Cryptococcosis is a potentially fatal invasive fungal infection with considerable health challenges. A seemingly immunocompetent middle-aged man with frequent exposure to pigeons and bird excreta presented with headaches, fever, gait instability and diplopia. Two years prior to his presentation, he sustained a blunt head trauma which resulted in sporadic headaches. On examination, a hard scalp nodule measuring approximately 3 x 3 cm was palpable on the topmost part of his head. Cryptococcus neoformans was cultured from his cerebrospinal fluid, blood and the biopsied scalp nodule. A diagnosis of disseminated cryptococcosis was made, with the scalp lesion being designated as the primary source of the infection. Following a protracted course of antifungal therapy lasting 10 weeks, the patient was asymptomatic without any neurological deficits when reviewed in the clinic at two months postdischarge.

Bartonella henselae is an uncommon but important cause of prolonged pyrexia of unknown origin (PUO) and hepatosplenomegaly. Conventional diagnostic tools often fail in disseminated disease, leading to delayed or missed diagnoses. We report a 60-year-old man with PUO, progressive weight loss, and hepatosplenomegaly. Clinical suspicion, guided by significant cat exposure, led to molecular confirmation of B. henselae infection after conventional workup proved inconclusive. Liver biopsy revealed pleomorphic rod-shaped organisms on Warthin-Starry staining, while real-time PCR targeting the rpoB gene and conventional PCR targeting the gltA gene performed on bone marrow aspirate confirmed disseminated bartonellosis. The patient responded well to prolonged doxycycline and rifampicin therapy, achieving near-complete recovery. This case underscores the importance of clinical vigilance, histological clues, and molecular diagnostics in identifying rare but treatable infections.

Melioidosis is endemic in Southeast Asia, including Malaysia. Liver abscess is not uncommon in melioidosis, but it is usually associated with bacteremia. We presented a case of a 55-year-old gentleman with underlying end-stage renal failure who presented with non-specific abdominal pain for three months. Initial blood investigations showed leukocytosis and increased C-reactive protein. Computed tomography (CT) of the abdomen revealed multiple hypodense lesions in the liver and spleen. The culture of the liver specimen obtained through the ultrasound-guided isolated Burkholderia pseudomallei. He was given an adjusted dose of intravenous ceftazidime due to underlying renal failure. Melioidosis serology also returned positive for IgM with titer >1:1280. His blood cultures were reported negative three times. Despite on antibiotics for five weeks, there was no significant improvement of the liver abscesses was observed. He was unfortunately infected with the SARS-CoV-2 virus during his admission and passed away due to severe COVID-19 pneumonia.