Standard therapy for infective endocarditis (IE) usually requires 4–6 weeks of intravenous (IV) antibiotics, ensuring sustained bactericidal concentrations, yet resulting in prolonged hospitalization and increased cost of care. These challenges have driven interest in oral antibiotic therapy (OAT) as a step-down strategy for selected, clinically stable patients. This review summarizes the clinical evidence and pharmacokinetic and pharmacodynamic (PK/PD) rationale and practical considerations supporting step-down OAT in IE. Antibiotics such as amoxicillin, fluoroquinolones, linezolid, and rifampicin have high bioavailability and maintain effective serum and tissue concentrations, and can be used as a safe transition from IV to oral therapy. The pivotal POET randomized controlled trial (RCT) demonstrated noninferiority of OAT compared with continued IV therapy in stable patients with left-sided IE caused by Streptococcus spp., Enterococcus faecalis, methicillin-susceptible Staphylococcus aureus, or coagulase-negative staphylococci. Further real-world studies and meta-analyses confirmed comparable efficacy and safety, with reduced catheter-related complications and shorter hospitalization length for patients receiving OAT. The latest European Society of Cardiology (ESC) guidelines have incorporated OAT regimens derived from the POET protocol for stable patients meeting specific criteria, while the American Heart Association guidelines have not yet been revised. Many areas remain uncertain, such as the optimal timing of transition to oral therapy; the ideal antibiotic combinations and dosing; and the applicability to complex cases such as methicillin-resistant S. aureus (MRSA), Gram-negative, or pediatric infections. Overall, clinical evidence supports OAT as a safe and effective alternative to prolonged IV therapy in selected patients with IE, highlighting a major step toward more individualized, patient-centered management.

Neurobrucellosis (NB) and Neurotuberculosis (NT) are rare central nervous system infections, but pose significant diagnostic and therapeutic challenges. If not diagnosed and treated early, they can have high mortality. Clinical presentations for both are nonspecific, mimicking diverse pathologies. Therefore, it is crucial to identify distinguishing features to ensure timely treatment. We conducted a retrospective review of cases of NB and NT admitted to the American University of Beirut Medical Center (AUBMC) between January 1982 and December 2022, identifying 20 patients with NT, and five cases of NB. Their presentation and diagnostic work-up were compared. NT patients were mostly male and presented earlier than NB patients (median symptom duration 150 days). Patients with NT had higher rates of systemic and neurologic symptoms compared to NB. Both groups had hyponatremia. NB patients had higher cerebrospinal fluid lymphocyte counts. Imaging in NT revealed diverse brain abnormalities such as hydrocephalus and small nodules whereas mostly meningeal enhancement in NB. Despite severe presentations no 30-day mortality occurred in either group. Neurological complications were more frequent in NT. Finally, NT patients generally present earlier with more severe symptoms than NB. Due to overlapping features but differing treatments, larger scale studies are crucial to better understand and manage these infections.

• Uncommon presentation of tuberculosis as an isolated persistent vulvar ulcer. • Diagnostic delay due to mimicry with sexually transmitted diseases. • Successful treatment with standard anti-tuberculosis therapy. • Importance of considering extrapulmonary TB in unusual genital lesions.