both the blood and puncture fluid cultures were negative. Cefazolin and vancomycin were administered, and his blood examination results and right forearm swelling improved; however, a slight fever persisted. The multiplex polymerase chain reaction isolated the chuA gene but not the YjaA gene; thus the patient was diagnosed with pyomyositis and osteomyelitis caused by Escherichia coli group D. The cefazolin was substituted with meropenem, and the vancomycin was discontinued. Thereafter, his fever promptly improved, which indicated that the cause of persistent fever was vancomycin drug fever. The patient was discharged after receiving 3 weeks of intravenous antimicrobial therapy, and recovered fully with no long-term sequelae. To the best of our knowledge, this is the first reported case of Escherichia coli pyomyositis in a child. find more The findings in this case suggest that Escherichia coli should be considered when choosing initial empiric therapy for pyomyositis, especially in children with underlying conditions.Japan has maintained measles elimination status since 2015. However, sporadic outbreaks of measles have been continuously reported. Here, we report a case of a measles-infected postpartum mother and infant in Japan. A 28-year-old Japanese woman, who had previously received a dose of the measles vaccination, experienced fever 5 days postpartum. Subsequently, a maculopapular rash appeared, and she was diagnosed with measles. Moreover, her baby developed a fever and maculopapular rash on the 13th day of life, 2 days after postexposure prophylaxis with intravenous immunoglobulin, and was also diagnosed with measles. Both showed full recovery. This case suggests that measles can still be a threat in a measles-eliminated country, and the administration of two doses of measles vaccination to women prior to childbearing age is crucial to protect newborns from measles.Streptococcal infections present in a variety of clinical syndromes. Invasive disease, such as infective endocarditis, was common in the pre-antibiotic era but is now seldom encountered. The author reports the case of an elderly man with pneumococcal tricuspid endocarditis presenting with fever and syncope, and reviews current literature regarding the epidemiology, clinical features and treatment of this condition.Cryptococcus neoformans is generally observed with immunosuppressive conditions. Rarely, it may be seen in immunocompetent individuals and presented with non-specific conditions. We described an immunocompetent case of cryptococcal meningitis presented with multiple cerebral infarcts. Despite the late diagnosis and emergence of hydrocephalus during treatment, the patient was recovered without any sequelae. In immunocompetent patients, the conventional diagnostics tests may be negative because of the low fungal load. If it is available, the Biofire FilmArray meningitis panel has high sensitivity and specificity for diagnosis.Sphyngomonas paucimobilis (S. paucimobilis) is a low-pathogenicity, gram-negative bacilli (GNB) that are previously known as an opportunist microorganism. Recent studies have shown that S. paucimobilis is an emerging pathogen causing various infections. Multidrug-resistant GNB has emerged as a major clinical and therapeutic dilemma in various hospital-associated infections. Although rare, S. paucimobilis could be associated with infective endocarditis (IE). Prosthetic valve endocarditis (PVE) is the most severe type of IE, which has high mortality rates despite diagnostic and treatment advances. We report a fatal case of early PVE associated with multidrug-resistant (MDR) – S. paucimobilis complicated with perivalvular abscess, complete heart block, valve detachment, and septic arthritis.Raoultella planticola is an uncommon gram-negative bacterium that has rarely been identified as the causative organism in severe infections. Few cases have been described and have included patients with pneumonia, urinary tract infections or cholangitis. Only one case has reported to involve a liver abscess, thought to be from a primary urologic source. We describe the case of a 73-year-old man with recently diagnosed hepatocellular carcinoma who developed multiple pyogenic liver abscesses. The abscesses were thought to have developed in the setting of recent transarterial chemoembolization leading to R. planticola bacteremia noted on admission. Treatment with ceftriaxone and metronidazole was initiated in addition to drainage of the abscesses, resulting in decreased size of liver collections and initial clinical improvement. R. planticola remains a rare infectious organism in severe infections affecting both immunocompromised and immunocompetent individuals. Our patient’s underlying malignancy and recent transarterial chemoembolization likely placed him at risk of liver abscess formation complicated by bacteremia and sepsis.