BACKGROUND An ingested fish bone may cause bowel penetration and subsequent infection, and approximately 1% of such cases require emergent surgery. Moreover, infection and hemorrhage may occur when a penetrated fish bone migrates into surrounding organs or vessels. CASE REPORT A 79-year-old man ate grilled Japanese horse mackerel. Three days later, he developed abdominal pain and a sustained fever. Computed tomography detected a fully migrated scad bone embedded in the pancreatic uncus through a duodenal diverticulum, along with multiple pyogenic liver abscesses. Intravenous broad-spectrum antibiotic therapy was started for sepsis. Endoscopic removal was attempted but failed. Surgical removal was proposed, and the pancreas and duodenum were mobilized. Intraoperative ultrasonography revealed that the fully migrated scad bone had been removed from the pancreatic parenchyma and broken into 2 fragments during the surgical procedure. The 2 fragments were located in the third portion of the duodenum and the diverticular cavity, respectively. One fragment in the third portion was successfully removed by an intraoperative endoscopic maneuver. Postoperative endoscopic examination and imaging demonstrated that the other fragment in the diverticular cavity had passed spontaneously by bowel peristalsis. Intravenous antibiotic therapy with appropriate de-escalation was continued for 14 days. The multiple pyogenic liver abscesses disappeared, and the patient recovered from sepsis. CONCLUSIONS Pyogenic liver abscess caused by hematogenous spread is a serious infectious disease, and sepsis may be fatal. A migrated fish bone within an adjacent organ should be removed as soon as practicable because this retained foreign body may subsequently cause severe infectious complications.

Myiasis is a parasitic infestation caused by dipterous larvae and is an important diagnostic consideration in travellers returning from endemic regions with infected skin lesions. Paediatric cases present unique management challenges, particularly when invasive procedures or general anaesthesia are considered. We report a case of cutaneous myiasis with associated cellulitis in a toddler following travel to Gambia, caused by Cordylobia anthropophaga (tumbu fly). A novel non-operative approach using eutectic mixture of local anaesthetic cream was successfully employed to facilitate larval extraction, avoiding the need for surgical intervention. This case highlights a safe, effective and minimally invasive technique for managing paediatric cutaneous myiasis in an emergency department setting.

Previous Mendelian randomization (MR) studies have linked obesity and type 2 diabetes (T2D) liability to osteomyelitis and skin or soft-tissue infection, but the reproducibility of these associations across independent outcome biobanks remains uncertain. We conducted cross-biobank univariable MR and multivariable MR analyses using European-ancestry genome-wide association study summary statistics. FinnGen Release 13 osteomyelitis (2519 cases and 471,012 controls) was designated as the primary clinical outcome, whereas cellulitis (10,223 cases and 468,418 controls) served as a comparative infection outcome; UK Biobank (UKB)-derived outcomes were used for replication. Exposure instruments containing UKB participants were restricted to FinnGen analyses, while separate non-UKB instruments were used for replication and cross-biobank pooling. Inverse-variance weighting was the primary estimator, with instrument-strength, pleiotropy, directionality, influential-variant, and multivariable conditional-strength analyses used to assess robustness. In FinnGen, each 1-standard-deviation increase in genetically predicted body mass index (BMI) on the source-GWAS standardized scale was associated with osteomyelitis (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.33-1.93) and cellulitis (OR 1.50, 95% CI 1.37-1.63), while T2D liability was associated with osteomyelitis (OR 1.41, 95% CI 1.24-1.61). Using non-UKB instruments, BMI-osteomyelitis estimates were directionally consistent across FinnGen and UKB (pooled OR 1.38, 95% CI 1.13-1.67; I2 = 0%), whereas BMI-cellulitis was positive in both biobanks despite heterogeneity in magnitude (I2 = 78.1%). T2D liability was associated with osteomyelitis in FinnGen but was not supported in UKB univariable MR, with substantial cross-biobank heterogeneity (I2 = 84.8%); the corresponding UKB multivariable MR estimate was nominal. In multivariable analyses, BMI-cellulitis remained supported across datasets, whereas BMI-osteomyelitis estimates attenuated after adjustment for T2D liability. BMI-cellulitis showed the greatest reproducibility. For osteomyelitis, BMI showed a reproducible total association but weaker evidence after adjustment for T2D liability, whereas T2D liability was consistently associated with osteomyelitis in FinnGen but was not robustly replicated in UKB. These findings emphasize the importance of external replication and evidence grading when interpreting metabolic-infection MR associations.

Wiskott-aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency characterized by thrombocytopenia, eczema, and recurrent infections. Live vaccines, such as Bacillus Calmette-Guérin (BCG), routinely administered in tuberculosis-endemic regions, may cause severe complications in undiagnosed patients. We report a 2-year-old boy with genetically confirmed WAS who developed a rare BCG-related brain abscess. The patient initially presented with neonatal thrombocytopenia and eczema, followed by recurrent respiratory and gastrointestinal infections. Whole exome sequencing identified a pathogenic mutation in the WAS gene. During pre-hematopoietic stem cell transplantation (HSCT) evaluation, brain imaging revealed a large multiloculated right parieto-occipital abscess with significant mass effect. Surgical drainage was performed, and polymerase chain reaction confirmed Mycobacterium bovis (BCG strain). Antitubercular therapy was initiated. Severe thrombocytopenia complicated management and necessitated splenectomy. Although platelet counts improved and infection was partially controlled, HSCT was postponed due to active infection. The patient subsequently died following a severe COVID-19 infection. This case highlights the diagnostic and therapeutic challenges of BCG-related brain abscess in patients with WAS and underscores the importance of early genetic diagnosis, avoidance of live vaccines, and timely definitive treatment in primary immunodeficiencies.

A boy in late adolescence presented with fever, weight loss, mediastinal and retroperitoneal lymphadenopathy, and was diagnosed with extrapulmonary tuberculosis. His clinical course was complicated by drug-induced liver injury, a tubercular psoas abscess requiring percutaneous drainage. After this procedure he developed rapidly recurring chylous ascites requiring frequent large-volume paracentesis. Despite prolonged antitubercular therapy, ascites persisted. Magnetic resonance lymphangiography demonstrated leakage from retroperitoneal lymphatics into the right perinephric region together with non-opacification of the thoracic duct beyond the cisterna chyli, suggesting lymphatic obstruction secondary to healed tuberculous lymphadenitis. Conservative measures, including dietary modification and octreotide, were unsuccessful. The patient underwent intranodal lymphatic embolisation using a glue-lipiodol mixture, resulting in sustained resolution of ascites. This case highlights the complex lymphatic complications of tuberculosis and demonstrates the diagnostic and therapeutic value of advanced lymphatic imaging and embolisation in refractory chylous ascites.

Central nervous system (CNS) infections may cause sudden unexpected death when diagnosis is delayed or missed. We report a fatal case of Streptococcus pyogenes meningoencephalitis and systematically review postmortem investigations of fatal bacterial CNS infections. A 57-year-old woman was found dead at home after untreated otalgia, hearing loss, purulent otorrhea, low-grade fever, asthenia, and vomiting. Autopsy showed diffuse cerebral edema, subdural empyema involving the posterior fossa, and cerebellar tonsillar herniation. Histology demonstrated acute suppurative meningoencephalitis with vasculitic injury. Streptococcus pyogenes was isolated from purulent material collected from the empyema; toxicological analyses were negative. The systematic review followed PRISMA 2020. PubMed/MEDLINE and Scopus were searched from database inception to 22 August 2026. Sixty-two studies describing 68 fatal bacterial CNS infections were included. The included cases showed a broad spectrum of postmortem-confirmed bacterial infections, including meningitis, meningoencephalitis, ventriculitis, brain abscess, subdural empyema, rhombencephalitis, spinal meningeal involvement, and infectious vascular complications. Postmortem pathogen-directed testing included culture, histochemical stains, antigen detection, immunohistochemistry, PCR, sequencing, MALDI-TOF identification, or equivalent methods. Autopsy remains central to diagnosing fatal bacterial CNS infections. Integration of neuropathology with postmortem pathogen-directed testing improves pathogen identification, cause-of-death determination, reconstruction of the route and mechanism of death, and infectious disease surveillance.