Drug-induced aseptic meningitis is a rare medical condition with trimethoprim-sulfamethoxazole being one of the most common antimicrobial agents associated with it. Here, I report a case of a 56-year-old male who presented to a health care facility with shock and meningitis-like syndrome in two occasions, one year apart following an exposure to trimethoprim-sulfamethoxazole for treatment of skin/soft tissue infection. Investigations did not reveal an infectious etiology in the two presentations. The patient improved with supportive care and withdrawal of the offending agent. In the two admissions, the patient improved following stopping the offending drug in addition to supportive care. The diagnosis of trimethoprim-sulfamethoxazole-induced aseptic meningitis was the most likely explanation for this case. Trimethoprim-sulfamethoxazole-induced aseptic meningitis is rare although it is a life-threatening side effect of TMP/SMX; therefore, the clinicians should keep the diagnosis of drug-induced aseptic meningitis in the differential diagnosis of aseptic meningitis in the appropriate clinical setting as early withdrawal of the culprit drug and supportive measurements will lead to early recovery.

Echinococcal infections are a rare but important disease in Canada. The parasite’s traditional endemic area includes rural, northern communities with wild canines and ungulates. There is evidence that the endemic area is enlarging. Echinococcus can cause significant morbidity, and rarely death. An 18-year-old female presented with right upper quadrant abdominal pain. Computed Tomography (CT) of the abdomen showed a 5.4 × 4 cm cyst with the presence of “water lily sign”. She showed signs of cyst leak including eosinophilia and fever. Therefore, she underwent surgical resection of her cyst with Albendazole cover and was continued post-operatively for three months. CT head, chest, and pelvis failed to identify further sites of cyst formation. She has recovered well from surgery and is no longer followed by Infectious Diseases. The annual incidence and prevalence of Echinococcus disease are very low among the Canadian population. Therefore, there is a paucity of experience with new interventional techniques. Traditional management with surgery and anti-helminthic drugs is a reasonable alternative to percutaneous drainage. Screening communities has previously been determined not to be cost effective. Screening family members with similar risk factors has not been previously documented, and treatment has historically been reserved for symptomatic individuals with the disease.

Mycobacterium tuberculosis bone and joint infection accounts for 2% to 3% of all tuberculosis cases but is uncommon in the foot. A 32-year-old woman had foot pain and swelling, and radiographs showed midfoot bony destruction and fragmentation. She was diagnosed with Charcot arthropathy, but had no neuropathy or improvement despite total contact casting. Bone biopsy 16 months after initial presentation did not show acid-fast bacilli on smear, but M. tuberculosis was recovered on culture; concurrent chest radiographs showed patchy and nodular opacities in both upper lung zones, consistent with previous pulmonary tuberculosis. Sputum smear showed acid-fast bacilli and culture yielded M. tuberculosis. In retrospect, the patient was at increased risk for M. tuberculosis infection because of previous residence in Myanmar and India. Clinicians should consider M. tuberculosis infection in the differential diagnosis of Charcot arthropathy for patients who have exposure history and absence of risk factors for Charcot arthropathy.

Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. The rate of N. gonorrhoeae infections in Canada has increased from 2010 to 2015. Disseminated gonococcal infection typically results from bacteremic spread of N. gonorrhoeae from a preceding mucosal site of disease (e.g., urogenital). Common clinical manifestations of disseminated gonococcal infection include skin lesions, tenosynovitis, and septic arthritis. Bacterial meningitis as a manifestation of disseminated gonococcal infection has been rarely described. A case of bacterial meningitis due to N. gonorrheae, complicated by an ischemic stroke, is reported here. Clinical features that may point to N. gonorrhoeae as the pathogen in a patient with bacterial meningitis include a concomitant active urogenital infection, skin rash, arthritis, and/or tenosynovitis. Parenteral ceftriaxone for 10 to 14 days combined with a single oral dose of azithromycin is currently recommended as the treatment for gonococcal meningitis in recent guidelines. This case is presented to highlight a potential, albeit rare, complication of a preventable disease that has resurged in the last decade in our community.