Tuberculosis is a resurgent disease in most regions of the world, infecting one-third of the world's population and having a multisystemic involvement. Incidence of extra-pulmonary tuberculosis has increased in the last few decades as a result of the Human Immunodeficiency Virus (HIV) infection. The authors report a clinical case of the rare concomitant cutaneous and skeletal tuberculosis in an immunocompetent patient transferred from endemic area.

The hypervirulent K1 serotype Klebsiella pneumoniae is responsible for a new invasive syndrome, typically associated to hepatic abscesses with extra-hepatic complications. Initially described in Taiwan, it has significantly spread to several Asian countries and more recently to Europe and North America, thus constituting an emerging and global problem. The authors describe a case report of a 64-years-old portuguese caucasian woman without any previous diseases or epidemiological risk factors such as trips or contact with Asian products or population, diagnosed with a pyogenic liver abscess with pleural effusion caused by this hyper-virulent strain. A successful clinical cure was achieved after the etiological identification and treatment with antimicrobial therapy combined with catheter drainage. This is the first identification of hypervirulent Klebsiella pneumonia ST 23 clone in Portugal in the context of an invasive syndrome.

Fungal infections constitute an important cause of morbidity and mortality in HIV-infected patients. The authors describe the case of a 40-year-old healthy male patient with a 2-month history of fever, shivers, asthenia and anorexia, who had lost weight during the past 6 months. Laboratory investigations revealed a positive HIV screening. Computed tomography scans of the chest and abdomen showed thoracic and lumbo-aortic adenopathies. Cryptococcus neoformans was isolated from cultures of blood, bone marrow, cerebrospinal fluid and from material obtained by transbronchial biopsy. Moreover, Cryptococcus spp. were seen in the lymph node biopsy. Pneumocystis jirovecii was isolated from bronchoalveolar lavage, whereas Aspergillus fumigatus and Aspergillus flavus were detected in material from a transbronchial biopsy. The patient initially received treatment with sulfamethoxazole plus trimethoprim and amphotericin B, which resulted in a substantial clinical improvement. After the diagnosis of invasive aspergillosis, amphotericin B was replaced by voriconazole as antifungal therapy and antiretroviral therapy was added. The simultaneous occurrence of three different infectious diseases-disseminated cryptococcosis, invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonitis-in a HIV-infected patient is extremely rare and there is no doubt that both early diagnosis and treatment are crucial for the patient's chances of survival.

Conflicts of Interests:The Authors declare that there are no competing interests. This article is licensed under a Commons Attribution Non-Commercial 4.0 LicenseABSTRACT Cysticercosis is triggered by infection with the larval form of the tapeworm Taenia solium. The usual sites for the development of cyscticerci are the central nervous system (neurocysticercosis -NCC), subcutaneous tissue, skeletal muscle, heart muscle, and the eye. Ocular cysticercosis is caused by the growth of the larvae within ocular tissues. The extraocular muscles form is the most common type of orbital cysticercosis. We report a case of a patient admitted with seizures secondary to NCC, who developed ocular symptoms after starting combined treatment with albendazole, praziquantel and dexamethasone. The investigation revealed a cystic lesion in the lateral rectus muscle. LEARNING POINTS• Neurocysticercosis (NCC) is the main cause of epilepsy in someone coming from an endemic area; therefore, it is imperative to have a high index of suspicion.• Ocular cysticercosis can present at the time of diagnosis or can be triggered by the cysticidal treatment.• Before starting cysticidal treatment, systemic corticosteroid should be used in order to reduce the inflammatory response secondary to the release of toxins following the death of the parasite. KEYWORDS Neurocysticercosis (NCC), Taenia solium, orbit, extraocular muscles, dexamethasone CASE DESCRIPTION We present a 38-year-old male from Cape Verde, resident in Portugal. His last trip to Cape Verde had been two years previously. He has a history of alcohol and tobacco dependence. Six years previously, he had been admitted to the emergency department after collapsing. A cranial computed tomography (CT) scan revealed multiple punctiform calcifications in both cerebral hemispheres and in the cerebellum, surrounded by a small cyst and with an eccentric position, suggestive of parasitic infestation -cysticercosis. On the infectious diseases ward, treatment began with albendazole and dexamethasone. Beyond cysticidal treatment for NCC, carbamazepine was started as the diagnosis of secondary epilepsy was established. In April 2016, he was admitted again to the Emergency Department after a convulsion, presenting without fever or other neurological symptoms. He had undergone a cranial CT scan (Figs.

Epstein–Barr virus (EBV) is a well-known cause of different types of malignancies particularly Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkin's lymphomas, and non-Hodgkin's lymphomas including primary central nervous system lymphoma (PCNSL). A higher tendency of malignant transformation associated with EBV has been noticed in immunocompromised patients, such as human immunodeficiency virus (HIV) infected patients. The rapid and effective immune reconstitution is crucial to prevent PCNSL in HIV-positive patients. We present a clinical case of a young patient diagnosed with HIV infection and medicated with antiretroviral therapy (ART) with poor immunological recovery. After two weeks, he developed ventriculoencephalitis, observed in the cranial magnetic resonance imaging (MRI), caused by cytomegalovirus (CMV) and EBV, both with high serum viral load, rapidly evolving to PCNSL. With this unusual clinical case, the authors want to draw attention to the importance of rapid immunological reconstitution in preventing the progression of EBV infection to PCNSL, as well as encouraging the confirmation of the usefulness of early combination of chemotherapy and antiviral therapy, in order to reach a more effective treatment of this herpesvirus infection and associated malignancies.