A man in his 60s with insulin-dependent type 2 diabetes mellitus presented with concerns of fever, lower abdominal pain and generalised weakness shortly after returning from Caribbean travel. Imaging demonstrated emphysematous aortitis involving the infrarenal abdominal aorta, with associated penetrating aortic ulcer and pseudoaneurysm. Concurrent blood cultures confirmed an infection with Salmonella species. The patient's emphysematous aortitis was successfully treated by vascular surgery via an emergent surgical resection of the infected vessel and aorto-biliac reconstruction with a cryopreserved homograft. The patient was hemodynamically stabilised and consequently discharged with continued outpatient pharmacological management of Salmonella typhi infection with a 6-week course of intravenous ceftriaxone and subsequent lifelong amoxicillin-clavulanate suppression. On 3-month follow-up, imaging demonstrated interval postprocedural changes of prior aorto-biliac endograft placement, with a dissection flap in the infrarenal aorta that resolves just proximal to the aortic bifurcation. Aortic infections are rare and have a high rate of mortality, even with both pharmacologic and non-pharmacologic interventions. This case demonstrates the importance of recognising emphysematous aortitis, an aortic infection, on CT imaging and initiating prompt surgical and antimicrobial management.

Scrub typhus, caused by the obligate intracellular bacterium Orientia (O.) tsutsugamushi, is an under-recognized cause of febrile illness in travelers returning from endemic regions of the Asia-Pacific. We report the case of a 39-year-old woman who presented with high-grade fever, headache, and hepatitis with coagulopathy following travel to Vietnam. Her condition deteriorated rapidly progressing to sepsis. Laboratory investigations revealed hemolysis with mild anemia, thrombocytopenia, as well as markedly elevated liver enzymes and inflammatory markers. Computed tomography demonstrated extensive bilateral pulmonary infiltrates and pleural effusions consistent with a clinically impending acute respiratory distress syndrome (ARDS). A positive polymerase chain reaction (PCR) for O. tsutsugamushi from EDTA blood confirmed the diagnosis. The patient improved under the empirically initiated doxycycline therapy. This case highlights the importance of considering scrub typhus as a potentially life-threatening yet treatable cause of febrile illness in travelers returning from endemic regions. Given its diverse clinical manifestations and lack of coverage by beta-lactams that are usually applied for empirical sepsis therapy, heightened clinical awareness and timely diagnostic testing are crucial - particularly in the context of expanding endemic areas and increasing global mobility.

During September 2025-January 2026, 111 travellers (61 female/50 male; median age: 53 years) who acquired chikungunya virus (CHIKV) in Cuba were reported to GeoSentinel. Upon return, 64.2% (70/109) were potentially viraemic. Only 8.2% (9/98) had received pre-travel consultations. The CHIKV was of East-Central-South Africa genotype, closely related to Brazilian strains. International travellers can serve as arboviral outbreak sentinels and, if viraemic, risk introducing CHIKV into areas with established Aedes spp. vectors. Their effective surveillance can trigger adequate public health responses.

We describe the case of a 48-year-old Belgian woman who developed fever, dry cough and dyspnoea shortly after returning from a two-week trip to Suriname. CT scan of the thorax revealed 2 nodular masses with surrounding ground glass alterations in the right lung as well as multiple hilar and mediastinal lymphadenopathies. Bronchoscopy with broncho-alveolar lavage and endobronchial ultrasound-guided transbronchial needle aspiration of thoracic lymph nodes were performed. Broncho-alveolar lavage fluid showed no abnormalities, including a negative PCR for Aspergillus spp., and negative cryptococcal and galactomannan antigen tests. (1→3)-β-D-glucan determination on serum was also negative. Pathological analysis of all punctions showed granulomatous lymphadenitis and the presence of small, rounded structures on Grocott's staining. Fungal identification by targeted nanopore sequencing on lymph node tissue resulted in a weak but specific signal for Histoplasma capsulatum. Our case illustrates the diagnostic value of next-generation sequencing for a rare fungal disease.

A man in his early 30s presented with fever, widespread pruritic rash and deranged liver function tests shortly after returning from a religious pilgrimage. Initial assessment focused on infectious and travel-related causes given recent international travel. Investigations revealed marked eosinophilia, lymphocytosis and a mixed hepatocellular-cholestatic liver injury. Extensive viral, parasitic and autoimmune testing was negative. Despite partial symptomatic improvement following cessation of recently initiated allopurinol, the patient developed progressive eosinophilia and new lymphadenopathy. Multidisciplinary review supported a diagnosis of drug reaction with eosinophilia and systemic symptoms (DRESS), with allopurinol identified as the most likely culprit. Oral corticosteroid therapy led to rapid clinical and biochemical improvement, with normalisation of eosinophil count and liver function prior to discharge. This case highlights the diagnostic challenge of drug hypersensitivity reactions in the context of recent travel and emphasises the importance of early medication review in patients presenting with fever, rash and organ dysfunction.

Fever in the returning international traveler presents a diagnostic challenge in the emergency department due to the wide range of potential infectious diseases that may be encountered abroad, many of which may manifest with nonspecific presentations. Malaria remains the most common and life-threatening tropical cause of fever and must be ruled out in all febrile patients returning from malaria-endemic regions. Other key infections to consider in returning travelers include dengue, enteric fever, and leptospirosis. Early recognition and treatment of these diseases can reduce morbidity and mortality and may help contain disease outbreaks. This review presents a structured, systematic approach to the timely evaluation of fever in returning international travelers, including evidence-based recommendations for the diagnosis and treatment of malaria, dengue, enteric fever, and leptospirosis.

Coccidioidomycosis is endemic to the Western Hemisphere and is rarely encountered in Asia, including Thailand. A detailed history, particularly of prior travel to endemic areas, is critical in refining the differential diagnosis and considering coccidioidomycosis.Here, we report an early adolescent male who presented with fever, non-productive cough and pleuritic chest pain of 1 month's duration. Radiologic findings were suggestive of pulmonary tuberculosis. Antituberculosis therapy was started, but there was no clinical improvement. However, on specific questioning, we learned that he had recently returned from Los Angeles, USA, before the onset of the illness. Hence, pulmonary coccidioidomycosis was suspected based on his travel history to an endemic region and the recognition that its clinical presentation can closely mimic tuberculosis. The diagnosis was confirmed by the results of pathology, cultures and molecular methods of transbronchial lung biopsy specimens. The patient gradually improved after fluconazole treatment.

Leptospirosis is difficult to diagnose because of protean nonspecific clinical manifestations and the lack of rapid, actionable laboratory testing. A previously healthy woman who presented with nausea is described in the present study. She had modestly elevated liver function tests, an unusual pretibial rash, and no fever. She had recently swum in a waterfall in Costa Rica. After the clinicians proposed a leptospirosis diagnosis to the patient, an artificial intelligence program was selected for use by the clinicians to enhance confidence in proposing a rare and unknown diagnosis. The program independently produced a differential diagnosis that led with leptospirosis. Presumptive doxycycline administration led to symptom resolution. Blood (but not urine) Polymerase chain reaction (PCR) test for the LipL32 gene and a novel antibody detection test confirmed leptospirosis. This case represents an unusual clinical presentation of leptospirosis, including the absence of fever, the presence of a pretibial rash, and isolated, mildly elevated bilirubin and transaminases as sole laboratory abnormalities, and highlights difficulties associated with making a rapid, actionable diagnosis.

Relapsing fever is caused by various species of Borrelia bacteria and is traditionally categorized into louse-borne relapsing fever (LBRF) and tick-borne relapsing fever (TBRF). The epidemiological patterns differ according to the vector: LBRF is typically linked to epidemic outbreaks, while TBRF usually presents with an endemic distribution. Even though TBRF is endemic also in the Mediterranean Basin, diagnosis is mainly incidental in migrants or visiting friends and relatives travelling from sub-Saharan Africa. We report a case of TBRF with aseptic meningitis caused by Borrelia crocidurae/duttonii/hispanica in a 46-year-old Senegalese man, diagnosed through blood smear examination performed during the diagnostic workup for malaria. Diagnosis of TBRF is still primarily based on the direct detection of spirochetes in blood smear, although novel molecular methods (PCR) have recently been developed. Awareness, especially in non-endemic areas, and a One Health approach are crucial. Such an approach should aim to monitor the spread of Borrelia species, their vectors, and animal reservoirs, as well as to study their interactions with the environment and climate.