Rhino-orbital-cerebral mucormycosis is an invasive fungal infection that primarily affects immunocompromised individuals, particularly those with haematological malignancies, organ transplant recipients, and uncontrolled diabetes. Following initial infection of the nose and sinuses, fungal vascular invasion and bone erosion can lead to the spread of the disease to adjacent tissues, notably the orbits and brain, with the potential for multiple cerebrovascular complications. Early diagnosis and prompt treatment initiation are crucial for effective disease control. We report the case of a 29-year-old woman with a history of long-term uncontrolled type 1 diabetes, who was diagnosed with mucormycosis. Despite the absence of neurological symptoms initially, both computed tomography (CT) and magnetic resonance imaging (MRI) revealed ischaemic lesions in the left cortico-subcortical occipital, parietal, and frontal regions, caused by occlusion of the left cavernous internal carotid artery and left anterior cerebral artery. The patient later developed diplopia and underwent surgical intervention, prolonged antifungal therapy, and hyperbaric oxygen therapy, resulting in a slow but positive recovery. This rare case of stroke in a young adult underscores the importance of excluding cerebrovascular complications in rhino-orbital-cerebral mucormycosis, even in the absence of neurological symptoms, to prevent further damage and morbidity.

Thoracic splenosis is characterised by the autotransplantation of splenic tissue into the thoracic cavity, following splenic and diaphragmatic rupture. It is usually asymptomatic and diagnosed incidentally. The authors present the case of a 61-year-old woman, with a history of a car accident 36 years prior which resulted in splenectomy. The patient presented to the emergency department with a syncytial respiratory virus infection, which led to the identification on computed tomography of extensive nodular thickening of the left peripheric pleura (11cm extension, 2,9cm thickness), suggestive of neoplasia. She underwent a percutaneous pleural biopsy, followed by video-assisted thoracoscopy, which revealed lymphoid tissue with germinal centres and abundant lipid-laden CD68+ macrophages. A positron emission tomography with 18F-FDG identified a low metabolic signal on the left pleura. Follow-up chest computed tomography demonstrated the stability of the nodular lesions. After a multi-disciplinary discussion, given the patient's medical history, the hypothesis of thoracic splenosis was considered the most likely diagnosis. This case brings our attention to this rare entity, highlighting the importance of a detailed clinical history, a persistent search for a diagnosis and a multi-disciplinary approach.

Background/Objectives: Antimicrobial stewardship programs (ASPs) are essential to promote rational antibiotic use and limit resistance. However, their impact depends on how they are perceived and applied in clinical settings. This study aimed to identify areas for improvement in a hospital ASP and to offer a model for assessing prescriber engagement with stewardship activities. Methods: We conducted a cross-sectional survey between March and December 2024 among physicians prescribing antibiotics at a 1200-bed tertiary hospital in Portugal. The anonymized questionnaire covered six domains: (1) antibiotic knowledge; (2) awareness and use of local protocols; (3) access to antimicrobial use and resistance reports; (4) awareness of restrictive prescribing policies; (5) use of unscheduled consultations with the stewardship team; and (6) participation in scheduled multidisciplinary case discussions. Results: Of 1,539 invited physicians, 154 responded (10%). Most were female (64.3%) and specialists (75.8%). Although 78.6% were aware of institutional protocols, 66.9% rarely or never consulted them, citing poor accessibility and reliance on personal knowledge. Only 25.3% participated in regular case discussions, but these were widely viewed as useful. Awareness of restrictive policies was limited, although 69.5% acknowledged that such measures influenced prescribing. Respondents valued expert consultation, protocols, and feedback on antibiotic use. Interest in regular feedback on antimicrobial use and resistance patterns was high. Conclusions: Four main areas for improvement were identified: (1) improving access to protocols, (2) expanding weekly case-based discussions, (3) improving communication on restrictions, and (4) delivering clear, actionable feedback. This approach may serve as a model for aligning ASPs with clinical practice.