Non-typhoidal Salmonella infections commonly manifest as enterocolitis, bacteremia, osteomyelitis, and meningitis. However, pleural involvement is rare. Our patient was a 65-year-old immunocompromised male with alcoholic cirrhosis. He presented with shortness of breath for five days and was found to have a large loculated pleural effusion on imaging. The patient underwent surgical decortication and was found to have exudative pleural fluid with pleural fluid cultures eventually growing Salmonella. The patient was treated with a prolonged course of intravenous antibiotic therapy. This case highlights the necessity of including Salmonella infection in the differential diagnosis of exudative pleural effusions, particularly in patients with aspiration risk and underlying immunosuppressive conditions.

A 66-year-old woman with a 6-month history of new-onset psoriasis after her first dose of COVID-19 vaccination recently progressed to acute erythroderma accompanied by fever and systemic inflammation. She was started on secukinumab for erythrodermic psoriasis (EP) after conventional therapies were contraindicated. On hospital day 6, her condition deteriorated with dyspnea, high fever, and edema. Laboratory evaluation revealed severe hypoalbuminemia and elevated inflammatory cytokines, with no evidence of infection. Imaging studies showed pulmonary edema and massive pleural effusions requiring therapeutic thoracentesis. After excluding sepsis, cardiogenic pulmonary edema, and allergic reactions, a diagnosis of systemic capillary leak syndrome (SCLS) complicating EP was established. Secukinumab was discontinued, and the patient received supportive care while being switched to apremilast. Her condition improved rapidly, with resolution of fever, reduction in pleural effusions, and significant diminishment of skin erythema. This case highlights a rare but life-threatening complication of severe acute EP, as both conditions are driven by a systemic cytokine storm. A single loading dose of secukinumab failed to effectively control the systemic cytokine storm in this patient, and the potential association between secukinumab administration and disease progression requires further investigation. We review the pathogenesis of EP, differentiate it from plaque psoriasis, identify the risk factors for SCLS, and discuss therapeutic considerations. Clinicians managing patients with severe psoriasis should remain vigilant for the potential occurrence of SCLS, particularly in those presenting with acute EP. Additionally, careful consideration should be given to the selection of biologic agents in high-risk patients.

This report describes the first documented case of brigatinib-induced pleuritis in a patient with ALK-positive non-small cell lung cancer. A 77-year-old woman developed dyspnoea, fever, elevated inflammatory markers, and bilateral pleural effusion shortly after starting brigatinib as third-line therapy. Pleural fluid analysis showed lymphocyte-predominant exudative effusion without evidence of malignancy or infection, suggesting drug-induced pleuritis. Discontinuation of brigatinib led to rapid clinical and radiographic improvement. Although disease progression later occurred, pleuritis did not recur. Re-administration of brigatinib at a reduced dose of 30 mg/day achieved tumour shrinkage without pleuritis recurrence, and subsequent dose escalation to 60 mg/day was also tolerated. This case highlights that clinicians should consider drug-induced pleuritis when pleural effusion develops during brigatinib therapy, particularly when it is inconsistent with the disease progression. Dose reduction to as low as 30 mg/day may be a safe and effective therapeutic option for selected patients.

Strongyloides stercoralis is a soil-transmitted helminth that is increasingly reported in dogs across Europe. While most infections are subclinical, hyperinfection syndrome, marked by excessive larval proliferation and systemic spread, can occur in immunocompromised hosts. An 11-year-old male Boston Terrier dog, originating from southern France with a history of chronic diarrhoea and recent splenectomy was presented with severe regenerative anaemia, thrombocytopenia, and a degenerative left shift. Haemotropic Mycoplasma haemocanis infection was diagnosed, and doxycycline therapy was initiated. During hospitalisation, the dog developed dyspnoea, pneumonia, and progressive pleural effusion containing motile nematode larvae. Strongyloides stercoralis infection was diagnosed by morphological identification of larvae in pleural effusion (third-stage larvae) and faeces (first- and third-stage larvae) and confirmed by PCR targeting mitochondrial cox1 and nuclear 18S rDNA hypervariable regions (HVR) I and IV), followed by sequencing, which revealed the haplotypes HP16 (cox1), VI (HVR-I) and A (HVR-IV). The HVR-IV haplotype A is found in both dogs and humans, characterizing the zoonotic population of S. stercoralis. Respiratory signs worsened despite combined fenbendazole and escalating ivermectin treatment, requiring euthanasia. Post-mortem examination revealed chronic granulomatous pneumonia, a pulmonary carcinomatous nodule, lymphoplasmacytic enterocolitis, and glomerulonephritis. This case represents the first report of S. stercoralis hyperinfection in an adult splenectomised dog. It highlights the importance of including strongyloidiasis in differential diagnoses of dogs with respiratory and gastrointestinal signs, particularly in animals with compromised immunity or relevant travel history.

We present the case of a 35-year-old male with no known comorbidities who presented with chronic gastrointestinal (GI) and constitutional symptoms and was empirically treated with several antibiotics during multiple clinic visits at different health facilities. The laboratory test sent included a stool GeneXpert, which was positive for Mycobacterium tuberculosis (MTB). CT imaging revealed multiple necrotic abdominal and retroperitoneal lymph nodes, hypoenhancing splenic lesions, a nodo-colonic fistula between the necrotic retroperitoneal lymph nodes and the adjacent colon, and a mild left-sided pleural effusion. Colonoscopy demonstrated caseating discharge from the fistulous tract 40 cm from the anal verge, and histology showed abundant neutrophils and histiocytes with areas of caseous-like necrosis. The patient was diagnosed with disseminated tuberculosis (TB) with newly diagnosed HIV stage 4. Antituberculous therapy was initiated, followed by antiretroviral therapy (ART) two weeks later in accordance with World Health Organization and national treatment guidelines. This case highlights the need for a thorough evaluation of a patient with a history of chronic GI symptoms and the importance of maintaining a high index of suspicion when diagnosing disseminated TB. In TB-endemic regions, a differential diagnosis of TB should be sought in patients presenting with GI and constitutional symptoms, and such symptoms should prompt an HIV test. Imaging plays a pivotal role in identifying key features such as lymphadenopathy and fistulous tracts, and colonoscopy can show a caseating discharge, which should raise suspicion for chronic infectious or granulomatous diseases, including TB. Although rare, nodo-colonic fistula formation can occur as a complication of abdominal TB. Conservative management can be effective in stable patients, potentially avoiding the morbidity of surgical intervention, as demonstrated in this case. Comprehensive management, including prompt initiation of anti-TB therapy, timely ART, prophylaxis for opportunistic infections, and nutritional support, is crucial to optimize outcomes in such complex presentations.