Mycobacterium szulgai is a rare, slow-growing non-tuberculous mycobacterium (NTM), accounting for less than 0.2% of NTM isolates worldwide. It most often presents with pulmonary disease resembling tuberculosis, while disseminated infection is exceptionally uncommon and typically occurs in immunocompromised hosts. We report a 34-year-old male newly diagnosed with advanced HIV infection who presented with painful cutaneous nodular lesions, intermittent fever, anorexia, and significant weight loss. Initial investigations suggested cutaneous nocardiosis or fungal infection, with cultures yielding Aspergillus niger and Corynebacterium species. Despite antifungal and antibacterial therapy, his condition progressed to multifocal cutaneous lesions, oral mucosal involvement, and osteomyelitis of the tibia and fibula. An extended microbiological evaluation of a bone biopsy revealed acid-fast bacilli, and cultures identified M. szulgai via rpoB gene sequencing and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). Further imaging and bronchoalveolar lavage confirmed disseminated infection involving lungs, skin, and bone. The patient was treated with rifampicin, ethambutol, and moxifloxacin in combination with antiretroviral therapy. After six months, complete resolution of cutaneous lesions, regression of pulmonary nodules, and normalization of inflammatory markers were achieved. Therapy was planned for 12-18 months. This case underscores the diagnostic complexity of disseminated M. szulgai infection in advanced HIV. Initial misinterpretation as nocardiosis or fungal disease delayed diagnosis, highlighting the importance of extended microbiological workup when conventional therapies fail. Definitive identification through molecular sequencing and MALDI‑TOF MS was crucial. The patient's favorable response to a rifampicin‑based multidrug regimen emphasizes the need for early recognition and prolonged therapy. This report contributes to the limited literature on disseminated M. szulgai and reinforces the importance of considering atypical mycobacteria in immunocompromised patients.

The oral cavity provides a unique ecological site that harbors a dynamic microbiota. Candida, Aspergillus, and Rhizopus are commensal oral fungi species. However, they may become pathological and cause opportunistic infections under certain conditions. The incidence of fungal infections has been on the rise in recent years, especially in COVID-19 patients, due to several factors such as immunodeficiency, hyperglycemia caused by diabetes mellitus, prolonged hospitalizations, and prolonged use of steroids, and hematopoietic malignancies. The advent of newer therapies for several diseases has also influenced the incidence of fungal infections. The diagnosis of oral fungal infection is mainly based on clinical presentation and histopathology of the lesional tissue. Characteristic features include a burning sensation and an unpleasant taste in the mouth, white plaques, ulcerations, erythema, and pain. The most common oral cavity fungal infections include candidiasis, aspergillosis, mucormycosis or zygomycosis, histoplasmosis, blastomycosis, cryptococcosis, paracoccidioidomycosis, and geotrichosis. The modalities to detect fungal organisms have also evolved to include rapid molecular tests like polymerase chain reaction (PCR). Prompt evaluation of oral lesions is essential to establish the diagnosis, initiate therapy, and monitor clinical progress. Management primarily involves maintaining proper oral and denture hygiene, evaluating and correcting predisposing factors, and selecting an appropriate antifungal agent. For some types of fungal infections, surgical debridement is indicated. Clinical assessment of oral lesions, recognizing and correcting the underlying predisposing factors, and administering appropriate antifungal agents are the cornerstones for managing oral mycoses. 

Sexually transmitted dermatophytosis caused by Trichophyton mentagrophytes genotype VII (TMVII) has recently emerged as a novel clinical entity, particularly within sexual networks. This pathogen is characterized by inflammatory genital lesions, diagnostic challenges, and increasing antifungal resistance. We report a case of genital dermatophytosis caused by terbinafine-resistant TMVII in a heterosexual woman following sexual exposure abroad. A 35-year-old otherwise healthy woman presented with a 3-week history of rapidly progressive, intensely pruritic genital lesions unresponsive to topical antifungal therapy. Clinical examination revealed well-demarcated annular erythematous plaques with central clearing and an active scaly border confined to the pubic and inguinal regions. Direct microscopic examination demonstrated fungal hyphae, and fungal culture identified Trichophyton mentagrophytes. Molecular analysis by PCR sequencing confirmed genotype VII. The patient denied animal contact or fomite exposure but reported unprotected sexual intercourse during recent travel to Turkey. Screening for sexually transmitted infections, including HIV, hepatitis B, and syphilis, was negative. Oral terbinafine therapy (250 mg/day for 4 weeks) was ineffective. Antifungal susceptibility testing confirmed biological resistance to terbinafine. Treatment was switched to oral itraconazole (100 mg/day for 4 weeks), resulting in complete clinical resolution without relapse. This case illustrates an emerging sexually transmitted dermatophytosis due to terbinafine-resistant TMVII. To our knowledge, no previous cases linked to travel to Turkey have been reported. The report highlights the importance of considering TMVII in patients presenting with inflammatory genital dermatophytosis, particularly when lesions are refractory to standard antifungal therapy. Early recognition, molecular confirmation, appropriate treatment, and partner management are essential to prevent further transmission of this emerging pathogen.

Talaromyces marneffei is an important opportunistic fungal pathogen closely related to acquired immunodeficiency syndrome (AIDS), and its infection is relatively rare in human immunodeficiency virus (HIV)-negative populations. Although HIV-related immunosuppression remains the main risk factor, the history of treated tuberculosis and subsequent structural lung damage may constitute an underrecognized predisposing condition in non-epidemic areas, especially in elderly patients. This report described a 69-year-old HIV-negative male pulmonary infection case from a non-endemic area of T. marneffei, with a history of treated pulmonary tuberculosis and residual fibrotic lesions on imaging. The patient complained of chest tightness and cough for one month and fever (temperature 38.0-38.5°C) for a week upon admission. The chest computed tomography (CT) scan observed patchy consolidation and multiple cavities in the upper lobes of both lungs, accompanied by pulmonary texture disorder and pleural adhesions and thickening. The imaging findings were difficult to distinguish from active pulmonary tuberculosis. The diagnosis of T. marneffei infection was confirmed through sputum culture, bronchoscopy sampling culture, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and metagenomics next-generation sequencing (mNGS). After diagnosis, the patient was given oral voriconazole 200 mg every 12 hours, resulting in gastrointestinal intolerance. Subsequently, the dosage was adjusted to 100 mg every 12 hours, and the gastrointestinal symptoms improved significantly. The patient was eventually discharged but subsequently lost to follow-up. The case emphasizes that among HIV-negative individuals in non-epidemic areas of T. marneffei, for patients with unexplained pneumonia, especially those who have a history of tuberculosis and other potential immunological impairments, the differential diagnosis approach should be broadened and modern diagnostic techniques should be actively applied. It also highlights the importance of addressing drug tolerance issues and implementing long-term follow-up management in clinical treatment.

Kaposi sarcoma (KS) is an angioproliferative disorder associated with human herpes virus 8 (HHV-8) infection. It has both cutaneous and extracutaneous manifestations. With extracutaneous manifestations, it most commonly involves the oral cavity, gastrointestinal tract, and regional lymph nodes. Visceral organ involvement other than the gastrointestinal tract, such as the liver, lungs, and bones, is extremely rare. Here, we would like to discuss a patient with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) found to have pulmonary KS manifesting as acute hypoxemic respiratory failure (AHRF), along with bilateral pleural effusions and endobronchial lesions confirmed on bronchoscopy. He was treated with corticosteroids and paclitaxel, with significant improvement in AHRF. Traditionally, corticosteroids have been associated with exacerbation of pre-existing KS and even development of new-onset KS in HIV-infected patients and induction of KS. The experience gained from this case report suggests that judicious use of corticosteroids may improve the outcome of pulmonary dysfunction in HIV/AIDS-associated KS patients.

T-cell non-Hodgkin's lymphoma (NHL) is a rare and aggressive malignancy with unusual oral manifestations. Its clinical diagnosis can be particularly challenging in HIV-positive individuals due to overlapping features with other HIV-associated lesions, such as Kaposi sarcoma or necrotizing periodontal conditions. We report a case of a 38-year-old HIV-positive man presenting with a rapidly enlarging mass in the left posterior maxilla. Clinical and radiographic findings were nonspecific, necessitating histopathological and immunohistochemical evaluation. Immunohistochemical analyses confirmed the diagnosis of T-cell NHL. This case highlights the importance of immunohistochemistry in accurately diagnosing atypical oral lesions, especially in immunocompromised individuals.

Anogenital warts (AGW) are a common manifestation of human papillomavirus (HPV) infection, primarily caused by strains 6 and 11. According to results, mucosal HPV is transmitted through sexual contact, with risk factors including immunodeficiency, such as Human Immunodeficiency Virus (HIV). Individuals with HIV experience a higher incidence of AGW due to impaired immune function that hinders HPV clearance. There is currently no specific antiviral therapy available for HPV, although several management options exist. However, some of these treatments may cause pain and discomfort. Glycyrrhizinic acid (GA) has demonstrated potential in managing HPV infection because of its antiviral properties and minimal side effects. Despite these promising results, GA is not yet recognized as a standard therapy for AGW. This case report describes the effectiveness of Glizigen[®] (topical GA) combined with Viusid[®] (oral GA) in managing genital warts in a 28-year-old homosexual male living with HIV. The patient, examined by a dermatologist at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, presented with perianal warts that had developed over 3 months. According to the physical examination carried out, multiple flesh-colored papules were reported, while histopathological analysis showed koilocytes, and polymerase chain reaction (PCR) confirmed HPV types 6 and 11. The treatment process, carried out using topical and oral GA, was administered from August to October 2024. The improvement was reported only in smaller lesions, while larger ones persisted, leading to electrocautery scheduling. The limited response observed in this case might be influenced by the patient's low CD4+ count, which potentially affects HPV clearance. Factors such as age, number of sexual partners, circumcision status, HPV type, and anatomical location of the lesions may also have played a role.

Herpes simplex virus (HSV) resistance is rare, but incidence is rising. Managing resistant HSV phenotypes in individuals living with human immunodeficiency virus (HIV) poses an increasing challenge. Here, we present two (2) cases where a short course of oral amenamevir (helicase-primase Inhibitor) for the treatment of thymidine analogue-resistant herpes simplex lesions.Case presentationsCase 1: 55-year-old Liberian man living with HIV presented with an enlarging, hypertrophic lesion on his inner thigh. This had been diagnosed as HSV-2 by PCR. Despite treatment with acyclovir, the lesion persisted. It had also failed to respond to topical therapies and cidofovir. Further molecular diagnostics showed that it was thymidine analogue-resistant HSV. A novel oral, anti-viral agent, amenamevir was used with success.Case 2A 37-year-old Ghanaian woman living with HIV presented with recurrent painful confirmed HSV-2 genital ulceration. Despite escalating treatment from acyclovir to cidofovir, the HSV lesions failed to respond. A seven-day course of oral amenamevir provided excellent resolution of the lesions.ConclusionThese two cases highlight the challenges in managing aciclovir-resistant herpes simplex lesions and the swift resolution following treatment with a novel therapeutic agent, amenamevir. Early recognition of resistant HSV lesions allows for prompt outsourcing of alternative, novel anti-viral therapies such as amenamevir.

Mpox, formerly monkeypox (MPXV), is a zoonotic virus that has emerged globally in recent times, disproportionately affecting immunocompromised individuals, particularly people living with human immunodeficiency virus (HIV) (PWH). PWH with advanced HIV and low CD4 counts are at higher risk for severe, prolonged courses and sometimes fatal Mpox infections, which may often be complicated by bacterial superinfections and opportunistic co-infections. We present a case of Mpox in a PWH with an initial CD4 count of 2 cells/μL and a high HIV viral load, who had worsening disease despite treatment with tecovirimat, raising the question of persistent/resistant Mpox. Further investigations revealed co-infections with Bartonella and Cytomegalovirus (CMV), adding to the case's complexity. He initially presented with high-grade fever, and multiple, large necrotic lesions were noted on his face, scalp, left hand and knee, back, rectum, and genitalia. The patient was initiated on treatment with IV tecovirimat, oral brincidofovir, and vaccinia immunoglobulin (VIGIV). Anti-retroviral therapy (ART) was rapidly re-initiated. His hospital stay was further complicated by a superimposed extended-spectrum beta-lactamase (ESBL) Escherichia coli abscess underlying his necrotic left knee lesion. While admitted, he completed a two-week course of IV tecovirimat, three doses of brincidofovir, and a single dose of VIGIV with gradual improvement and no new lesions. This case demonstrates the potential for Mpox to have a prolonged and extensive course with widespread necrotic ulcers in the setting of HIV despite treatment. It is critical to have timely diagnosis and treatment of both Mpox and underlying HIV, alongside management of co-infections for improving disease outcomes.

Medical guidelines serve as systematic decision-making aids to ensure evidence-based and appropriate medical management of specific diseases. In Germany, dermatological guidelines are developed under the leadership of the German Dermatological Society (DDG) and the Professional Association of German Dermatologists (BVDD) following the methodology of the Working Group of Scientific Medical Societies (AWMF). In the period 2023-2024, various guidelines in the field of dermatology were revised or newly issued. These include guidelines on the diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis), atopic dermatitis, hidradenitis suppurativa/acne inversa, cutaneous Lyme borreliosis, primary hyperhidrosis, circumscribed scleroderma, screening for anal dysplasia and anal carcinoma in HIV-infected individuals, aphthae and aphthous lesions of the oral and pharyngeal mucosa, and allergological diagnostics of hypersensitivity reactions to drugs. Additionally, updates were published on basal cell carcinoma of the skin, anal pruritus, anal eczema, actinic keratosis and squamous cell carcinoma of the skin, bee and wasp venom allergy, and hand eczema. This review summarizes the key recommendations and recent updates in dermatological guidelines.