Mucosal immunity to SARS-CoV-2 is crucial in attenuating viral replication. While intramuscular mRNA vaccination has been shown to produce durable SARS-CoV-2 specific antibody responses in the systemic circulation, there are few studies pertaining to local responses in the nasal mucosa. The extent to which vaccination may recall nasal antibody responses primed by prior infection or if nasal antibody responses to infection are primed by prior vaccination remains unelucidated. In the present study, we compared SARS-CoV-2 specific nasal antibody responses among unvaccinated infected, vaccinated infected, infection-experienced vaccinated, and infection-naïve vaccinated participants.

Between June 2020 to February 2023, nasopharyngeal swab (NPS) samples were collected from participants as part of an ongoing longitudinal surveillance study. Samples collected within 14-89 days after either confirmation of an acute SARS-CoV-2 infection via RT-PCR or vaccination with a third mRNA dose were selected for the present study. Secretory-IgA (SIgA) and IgG responses to the Spike antigen of ancestral (B.1 lineage) SARS-CoV-2 were measured via enzyme-linked immunosorbent assay. SIgA was normalized to total-IgA concentration. Nonparametric continuous variables were analyzed using the Kruskal-Wallis test followed by Dunn’s multiple comparisons test. Paired groups were compared using Wilcoxon signed-ranked test. This study was approved by the Children’s Hospital Los Angeles Institutional Review Board.

Of 429 NPS samples, 176 (41.0%) were from male participants, and the mean age at collection was 27.7 years (range, 0.1-81.3 years). Median SIgA concentrations (x10 3 AU/mL) were 39.2 (unvaccinated infected), 230.2 (vaccinated infected), 22.1 (infection-experienced vaccinated), and 5.3 (infection-naïve vaccinated). Median IgG concentrations (x10 3 AU/mL) were 2.2 (unvaccinated infected), 16.0 (vaccinated infected), 5.4 (infection-experienced vaccinated), and 4.4 (infection-naïve vaccinated).

SIgA and IgG were significantly higher in vaccinated infected participants compared to unvaccinated infected (p<0.001), infection-experienced vaccinated (p<0.001), and infection-naïve vaccinated (p<0.001) participants.
SIgA was significantly lower in infection-experienced vaccinated participants compared to unvaccinated infected (p=0.045) participants whereas the opposite trend was observed for IgG (p<0.001).

Acute COVID-19 infection robustly induces SARS-CoV-2 specific nasal SIgA and IgG
responses in vaccinated participants to a greater extent than infection alone. Infection-experienced vaccinated individuals elicit a weaker SIgA response compared to infection alone, indicating that vaccination cannot completely recall nasal SIgA responses. Acquiring a better understanding of SARS-CoV-2 specific nasal antibody responses is an important step towards developing vaccines that can elicit strong mucosal immunity.

Nasal SARS-CoV-2 specific secretory-IgA and IgG are robustly induced in vaccinated individuals after infection

Background
Malaria in the United States is a rare disease with a reported number of cases typically 2,000 each year. In 2022, the State of Ohio had 32 malaria cases: 10 females and 22 males. This mosquito born illness poses a major threat to American travelers, military personnel, and US citizens living abroad in endemic areas. In returning travelers from high-risk countries, Malaria is the most common cause of febrile illness. Plasmodium ovale can remain dormant in the liver and presentation will be delayed. Chronic infection and relapsing disease will persist if the infection is not treated in the initial stages. Relapse episodes may occur months or years later. 

Case Presentation
We present a case of a 39-year-old male with a past medical history of chronic pancreatitis, depression, type 2 diabetes mellitus, gastroesophageal reflux disease, recent Epstein- Barr virus infection, who presents with fever, nausea, and vomiting beginning 10 days prior to admission. The patient has an extensive travel history abroad and returned from Angola six months ago. Prior to admission, he underwent treatment at a different hospital for sepsis, encephalopathy, fever, Epstein-Barr virus and babesia. His condition worsened and he left against medical advice and opted to seek treatment at our facility. With concern for malaria, immediate testing included: Giemsa-stained peripheral blood smear and malaria polymerase chain reaction. His anti-malarial treatment regimen included artemether-lumefantrine tablets for 3 days. Plasmodium species PCR was positive for Plasmodium ovale. The patient responded well to therapy, and continued follow-up at the infectious disease clinic. Likely, the progression and severity of his malaria infection progressively worsened due to delays in treatment and testing. Given his travel history, a concern for malaria should have been on the differential diagnosis at his previous hospital admission.

Discussion
Plasmodium ovale and Plasmodium vivax infection can remain dormant for months and will cause relapses despite anti-malarial prophylaxis treatment. An immunocompromised patient with infection can trigger nonspecific host defense mechanisms. The patient’s symptoms were initially attributed to Epstein-Barr virus infection; unfortunately, there was a missed malaria diagnosis. New research suggests climate change is increasing the mosquito population worldwide and likely causing higher malaria cases. Anti-malarial prophylaxis should be initiated and completed in patients traveling to endemic regions. Returning travelers with flu-like symptoms should be evaluated for malaria as soon as possible.


A Case of Plasmodium Ovale Malaria Presentation

Background
The reimbursement landscape for infectious diseases is constantly evolving. In recent years, there have been significant changes in Medicare reimbursement for infectious disease procedures. These changes have had a major impact on infectious disease specialists, who may be disproportionately affected by changes in reimbursement in certain regions, which could have implications for access to care. Previous research has not examined these fluctuations especially in different geographic regions. Thus, our study analyzed Medicare reimbursement changes from 2013 to 2023 for all U.S. states and territories. We also explored the relationship between these changes and select social determinants of health (SDOH).
Methods
Medicare Administrative Contractor codes for the top 50 infectious disease procedures were used to identify states using the Centers for Medicare and Medicaid Services’ Physician Fee Schedule. Each price was adjusted for inflation using the consumer price index and weighted using an index of codes. A total percent change was generated for each state or territory. State-based data for various SDOH were used to calculate a correlation coefficient with geographic changes in
reimbursement (statistical significance factored with α of 0.05).
Results
From 2013 to 2023, the inflation-adjusted Medicare reimbursement for the top-grossing infectious disease procedures for U.S. states and territories decreased by a mean and median of 24.8% and 25.0%, respectively. The greatest total decrease was experienced by Illinois (-29.0%), Wyoming (-26.8%), Kansas (-26.8%), and Wisconsin (-26.6%). Massachusetts (-22.5%), New York (-22.3%), Washington (-19.8%), and Puerto Rico (-14.2%) were states that had the lowest change over the ten-year period. Some of the top grossing procedures (Current Procedural Terminology code) and their yearly percent change included critical care for the first 30-74 minutes of instance(99291, -197.2%), debridement of subcutaneous tissue for the first 20 cm2 or less(11042, -197.0%), transitional care management with high medical decision complexity(99496, -197.0%), and removal of central venous catheter without subcutaneous port or pump (36589, -197.0%).
Conclusion
Our findings suggest that over the past ten years, Medicare reimbursement for infectious disease procedures has decreased in many regions of the United States. These findings have important implications for access to care. Decreased reimbursement may make it more difficult for infectious disease specialists to provide care in certain regions, which could lead to longer wait times and decreased
access to care for patients. Policymakers should consider and develop strategies to address these geographic disparities. This could include providing financial assistance to infectious disease practices or expanding access to telehealth services.

The Impact of Geography on Medicare Reimbursement for Infectious Diseases: A 10-Year Analysis

Background
Schistosomiasis, also known as Bilharzia, is a disease caused by schistosomes, a type of trematode or fluke parasite. Transmission occurs through contact with parasite-infested water. There are three major schistosome species that cause severe infection in humans, each with a preference for a specific organ system. The disease is predominantly found in rural areas with inadequate sanitation of freshwater sources and is endemic in Africa, Asia, and South America. Infected individuals excrete schistosome eggs, which hatch and infect freshwater snails, serving as intermediate hosts. The cercariae that develop within the snails can penetrate human skin and enter the bloodstream. Adult schistosomes migrate to various organ systems via the venous system, most commonly affecting the gastrointestinal and genitourinary tracts. Clinical manifestations and chronic inflammation are associated with the presence of schistosome eggs. Schistosomiasis can involve multiple organ systems, with symptoms varying depending on the affected system. Genitourinary schistosomiasis can lead to hematuria, dysuria, and pelvic pain. Diagnosis involves antigen detection, imaging, and tissue sampling. Chronic infection can result in bladder fibrosis and calcification, as well as an increased risk of bladder cancer, particularly squamous cell carcinoma. Early detection and treatment with Praziquantel are crucial in reducing the risk of cancer development.

Case Presentation
A 26-year-old man with a history of intermittent gross hematuria presented to his primary care physician. Previous evaluation at a local hospital revealed a possible clot or mass in the bladder, but further investigation was not pursued. The recent presentation showed gross hematuria with small clots, and urinalysis confirmed the presence of red blood cells. Urine culture, cytology, and STI panel were negative. CT Urogram with contrast revealed plaque-like and nodular wall thickening of the bladder. Cystoscopy showed diffuse white-yellow deposits, and pathology confirmed the diagnosis of schistosomiasis. CT of the abdomen and pelvis was valuable in assessing the extent of involvement. The patient was referred to infectious disease for treatment.

Discussion
As global travel increases, physicians are more likely to encounter uncommon conditions such as schistosomiasis, which may not be endemic to their population or location. Awareness, early detection, and immediate treatment are crucial to prevent long-term complications and improve patient outcomes. This case emphasizes the importance of staying informed about rare conditions and utilizing imaging techniques to provide timely and appropriate care to patients.

A Case Report on Chronic Schistosomiasis

Background:
Coccidioidomycosis, commonly known as Valley Fever, and Paracoccidioidomycosis, referred to as the Mycosis of Lutz, Splendore, and Almeida, are the infections caused by two different types of dimorphic fungi, namely Coccidioides spp and Paracoccidioides spp, respectively, following inhalation of arthroconidia. While the San Joaquin Valley of California and the South-Central region of Arizona are the endemic regions for the Valley Fever, the most paracoccidioidomycosis cases are reported from Brazil, Colombia, Venezuela, and Argentina. The symptoms range from asymptomatic (60% of the total) coccidiomycosis cases to more severe forms, including disseminated infection. Chronic paracoccidioidomycosis comprises over 80 to 90% of total cases and patients with CNS involvement presents with clinical manifestations associated with space- occupying lesions. It is important to note that the disseminated coccidioidomycosis can result in meningitis, a condition if not treated, carries a significant mortality risk of 95% within a span of 2 years. Therefore, early detection plays a pivotal role in ensuring effective management. This article describes a case of disseminated coccidioidomycosis with neuroparacoccidioidomycosis co-infection in an otherwise healthy immunocompetent patient.

Case Presentation:
A 49-year-old Brazilian male presented with an episode of dizziness and near syncope. The head CT scan revealed two brain lesions at left temporal and parietal lobes with surrounding vasogenic edema causing mild mass effect. CT chest showed extensive bilateral small pulmonary nodules and small ill-defined opacities(figure-1), making it indistinguishable from infection due to other infectious, neoplastic, or inflammatory etiologies. Brain MRI revealed two ring-enhancing lesions with perilesional white matter edema. Subsequently, the CSF studies were positive for antibodies to coccidioides TP-antigen and F-antigen, confirming CNS involvement. The fungal isolate from bronchial washing was positive for growth of Paracoccidioides brasiliensis. The patient was treated with Dexamethasone, Fluconazole, and Levetiracetam. The patient is currently receiving the maintenance dose of fluconazole, which is for life.

Discussion:
Chronic paracoccidioidomycosis involving the lung can present as dry cough and dyspnea. The gold standard for diagnosing paracoccidioidomyosis is through isolation of Paracoccidioides spp. in culture and direct myocological examination. CNS involvement with paracoccidioidomycosis has been observed in 10-15 percent of patients presenting with seizures and focal neurologic signs, with positive ring-enhancing lesions with perilesional edema observed in MRI. Disseminated coccidioidomycosis is confirmed by antibody detection in CSF, warranting azole antifungal therapy. For patients with neuroparacoccidioidomycosis, TMP-SMX and amphotericin-B are effective. IV fluconazole is an alternative. Antifungal treatment should be provided to all disseminated coccidioidomycosis patients. To prevent relapse, lifelong antifungal therapy and follow-up are necessary. The role of a single azole for treatment of coexisting coccidioidomycosis and paracoccidioidomycosis infections is still unclear.

Conclusion:
Co-infection of disseminated coccidioidomycosis and paracoccidioidomycosis with neurologic involvement is a rare and unique presentation in a middle-aged otherwise immunocompetent individual. The role of a single azole for the treatment of coexisting coccidioidomycosis and paracoccidioidomycosis infections is still unclear. We aim to add more on literature on the treatment strategies for these disseminated fungal co-infections in the context of lifelong antifungal therapy needed to prevent relapse. Given that there are no proper guidelines for treating disseminated coccidioidomycosis and paracoccidioidomycosis co-infections for longer duration, further studies into the topic are recommended.

Disseminated Coccidioidomycosis with Neuroparacoccidioidomycosis Co-infection: A Rare Case Report and a Literature Review

Our study addressed COVID-19 vaccine knowledge and attitudes among medical students at the University of New England College of Osteopathic Medicine (UNECOM). Medical students recruited to complete an anonymous online survey assessed backgrounds, experiences, knowledge, and attitudes toward the COVID-19 vaccine. The correlation analysis utilized gender, physical health rating, close connection to someone with COVID-19, and work in the medical field during March 2020 as potential factors affecting students' attitudes. Respondents included 139 medical students aged 20-39 years old, with 99.3% having received at least one dose of the COVID-19 vaccine under institutional mandate. Every student obtained vaccine information from any combination of medical professionals, scientific journals, or review articles. Almost all correctly identified the components of the vaccine, its benefits, and its potential side effects. We found that 85% of medical students expressed little hesitancy toward receiving the vaccine; about 90% of participants supported a vaccine mandate for students. The marked enthusiasm expressed by UNECOM medical students to receive the vaccine contrasts surveys conducted before any vaccine mandate, although students' accurate knowledge of the vaccine and its potential benefits may have influenced acceptance. Overall, consideration of societal and individual implications is paramount. Access to scientifically validated information is essential when implementing public health policy at both institutional and federal levels.




Medical Students' Attitudes and Knowledge on the COVID-19 Vaccine and Mandate

**Scoring is only possible in the semifinals hall**

**Abstract:**



Saccharomyces cerevisiae (Baker’s Yeast) Pneumonia in an Immunocompromised Host

Background
Coronaviruses, including SARS-CoV-2, cause the respiratory disease known as COVID-19. Some individuals experience persistent symptoms, referred to as long COVID. Among the complications reported after COVID-19 are Guillain-Barre Syndrome (GBS) and its variant, Miller Fisher Syndrome (MFS). MFS causes muscle weakness, ataxia, and ophthalmoplegia. Treatment typically includes intravenous immunoglobulin (IVIG) or plasmapheresis. While most COVID-19-associated MFS cases improve with IVIG, this case highlights a patient who did not show symptomatic relief.
Case Presentation
A 57-year-old male with a medical history of prior COVID-19 infection, facial fracture repair, and treated syphilis presented to the emergency department (ED) with sudden-onset double vision, pain behind the left eye, dizziness, frontal headache, and generalized weakness. The diplopia began five days after the initial COVID-19 diagnosis and progressively worsened. The patient had experienced a dry cough and rhinorrhea prior to admission, with a confirmed SARS-CoV-2 infection. On admission, the patient exhibited facial nerve weakness, impaired eye movement, ptosis, diminished reflexes, and generalized weakness. Sensation, cerebellar function, and gag reflex were normal, but the patient required a cane for ambulation. The patient 
underwent a comprehensive evaluation and was diagnosed with Miller Fisher Syndrome. Treatment with IVIG and prednisone was administered, but there was no improvement in symptoms even after 8 weeks.
Discussion
This case report presents a unique case of a patient who developed MFS following a COVID-19 infection. Despite receiving IVIG treatment, the patient did not experience any improvement in symptoms even after 8 weeks. This is a notable finding as most reported cases of COVID-19-associated MFS have shown some improvement after IVIG therapy within 2 weeks. The patient's prolonged lack of symptomatic improvement raises questions about potential modifications of MFS or resistance to standard treatment. Further research is needed to understand the relationship between COVID-19 and MFS, including potential predisposing factors and pathophysiological mechanisms. The case highlights the need for targeted therapies and diagnostic markers for MFS in the context of COVID-19, as well as the importance of early detection and understanding the impact of different strains of the virus on neurological manifestations.



Title of Persistent Miller Fisher Syndrome Following COVID-19 Infection: A Case Report

Background
Cetuximab is a chimeric antibody used in treatment of metastatic colorectal cancer. Administered via an infusion, the most common side effect of cetuximab is mild allergic response. However, more serious reactions of anaphylaxis and cardiac arrest have been reported. Given the scarcity of the incidence of these reactions, and their reversible nature, there is limited understanding of predisposing factors and essentials of prevention. The present report aims to bridge this gap in knowledge and describes a case of cardiac arrest following cetuximab infusion. 

Case Presentation
A 68-year-old male with a medical history of stage 4 colorectal cancer with metastasis to the lung and liver presented to the emergency department (ED) with cardiac arrest following his first dose of cetuximab as a part of an outpatient clinical trial. Prior to infusion, the patient received 50 mg of Benadryl and underwent an electrocardiogram which revealed no abnormalities. Three minutes following initiation of cetuximab infusion, the patient developed pulseless electrical activity (PEA) and manual cardiopulmonary resuscitation (CPR) was begun. Vitals included a blood pressure of 95/38 mmHg and an oxygen saturation of 73%. En route to the emergency department (ED), the patient was intubated, and manual chest compressions were continued. Upon arrival, Acute Cardiac Life Support protocol was initiated and 2.3 mg of epinephrine was administered. The patient regained cardiac activity after fifteen minutes and was transferred to the critical care unit on an epinephrine drip. 

Initial laboratory testing revealed acidemia with a low bicarbonate level, hyponatremia and hyperchloremia, and normal potassium and magnesium levels. Elevated troponin T levels of (199 ng/L) were observed; however, echocardiography showed no abnormalities except for the slightly prolonged QTC interval in the ECG. Additionally, the patient had a high tryptase level of (63.6 ng/mL), suggesting an anaphylactic response. A CT chest image identified a new large left pneumothorax within a pre-existing subpleural bulla, bilateral rib fractures, and small pleural effusions likely due to recent CPR. The pneumothorax resolved with chest tube insertion. Although the patient initially improved, unfortunately he deteriorated with worsening hypoxia and aspiration pneumonia expired on the eighth day of admission.

Discussion
This case demonstrates the risk of life-threatening acute hypersensitivity responses following chemotherapy infusions, regardless of premedication with antihistamines. It underscores the importance of preliminary allergy testing, close monitoring of electrolytes and tryptase levels during transfusion, and quick access to crash carts.

Cardiac Arrest Following Cetuximab: A Fatal Iatrogenic Outcome

Introduction
Colon cancer is one of the top five leading causes of cancer in both males and females. There is a well-known association between colon cancer and microbial infections. The presence of certain bacterial infections in the appropriate clinical context should prompt further investigation of colon cancer.

Case Presentation
A 41-year-old male with history of alcohol use disorder and bipolar disorder who presented for acute encephalopathy after cardiac arrest with return of spontaneous circulation within 2 minutes in the field.
In the emergency department he was found to be hypotensive and hypoxic; labs revealed leukocytosis (50.9 K/ul) with bandemia (15%), anemia (5.9g/dl), and LFTs consistent with acute liver failure. CT abdomen/pelvis showed hepatosplenomegaly, pelvic ascites, colonic wall thickening and luminal narrowing in mid-sigmoid colon.
He was admitted to the ICU for twelve days for septic shock intermittently requiring vasopressors, acute liver failure, and respiratory failure. A diagnostic paracentesis revealed a transudative effusion; blood cultures were positive for Clostridium septicum and Enterococcus avium.
A subsequent colonoscopy demonstrated a sigmoid colonic mass whose pathology was consistent with adenocarcinoma. Due to his acute decompensated liver failure secondary to alcohol use; he was not a candidate for surgery. The family placed the patient in hospice care and he eventually expired.

Discussion
Colon malignancy has been associated to certain bacterial strains, with the most common being Streptococcus bovis/gallolyticus, and less frequently Clostridium septicum, Enterococci species, Bacteroides fragilis, Fusobacterium nucleatum, and other Streptococci species. In fact, of the approximately 106,180 new cases of colon cancer reported yearly, 10-25% are associated with infections caused by Streptococcus bovis and Clostridium septicum.
Clostridium septicum is an opportunistic, gram-positive anaerobe that has several virulence factors, including alpha toxin. It can survive in acidic environments due to its ability to produce spores and has the capability to perforate the colonic epithelial lining, releasing spores into the blood and leading to bacteremia. The risk factors for C. septicum infection include immunosuppressed states, hematological malignancies, neutropenia, and diabetes mellitus. Unfortunately, C. septicum infection has a high mortality rate of 60%, which can only be diagnosed through positive cultures.
Treatment for C. Septicum infection varies depending on the presentation, as it can cause aortitis, myonecrosis, gangrene, cellulitis, septic shock, fasciitis, hemolysis, and abscess. However, early antibiotics and possible surgical intervention are recommended for effective management. Piperacillin/tazobactam or penicillin G are the first-line treatments for C. septicum infection. Therefore, it is crucial to identify and manage this infection as early as possible to prevent the high mortality rate associated with it.
Conclusion
Clostridium septicum infection and colonic malignancy is a well-known association therefore clinicians should have a high suspicion for colon cancer in patients who present with this infection.

A Potentially Lethal Harbinger: Clostridium Septicum Bacteremia in a Patient Found to have Adenocarcinoma of the Colon

Background
Shigella is a Gram-negative, facultative anaerobic bacteria that causes a gastrointestinal infection characterized by bloody diarrhea. First-line treatment is azithromycin; however, in the men who have sex with men (MSM) population, Shigella is known for higher rates of azithromycin resistance. Other treatments, including trimethoprim-sulfamethoxazole, fluoroquinolones, and ampicillin, are also increasing in resistance. 

Glucose-6-Phosphate Dehydrogenase (G6PD) is an enzyme that prevents cellular damage from reactive oxygen species (ROS), to which red blood cells are especially susceptible. G6PD-deficiency is an inherited disorder characterized by acute hemolytic anemia after exposure to high levels of ROS from foods and certain antibiotics, including many that are used for treatment of Shigella.

Case Presentation
A healthy 28-year-old male with a history of MSM activity presented to the emergency department (ED) with four days of 15-20 daily episodes of increasingly bloody diarrhea and a recent exposure to a sick contact with similar symptoms. As an Active Duty Sailor, he initially sought care from his ship’s physician who prescribed azithromycin and acetaminophen without relief. In the ED, he was tachycardic and physical exam revealed tenderness of left abdominal quadrants with rebound. Rectal exam showed bright red blood and watery brown stool. Lab work was notable for leukocytosis, acute kidney injury (BUN 40, Cr 3.3), and lactate 2.1. A CT abdomen/pelvis revealed moderate proctocolitis. He reported no known drug allergies, and was given fluids, ciprofloxacin 500 mg, and metronidazole 500 mg for presumed infectious diarrhea. He was admitted to the Internal Medicine Ward, where GI Stool PCR resulted positive for Shigella. Chart review indicated a history of G6PD-deficiency, at which point he was transitioned to ceftriaxone from ciprofloxacin with an Infectious Disease consult. He clinically improved and was discharged home on Augmentin; however his symptoms did not resolve on Augmentin. Culture sensitivities resulted after his discharge, which demonstrated resistance to ampicillin. He was switched to cefpodoxime per Infectious Disease recommendation and recovered fully.

Discussion
This case illustrates the value of complete history gathering in determining a patient’s full spectrum of risk factors. Relevant for this patient was his sexual history and medication intolerances that he did not initially disclose. It also highlights the growing importance of alternative treatment regimens to mitigate the adverse effects of increasing global rates of antibiotic resistance, especially for patients with complex histories and medication intolerances.

Diarrheal Dilemma: G6PD-Deficiency Complicating Treatment of Antibiotic- Resistant Shigella in the MSM Population

Background: 
Monkeypox, caused by the Monkeypox virus (MPV), is a double-stranded DNA virus belonging to the genus Orthopoxvirus. While confirmed cases of Mpox disease have been reported in since the 1970s, the recent global outbreak has escalated Monkeypox to a public health emergency. Although Monkeypox is typically considered a self-limiting disease, the recent outbreak has demonstrated an increase in disease morbidity and mortality, particularly in those with immunocompromised status. For those with HIV infection, co-infection with Monkeypox can lead to atypical disease presentation. This poster highlights an example of a highly atypical dermatological presentation in a patient with HIV and Monkeypox co-infection. 

Discussion: A 28-year-old male with a history of untreated HIV/AIDS presented with diffuse bilateral eschars with well-extended surrounding erythema for two days. The lesions were expansive and located diffusely across the bilateral upper extremities. The patient reported the lesions were slowly enlarging and mildly pruritic. Additionally, bilateral tender inguinal lymphadenopathy and a single painful shallow ulcer on the right-side penile shaft was present. While Monkeypox typically presents with small well-localized eschars surrounded by slight erythema, this patient demonstrated well-extended erythema and diffuse eschars on the bilateral upper extremities. This case illustrates that HIV and Monkeypox co-infection may lead to exacerbation of the typical symptoms of each disease– resulting in atypical dermatologic presentations, unique disease manifestations, and more difficult management. 


Underline digital video library

Nasal SARS-CoV-2 specific secretory-IgA and IgG are robustly induced in vaccinated individuals after infection

A Case of Plasmodium Ovale Malaria Presentation

The Impact of Geography on Medicare Reimbursement for Infectious Diseases: A 10-Year Analysis

A Case Report on Chronic Schistosomiasis

Disseminated Coccidioidomycosis with Neuroparacoccidioidomycosis Co-infection: A Rare Case Report and a Literature Review

Medical Students' Attitudes and Knowledge on the COVID-19 Vaccine and Mandate

Saccharomyces cerevisiae (Baker’s Yeast) Pneumonia in an Immunocompromised Host

Title of Persistent Miller Fisher Syndrome Following COVID-19 Infection: A Case Report

Cardiac Arrest Following Cetuximab: A Fatal Iatrogenic Outcome

A Potentially Lethal Harbinger: Clostridium Septicum Bacteremia in a Patient Found to have Adenocarcinoma of the Colon

Diarrheal Dilemma: G6PD-Deficiency Complicating Treatment of Antibiotic- Resistant Shigella in the MSM Population

Rare presentation of Monkeypox in a Patient with Coexisting HIV

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