Sage Open Medical Case Reports

Aggregatibacter aphrophilus, a fastidious Gram-negative member of the Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella group, is an exceptionally rare cause of hepatic abscess, particularly in immunocompetent individuals. We describe a case of a healthy, middle-aged man who presented with a 5-day history of cyclical fevers, chills, and night sweats. Computed tomography imaging revealed a solitary hepatic lesion, initially suspicious for malignancy. Magnetic resonance cholangiopancreatography confirmed a hepatic abscess. Culture from a computed tomography-guided aspirate identified A. aphrophilus as the causative organism. Despite empiric broad-spectrum antibiotics and drainage, the patient continued to experience febrile episodes until culture-directed therapy led to clinical resolution. He received 3 weeks of intravenous ceftriaxone 2 g q24 h and PO metronidazole 500 mg q8 h and percutaneous drainage. Upon follow-up with infectious disease, no recurrence was noted upon review of repeat computed tomography imaging. This case highlights the importance of early microbiological identification and targeted treatment, even in healthy hosts.

Cerebral arteriovenous malformations (AVMs) are congenital vascular abnormalities that can lead to neurological impairments following rupture. This proof-of-concept case report examines the integration of the Monitored Augmented Rehabilitation System (MARS), an immersive virtual gaming platform, into a multidisciplinary rehabilitation program for a 12-year-old female recovering from a ruptured AVM. MARS was used as an adjunct modality alongside conventional interventions over a 4-week period to target functional outcomes as assessed by the Neurocom Balance Manager^®. Quantitative results demonstrated targeted functional gains: Directional Control during the Limits of Stability test increased from 66% to 73%, toes-up Adaptation Test scores improved from 104.2 to 116.2, and toes-down scores from 115.6 to 119.0. Clinically observed increases in engagement, motivation, and adherence were noted during therapy sessions. This report underscores the feasibility and clinical potential of MARS as a complementary tool for enhancing motor learning and functional outcomes in pediatric neurorehabilitation. Future research should focus on larger sample sizes and extended intervention periods to validate the efficacy of MARS in improving long-term recovery outcomes.

Acquired ptosis may result from multiple etiologies, including aponeurotic, neurogenic, myogenic, traumatic, and mechanical causes. When structural eyelid abnormalities are prominent, the clinical signs of underlying neuromuscular disorders may be physically masked and difficult to recognize. A patient in her 70s presented with an acute onset of unilateral ptosis. Neuroimaging revealed an incidental aneurysm of the left middle cerebral artery that was anatomically independent of the oculomotor nerve. Ophthalmic examination suggested aponeurotic ptosis, and surgical repair restored eyelid height immediately. However, fluctuating ptosis with diurnal variation was observed 1 week postoperatively. Electromyography showed a postsynaptic neuromuscular junction disorder. Together with positive acetylcholine receptor antibodies, ocular myasthenia gravis was diagnosed. Treatment with oral pyridostigmine resulted in marked clinical improvement. Severe aponeurotic disinsertion can obscure the fatigability typical of ocular myasthenia gravis and delay recognition of the underlying disorder. In patients with atypical presentations such as acute-onset ptosis, additional evaluation, including electrophysiological testing, is essential to identify coexisting neuromuscular dysfunction.

Primary central nervous system choriocarcinoma is a non-germinomatous germ cell tumor with a highly malignant character, comprising up to 5% of all central nervous system germ cell tumors. Locations affected can include suprasellar or pineal locations most commonly, with others including the basal ganglia and lateral ventricles. Guidelines do not specify an optimal radiation regimen but recommend proceeding with maximally safe resection if feasible and then chemotherapy before radiotherapy. Radiation is often comprised of craniospinal irradiation with subsequent tumor bed boost. We present a case of an adult male with a primary central nervous system choriocarcinoma who underwent reversed sequence radiation therapy with photon tumor bed boost before proton craniospinal irradiation due to recurrent intracranial hemorrhages with long-term control of cancer and no subsequent hemorrhages. This case highlights the excellent outcome and feasibility of reversed sequence radiotherapy on choriocarcinoma in hemorrhage and tumor control.

We present a case of severe and atypical Drug Reaction with Eosinophilia and Systemic Symptoms/Drug-induced hypersensitivity Symptoms (DRESS/DiHS), also known as DiHS, in a 46-year-old Chinese woman, triggered by bortezomib (Velcade), a proteasome inhibitor, commonly used for the treatment of multiple myeloma. Bortezomib-induced DRESS/DiHS syndrome is rare, with this being the second case documented in the literature. The patient presented with severe erythroderma with ichthyosis-like features, hypereosinophilia, and liver injury. Initial response to high dose of solumedrol was followed by relapses upon switching to oral prednisone. Ultimately, the patient responded to dupilumab and maintained complete remission.

Malignant tumours within the nipple-areola complex (NAC) should be considered when a non-healing, bleeding, or painful unilateral lesion persists. We report the unusual case of an 81-year-old male with prior melanoma and non-melanoma skin cancers who presented for a 1- to 2-year history of a painful lesion on the left nipple. On examination, there was a pink, crusted, tender, indurated papule within the left nipple without underlying breast masses or axillary lymphadenopathy. Histopathology revealed nodular basal cell carcinoma (BCC). The patient also had suspicious pulmonary nodules, which demonstrated metastatic melanoma. Unexpectedly, the BCC rapidly grew. It was ultimately treated with Mohs micrographic surgery. This case highlights the importance of maintaining a high index of suspicion for malignant tumours in atypical areas like the NAC, especially unexpected tumours such as BCC. Within the NAC, tumours may display more aggressive features, be misdiagnosed or undiagnosed until later stages, or inadequately treated.

Acromegaly is a rare endocrine disorder caused by excessive secretion of growth hormone, resulting in elevated serum levels of hepatic insulin-like growth factor-1 (IGF-1). With an estimated annual incidence of approximately three cases per million individuals, the condition is associated with a significantly increased risk of cardiovascular complications, such as arrhythmias and acromegaly-induced cardiomyopathy. Heart failure secondary to acromegalic cardiomyopathy occurs in approximately 3% of affected patients and is recognized as the leading cause of mortality in individuals with this condition. This case report describes a 53-year-old male diagnosed with acromegalic cardiomyopathy caused by a pituitary adenoma.

Carfilzomib is a second-generation irreversible proteasome inhibitors commonly used in the treatment of relapsed or refractory multiple myeloma. However, cardiac toxicity (heart failure, hypertension, coronary heart disease, etc.) has become the main factor leading to its reduction or withdrawal. We report a case of a 55-year-old female patient with multiple myeloma who developed sinus bradycardia following the administration of carfilzomib, along with a review of the relevant literature. The correlation between carfilzomib and cardiotoxicity was assessed by reviewing the medical history, applying the adverse drug reaction correlation evaluation, and using the Naranjo assessment scale. The clinical manifestations included chest tightness, shortness of breath, and abnormal electrocardiogram monitoring. The condition was effectively managed following treatment with a combination of trimetazidine and salbutamol. We conducted a literature review of 27 published cases of proteasome inhibitor-induced cardiac toxicity. In the 27 published cases, 12 cases were caused by carfilzomib (44.4%). To our knowledge, this is the first reported case of carfilzomib-associated sinus bradycardia, expanding the spectrum of proteasome inhibitors-related cardiotoxicity. This provides inspiration for suspected patients to stop using carfilzomib early and symptomatic treatment can effectively reduce mortality and improve prognosis.

Pertussis, caused by Bordetella pertussis, is increasingly recognized in adults who often present with atypical symptoms, leading to underdiagnosis. We report a case of a 64-year-old woman with a persistent cough and sore throat initially treated as refractory community-acquired pneumonia. Despite empirical antibiotic therapy, her symptoms persisted. Conventional diagnostic tests, including sputum and bronchoalveolar lavage fluid cultures, were negative. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid identified Bordetella pertussis with high sequence coverage (7497 reads). The patient showed no clinical improvement with azithromycin, prompting a switch to trimethoprim–sulfamethoxazole, after which she improved and was discharged to complete a 14-day course. At 1-month follow-up, she was asymptomatic with resolved radiographic findings. This case highlights that pertussis can mimic refractory pneumonia in adults without typical features such as whooping cough, and underscores the diagnostic value of metagenomic next-generation sequencing when conventional methods fail. Clinicians should consider pertussis in adults with prolonged cough unresponsive to standard community-acquired pneumonia therapy and be aware of potential macrolide resistance, which may necessitate alternative antibiotics like trimethoprim–sulfamethoxazole.

Obstructive uropathy from uterine fibroids is recognized in the general population but is rare in renal transplant recipients. We report the first case, to our knowledge, of uterine artery embolization successfully treating fibroid-induced hydronephrosis of a transplanted kidney. A woman with a prior renal transplant presented with urinary symptoms and anemia due to menorrhagia from uterine fibroids. Imaging revealed a markedly leiomyomatous uterus causing transplant ureteral compression with hydronephrosis. Uterine artery embolization was performed without traversing the transplant arterial anastomosis. At 4 weeks postintervention, hemoglobin levels improved from 7.1 to 11.4 g/dL. Subsequent magnetic resonance imaging performed 6 months after therapy confirmed a 34% reduction in uterine volume and resolution of hydronephrosis. Renal function remained stable. Uterine artery embolization may be a feasible treatment option for fibroid-induced hydronephrosis in selected renal transplant patients, with symptom resolution and preservation of allograft function.

Ethylmalonic encephalopathy is a rare autosomal recessive mitochondrial disorder caused by biallelic pathogenic variants in ETHE1, the gene encoding mitochondrial persulfide dioxygenase, an enzyme crucial for hydrogen sulfide (H₂S) detoxification. Loss of this enzyme results in H₂S accumulation, cytochrome c oxidase inhibition, oxidative stress, and disrupted energy metabolism. Clinically, ethylmalonic encephalopathy manifests during early infancy with developmental delay, hypotonia, progressive encephalopathy, seizures, chronic diarrhea, and microvascular abnormalities such as petechiae and acrocyanosis. Fewer than 100 cases have been reported globally, mostly among Mediterranean and Arab populations, with scarce data from Latin America. We report the first documented case of ethylmalonic encephalopathy in a Mexican patient. The affected male infant, born to healthy nonconsanguineous parents of indigenous Maya origin from Yucatán, presented at 2 weeks of age with persistent hemorrhagic diarrhea, followed by metabolic acidosis, hyperammonemia, hyperlactatemia, elevated C4-acylcarnitine, and increased urinary ethylmalonic acid. Neurological findings included developmental delay, hypotonia, and myoclonic epilepsy. Whole-exome sequencing revealed a homozygous frameshift pathogenic variant in ETHE1 (NM_014297.5):c.19_20dup (p.Val8Glyfs*7), predicted to introduce a premature stop codon and abolish protein function. Despite targeted interventions—antiepileptic therapy, ammonia-lowering treatment, and metabolic support—the patient’s condition progressively worsened, culminating in death at 15 months after metabolic decompensation and brain death. This case broadens the known mutational spectrum of ETHE1 by identifying a previously unreported pathogenic variant and underscores the need to include ethylmalonic encephalopathy in the differential diagnosis of infants presenting with chronic diarrhea, vascular lesions, and neurological deterioration, even in regions where the condition is not typically observed.

Rosai–Dorfman disease is a rare reactive histiocytic proliferation disorder. It is rarely reported in the literature, and its clinical manifestations vary depending on the location of occurrence. The clinical manifestations and imaging features are not characteristic, and the diagnosis mainly relies on pathology and immunohistochemistry. Here, we report a case involving the nasal cavity and paranasal sinuses, which did not exhibit typical symptoms such as painless cervical lymphadenopathy and fever. It could easily have been misdiagnosed as a malignant tumor before surgery. This case did however exhibit typical histopathological features. The patient was treated with surgery combined with hormone therapy and a good clinical outcome was achieved.

Pancreatitis, panniculitis, and polyarthritis syndrome is a rare extrapancreatic triad associated with pancreatic disease and occasionally malignancy. We report a 51-year-old woman with prior hormone receptor-negative, human epidermal growth factor receptor 2-positive breast invasive ductal carcinoma (bilateral mastectomy, adjuvant trastuzumab/pertuzumab, radiation) who developed abrupt painful erythematous nodules of both legs and progressive polyarthralgia of the hands, knees, and ankles. Symptoms were initially treated as inflammatory rheumatic disease with systemic corticosteroids and disease-modifying therapy without benefit, leading to severe functional decline. Imaging later revealed a large hepatic mass; biopsy confirmed metastatic pancreatic acinar cell carcinoma, unifying the presentation as pancreatitis, panniculitis, and polyarthritis syndrome. Coordinated multidisciplinary care, oncology-directed chemotherapy, interventional pain management, and psychological support, improved pain control and mobility. This case adds to the limited pancreatitis, panniculitis, and polyarthritis literature and highlights that absent gastrointestinal symptoms can delay diagnosis; early recognition and collaborative management are essential in malignant pancreatitis, panniculitis, and polyarthritis presentations.

Sjögren’s syndrome-associated interstitial lung disease is a severe systemic complication that often proves refractory to conventional immunosuppressive and biologic therapies. Molecular hydrogen has recently emerged as a novel therapeutic agent known for its selective antioxidant, anti-inflammatory, and immunomodulatory properties. This report evaluates the therapeutic potential of hydrogen in a patient with progressive Sjögren’s syndrome-associated interstitial lung disease. A 72-year-old female with refractory primary Sjögren’s syndrome-associated interstitial lung disease presented with worsening dyspnea, anemia, and progressive pulmonary fibrosis despite prior treatment with corticosteroids, synthetic disease-modifying antirheumatic drugs, and rituximab. The patient initiated oral molecular hydrogen capsule therapy as an adjunctive treatment. Follow-up assessments revealed marked clinical stabilization: pulmonary function tests demonstrated significant objective improvement in gas exchange capacity, anti-Ro antibody titers significantly decreased, and high-resolution computed tomography showed no further progression of fibrosis. Notably, flow cytometric analysis indicated changes associated with the normalization of immunophenotypic markers suggestive of improved immune homeostasis, evidenced by observed alterations in effector T-cell subsets and a shift in previously aberrant regulatory T-cell populations toward levels comparable to healthy controls. No adverse events were observed. Although the patient had received multiple immunosuppressive therapies, including a single dose of rituximab nearly 3 years prior, these outcomes require a cautious interpretation of causality. While the observed clinical and immunophenotypic changes may represent delayed effects of prior therapies or natural disease fluctuation, the extended timeframe makes a solely delayed effect unlikely, strengthening the potential association with hydrogen therapy. These findings suggest hydrogen therapy as a safe and potentially beneficial adjunctive strategy for refractory autoimmune fibrotic diseases, supporting further clinical validation.

A 21-month-old male presented with a suction blister on his thumb caused by the thumb being caught in a pacifier overnight. This rare presentation highlights the need for careful monitoring of pacifier use in young children to prevent similar injuries and underscores the importance of considering uncommon causes in the differential diagnosis of blisters.

Sudden cardiac death is a major forensic challenge because it can occur unexpectedly in apparently healthy individuals and postmortem artefacts may complicate interpretation. We report the case of a 28-year-old male who was found deceased, with autopsy revealing critical coronary artery blockages alongside insect-related postmortem artefacts. These artefacts initially mimicked antemortem injuries, but careful examination distinguished them from actual pathology. Comprehensive ancillary investigations including histopathological examination that confirmed the gross autopsy findings, and a full toxicological screen yielding negative results corroborated the diagnosis of coronary insufficiency as the cause of death. This case underscores the importance of meticulous autopsy protocols in recognising postmortem changes, preventing misdiagnosis, and ensuring accurate determination of the cause of death in suspected cases of sudden cardiac death.

Spectral domain optical coherence tomography has changed the way we view retinal diseases by providing us with high-resolution, cross-sectional images. It is very important for diagnosing and keeping a track of cystoid macular oedema, especially when it is caused by vascular conditions such as branch retinal vein occlusion. A 47-year-old man with poorly controlled type 2 diabetes mellitus presented with reduced visual acuity in his left eye. Amsler grid testing showed that the patient had metamorphopsia. The fundus examination indicated inferotemporal branch retinal vein occlusion, necessitating additional assessment. Spectral domain optical coherence tomography confirmed cystoid macular oedema with increased macula thickness and disruption of the external limiting membrane and ellipsoid zone, indicating disorganization of the outer retinal layers with photoreceptor involvement. There was also a partial posterior vitreous detachment. The changes in the outer retinal layers are important optical coherence tomography biomarkers that are linked to reduced visual acuity. The patient received an intravitreal injection of ranibizumab along with an adjunctive course of topical nepafenac (a nonsteroidal anti-inflammatory drug). During follow-up, spectral domain optical coherence tomography showed resolution of macular oedema, and the best-corrected visual acuity improved from 20/80 to 20/40, and the metamorphopsia was diminished. A small intraretinal cyst close to the fovea, hard exudates, and progressing posterior vitreous detachment were, however, seen. This case underscores the significance of systemic metabolic dysfunction, the prognostic utility of optical coherence tomography biomarkers, and the necessity of therapeutic strategies in the management of branch retinal vein occlusion.

Drug reaction with eosinophilia and systemic symptoms is a severe cutaneous adverse reaction frequently associated with lamotrigine, an antiepileptic drug also used to treat bipolar disorder. Although a mainstay of therapy for drug reaction with eosinophilia and systemic symptoms is oral corticosteroids, steroids should be used with caution in patients with bipolar disorder, as mania is a well-known drug side effect. We present a case of a 21-year-old female patient with bipolar disorder who was treated with prednisone for lamotrigine-induced drug reaction with eosinophilia and systemic symptoms, and subsequently experienced steroid-induced mania, exacerbated by an unopposed antidepressant medication. This resulted in involuntary hospital admission under psychiatry, which was profoundly distressing for the patient. We present this case as a reminder to screen for risk of mania in patients receiving systemic corticosteroids, and to carefully assess concurrent antidepressant use when discontinuing mood stabilizers like lamotrigine.

We report a rare case of acquired, transient platelet dysfunction induced by infection in an older patient. An 84-year-old female with persistent pneumonia presented with severe mucocutaneous bleeding and anemia (nadir hemoglobin: 38 g/L) despite normal platelet count and coagulation parameters. Platelet function tests showed absent or reduced aggregation to all standard agonists. Treatment included platelet transfusion support, targeted anti-infection therapy, and adjunctive agents (ulinastatin and sulodexide) to address inflammation and endothelial dysfunction. The patient’s platelet function normalized with the resolution of infection. This case highlights infection as an underrecognized etiology of acquired platelet dysfunction, particularly in older patients, where normal platelet counts may obscure the diagnosis of major platelet functional impairment.

Natural killer cells are the most researched and employed cells for immunotherapy, which have expanded from autologous immune-enhanced therapies to genetically enhanced cell therapies such as chimeric antigen receptors natural killer cells. The present clinical case study aims to analyze and evaluate the safety and tolerability of ex-vivo expanded autologous natural killer cells via an in-house developed culture protocol. The novel, cultivation protocol enables high-yield and pure natural killer cell batches free of antibody usage, prior natural killer cell purification, or any magnetic-bead labeling, resulting in a fully human compatible cell expansion process. In this report, a total of nine patients were clinically infused with the in-house cultured natural killer cells and were monitored pre- and postinfusion for haematological parameters, liver function profile, hypersensitivity, inflammatory markers as well as pretumor markers to assess for the possibilities of natural killer cell-induced or any dose-dependent toxic/adverse reactions. The outcomes indicate that the patient infused with natural killer cells demonstrates good level of clinical safety with no signs of hepatotoxicity, hypersensitivity, inflammation, or any flares of preliminary tumor markers. The study provides supportive evidence of the clinical tolerance of autologous-derived natural killer cells cultured via the in-house protocol on patients in Malaysia and establishes a baseline for future clinical studies with a wider range of patients.

Hemorrhagic cholecystitis is a rare cause of obstructive jaundice and presents diagnostic and therapeutic challenges. This case report describes a patient with obstructive jaundice secondary to hemorrhagic cholecystitis who was successfully treated with percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography. A 42-year-old woman sustained a high-altitude fall resulting in pulmonary contusion and pelvic and femoral fractures. After orthopedic surgery, she developed hemorrhagic cholecystitis. Although percutaneous transhepatic gallbladder drainage resolved the intragallbladder hemorrhage, obstructive jaundice persisted due to a blood clot in the common bile duct, caused by hemobilia, obstructed biliary outflow. Subsequent endoscopic retrograde cholangiopancreatography successfully removed the clot and restored biliary drainage. The patient achieved complete clinical recovery and was discharged without complications within 1 month. Obstructive jaundice due to hemorrhagic cholecystitis is uncommon and requires prompt diagnosis and intervention. To our knowledge, this report is among the few describing successful combined management with percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography using a fully covered metal stent and endoscopic nasobiliary drainage for obstructive jaundice secondary to hemorrhagic cholecystitis complicated by hemobilia.

Pyoderma gangrenosum is a rare neutrophilic dermatosis often associated with systemic inflammatory or malignant conditions. We report a case of recurrent pyoderma gangrenosum injection site reactions following subcutaneous Maveropepimut-S (previously known as DPX-Survivac), an anti-cancer vaccine, in a 31-year-old woman undergoing immunotherapy for stage 3C ovarian cancer. The diagnosis was confirmed histologically and clinically after repeated ulcerative lesions developed at injection sites. The lesions showed a rapid response to corticosteroid therapy. This case highlights the importance of recognizing pyoderma gangrenosum as a potential cutaneous adverse event in immunotherapy treatments and suggests that timely dermatologic evaluation may help avoid delays in diagnosis and treatment.

Traumatic and iatrogenic cataracts may conceal occult capsular injury that routine slit-lamp examination and biometry fail to detect, increasing the risk of intraoperative complications. We present a mechanism-aware, imaging-guided approach to cataract surgery in an eye with suspected capsular compromise. An elderly man with a dense cataract and limited fundus view underwent preoperative imaging, which revealed a focal anterior capsular defect on ultrasound biomicroscopy, while posterior capsule integrity remained uncertain. His history included multiple intravitreal injections and prior anterior chamber paracentesis, raising suspicion for iatrogenic capsular injury. Given possible posterior fragility, surgery was performed using a noncontinuous curvilinear capsulotomy with radial relaxing incisions, low-vacuum and low-flow phacoemulsification, and contingency planning for capsular support and anterior vitrectomy. A monofocal intraocular lens was successfully implanted in the capsular bag without complication. This case highlights the importance of linking mechanism, targeted imaging (swept-source OCT or ultrasound biomicroscopy depending on media clarity), and a modified surgical strategy to reduce the risk of posterior capsule rupture and improve intraoperative preparedness.

Pyoderma gangrenosum is a rare neutrophilic dermatosis, that is, often recalcitrant to conventional therapies. Biologics targeting specific inflammatory pathways, including IL-17, are emerging as alternative treatment options in refractory cases. We report a case of severe, ulcerative pyoderma gangrenosum in a 78-year-old woman with complex comorbidities, including advanced sarcoma and prior venous thromboembolism, which precluded use of several immunosuppressive agents. The patient was refractory to corticosteroids, dapsone, and roflumilast, and developed recurrent Gram-negative infections. Initiation of brodalumab, an anti-IL-17RA monoclonal antibody, led to rapid ulcer improvement and sustained clinical response, with successful tapering of systemic steroids. Brodalumab may offer a safe and effective treatment option in refractory pyoderma gangrenosum, particularly in patients with contraindications to conventional therapies. This case supports further evaluation of IL-17 pathway inhibition in neutrophilic dermatoses.

Sudden sensorineural hearing loss is a condition marked by a rapid decline in hearing, defined as a decrease of 30 dB or more across three adjacent audiometric frequencies within 72 h. It can result from various factors, including ischemic events, infections, or tumors like meningioma and schwannoma, and in rare cases, may be linked to Langerhans histiocytosis, which involves an accumulation of specific immune cells. This document reviews literature and presents a case study of a 24-year-old male from Iran diagnosed with sudden sensorineural hearing loss due to Langerhans cell histiocytosis. The patient, who had diabetes insipidus, showed eosinophil-rich lesions with CD1a-positive, S100-positive, and Cyclin D1-positive cells. After 6 months of chemotherapy, there was no change in hearing levels. This case report underscores the importance of considering an occupying lesion in cases of sensorineural hearing loss, particularly when there are indications of additional paraneoplastic conditions.

Greater tuberosity (GT) fractures with rotator cuff injuries are challenging due to risks of nonunion and functional loss. We report a case treated with a distal radius locking plate combined with suture anchors. A female patient presented with shoulder pain and immobility 4 weeks after trauma, diagnosed with humeral head dislocation and rotator cuff tear. She underwent minimally invasive fixation using this combined technique, which provides stable fracture reduction while repairing the rotator cuff. At the 18-month follow-up, shoulder function was fully restored with no complications. This combined technique achieved favorable outcomes, suggesting that it may represent a safe and effective option for selected patients with similar complex injuries.

Pilomatricomas are slow-growing benign skin growths seen predominantly in the head and neck region of pediatric patients. Current literature review notes that these lesions are often misdiagnosed both clinically and radiologically, as their features are non-specific, making excision and histologic evaluation the only means to confirm the diagnosis. This case report illustrates the course of a pediatric patient who presents with a pilomatricoma in a less commonly seen location. As with most of these cases, the diagnosis was unclear until surgical excision and pathology were performed.

Systemic allergic contact dermatitis to nickel is a challenging condition often presenting as severe hand dermatitis. This case report details the clinical course of a 33-year-old male truck driver with severe hand dermatitis secondary to systemic allergic contact dermatitis to nickel. Despite significant improvement with avoidance, the patient experienced recurrent flares due to ongoing accidental nickel exposure. Upadacitinib provided an effective salvage strategy. The case underlines challenges of managing systemic allergic contact dermatitis.

Auditory hallucinations are frequently linked to the onset of psychotic disorders, especially when accompanied by delusions or disorganized thinking. However, hallucinations may also arise from non-psychiatric causes. Hearing loss is often underrecognized as a contributing factor, since reduced auditory input can produce perceptual experiences that mimic psychosis. This case report presents a woman in her 50s with bilateral sensorineural hearing loss who experienced persistent auditory hallucinations for more than 3 years. She maintained insight, normal daily functioning, and exhibited no other features of a primary psychotic disorder. Neuroimaging was unremarkable, and multiple antipsychotic trials yielded minimal benefit. Despite improved auditory input with hearing aids, her hallucinations persisted, highlighting that symptoms related to sensory deprivation may not resolve immediately after hearing correction. This case illustrates how sensory deprivation-related hallucinations can be misdiagnosed as psychiatric illnesses, resulting in unnecessary interventions. It underscores the importance of early identification of sensory impairments and interdisciplinary collaboration when clinical presentations deviate from typical psychiatric conditions.

Pneumoparotid is a rare cause of parotid gland swelling characterized by the presence of air within Stensen’s duct and/or the parotid gland itself. It is often confused with more common causes of parotid enlargement, such as infection, and may be self-induced or associated with increased intraoral pressure. Awareness of this entity is important to avoid misdiagnosis and inappropriate treatment. We report an adult case of self-induced pneumoparotid in a 46-year-old male who developed recurrent bilateral parotid swelling over several months due to intentional oral auto-insufflation performed to relieve temporomandibular joint discomfort and anxiety. On otolaryngology evaluation, he had mild, soft, non-erythematous parotid swelling with subtle crepitus over the left gland. Computed tomography of the head and neck demonstrated air within both Stensen’s ducts, the parotid parenchyma, and the overlying facial subcutaneous tissues, with no signs of inflammation or abscess. The patient was afebrile and without leukocytosis, and a diagnosis of self-induced pneumoparotid was established. He was managed conservatively with counseling to discontinue the pressure-generating maneuvers, and no procedural intervention was required. The swelling resolved with behavior modification, and he remained free of recurrence over 3 months. This case highlights pneumoparotid as an important differential diagnosis for recurrent, noninfectious parotid swelling and demonstrates that early recognition combined with targeted history-taking and conservative management can prevent unnecessary invasive treatments and serious complications, even in adult patients.

Combined small-cell lung carcinoma is a rare and heterogeneous lung cancer characterized by the coexistence of small-cell and non-small-cell components. Concurrent epidermal growth factor receptor mutation and anaplastic lymphoma kinase rearrangement in combined small-cell lung carcinoma is extremely uncommon and presents diagnostic and therapeutic challenges. We report a 63-year-old man presenting with cough and right-sided chest pain. Imaging revealed a right lower lobe mass with mediastinal lymphadenopathy. Initial biopsy showed adenocarcinoma without actionable mutations. Following a limited response to neoadjuvant chemotherapy, right lower lobectomy was performed. Histopathological examination revealed combined small-cell carcinoma and adenocarcinoma, while molecular analysis identified concurrent epidermal growth factor receptor exon 19 deletion and anaplastic lymphoma kinase rearrangement. Lymph nodes were negative for metastasis. Postoperative targeted therapy was initiated, and follow-up imaging showed no evidence of recurrence. This case highlights tumour heterogeneity and the importance of comprehensive pathological and molecular evaluation in guiding personalized therapy.

Acromegaly is a rare endocrine disorder with an insidious onset and delayed diagnosis, and emerging evidence suggests a potential link to an increased risk of thromboembolic and cerebrovascular events. We present three cases where vascular events were the initial or incidental diagnostic clue. Case 1 involves a 52-year-old man with pulmonary embolism who was subsequently diagnosed with acromegaly. Case 2 describes a 30-year-old man with bilateral pulmonary embolism and a delayed diagnosis of acromegaly. Case 3 reports a 44-year-old man who presented with a transient ischemic attack, leading to the incidental discovery of a pituitary microadenoma and a diagnosis of acromegaly. All patients showed a clinical or biochemical response to therapy. These cases highlight the importance of considering acromegaly in patients with unexplained thromboembolic or cerebrovascular events, as early diagnosis and treatment are crucial for reducing long-term morbidity.

Lingual osseous choristoma is a rare benign lesion characterized by ectopic mature bone within the soft tissues of the tongue, with just over 100 cases reported in the literature. Its clinical presentation is often nonspecific, making diagnosis challenging. A 45-year-old woman was referred for evaluation of a slowly enlarging mass on the posterior dorsal surface of the tongue, initially noted during a routine dental examination. The lesion was asymptomatic, with no associated pain, dysphagia, or bleeding. Clinical examination revealed a firm, whitish, non-ulcerated mass suggestive of a fibroma or an irritated circumvallate papilla. An excisional biopsy was performed under local anesthesia. Histopathological analysis demonstrated mature cortical bone embedded within the lingual submucosa, confirming the diagnosis of lingual osseous choristoma. The postoperative course was uneventful, and no recurrence was observed during a 2-year follow-up. Lingual osseous choristoma is an uncommon but important entity to consider in the differential diagnosis of posterior tongue masses. Surgical excision is both diagnostic and curative, with an excellent prognosis.

We report the case of a 74-year-old Inuit man from Kangiqsualujjuaq, Quebec, with a 10-year history of persistent facial skin changes, reported as “dry skin.” Examination revealed violaceous scaly papules on sun-exposed areas that had sandpaper texture on palpation. The patient, with no significant medical history, spends extensive time outdoors in a subarctic environment. A diagnosis of actinic keratoses was made. This case highlights the need to recognize atypical presentations of actinic keratoses in patients with darker skin phototypes and high environmental ultraviolet exposure. Topical 5% fluorouracil was initiated.

We report a rare case of Stevens–Johnson syndrome/toxic epidermal necrolysis as the initial manifestation of paraneoplastic dermatomyositis in a 50-year-old man subsequently diagnosed with diffuse large B cell lymphoma, in the absence of any identifiable drug exposure. The patient presented with periorbital edema, progressive dusky blistering eruption (Nikolsky sign positive), mucositis, and histopathology consistent with Stevens–Johnson syndrome/toxic epidermal necrolysis. Over the following weeks, he developed proximal muscle weakness, elevated creatine kinase, and cutaneous signs of dermatomyositis, including heliotrope rash and Gottron’s papules, with serologic confirmation via anti-TIF1-γ antibodies. Imaging revealed a hypermetabolic axillary mass, and excisional biopsy confirmed diffuse large B cell lymphoma. This case highlights a novel presentation of Stevens–Johnson syndrome/toxic epidermal necrolysis in the setting of autoimmune and paraneoplastic immune dysregulation. It underscores the importance of considering nondrug-induced triggers in Stevens–Johnson syndrome/toxic epidermal necrolysis.

Cerebral hemosiderosis is a condition resulting from recurrent or extensive intracranial hemorrhages, leading to hemosiderin deposition in central nervous system structures and affecting cranial nerves. The classic clinical triad includes sensorineural hearing loss, cerebellar ataxia, and pyramidal signs, with less frequent involvement of other cranial nerves. In our case however, we report a unique presentation of multiple lower cranial nerve involvement following a right-myelencephalic subarachnoid hemorrhage secondary to hemorrhagic ventricular effraction in a 58-year-old male patient. We aim to highlight the implications of atypical cranial nerve hemosiderosis on swallowing and tracheotomy weaning and demonstrate the importance of tailored rehabilitation approaches. The patient presented a coma after hemorrhagic stroke and was later diagnosed with hemosiderosis affecting cranial nerves IX, X, and XII, leading to severe dysphagia and delayed tracheotomy weaning. Magnetic resonance imaging with susceptibility-weighted sequence confirmed the diagnosis. Neurorehabilitation was adjusted to incorporate specific swallowing techniques addressing pharyngeal motor deficits. Despite the tracheotomy weaning delay (31 vs 12.75 days average), a specific adaptation of cervical posture during the swallowing, that is, anterior flexion combined with a rotation ipsilateral to the affected side helped to secure swallowing and promote tracheotomy weaning. This case emphasizes that hemosiderin deposits can affect cranial nerves beyond the typical vestibulocochlear nerve, possibly influenced by cerebrospinal fluid flow patterns near Magendie’s foramen. This case underscores the need for early diagnosis and tailored rehabilitation in cerebral hemosiderosis with atypical cranial nerve involvement to optimize functional outcomes. Further research is essential to guide management in such rare presentations.

Superior vena cava syndrome (SVCS) caused by gallbladder cancer is extremely rare, with tumor thrombus potentially leading to right atrial obstruction or fatal pulmonary embolism. This report presents a 56-year-old female with gallbladder cancer who developed SVCS due to tumor metastasis. The patient presented with cough, hoarseness, dyspnea, headache, and facial-cervical swelling. Contrast-enhanced chest computed tomography confirmed tumor thrombi in the left brachiocephalic vein, right brachiocephalic vein, and superior vena cava (SVC). Under cardiopulmonary bypass, SVC thrombectomy was performed, revealing two massive thrombi (20 × 80 mm, 10 × 80 mm). At the 11-month follow-up, the patient showed good recovery without thrombus-related complications. Surgical intervention directly relieved mechanical obstruction caused by tumor or thrombus, demonstrating its crucial role in palliating life-threatening obstruction and improving quality of life in advanced cancer with SVCS.

Ceruminous adenocarcinoma (CAC) represents an exceedingly rare malignant glandular neoplasm originating from the ceruminous glands within the external auditory canal (EAC), constituting approximately 5%–10% of all EAC malignancies. Owing to its insidious onset and nonspecific symptoms, diagnosis is frequently delayed. This report delineates a case of right EAC CAC in a 39-year-old male, focusing on the diagnostic trajectory, multimodal therapy, and short-term outcomes. The patient presented with a one-month history of recurrent bloody purulent discharge from the right ear, intermittent otalgia, and mild conductive hearing loss. Otoscopy revealed a cauliflower-like, ulcerated, and bleeding mass on the floor of the right EAC. Computed tomography (CT) showed a mass within the right EAC encroaching upon the superficial parotid lobe and the facial nerve’s vertical segment, with no intracranial extension. Cervical ultrasound demonstrated multiple enlarged lymph nodes in right levels 2–4. A pathological biopsy confirmed CAC, with immunohistochemical staining positive for CK7, EMA, and partially for S-100. The patient underwent radical surgery, including right subtotal temporal bone resection (with EAC and mastoid removal, reconstructed using temporalis fascia and a skin graft), right total parotidectomy, and right cervical level 2–4 lymph node dissection. Intraoperatively, the tumor infiltrated the facial nerve sheath, but the nerve parenchyma was preserved; the sheath was dissected free without nerve resection or anastomosis. Postoperative adjuvant radiotherapy (60 Gy in 30 fractions) was administered. Recovery was uneventful. At 3-month follow-up, the EAC wound had healed completely, and CT/magnetic resonance imaging showed no residual or recurrent tumor.

Crohn’s disease is a chronic inflammatory bowel disease in which extraintestinal manifestations may occur before the onset of intestinal symptoms. Ocular manifestations, such as orbital myositis, are extremely rare as initial presentations. We present an interesting case of a 10-year-old female who presented with fever, abdominal pain, weight loss, diarrhea, and purulent rectal drainage and was subsequently diagnosed with Crohn’s disease. Notably, she had been diagnosed with orbital myositis the previous year after presenting with right-greater-than-left eyelid drooping, swelling, pain, and redness. This case underscores the importance of recognizing the rare yet clinically significant association between orbital myositis and Crohn’s disease. Awareness of this relationship may facilitate prompt diagnosis and earlier therapeutic intervention, potentially preventing disease progression or complications. Clinicians should consider inflammatory bowel disease in their differential diagnosis workup of patients presenting with initial symptoms concerning for orbital myositis.

Radiation-induced morphoea is an under-recognised complication of radiotherapy that can cause significant pain, functional impairment, and disfigurement. It is frequently misdiagnosed due to its non-specific presentation. We report the case of a 70-year-old female with prior right breast invasive ductal carcinoma, status post-lumpectomy, who developed painful cutaneous thickening and atrophy within the irradiated field 18 months after adjuvant radiotherapy. Malignant recurrence was excluded, and biopsy revealed dermal sclerosis with collagen thickening consistent with radiation-induced morphoea. Management included intralesional corticosteroid injections, regional nerve blocks, and physical therapy. Early recognition, biopsy, and multidisciplinary management are critical to improving patients’ quality of life.

Lophomoniasis is a new emerging parasitic disease caused by Lophomonas spp., a protozoan that predominantly resides in a commensal relationship within the hindgut of cockroaches. This pathogen is known to affect the lower respiratory tract in humans, resulting in clinical manifestations such as cough, sputum production, and shortness of breath. We present two case studies involving a 54-year-old- and a 38-year-old male, both with a history of cigarette smoking but no known underlying medical conditions. These individuals presented at the emergency room with respiratory symptoms and were subsequently evaluated. No significant abnormalities were shown on the lung computed tomography scan in Case 1, whereas empyema was observed in the right lung in Case 2. Analysis of bronchoalveolar lavage fluid from each patient revealed Lophomonas spp., an emerging protozoan pathogen, by microscopic examination. Based on these findings, metronidazole was administered to both patients, resulting in successful treatment of the infection. These cases highlight that Lophomonas spp. is a significant respiratory pathogen capable of causing a spectrum of disease in immunocompetent individuals, from mild bronchitis to severe pneumonia with complications. They emphasize the critical importance of including lophomoniasis in the differential diagnosis for persistent or atypical respiratory infections. Timely treatment with metronidazole was effective, resulting in clinical resolution.

Galactocele is a rare clinical finding in males and is even more uncommon in the context of prolactin-secreting pituitary adenomas. Its occurrence raises important questions about the effects of hyperprolactinemia in men, especially when there is poor treatment adherence. We describe a 34-year-old man with type 2 diabetes who presented with erectile dysfunction, gynecomastia, and galactorrhea. Investigations confirmed hyperprolactinemia secondary to a pituitary macroadenoma. He was started on cabergoline, which improved his symptoms. However, after discontinuing therapy for several months, he developed a painful breast mass. Ultrasound and aspiration confirmed a galactocele—a finding rarely reported in adult males. The mass resolved after aspiration, and dopamine agonist therapy was resumed. This case highlights the importance of recognizing galactocele as a potential complication of untreated or poorly managed hyperprolactinemia in men. It underscores the need for sustained adherence to dopamine agonists and vigilance in evaluating male patients with gynecomastia and galactorrhea.

A 70-year-old male with type 2 diabetes presented to the emergency department with severe abdominal pain and dyspnea after 24 weeks of treatment with weekly subcutaneous semaglutide (1 mg). He was diagnosed with acute pancreatitis and diabetic ketoacidosis (DKA) and admitted to the intensive care unit. Following 5 days of stabilization and symptom relief, he was transferred to a general ward. However, the patient subsequently developed a high-grade fever persisting for 3 days, accompanied by severe leukocytosis, despite normalized serum lipase levels. A repeat abdominal computed tomography scan revealed acute acalculous cholecystitis complicated by gallbladder rupture. The patient underwent emergency percutaneous transhepatic gallbladder drainage and antibiotic therapy, leading to gradual recovery. This clinical course illustrates a rare cascade of severe complications in a patient receiving a glucagon-like peptide-1 (GLP-1) receptor agonist. Specifically, when new-onset systemic symptoms emerge following the initial stabilization of a critical illness, clinicians should maintain vigilance for repeating imaging studies. This rare case highlights the need for further investigation into whether the pharmacological effects of GLP-1 receptor agonists, such as biliary stasis, might act as a predisposing factor for complex biliary complications in the setting of severe physiological stress.

Parotid gland malignancies are rare and represent less than 5% of all head and neck cancers. Squamous cell carcinoma of the parotid gland is an uncommon subtype and is often associated with aggressive clinical behavior. While regional lymphatic spread is common, distant metastases to organs such as the lungs, brain, and liver are rare but indicate advanced disease and poor prognosis. We report a 60-year-old male with primary right parotid squamous cell carcinoma who initially presented with facial nerve paralysis and locally advanced infiltrative disease requiring debulking parotidectomy followed by chemoradiotherapy. Despite multimodal treatment, the patient developed progressive metastatic disease with respiratory symptoms, ocular pain, and worsening clinical status. Computed tomography imaging revealed extensive metastatic involvement including multiple bilateral pulmonary nodules with a dominant left perihilar mass, multiple cerebral metastases demonstrating ring-enhancing lesions with marked surrounding vasogenic edema, pleural metastatic involvement, and multiple hepatic hypodense lesions. An incidental left thyroid lobe nodule was also identified and subsequent fine-needle aspiration cytology confirmed benign colloid goiter. The patient received palliative chemotherapy with carboplatin and paclitaxel alongside supportive therapy. This case highlights the aggressive metastatic potential of parotid squamous cell carcinoma, the possibility of progressive systemic dissemination despite multimodal therapy, and the importance of comprehensive imaging in detecting disease progression and guiding management.

Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders defined by resistance to parathyroid hormone (PTH), typically stemming from GNAS locus abnormalities. This report describes an unusual case of a 32-year-old Han Chinese male with sporadic PHP Type 1B (PHP1B) who presented with paroxysmal numbness and significant hypokalemia. Despite elevated PTH levels, the patient maintained normocalcemia and showed no evidence of globus pallidus calcification on brain imaging. Diagnosis was confirmed using methylation-specific multiplex ligation-dependent probe amplification, which identified characteristic GNAS imprinting defects: a gain of methylation at the NESP55 exon and loss of methylation at the AS, XL, and A/B exons. With a normal copy number, no detectable GNAS mutations, and a negative family history, the case was classified as sporadic PHP1B. This rare presentation highlights the broad phenotypic spectrum of PHP and emphasizes the clinical importance of monitoring diverse electrolyte disturbances, such as hypokalemia, even when calcium levels appear normal.

Vertical root fractures in young permanent teeth secondary to dental trauma are rarely documented in the literature. This case report presents an effective conservative management strategy for preserving a young permanent tooth with a cervical vertical root fracture utilizing splinting techniques and long-term follow-up. We report the case of a 6.5-year-old child who presented with a trauma-induced vertical root fracture in the maxillary left central incisor (tooth #21). Over a 5-year follow-up period, successful hard tissue healing and complete root maturation were observed. By detailing the treatment protocol and reviewing relevant literature, this report analyzes the factors influencing vertical root fracture prognosis and highlights the remarkable self-healing capacity of immature teeth. The favorable clinical outcomes demonstrate that conservative management through splinting provides a viable and highly effective therapeutic option for treating vertical root fractures in young permanent dentition.

Autosomal-dominant polycystic kidney disease is a clinically significant disorder associated with progressive renal impairment. In these patients, cyst infection is an important but variably occurring complication, and optimal antibiotic selection remains challenging owing to the limited available evidence and restricted antibiotic penetration into cysts. An 81-year-old Japanese man with autosomal-dominant polycystic kidney disease undergoing maintenance hemodialysis presented with fever and a suspected cyst infection. Blood cultures showed the fluoroquinolone-resistant Enterococcus faecium. Vancomycin was contraindicated due to allergy, and teicoplanin was ineffective. Oral linezolid was initiated, resulting in clinical improvement. However, treatment was discontinued after 15 days of therapy (on hospital day 27) because of grade 1 thrombocytopenia. This case contributes to the limited clinical evidence in this field and highlights the potential role of linezolid in the management of Enterococcus faecium suspected cyst infections in autosomal-dominant polycystic kidney disease when glycopeptides are ineffective or contraindicated.

Sucking pads are benign, self-limiting skin findings that develop on the red lip in infants as a result of repetitive suction and pressure during feeding. Although well described in pediatric dermatology, documentation of these lesions in infants with skin of color is limited, which may cause diagnostic uncertainty. We present a case of a 41-day-old infant with skin phototype V and a 2-week history of progressive fixed darkening and mild scaling of the lips. The mucosal areas were spared and there was no evidence of central cyanosis, clinically consistent with sucking pads. This case highlights the importance of recognizing sucking pads as a cause of lip dyspigmentation in infants across all skin phototypes and understanding normal physiologic variations among diverse populations. Increased representation of pediatric skin of color in educational resources is critical to ensure equitable and accurate clinical assessment.

Thyroid nodules are commonly found in clinical practice, with a prevalence of 5%–7% on physical examination and up to 20%–67% when detected by high-resolution ultrasound in adults. The annual incidence of thyroid cancer varies significantly in different countries, ranging from 2.0 to 3.8/100,000 in women and from 1.2 to 2.6/100,000 individuals in men, with papillary thyroid cancer being the most frequently diagnosed type. While most of these nodules are nonfunctioning and benign, some may be hyperfunctioning (“hot” nodules), potentially causing thyrotoxicosis. Differentiated thyroid cancers, such as papillary and follicular thyroid carcinoma, are typically considered “cold” on scintigraphy, rarely presenting with hyperthyroidism. This case series describes a unique presentation of papillary and follicular thyroid carcinoma in two patients with thyrotoxicosis secondary to a hyperfunctioning nodule (“hot” nodule). Both patients presented with signs of hyperthyroidism. Diagnostic imaging revealed a hyperfunctioning thyroid nodule and subsequent histopathology confirmed the presence of both papillary and follicular carcinoma. This case series highlights the rare coexistence of differentiated thyroid cancer and thyrotoxicosis due to a hot nodule. It emphasizes the importance of thorough evaluation of hyperfunctioning nodules to rule out malignancy. Early recognition and appropriate management are crucial in optimizing patient outcomes.

Fibrous hamartoma of infancy (FHI) is a rare benign mesenchymal tumor typically presenting with a triphasic histologic pattern. We report an unusual case of FHI presenting as a breast mass in a 6-month-old infant, characterized by a predominant pseudoangiomatous pattern. Diagnosis was confirmed through clinical, radiologic, and histopathologic correlation, supported by the identification of a specific epidermal growth factor receptor exon 20 mutation. This case highlights the importance of molecular analysis in distinguishing atypical FHI variants from other pediatric tumors.

Dipyrone (metamizole) is a widely used non-opioid analgesic. Its use is restricted due to the risk of side effects such as liver toxicity. We report the case of a patient who accidentally received an oral dose of 12.5 g (132 mg/kg) dipyrone. The patient was monitored for the next 62 days and remained asymptomatic, showing no signs of gastrointestinal, hepatic, or other toxicity. Dipyrone was not detectable in the plasma, while the plasma concentrations of its active metabolites 4-methylaminoantipyrine and 4-aminoantipyrine were elevated. The pharmacokinetics were best described by nonlinear one-compartment models with Michaelis–Menten elimination. The terminal half-life of both metabolites was 2.9 h. These results demonstrate the rapid absorption of dipyrone and the extremely short window for effective gastric decontamination. Due to its specific pharmacokinetic profile, the high systemic exposure to active dipyrone metabolites did not result in acute organ toxicity in this case. Therefore, intensive medical monitoring may not always be mandatory after dipyrone overdose in otherwise clinically stable patients, although agranulocytosis remains as idiosyncratic long-term risk.

Nephrotic syndrome can have overlapping features across multiple diseases, making diagnosis difficult without tissue confirmation. We describe a 30-year-old uninsured Hispanic woman with type 1 diabetes, hypertension, and CKD3B who presented with nephrotic syndrome, sepsis, and progressive muscle weakness. Her pleural effusions, periorbital changes, elevated free light chains, and dysphagia raised concern for systemic conditions such as amyloidosis or polymyositis, especially given inconsistent outpatient follow-up. Because her management would differ significantly depending on the underlying cause and due to the high risk of loss to follow-up, a renal biopsy was pursued. Serologic studies were unremarkable, and biopsy ultimately confirmed diabetic nephrosclerosis. This case highlights how clinical findings alone may be misleading in diabetic patients with heavy proteinuria. Renal biopsy remains the most reliable tool for distinguishing diabetic nephropathy from other systemic diseases. An individualized approach that considers comorbidities and social determinants of health is essential for accurate diagnosis and care.

Soft tissue injuries of the foot are common in scenarios such as traffic accidents and construction site incidents, involving damage to the plantar fat pad, blood vessels, nerves, and important tendon tissues. The treatment of these injuries faces significant challenges. A 46-year-old male patient suffered soft tissue injuries to the plantar and calcaneus of his right foot due to trauma, without any fractures. Following injury, the patient developed spasms in the right gastrocnemius muscle for unknown reasons. Nevertheless, after undergoing several sessions of negative pressure wound therapy to treat the soft tissue injury on the foot, the spasms in the gastrocnemius muscle resolved, and the soft tissue damage on the plantar and calcaneus of the right foot was effectively treated. This research presents a case of utilizing negative pressure wound therapy to treat a trauma patient with a foot injury-induced gastrocnemius spasms. By explaining and discussing the changes in spasm symptoms post-treatment, the clinical significance and potential mechanism of negative pressure wound therapy in managing foot soft tissue injuries causing gastrocnemius spasms are investigated.

Although thrombotic events are common complications after cardiac arrest, the rapid formation of intracardiac thrombi is rarely directly observed. Here, we report a 57-year-old male who underwent laparoscopic bladder flap ureteral replacement surgery for a right ureteral fistula. During the surgery, indocyanine green was injected into the ureter, resulting in sudden respiratory and cardiac arrest. Immediate cardiopulmonary resuscitation was initiated, and transesophageal echocardiography revealed right atrial mass formation. After cardiopulmonary resuscitation, the patient’s vital signs remained stabilized. Repeat cardiac ultrasound demonstrated rapid mass resolution. The patient was successfully extubated in the intensive care unit and was subsequently discharged without complications. This case directly documents the rapid formation of intracardiac mass following cardiac arrest, highlighting the need to promptly rule out thrombotic events after successful resuscitation to enable timely management.

Multiple primary lung cancer is a very rare type of tumour that occurs when two or more primary malignant tumours develop simultaneously or sequentially in the same patient’s lungs. When two or more primary sites are present at the same time, it is called synchronous multiple primary lung cancer. Currently, the pathogenesis, clinical features, and prognostic factors of synchronous multiple primary lung cancer are unclear, and there are no guidelines for diagnosis and treatment. We present a 74-year-old male patient with a combination of three histological types of synchronous primary lung cancer. He underwent partial lobectomy and was diagnosed with synchronous multiple primary lung cancer. The pathological diagnosis revealed adenosquamous carcinoma in the right lower lobe and small-cell lung cancer in the left lower lobe. After comprehensive treatment, the patient is currently stable and is under follow-up. Refining the diagnosis and treatment of multiple primary lung cancers remains challenging. Our case and case studies in the literature may provide some ideas for more standardized diagnosis and treatment.

Dual biologic therapy is not often used in psoriasis and psoriatic arthritis due to cost and safety concerns, with limited literature supporting its use. We present a case of a 31-year-old man with severe plaque psoriasis and erosive psoriatic arthritis, refractory to multiple therapies. While guselkumab improved skin symptoms, joint inflammation persisted. Given the patient’s reluctance to discontinue guselkumab and his poor response to prior therapies, bimekizumab was added. This combination led to near-complete skin clearance and significant joint improvement within 3 months, with sustained benefits and no adverse effects at 17 months. This case illustrates how targeting multiple points in the interleukin-23/interleukin-17 pathway can improve outcomes in patients unresponsive to monotherapy. Dual biologic therapy may be a viable option for select patients with complex disease, though further research is needed to evaluate its long-term safety and efficacy.

Plasmablastic lymphoma is a rare and aggressive variant of diffuse large B-cell lymphoma characterized by heterogeneous clinical presentations and poor outcomes. This study presents a comprehensive review integrated with three cases demonstrating diverse clinical manifestations and treatment outcomes. We conducted a detailed analysis of three plasmablastic lymphoma cases diagnosed and treated at our institution between 2022 and 2023, incorporating clinical presentations, diagnostic findings, treatment approaches, and outcomes. These cases were analyzed in the context of current literature and treatment guidelines. The cases included an HIV-positive male with perianal plasmablastic lymphoma, an HIV-negative female with gastric plasmablastic lymphoma arising from marginal zone lymphoma, and an HIV-negative female with retroperitoneal plasmablastic lymphoma. Two patients achieved complete remission with bortezomib plus dose-adjusted-etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin therapy, while one experienced treatment failure and death. Epstein–Barr virus positivity was observed in two cases. Treatment-related complications included peripheral neuropathy and organ failure. The cases demonstrated variable outcomes independent of HIV status but correlating with age and performance status. Our series highlights the diverse presentation patterns of plasmablastic lymphoma and validates known prognostic factors while demonstrating the efficacy of contemporary treatment approaches. The outcomes underscore the importance of individualized therapy and careful patient selection for intensive treatment regimens.

Many individuals with localized melanoma undergo wide local excision and live many years with the surgical scar. The present case describes a basal cell carcinoma arising from a malignant melanoma excision scar. There are no similar reports in the literature. A 69-year-old female with a 25-year remote history of localized melanoma treated with wide local excision presents with two new lesions overlying the scar. The lesions were confirmed to be a basal cell carcinoma and dysplastic nevi on punch biopsy. Complete scar excision is performed. This report warns of the possibility of secondary primary malignancy arising from within the scar of a previous malignancy excision. With any changes to a scar, a prompt biopsy should be performed and treatment administered appropriately depending on the diagnosis.

Epithelioid hemangioendothelioma is a rare vascular neoplasm with clinical behavior that varies from indolent to aggressive. While the clinical presentation of epithelioid hemangioendothelioma may be variable, the diagnosis of epithelioid hemangioendothelioma is based on histologic and immunohistochemistry features. We describe a case of epithelioid hemangioendothelioma presenting as a groin nodule in a 76-year-old man. He was admitted to hospital with progressive hemoptysis, accompanied by a growing, ulcerated right groin nodule. Excisional biopsy confirmed a diagnosis of epithelioid hemangioendothelioma. The patient opted for palliation and died 1 month after hospital admission. Our case highlights an atypical presentation of epithelioid hemangioendothelioma characterized by hemoptysis and a solitary groin nodule, underscoring the importance of timely diagnosis and management.

Angiotensin receptor blockers (ARBs) are commonly used to slow the progression of chronic kidney disease (CKD) but may worsen renal function in advanced kidney disease. We describe a 35-year-old man with stage 4 CKD who developed acute kidney injury shortly after starting an ARB, followed by severe abdominal pain and biochemical evidence of pancreatitis. Imaging excluded gallstones and ductal obstruction. Laboratory studies ruled out hypertriglyceridemia and hypercalcemia. He was found to have profound azotemia, consistent with uremia. His abdominal pain and elevated pancreatic enzymes improved rapidly with hemodialysis, supporting a diagnosis of uremic pancreatitis rather than direct losartan toxicity. Uremic pancreatitis is rare and usually described in patients with end-stage renal disease; its occurrence in earlier CKD stages is underrecognized. This case highlights uremia as a rare cause of pancreatitis that should be considered in the setting of worsening azotemia and abdominal pain. Patients should be carefully monitored when initiating ARBs in the setting of advanced CKD.

Hepatic abscesses are uncommon and rarely associated with diverticulitis as an indirect source of infection. We report the case of a 60-year-old male with a history of recurrent diverticulitis who presented with fever, nausea, and abdominal pain demonstrating a single multiloculated hepatic lesion measuring 5.8 × 5.1 × 5.1 cm upon admission. Piperacillin–tazobactam was initiated for sepsis management, and metronidazole was initiated for amoebic coverage. Aspiration and drainage of the abscess were performed, and cultures confirmed Streptococcus intermedius, prompting antibiotic therapy to be narrowed to ceftriaxone and metronidazole. Subsequent imaging showed a reduction in the size of the abscess. A pyogenic liver abscess can rarely arise from hematogenous spread of infection via the portal venous system in the setting of diverticulitis. Early imaging, prompt antimicrobial therapy, and source control are essential to optimize outcomes and prevent complications.

Normal pregnancy causes marked increases in lipids, but in women with underlying dyslipidaemia, this can lead to severe hypertriglyceridemia (triglyceride >1000 mg/dL) and acute pancreatitis. Coexisting conditions like diabetes and hypothyroidism further exacerbate this risk. We report a 34-year-old G2P1 woman at 32 weeks of gestation with type 2 diabetes and treated hypothyroidism who presented with acute pancreatitis and a serum triglyceride level of 33.8 mmol/L. Her management included therapeutic plasmapheresis, insulin infusion, and fenofibrate, followed by a planned elective caesarean section at 35 weeks, which resulted in the delivery of a healthy infant. This case highlights the critical need for vigilant lipid monitoring and a coordinated, multidisciplinary approach in high-risk pregnancies to prevent life-threatening complications and improve maternal and fetal outcomes.

Pseudoaneurysmal bone cysts are rare complications of advanced primary hyperparathyroidism, mimicking malignant lesions or postoperative infections, particularly when accompanied by wound drainage and elevated inflammatory markers. A 49-year-old man underwent cemented total hip arthroplasty for a pathological femoral neck fracture. Persistent postoperative bloody-serous discharge and elevated infection markers such as C-reactive protein suggested early periprosthetic joint infection, prompting two surgical revisions. During both revision procedures, multiple deep tissue samples were obtained and sent for aerobic and anaerobic cultures with extended incubation as well as histopathological analysis. All microbiological cultures remained negative. Histopathology revealed a giant cell-rich, hemorrhagic, fibrous lesion consistent with a pseudoaneurysmal bone cyst due to undiagnosed primary hyperparathyroidism. Timely surgical debridement, microbiological sampling, and empiric antibiotics ensured patient safety while the metabolic etiology was being established. Biochemical tests confirmed hypercalcemia and elevated parathyroid hormone from a parathyroid adenoma. Primary hyperparathyroidism-induced osteoclastic activity can produce hemorrhagic cystic lesions resembling infection or malignancy. Meticulous surgical exploration, repeated microbiological sampling, and histopathological analysis excluded infection and malignancy, while definitive management via parathyroidectomy prevents further skeletal complications. This case emphasizes structured diagnostics and interdisciplinary orthopedic-endocrine collaboration for managing rare primary hyperparathyroidism complications effectively and underlines that persistent postoperative drainage with repeatedly negative cultures should prompt metabolic evaluation.

Venetoclax, a BCL-2 inhibitor used in chronic lymphocytic leukemia and acute myeloid leukemia, has been rarely associated with autoimmune hemolytic anemia, mostly in chronic lymphocytic leukemia. We report the first case of venetoclax-triggered autoimmune hemolytic anemia in acute myeloid leukemia secondary to chronic myelomonocytic leukemia. An 80-year-old man developed abrupt warm autoimmune hemolytic anemia 4 days after venetoclax initiation with azacitidine. Hemolysis resolved rapidly after venetoclax withdrawal and corticosteroid therapy. Rechallenge led to compensated hemolysis. This case supports venetoclax causality and highlights that autoimmune hemolytic anemia can occur beyond lymphoid malignancies. Clinicians should monitor for autoimmune cytopenias during venetoclax therapy, even in myeloid disorders.

Sebaceoma is a benign sebaceous neoplasm with rare potential for malignant transformation. We report a case of recurrent sebaceoma in a 70-year-old male with Muir–Torre syndrome, successfully treated with Mohs micrographic surgery. Despite its benign histology, the lesion demonstrated rapid growth and incomplete initial excision. Mohs micrographic surgery provided complete margin control with tissue preservation. This case highlights the value of Mohs micrographic surgery in managing select benign sebaceous neoplasms exhibiting concerning clinical behavior or diagnostic uncertainty, supporting its inclusion in treatment considerations for high-risk patients.

The proteasome inhibitor bortezomib is widely used in the treatment of multiple myeloma. While peripheral neuropathy and gastrointestinal effects are well-documented adverse reactions to bortezomib administration, cutaneous side effects in patients with multiple myeloma are less commonly reported. We present a patient with IgG kappa multiple myeloma who developed a spider-like and digitate eruption at the site of subcutaneous bortezomib injection. This report expands the spectrum of bortezomib-associated dermatologic toxicity and emphasizes the importance of clinician awareness for prompt diagnosis and management.

Post-traumatic facial scars cause significant emotional distress. Early multimodal approach combining topical and laser treatments may improve outcomes. A 26-year-old woman presented with multiple upper-facial lacerations after a car accident. Silicone gel was applied twice daily beginning 1-month post-injury, followed by 4 monthly sessions of combined Neodymium-doped Yttrium Aluminum Garnet (15 J/cm², 9 mm, 0.6 ms) and fractional Erbium-doped Yttrium Aluminum Garnet (60 J/cm², 1.2 Hz, 300 ms) laser therapy starting at 1.5 months. After 6 months, excellent cosmetic results were achieved. This case highlights the importance of early multimodal intervention with silicone gel and laser treatment as an effective method to improve esthetic and psychological outcomes in post-traumatic facial scarring.

Psoriasis is a chronic, autoinflammatory skin disease. Tumor necrosis factor-alpha inhibitors are commonly used for the treatment of moderate-to-severe psoriasis; however, paradoxical psoriatic eruptions are a well-recognized adverse effect. There are no validated guidelines to manage this. We present the case of a 48-year-old woman with severe pustular psoriasis who developed acute paradoxical reactions after her first two infusions of infliximab, requiring hospitalization. She achieved disease control after transitioning to secukinumab, an interleukin-17 inhibitor. This case highlights the importance of early monitoring for paradoxical reactions in patients with severe psoriasis after initiating tumor necrosis factor-alpha inhibitor therapy and the value of transitioning to an alternative biologic class for effective management.

Molluscum contagiosum is a common pediatric viral skin infection characterized by small, flesh-colored, umbilicated papules on the skin. Molluscum contagiosum lesions are typically benign and self-resolve, but they may trigger a surrounding eczematous dermatitis that may mimic other infections or an atopic dermatitis flare. We report a case of an 8-year-old boy with eczematous molluscum contagiosum whose eruption masqueraded as herpes simplex virus infection. The patient presented with a several week history of pruritic rash with bleeding and crusting, but careful examination revealed conventional umbilicated papules consistent with molluscum contagiosum. The dermatitis was managed with conservative skin care, low-potency corticosteroids, and topical antibiotics (for cracked skin/open sores). This case highlights the importance of recognizing molluscum dermatitis and distinguishing it from herpes simplex virus, atopic dermatitis flare, or bacterial infection to avoid unnecessary investigations or treatments.

Radicular lumbar pain is a widespread condition characterized by nerve dysfunction. Many treatments have been proposed over time for its management, ranging from surgery to conservative approaches. The combined application of multiple transcutaneous electrotherapies may be a valid approach for the condition; however, the evidence supporting it is currently weak, as most proposed application protocols are often lacking in detail and replicability. A case series of seven patients (mean age 65 ± 9 years) was conducted to observe their response to a specific non-invasive multimodal transcutaneous electrotherapy protocol, monitored through pain and perceived disability rating scales and postural assessments. Patients showed a general improvement in the monitored parameters, particularly the painful component of the condition. The proposed protocol appears effective and merits further, more in-depth studies, while it continues to be successfully applied in the management of patients with radicular lumbar pain.

Kikuchi–Fujimoto disease (KFD) is a rare, benign, self-limited lymphadenitis most commonly affecting children and young adults, particularly females of Asian descent. Its etiology is unclear but is thought to involve immune dysregulation triggered by infection. We report a 14-year-old South Asian female presenting with 8 days of high fever, frontal headache, bilateral eye redness, transient arthralgias, and palpable lymphadenopathy in the cervical, axillary, and supraclavicular regions. Her history included recent travel to multiple countries and a prior episode of fever of unknown origin attributed to Bartonella. Initial laboratory evaluation revealed pancytopenia, elevated transaminases, and increased erythrocyte sedimentation rate and lactate dehydrogenase with normal C reactive protein. Infectious workup was negative for malaria, cytomegalovirus, West Nile virus, Rickettsia, Bartonella, and dengue. Ultrasound of the left axilla and computed tomography showed bilateral axillary lymphadenopathy. A cytokine panel demonstrated markedly elevated IL-18. Definitive diagnosis was established by axillary lymph node biopsy, which revealed histiocytic necrotizing lymphadenitis consistent with KFD. Systemic inflammatory disorders such as systemic-onset juvenile idiopathic arthritis, multisystem inflammatory syndrome in children, and Kawasaki disease were considered and excluded based on clinical, laboratory, and histopathological findings. The patient’s fever resolved after dexamethasone administration, supporting an immune-mediated process. She subsequently developed recurrent fever, rash, and oral ulcers, which responded rapidly to intravenous corticosteroids, followed by a steroid taper.

Scleromyxedema is a rare, chronic mucinosis characterized by widespread skin fibrosis and an associated monoclonal gammopathy. Therapeutic options remain limited. We present the case of a male in his 50s with biopsy-confirmed scleromyxedema and IgG λ monoclonal gammopathy who initially responded to intravenous immunoglobulin but later progressed despite full-dose maintenance. Due to severe pruritus and recent evidence implicating Type 2 cytokines in scleromyxedema pathogenesis, dupilumab was added to ongoing intravenous immunoglobulin. Pruritus improved within 4 months, but fibrosis remained unchanged and M-protein levels continued to rise, reaching 35.3 g/L by month 12. Dupilumab was discontinued due to lack of disease modification. Bone marrow biopsy confirmed smoldering multiple myeloma. The patient subsequently responded well to daratumumab, cyclophosphamide, bortezomib, and dexamethasone chemotherapy and autologous stem cell transplant. This case illustrates the potential for IL-4Rα blockade to control symptoms such as pruritus in scleromyxedema, but underscores the need for plasma cell-directed therapy to address the underlying disease process.

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution.

Hypertrophic cardiomyopathy in infancy often follows a rapidly progressive clinical course, with many cases becoming fulminant and fatal. We reported a case of a 4-month-old infant with worsening breathlessness. While admitted, she was in severe respiratory distress and appeared drowsy. We also noted indiscernible heart sounds from physical examination and cardiomegaly with a globular cardiac silhouette from chest X-ray. Considering her distressing clinical presentation, we suspected cardiac tamponade and performed an emergent transthoracic echocardiography to confirm our suspicion. Echocardiogram, however, demonstrated only mild pericardial effusion—insufficient to explain her symptoms. Moreover, we found exceedingly thick myocardium consistent with hypertrophic cardiomyopathy, so we initially focused our treatment strategy on congestion relief.

Multiple eruptive dermatofibroma is a rare variant of dermatofibroma and often occurs in association with systemic disease, particularly involving immune dysregulation. We present what may be the first reported case of multiple eruptive dermatofibroma in association with monoclonal gammopathy of undetermined significance, a premalignant plasma cell dyscrasia. A 66-year-old male with stable IgM monoclonal gammopathy of undetermined significance developed over 50 asymptomatic papulonodular lesions over two years. Histopathology confirmed dermatofibromas, the timeline of lesion development was consistent with multiple eruptive dermatofibroma, and laboratory evaluation revealed elevated IgM and a monoclonal paraprotein band. This case highlights a novel systemic association between multiple eruptive dermatofibroma and monoclonal gammopathy of undetermined significance. Given the frequent co-occurrence of immune dysregulation in patients with multiple eruptive dermatofibroma, evaluation for underlying systemic immunologic conditions in affected individuals is warranted. Recognition of such associations may facilitate earlier diagnosis and surveillance of systemic disease.

Denervation pseudohypertrophy is an important and well described, albeit rare, cause of limb swelling that is seldom encountered in the clinical setting. Careful history taking, reasonable clinical suspicion, and referral for magnetic resonance imaging are crucial to arriving at the diagnosis and recommending appropriate treatment. Although typically a slow, insidious process, we report a rare case of acute denervation pseudohypertrophy in a 76-year-old male with diabetic neuropathy, chronic venous insufficiency, and remote tibial fracture repair. Magnetic resonance imaging findings were significant for bilateral denervation pseudohypertrophy of the left greater than right calf muscles with associated diabetic neuropathy. We postulated that the latter is likely the main underlying etiology, particularly given the magnetic resonance imaging’s bilateral findings. The case highlights the importance of considering denervation pseudohypertrophy in the differential diagnosis of acute limb swelling despite its rarity.

This case report describes a case of pyogenic liver abscess potentially associated with toxocariasis, a rare disease in the United States. A 3-year-old girl presented with new abdominal pain and fever. Contrasted computed tomography of the abdomen revealed a 2-cm hepatic abscess, which was subsequently drained. Culture of abscess fluid grew methicillin-resistant Staphylococcus aureus, and the patient was treated with intravenous vancomycin before transition to clindamycin and discharge home. Further laboratory evaluation yielded persistent eosinophilia and elevated IgE levels, with ambiguous primary immunodeficiency genetic testing. The patient’s hepatic abscess resolved; however, persistent eosinophilia prompted a parasitic workup, which returned positive for Toxocara IgG. The patient was thereafter treated with albendazole with subsequent decrease in eosinophil levels. This case report brings attention to a pediatric pathology previously unreported in the United States: toxocariasis potentially associated with development of pediatric methicillin-resistant S. aureus-associated pyogenic liver abscess.

Polymorphic eruption of pregnancy predominantly occurs during the last month of pregnancy or the immediate postpartum period. Dupilumab, an IgG4 monoclonal antibody, has been utilized in pregnancy and lactation. A 34-year-old gravida 2 para 1 female, on postoperative day 2 following a Cesarean section, presented with pruritic erythematous urticoid papules coalescing into plaques on the abdomen, bilateral arms, legs, and feet, suggestive of polymorphic eruption of pregnancy. A punch biopsy ruled out gestational pemphigoid. Prednisone was contraindicated given her gestational diabetes and gestational hypertension. Dupilumab was administered with betamethasone valerate ointment followed by transition to roflumilast cream. At 6-week follow-up, the skin was cleared of the rash. This case highlights a new potential utility for dupilumab in polymorphic eruption of pregnancy and may represent an alternative to oral steroids in severe or refractory disease.

A 5-month-old infant presented with paroxysmal crying and vomiting for more than 4 h. Ultrasonography confirmed intussusception in the right abdomen, but intraluminal gas limited precise classification. On the assumption of ileocolic intussusception, air enema reduction was attempted but was unsuccessful. Due to the persistence of symptoms, low-dose computed tomography was performed to further characterize the intussusception subtype. The scan demonstrated concentric ring and pseudokidney-like signs within a segment of the ileum, strongly suggesting small-bowel intussusception. Exploratory laparotomy confirmed ileal-ileal intussusception with Meckel’s diverticulum as the pathological lead point. Segmental ileal resection with primary anastomosis was performed, and histopathology demonstrated ectopic gastric mucosa within the diverticulum. The infant recovered uneventfully and remained well at short-term follow-up. This case emphasizes that failed air enema reduction together with indeterminate ultrasonographic subtyping should raise suspicion for a pathological lead point and that low-dose computed tomography should be reserved as a selective diagnostic tool rather than as a routine step in infants with intussusception.

Infective endocarditis is a serious complication in people who inject drugs, most caused by Staphylococcus aureus. Gram negative etiologies are rare, and Neisseria lactamica, a commensal of the nasopharynx, has not previously been reported as a cause of infective endocarditis. A 34-year-old man with a history of intravenous drug use, hepatitis C, and recurrent tricuspid valve infective endocarditis presented with petechial rash, fatigue, and dyspnea. Blood cultures grew N. lactamica, and echocardiography revealed new vegetations on a prosthetic tricuspid valve. He was treated with 6 weeks of intravenous ceftriaxone, with resolution of vegetations on follow-up imaging. This is the first reported case of N. lactamica infective endocarditis. Clinicians should consider atypical organisms in people who inject drugs, particularly in prosthetic valve infections. Reporting such cases broadens understanding of rare pathogens and may guide future management.

Accidental foreign body ingestion is a recognized clinical emergency, particularly among elderly individuals, and may lead to serious gastrointestinal complications. Denture ingestion is often silent and may occur due to poor prosthesis fit or fracture. We report a case of a 78-year-old hypertensive woman who presented with a 1-week history of colicky abdominal pain, abdominal distension, constipation, and hematochezia. On examination, she showed signs of generalized peritonitis. Further history revealed that she had unknowingly swallowed a fragment of her broken removable denture several days earlier. Contrast-enhanced computed tomography demonstrated sigmoid colon perforation with a retained foreign body. Emergency exploratory laparotomy confirmed a metallic denture fragment perforating the sigmoid colon. The affected bowel segment was resected, the foreign body removed, and a Hartmann procedure performed. Denture ingestion accounts for a small proportion of gastrointestinal foreign bodies but carries a higher risk of perforation due to sharp components. Early recognition, prompt imaging, and timely surgical intervention are essential for favorable outcomes.

Hemolytic uremic syndrome is an acute condition where microvascular thrombi occur in the vasculature of the renal system, resulting in thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. Hemolytic uremic syndrome may originate from either congenital or acquired causes. Hemolytic uremic syndrome is initially treated with supportive care measures; however, if fulminant renal failure ensues, dialysis may be necessary.

Sweet syndrome is an uncommon neutrophilic dermatosis in the pediatric population. As in adults, it is frequently associated with underlying conditions, including infectious diseases, neoplasias, inflammatory bowel disease, and autoimmune or autoinflammatory disorders. Genetic causes, such as chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature syndrome, should also be considered, particularly in neonates. We report a case of a 5-week-old female infant with a confirmed Sweet syndrome associated with a rectovestibular fistula—an unusual association, with only three cases previously reported in the literature. To our knowledge, this is the first reported case in a non-Japanese neonate.

Headache is a common reason for consulting inpatient neurology and the most common outpatient reason for referral to neurology clinics. Idiopathic intracranial hypertension is a common cause of secondary chronic headaches. Presence of typical patient traits and comorbid risk factors such as obesity could lead to bias and misdiagnosis without investigation into other etiologies. Primary leptomeningeal medulloblastoma in adults is an extremely rare cause of headache that initially mimicked idiopathic intracranial hypertension in this case. A 25-year-old male with months of intractable headaches developed confusion, vision changes, and weakness. Headaches were initially attributed to idiopathic intracranial hypertension, so spinal imaging was not attained at other hospitals, and he was first treated with cerebrospinal fluid diversion and optic nerve sheath fenestration. However, he later developed decompensated hydrocephalus and myelopathy. Imaging at our hospital showed extensive leptomeningeal enhancement in the brain, spinal cord, and cauda equina. A lumbar intradural mass was biopsied with pathology showing nodular/desmoplastic and anaplastic/large cell medulloblastoma, consistent with disseminated isolated leptomeningeal medulloblastoma. This case highlights that when headaches are refractory, the differential diagnosis should be expanded, and comprehensive work-up should be pursued. Leptomeningeal metastasis is a rare cause of intractable headaches. Further, isolated leptomeningeal medulloblastoma is rare. Early recognition, comprehensive neuroimaging, and prompt tissue biopsy are critical to facilitating an accurate diagnosis and optimizing therapeutic opportunities. Rapid clinical and radiographic response to proton craniospinal irradiation and the Packer protocol suggests this regimen is effective for adult-onset primary leptomeningeal medulloblastoma.

The placement of C1 lateral mass screws is a common procedure in posterior atlantoaxial fixation, but variations in local anatomy, including the C1 lateral mass and vertebral artery, can complicate screw placement, increasing the risk of complications. This case report presents the use of a C1 translaminar screw as a salvage technique following the failure of a C1 lateral mass screw during the treatment of a type II odontoid fracture. A 16-year-old male involved in a motor vehicle accident was scheduled for posterior atlantoaxial fixation with C1 lateral mass screws and C2 pedicle screws. However, intraoperative failure of one C1 lateral mass screw necessitated the insertion of a C1 translaminar screw. Postoperative recovery was without complications, with fracture healing confirmed by computed tomography imaging at 3 months after the operation, showing no signs of implant loosening or delayed union. This case highlights the effectiveness of the C1 translaminar screw as a reliable salvage technique in complex situations where conventional screw placement is compromised. It provides a viable alternative for ensuring stable fixation and achieving favorable outcomes in patients with challenging anatomical variations.

Angiomatoid fibrous histiocytoma is a rare intermediate soft tissue tumor with uncertain differentiation and prone to misdiagnosis because of atypical morphology and aberrant biomarker expression. Herein, we report a unique case of occipital scalp angiomatoid fibrous histiocytoma in a 33-year-old female, which presented with rapid tumor growth, marked nuclear pleomorphism, elevated mitotic activity, and atypical positive expression of CDK4 and MDM2 immunohistochemically, leading to an initial misdiagnosis of dedifferentiated liposarcoma. Preoperative routine blood tests, biochemical examinations, and inflammatory biomarker detection, including C-reactive protein, erythrocyte sedimentation rate, and interleukin-6, were performed, and all hematological indicators were within normal reference ranges without systemic inflammatory or hematological abnormalities. The patient underwent complete marginal resection of the tumor, and no adjuvant radiotherapy or chemotherapy was administered postoperatively because of the absence of high-risk malignant features, residual lesions, and distant metastasis. Molecular testing confirmed EWSR1 gene rearrangement without CDK4 or MDM2 gene amplification, which confirmed the final diagnosis of angiomatoid fibrous histiocytoma. The patient achieved a favorable prognosis with no recurrence or metastasis during 20 months of postoperative follow-up. Distinct from previously reported conventional angiomatoid fibrous histiocytoma cases with low proliferative activity and negative liposarcoma-related markers, the present case is characterized by atypical dual positive expression of CDK4/MDM2 and a markedly elevated Ki-67 proliferation index, which fills the clinical data gap of atypical angiomatoid fibrous histiocytoma with liposarcoma-mimicking immunophenotype. This study further clarifies the differential diagnostic criteria between angiomatoid fibrous histiocytoma and dedifferentiated liposarcoma, verifies that isolated CDK4/MDM2 immunohistochemical positivity cannot independently support the diagnosis of liposarcoma, and highlights the irreplaceable value of molecular testing in the definitive diagnosis of atypical angiomatoid fibrous histiocytoma, providing a reliable reference for pathologists to avoid diagnostic errors in similar rare soft tissue tumors.

Acromegaly is a rare endocrine disorder characterized by chronic hypersecretion of growth hormone and insulin-like growth factor-1, leading to an increased incidence of colonic polyps and neoplasia. This report describes a 38-year-old man who presented with gastrointestinal symptoms and was found to have a giant sessile polyp in the colon. Routine preoperative evaluation revealed elevated serum insulin-like growth factor-1 and unsuppressed growth hormone levels, leading to the diagnosis of acromegaly, which was confirmed by a pituitary MRI that showed a macroadenoma. This case highlights that unusually large colonic polyps in younger patients should prompt consideration of systemic etiologies, including endocrine disorders. A multidisciplinary approach, integrating gastroenterological and endocrinological assessment, is essential for early diagnosis and management to reduce morbidity.

A previously healthy 44-year-old man presented with acute severe dyspnea. Laboratory evaluation revealed severe hypoalbuminemia, elevated low-density lipoprotein cholesterol and D-dimer levels, and marked proteinuria, suggesting nephrotic syndrome (NS). Imaging demonstrated bilateral pulmonary emboli with right ventricular strain. Since he developed progressive shock, veno-arterial extracorporeal membrane oxygenation (VA ECMO) and thrombolytic therapy were initiated. Persistent thrombi and failed ECMO weaning due to poor oxygenation prompted urgent pulmonary thromboendarterectomy on day 8, confirming both fresh and organized clots and intimal thickening. The patient was extubated on postoperative day (POD) 3, transferred from intensive care on POD 6, and discharged ambulatory on POD 63. This case represented acute-on-chronic pulmonary thromboembolism (PTE) secondary to previously undiagnosed NS, a condition that predisposes patients to hypercoagulability, including asymptomatic PTE. The case underscores the hazards of NS in acute care settings. Successful management was achieved through coordinated efforts between multidisciplinary specialists and interprofessional collaboration.

Hidradenitis suppurativa is typically found in intertriginous areas such as the axillae and groin. As incidence rates rise, however, hidradenitis suppurativa is increasingly identified in unexpected locations. As this phenomenon has been underreported, these patients experience diagnostic delays and inappropriate or inadequate treatment. This case involves a man in his 60s who presented with an inflamed earlobe that had waxed and waned without diagnosis or treatment for many years. Recognition of the signs and symptoms of hidradenitis suppurativa led to diagnosis, effective therapy, and improved quality of life; however, due to diagnostic delay related to the atypical location, tunneling and scarring had already developed. This case highlights auricular and periauricular hidradenitis suppurativa to promote earlier recognition and timely intervention to limit progression of this highly morbid disease.

Lung aspergilloma is a noninvasive form of fungal infection of the Aspergillus species and usually presents radiologically as nodular masses in the lungs of patients with pulmonary tuberculosis, chronic obstructive pulmonary disease, and immunosuppressed patients. It may mimic lung metastatic nodules or primary lung cancer. A 57-year-old male patient who underwent surgery for stomach cancer was admitted to our hospital with complaints of shortness of breath, fatigue, and weight loss. Chest computed tomography scan revealed a new nodular lesion measuring 16 × 14 mm in diameter in the upper lobe of the right lung and an embolism in the left pulmonary artery. Wedge resection of the solitary pulmonary nodular was performed. After pathological evaluation, it was interpreted as aspergilloma. Here, we report a case of pulmonary aspergilloma that was followed up with the diagnosis of gastric cancer in remission and underwent resection due to the suspicion of lung metastasis.

A young woman in late pregnancy (31 weeks of gestation) was diagnosed with diffuse large B-cell lymphoma, presenting with bilateral cervical and upper thoracic paratracheal lymphadenopathy that led to superior vena cava syndrome. Her clinical presentation included progressively worsening dyspnea and an inability to lie flat. The initial treatment consisted of a combination of rituximab, cyclophosphamide, pirarubicin, vincristine, and dexamethasone and etoposide chemotherapy. After tumor shrinkage and symptomatic improvement, the pregnancy was terminated via cesarean section, yielding a healthy neonate. Although the patient was classified as high-intermediate risk, consolidated autologous hematopoietic stem cell transplantation was not performed due to her young age. Notably, NKG2C+ natural killer cells—potentially representing antitumor reactive lymphocytes—were detected during the initial treatment but eventually became undetectable. Overall, the patient achieved a satisfactory and notable treatment outcome.

Human umbilical cord mesenchymal stem cell-derived exosomes have gained attention as a promising, cell-free regenerative therapy due to their immunomodulatory and tissue-repair properties. This study retrospectively evaluated the safety and efficacy of nebulized human umbilical cord mesenchymal stem cell exosome therapy in three patients with asthma and/or chronic obstructive pulmonary disease who underwent weekly nebulized exosome therapy for 5 weeks at ALPS Medical Centre, Kuala Lumpur, Malaysia. Clinical outcomes were assessed using pulmonary function tests, inflammatory markers, and laboratory parameters. Post-therapy, pulmonary function improved, with increases in forced expiratory volume in 1 s from 2.59 to 3.4 L (p = 0.07) and forced vital capacity from 2.48 to 3.32 L (p = 0.11), while the forced expiratory volume in 1 s/forced vital capacity ratio significantly increased from 82.57% to 92.9% (p = 0.05), indicating reduced airflow limitation. Inflammatory markers, including C-reactive protein and eosinophil count, remained stable, and no significant changes were observed in hepatic, renal, or haematological parameters. Additionally, no adverse reactions or safety concerns were reported. In conclusion, nebulized human umbilical cord mesenchymal stem cell-derived exosome therapy demonstrated potential in improving pulmonary function and alleviating respiratory symptoms in patients with asthma and chronic obstructive pulmonary disease while maintaining a favourable safety profile. These preliminary findings support further investigation of exosome therapy as an adjunctive treatment for chronic respiratory diseases.

Recent research has indicated a potential link between specific diets and an increased risk of stroke or cardiovascular disease. In this report, we describe a case involving a 45-year-old male who consumed a nightly diet consisting entirely of convenience store bento or cup noodle ramen for over two decades. After two decades of this diet, he experienced a bilateral internal carotid artery dissection in the petrous and cervical portions in his 40s. This condition resulted in an infarction in the left middle cerebral artery area. After stroke treatment, he was discharged and went home without any sequelae. There was no recurrence of stroke after his diet was adjusted appropriately. Although this is a single case study and we cannot exclude that an unbalanced diet is not the cause, it highlights that certain extreme dietary habits may pose a risk of early-onset artery dissection.

A man in his early 40s with peripheral arterial disease and prior ultrasound-assisted catheter-directed thrombolysis using the EKOS™ system (Boston Scientific) for arterial thrombosis presented with severe pleuritic chest pain. Initial evaluation demonstrated an acute right-sided segmental pulmonary embolism and a small-to-moderate pericardial effusion. His D-dimer was elevated at 2.8 µg/mL FEU, and his Wells’ score was calculated at 6, indicating moderate-to-high clinical probability. He was treated with intravenous heparin and colchicine for pulmonary embolism with suspected pericarditis. Persistent severe pain prompted repeat imaging, which revealed a retained intravascular guidewire extending from the inferior vena cava into the right atrium, associated with fibrin sheath formation and interval enlargement of the pericardial effusion. Endovascular retrieval achieved partial removal, but a residual intracardiac fragment remained. Two weeks later, the patient re-presented with recurrent symptoms, and an additional 10 cm retained guidewire fragment was successfully retrieved. This rare case of a retained intravascular guidewire causing iatrogenic pericarditis highlights the importance of careful post-procedural imaging review, multidisciplinary management, and confirmation of complete foreign body removal.

Rathke cleft cysts are typically benign and asymptomatic lesions of the sellar region, with apoplexy and panhypopituitarism being uncommon presentations. We report the case of a 78-year-old male who presented with acute metabolic encephalopathy and panhypopituitarism secondary to a likely Rathke cleft cyst measuring less than 10 mm. Magnetic resonance imaging and clinical findings were consistent with a pituitary tumor, likely Rathke cleft cyst, causing suspected pituitary apoplexy, and subsequent panhypopituitarism, likely the cause of the patient’s symptoms that developed and worsened over the next 6 months leading up to diagnosis. Despite the small cyst size, the patient developed central hypothyroidism, central adrenal insufficiency, and hypogonadism, all of which improved with hormone replacement therapy. The patient’s improvement with medical management led to the decision not to pursue surgical intervention. Rathke cleft cyst apoplexy-inducing panhypopituitarism remains exceedingly rare; the largest published series identified only 21 confirmed cases over a decade-long period. This case highlights that even small Rathke cleft cysts can lead to significant endocrine dysfunction and underscores the need for vigilant follow-up.

This is a care of endophthalmitis following XEN45 Gel Stent implantation managed with combined corneal transplant and pars plana vitrectomy, and to review reported cases of endophthalmitis after minimally invasive glaucoma surgery. A 67-year-old male with primary open-angle glaucoma developed endophthalmitis 2 months after XEN45 implantation. Upon referral to our tertiary care center, he underwent urgent implant removal, penetrating keratoplasty with temporary keratoprosthesis, and pars plana vitrectomy with intravitreal antibiotics. Cultures grew Streptococcus gordonii. A second corneal transplant with fresh donor tissue was performed 4 months later. Despite vision limited to light perception, the infection resolved and the eye was preserved. This is the first reported case of XEN45 Gel Stent-associated endophthalmitis which was successfully controlled with combined keratoplasty and vitrectomy. Our review of published cases identified 45 minimally invasive glaucoma surgery-related endophthalmitis cases, with XEN45 accounting for 58%. Potential risk factors included the XEN45 stent’s susceptibility to exposure after conjunctival erosion, pool water exposure, and ab externo insertion during implantation. In cases of XEN45 Gel Stent-associated endophthalmitis, corneal transplant with pars plana vitrectomy could be a successful strategy to control infection and spare the globe.

Rhupus syndrome is a rare disease that presents with features of both rheumatoid arthritis and systemic lupus erythematosus. It is typically characterized by a rheumatoid arthritis pattern of symmetric, polyarticular small joint pain and swelling along with features of lupus such as photosensitive skin rashes and hematologic abnormalities. The disease is rare and inclusion criteria are mixed, but diagnosis is generally based on clinical features in conjunction with positive serologic lab results for both diseases. Severity can vary from benign to severe manifestations, rarely including anterior scleritis. We describe a case of a 20-year-old female with recently diagnosed inflammatory arthritis who presented with severe bilateral anterior scleritis and lupus nephritis, who achieved complete remission following treatment with high-dose intravenous glucocorticoids.

Lichen planus is a chronic immune-mediated inflammatory disorder, and vulvar lichen planus (VLP) is a debilitating subtype often refractory to standard therapy. Emerging evidence on Janus kinase–signal transducer and activator of transcription pathway dysregulation in the pathogenesis of VLP supports Janus kinase inhibition as a potential therapeutic strategy. We report a 71-year-old woman with chronic VLP, including severe pruritus, pain, erosive erythema, and progressive vulvar scarring, who failed multiple topical and systemic therapies. These therapies included topical and oral corticosteroids, mycophenolate mofetil, acitretin, tacrolimus, and roflumilast, which were discontinued due to inadequate response or intolerance. Following the initiation of topical ruxolitinib 1.5% cream twice daily, she achieved complete resolution of erythema, pruritus, and burning after 3 months, without local or systemic adverse effects. This is the first reported case of VLP treated with a topical Janus kinase inhibitor, supporting topical Janus kinase inhibition as a steroid-sparing therapeutic option for refractory disease; however, cost and access may limit its use.

Caroli’s disease is a rare congenital disorder of the intrahepatic bile ducts that may be complicated by congenital hepatic fibrosis, portal hypertension, and recurrent variceal bleeding. We report the 10-year clinical course of a 29-year-old woman with Caroli’s disease and portal hypertension who was managed in the Department of Gastroenterology. At initial presentation in 2015, she had splenomegaly, severe esophagogastric fundal varices, preserved liver biochemistry, Child-Pugh class A disease, and a low model for end-stage liver disease score. Symptoms improved after nonselective beta-blocker therapy; however, longitudinal follow-up showed persistent portal hypertension, recurrent gastrointestinal bleeding, and progressive impairment of hepatic reserve. From 2023 onward, she experienced recurrent hematemesis and melena despite sequential endoscopic variceal ligation and beta-blocker therapy, including conversion from propranolol to carvedilol. During the most recent admission on May 25, 2024, laboratory and imaging findings indicated progressive cholestasis, portal hypertension, Child-Pugh class B disease, and a model for end-stage liver disease score of 9.9. After multidisciplinary team evaluation, liver transplantation was considered clinically indicated, and the patient was activated on the transplant waiting list. This case demonstrates the limitations of long-term endoscopic and pharmacological therapy in Caroli’s disease complicated by portal hypertension and supports timely transplant referral before advanced hepatic decompensation occurs.

Coronavirus disease 2019 (COVID-19) swab testing has been commonplace since the onset of the pandemic, with few reported adverse effects beyond general discomfort. We report a rare clinical presentation of a cerebrospinal fluid leak following a nasopharyngeal COVID-19 swab. The patient, a 49-year-old female with a history of migraines, idiopathic intracranial hypertension (pseudotumor cerebri), fibromyalgia, depression, and prior traumatic brain injury, presented to the emergency department with a headache. The patient underwent nasopharyngeal swab testing 10 days before her visit. She experienced the immediate postprocedure onset of a global headache and clear nasal discharge that persisted until presentation. Physical examination revealed continuous clear rhinorrhea from the left nostril. Associated symptoms included blurry vision, nausea, vomiting, and postural instability. The patient was managed conservatively; the leak and associated symptoms resolved within 24 h. Computed tomography of the head and paranasal sinuses showed no overt skull base defect but revealed subtle dehiscence along the right optic canal and right foramen rotundum, as well as dilation of the optic nerve sheaths. These findings suggest elevated intracranial pressure, which may have predisposed the patient to a cerebrospinal fluid leak. Given the clinical history and temporal relationship, this is a presumptive cerebrospinal fluid leak secondary to the COVID-19 swab; however, no confirmatory testing was performed. Increased awareness of this adverse effect, particularly in patients with pre-existing risk factors, is essential for early diagnosis. Anterior nasal or mid-turbinate swabs may be safer for vulnerable patients, as nasopharyngeal swabs are more frequently linked to iatrogenic skull base injuries according to reported cases. To our knowledge, this represents the 15th reported instance of a post-swab cerebrospinal fluid leak and includes a comprehensive literature review.

Discrepancies in platelet counts between laboratories may lead to diagnostic confusion and unnecessary interventions. We report a case in which platelet counts were consistently normal in an in-house laboratory but repeatedly decreased in external laboratory testing. The patient had no bleeding symptoms, and coagulation findings were normal. Peripheral blood smear examination revealed platelet aggregation in externally processed samples, whereas no aggregation was observed in samples processed immediately in-house. These findings strongly support ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia associated with pre-analytical factors, particularly processing delay. Recognition of this phenomenon is essential to avoid unnecessary investigations and inappropriate management.

Refractory status epilepticus complicating hepatic encephalopathy poses unique palliative challenges as standard extubation protocols typically reduce or discontinue sedative infusions, risking immediate seizure recurrence and distress. We report a 53-year-old man with end-stage cirrhosis and hepatocellular carcinoma who developed hepatic encephalopathy and refractory status epilepticus precipitated by small bowel obstruction. Despite ammonia-lowering therapy and multiple antiseizure medications, seizures remained refractory. Electroencephalography confirmed status epilepticus despite escalating therapy. Given prohibitive surgical risk and poor prognosis, the multidisciplinary team and patient’s family elected to withdraw life-sustaining treatments, requesting he not die with an endotracheal tube in place. He underwent palliative extubation while continuing propofol and midazolam infusions to suppress seizure activity and ensure comfort. He died peacefully without visible seizure activity. Although limited by a single patient, this case provides a practical example of a rarely described palliative strategy: continuing sedative infusions during palliative extubation to prevent agonal seizures in refractory status epilepticus.

Alport syndrome is a genetic disorder of chronic kidney disease, hearing loss, and ocular abnormalities, caused by mutations in type IV collagen. While X-linked Alport Syndrome demonstrates characteristic severe renal failure in males, it has a variable presentation in females. Here, we present a case of a pregnant woman who was found to have X-linked Alport Syndrome with a heterozygous c.3587G>A (p.Gly1196Glu) mutation in the COL4A5 gene. The patient presented in her third trimester of pregnancy with preexisting chronic proteinuria. Family history was notable for kidney failure in her mother and two brothers, consistent with suspected hereditary nephropathy. She developed worsening proteinuria and new-onset hematuria, without preeclampsia or renal failure, and was induced at 39 weeks with an uncomplicated delivery. Genetic testing revealed a heterozygous c.3587G>A (p.Gly1196Glu) mutation in the COL4A5 gene, consistent with X-linked Alport Syndrome. Postpartum, the patient had mildly worsened proteinuria that transiently reached nephrotic range before improving, with normal to low blood pressures. Out of concern for symptomatic hypotension, she was not a candidate for first-line therapy with renin-angiotensin-aldosterone system blockade. In cases of hereditary nephropathies such as X-linked Alport Syndrome, cascade testing may be highly considered to identify family members at risk. Our case demonstrates the variable phenotype of X-linked Alport Syndrome in females and the need for close management during pregnancy, along with the benefits of early genetic testing, given the risks of long-term renal, hearing, and ocular manifestations of this disease.

Lymphatic malformations and branchial cleft anomalies are rare congenital lesions that can present similarly as cystic neck masses, often in childhood, but occasionally in adults. Differentiating between the two can be challenging, especially when clinical, radiographic, and cytologic findings overlap. We present the case of a 41-year-old male with hemophilia B and a right lateral cystic neck mass, underscoring preoperative diagnostic ambiguity and illustrating perioperative coordination required for safe surgical excision in a patient with a bleeding disorder. On examination, patient’s neck had a mobile, cystic feeling, 5 cm right upper neck mass lateral or involving the sternocleidomastoid muscle. Computed tomography imaging revealed a 5 cm cystic lesion deep to the sternocleidomastoid muscle. Ultrasound-guided fine needle aspiration showed bland lymphocytes, suggesting either a second branchial cleft cyst or macrocystic lymphatic malformation. Due to diagnostic uncertainty and the potential for future infection, the patient underwent surgical excision following perioperative Factor IX replacement. Final pathology confirmed a lymphatic malformation. This case highlights the diagnostic overlap of lateral cystic neck masses in adults and emphasizes the importance of multidisciplinary care in patients with comorbidities such as hemophilia.

Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC) is a rare autosomal dominant disorder caused by the fumarate hydratase (FH) gene mutations. Here, we report the first identification of the rare FH-Q185R mutation in a Chinese patient with HLRCC. This case report not only examines the distribution of the FH gene using the Cancer Genome Atlas database but also provides a series of evidence to assess the pathogenicity of the Q185R mutation. This missense mutation, encoded by mitochondrial DNA, corresponds to the cytoplasmic amino acid residue 142 in human cells. These findings could pave the way for more effective management and treatment approaches for patients suffering from HLRCC.

Esophageal nerve sheath tumors are the least common type of esophageal submucosal tumors, with fewer than 60 cases reported in the literature.¹ These tumors typically occur as a solitary lesion in individuals aged 40–70, with a slight female predominance² and possible links to genetic syndromes such as neurofibromatosis type 2.³ Due to their rarity, they are often poorly recognized clinically and misdiagnosed prior to surgery. We present a rare case of esophageal nerve sheath tumor, diagnosed on esophagogastroduodenoscopy in a 46-year-old male who presented with chronic iron deficiency anemia. The patient was successfully treated with endoscopic submucosal dissection. This case highlights diagnostic and therapeutic considerations of this uncommon entity.

Hemophagocytic lymphohistiocytosis is a life-threatening inflammatory syndrome resulting from uncontrolled immune activation. Secondary hemophagocytic lymphohistiocytosis is typically triggered by infection, malignancy, or autoimmune disease, though diagnosis is often difficult due to nonspecific findings. We present the case of a 55-year-old man with pancytopenia and fever following a blood transfusion. There were no clear infectious, malignant, or autoimmune triggers identified. Bone marrow biopsy showed no hemophagocytosis, but laboratory workup revealed hypertriglyceridemia, hyperferritinemia, and elevated soluble IL-2 receptor. He met six hemophagocytic lymphohistiocytosis-2004 criteria and had a high H-score. He was treated with dexamethasone and etoposide, with rapid clinical improvement. This is a unique case of secondary hemophagocytic lymphohistiocytosis after a blood transfusion without other identifiable triggers, which has not yet been reported in the literature. This case underscores the importance of maintaining high clinical suspicion for hemophagocytic lymphohistiocytosis in adults with persistent fever and cytopenias, even in the absence of known triggers.

In this case report, we present the first 14 months of an 18-year-old adolescent male with comorbid diagnoses who exhibits extremely aggressive and self-injurious behavior and is treated with a combination of clozapine and behavioral interventions. The patient responded positively to clozapine and behavioral interventions, with decreased behavioral disturbances and improved social skills. The patient was maintained on clozapine with no significant side effects or hematologic adverse events. We would like to emphasize, through this case report, that clozapine, despite its dose-dependent effects and potential adverse effects such as increased susceptibility to infections and hematological irregularities, can be an effective treatment option for patients with severe behavioral disturbances associated with Autism.

This case describes a 28-year-old female with amyotrophic lateral sclerosis and recurrent urinary tract infections who developed myxedema coma following a botulinum toxin type-A (Btx) injection for muscle spasticity. On intensive care unit admission, she presented with hypothermia, bradycardia, and reduced consciousness. Laboratory evaluation revealed markedly elevated thyroid-stimulating hormone levels, confirming myxedema coma. Prompt treatment with intravenous levothyroxine and hydrocortisone resulted in rapid improvement in temperature and mental status. Further investigation showed elevated antithyroid peroxidase antibodies, suggesting drug-induced autoimmune thyroiditis triggered by Btx. This case highlights the potential link between Btx injection and thyroid autoimmunity, emphasizing the importance of early recognition and monitoring of thyroid function to prevent life-threatening complications in at-risk patients.

A 65-year-old female patient developed recurrent cough and sputum production without an apparent cause for 4 months prior. A chest CT scan performed 1 month earlier revealed a right lower lung opacity with cavitation. Despite treatment, she continued to experience paroxysmal coughing. Upon admission, multiple investigations were conducted, including chest CT, T-cell testing for tuberculosis infection, bronchoscopy, lung biopsy, and next-generation sequencing. The final diagnosis was pulmonary coccidioidomycosis presenting as right lower lung opacity with cavitation. Improvement was observed following treatment with fluconazole tablets. For pulmonary cavitation, beyond common causes such as lung cancer and tuberculosis, rare aetiologies, including coccidioidomycosis, must be considered, particularly in patients with relevant travel history to endemic regions. This case provides valuable diagnostic insights and therapeutic reference.

Exophytic gastrointestinal tumors, including gastrointestinal stromal tumors and leiomyomas, present unique technical challenges due to their predominantly outward growth pattern. Conventional endoscopic techniques, such as endoscopic mucosal resection and endoscopic submucosal dissection, often have limitations in achieving complete resection in these cases, and surgical approaches are therefore frequently required. We report a case of an exophytic gastric tumor successfully treated using dental floss-assisted traction combined with endoscopic full-thickness resection. This approach improved lesion exposure by enabling active repositioning of the extraluminal component into the gastric lumen, thereby enhancing procedural controllability. This case highlights a practical technical strategy for managing selected exophytic lesions and suggests that endoscopic resection may represent a feasible minimally invasive alternative in appropriately selected patients.

Takotsubo syndrome or “broken heart syndrome,” is an uncommon but increasingly recognized condition that can mimic acute coronary syndrome and is characterized by transient regional left ventricular dysfunction, often with apical ballooning. Perioperative physiological stress, catecholamine surges, and vasopressor exposure are recognized triggers. This case describes suspected perioperative takotsubo syndrome in a high-risk surgical patient and emphasizes the need for vigilance and early recognition. A 66-year-old woman with hypertension, type B aortic dissection, prior stroke, carotid disease, hyperlipidemia, and tobacco use presented with a left intertrochanteric fracture requiring operative repair. During anesthesia induction, she developed profound hypotension and bradycardia refractory to fluids and vasopressors, resulting in procedure cancellation. Her initial echocardiogram demonstrated normal systolic function without regional wall motion abnormalities. Surgery was rescheduled the following day; however, she experienced pulseless electrical activity arrest postoperatively. Advanced cardiovascular life support with epinephrine achieved return of spontaneous circulation. A post-arrest echocardiogram demonstrated new mid-apical hypokinesis with an ejection fraction of 35%–40%, most consistent with takotsubo syndrome in the clinical context. She was treated with guideline-directed medical therapy, including beta-blockade and an ACE inhibitor, with subsequent stabilization and discharge. Formal coronary angiography was not performed, and the patient was lost to cardiology follow-up, limiting definitive exclusion of obstructive coronary artery disease and confirmation of left ventricular recovery. This case illustrates the multifactorial perioperative contributors to takotsubo syndrome and highlights the importance of recognizing warning features, including recurrent hypotension, catecholamine exposure, labile hemodynamics, and high-risk cardiovascular comorbidity.

Demodex blepharitis is a chronic inflammatory ocular condition caused by Demodex mite infestation of the eyelid that can negatively impact quality of life. Currently, lotilaner ophthalmic solution 0.25% is the only FDA-approved treatment for Demodex blepharitis. The Demodex Expert Panel on Treatment and Eyelid Health has established consensus that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis. We report a patient who presented with collarettes, the pathognomonic sign of Demodex blepharitis, meibomian gland dysfunction, and poor visual acuity. The patient also had a history of neovascular age-related macular degeneration. Consistent with the Demodex Expert Panel on Treatment and Eyelid Health consensus recommendations, the patient was treated with lotilaner ophthalmic solution 0.25%, lid scrubs, and warm compresses. At the 2-month follow-up, collarettes had resolved, and signs of meibomian gland dysfunction had improved. This case supports the Demodex Expert Panel on Treatment and Eyelid Health recommendation that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis.

Midline peripheral intravenous catheters are widely used for long-term peripheral venous access due to ease of placement and a lower complication profile than central lines. To date, gas embolism has not been reported in association with midline catheters. We report the case of a 59-year-old man with COVID-19-related acute respiratory distress syndrome, who developed sudden coma and acute hypoxemia. Bedsides, echography revealed gas embolism in all cardiac chambers, and body-CT scan showed cerebral air emboli and hepatic portal venous gas. The event followed disconnection of a midline catheter infusion set while the patient was spontaneously breathing, hypovolemic and seated. Neurological sequelae persisted despite prompt hyperbaric oxygen therapy and supportive care. This is the first reported case of cerebral gas embolism related to a midline catheter. The case highlights the importance of individualized catheter length, secure line fixation, and risk factor awareness to prevent air embolism, even with peripheral lines.

Childhood granulomatous periorificial dermatitis is an uncommon variant of periorificial dermatitis seen in patients under 18 years of age with several proposed triggers, including topical or inhaled corticosteroid exposure. We report and discuss a case of refractory childhood granulomatous periorificial dermatitis in a 14-year-old female with past inhaled corticosteroid use. After 7 months of isotretinoin therapy followed by 3 months of oral methotrexate, we observed complete resolution of her facial eruption.

Tyrosine kinase inhibitors (TKIs) are widely used in cancer therapy and are known to induce hypothyroidism in some patients, though the mechanisms remain unclear. We describe a 58-year-old man with metastatic gastrointestinal stromal tumor who developed clinical hypothyroidism during TKI treatment. Imaging revealed thyroid enlargement, and fine-needle aspiration yielded indeterminate cytology. The patient subsequently underwent thyroid lobectomy, which revealed a unique pattern of thyroiditis with multiple hyaline nodules containing entrapped follicular cells and scattered immune cell infiltration. Postoperatively, the patient was in a good clinical condition, but persistently elevated thyroid-stimulating hormone concentrations despite normal T4 concentrations were likely due to pre-existing TKI-induced thyroid dysfunction limiting compensatory function after hemithyroidectomy. The above-mentioned histological presentation is atypical for conventional thyroiditis and may represent a distinct pathological response associated with TKI therapy. The clinical, cytological, and histological findings in this case suggest a potential link between TKIs and thyroid dysfunction, highlighting the need for increased awareness of thyroid complications during targeted therapy. This case underscores the importance of considering iatrogenic causes in new-onset hypothyroidism in oncology patients and suggests that distinct histological features may serve as clues to the underlying pathogenesis.

Leiomyosarcoma (LMS) of the skin is a rare malignant neoplasm that can have varied clinical presentations, even mimicking benign lesions, making diagnosis challenging. We describe a 74-year-old male with a history of subcutaneous LMS of the left leg treated successfully with surgery, chemotherapy, and radiation over 10 years prior, who presented with an incidental papule on the lower back resembling an accessory nipple. Biopsy revealed a spindle cell tumour with diffuse smooth muscle actin and desmin positivity and a high Ki-67 index, consistent with a non-metastatic subcutaneous LMS. Wide local excision confirmed dermal and subcutaneous involvement with negative margins. This case is notable for the occurrence of two distinct primary LMS lesions more than a decade apart, underscoring the importance of long-term surveillance in high-risk patients. Given the potential for recurrence or metastasis, careful histopathologic evaluation and ongoing monitoring remain critical in the management of LMS.

Leprosy, or Hansen’s disease, is a chronic granulomatous infection caused by Mycobacterium leprae, with a broad spectrum of clinical and histopathological manifestations. Histological examination plays a pivotal role in accurately diagnosing its various subtypes. Elastophagocytosis (phagocytosis of elastic fibers by giant cells) is typically associated with annular elastolytic giant cell granuloma and other granulomatous conditions but has rarely been reported in leprosy. We report the case of an 85-year-old male who presented with a solitary, slowly enlarging annular plaque on the trunk. The lesion was asymptomatic and exhibited mild sensory loss without peripheral nerve involvement. Histopathological analysis of the skin biopsy showed granulomatous inflammation with Langhans-type giant cells and a striking feature of elastophagocytosis. Fite-Faraco staining confirmed the presence of acid-fast bacilli, establishing the diagnosis of borderline tuberculoid leprosy. The patient was treated with multibacillary multidrug therapy and demonstrated complete lesion resolution.

Marginal zone lymphoma is the second most common subtype of indolent non-Hodgkin lymphoma. Its clinical manifestations are heterogeneous and largely determined by the involved site. Chylous ascites, as the initial presentation of marginal zone lymphoma, is extremely rare. We report a 79-year-old man who presented with rapidly progressive abdominal distension due to high-volume chylous ascites. Flow cytometry of the ascitic fluid revealed a monoclonal lambda-restricted B-cell population consistent with low-grade B-cell lymphoma. Bone marrow biopsy confirmed splenic marginal zone lymphoma. Initial rituximab monotherapy was ineffective; however, combination therapy with orelabrutinib and rituximab led to complete resolution of ascites after two cycles and marked disease control. At 6-month follow-up, the patient remained in remission. Clinicians should consider lymphoma in the differential diagnosis of unexplained chylous ascites. Prompt etiologic treatment can result in favorable outcomes even in elderly patients with advanced disease.

Psoriasis is an immune-mediated inflammatory disorder with a strong genetic predisposition. However, in some cases, it can emerge as an adverse effect of biologic therapy, particularly interleukin-6 inhibitors such as tocilizumab. This case report describes the unexpected onset of psoriatic dermatitis in a 16-year-old male diagnosed with polyarticular juvenile idiopathic arthritis following treatment with tocilizumab. The patient had no prior personal or family history of psoriasis, highlighting a potential paradoxical reaction to interleukin-6 inhibition. Management strategies included topical corticosteroids and vitamin D analogs, with consideration of dose adjustment or transition to an alternative biologic therapy. This case highlights the importance of recognizing dermatologic adverse effects associated with interleukin-6 inhibitors and emphasizes the need for individualized treatment strategies in juvenile idiopathic arthritis patients receiving biologic therapy.

Vasculitis comprises a spectrum of disorders defined inflammation of the blood vessel walls and is categorized based on vessel size into small-, medium-, and large-vessel vasculitis. The histological characteristics of leukocytoclastic vasculitis include neutrophil infiltration around small cutaneous blood arteries and fibrinoid necrotizing inflammation. Annular morphology is a unique and rare type of leukocytoclastic vasculitis. We report a case of annular leukocytoclastic vasculitis in a 39-year-old Saudi man who presented with scaly annular erythema and targetoid lesion configurations with prominent, raised borders. He was managed with oral prednisolone 40 mg daily as a tapered dosage regimen, in combination with topical mometasone furoate 0.1% cream applied twice daily, resulting in complete resolution of lesions. To the best of our knowledge, this is the first reported case of annular morphology of leukocytoclastic vasculitis with microvascular occlusions in the Middle East.

Penile metastasis from prostate adenocarcinoma is an exceptionally rare clinical finding, occurring in <0.3% of cases. We report an 85-year-old male with a history of Gleason 4+3 acinar adenocarcinoma, managed conservatively with long-term bicalutamide monotherapy because of his clinical stability. Eight years after diagnosis, he developed a painful, ulcerated glans lesion, surgically excised via glansectomy. Histopathology revealed solid adenocarcinoma with angiolymphatic invasion, high Ki-67 index (20–70%), PSA and CDX2 positivity, and negative CK7/CK20/TTF-1/p63 staining, confirming prostatic origin. Despite the presence of metastasis, disease progression remained indolent, supporting the feasibility of individualized, conservative therapy in selected elderly patients. Literature review highlights venous or lymphatic spread as probable pathways, with prognosis varying widely. This case underscores the importance of considering secondary malignancy in penile lesions, utilizing histopathology and immunohistochemistry for definitive diagnosis, and tailoring management to patient comorbidities and preferences to preserve quality of life.

Gastrointestinal tract (GIT) metastases occur in only 0.6% of metastatic breast cancer cases, with invasive lobular carcinoma being the predominant histological subtype. Synchronous GIT metastases at the time of invasive ductal carcinoma (IDC) diagnosis are exceptionally uncommon. We report a case of de novo IDC presenting with synchronous, multifocal metastases in the stomach and colon. The diagnosis was prompted by significantly elevated tumor markers and confirmed via endoscopic examination and biopsy. This case underscores the rarity of GIT metastases, particularly in IDC, and highlights the critical need for a high index of suspicion in the face of markedly elevated tumor markers, even without gastrointestinal symptoms. While contrast-enhanced computed tomography has limited sensitivity for detecting small GIT lesions, endoscopic biopsy with immunohistochemical analysis remains the gold standard for diagnosis. Accompanying this report is a systematic literature review on breast cancer metastases to the GIT.

Mid-fibular stress fractures are rare in the pediatric population and frequently present a diagnostic dilemma due to their subtle clinical presentation. In young, active children, the localized pain and associated periosteal reaction can closely mimic aggressive pathologies, such as primary bone malignancies or osteomyelitis, often leading to unnecessary parental anxiety and invasive diagnostic procedures. We report the case of a 4-year-old boy presenting with a 2-week history of an antalgic gait and localized tenderness over the left fibular shaft in the absence of acute trauma. While initial plain radiography revealed a reactive cortical lesion suspicious for malignancy, subsequent cross-sectional imaging with computed tomography and magnetic resonance imaging identified a subtle fracture line and circumferential periosteal thickening, confirming a mid-fibular stress fracture. The patient was managed conservatively with restricted weight-bearing and analgesics, with complete clinical recovery and radiographic bone remodeling documented at 2-month follow-up. This case underscores the necessity of maintaining a high index of suspicion for stress-related injuries in the pediatric population, even in the absence of a high-impact mechanism. A comprehensive diagnostic approach utilizing multimodal imaging is essential to differentiate benign stress fractures from more ominous conditions, ensuring appropriate conservative management and avoiding the risks associated with unnecessary biopsy or over-treatment.

Recurrent respiratory papillomatosis is a benign neoplastic growth of the respiratory system, often linked to human papillomavirus types 6 and 11. This case report presents a rare progression to severe airway obstruction and potential malignancy in a 59-year-old male with a history of smoking, hepatitis B carrier status, pulmonary tuberculosis, and a tracheal papilloma. Initially hospitalized for right upper lobe pneumonia, a computed tomography scan revealed a bronchial tumor. Bronchial brushing, washing, and biopsy confirmed squamous cell papilloma. Treatment included bronchoscopy with argon plasma coagulation ablation and debulking surgery for the right upper lobe bronchus and airway tumor; however, recurrence was noted on a follow-up computed tomography scan. Repeat bronchoscopy with argon plasma coagulation ablation confirmed squamous cell papilloma with squamous cell carcinoma in situ. The patient was administered human papillomavirus vaccination to mitigate disease progression and remains under active surveillance. This paper highlights a rare malignant transformation of airway recurrent respiratory papillomatosis.

We report an uncommon case of transient Bell’s palsy-like facial paralysis following local anesthesia during Mohs micrographic surgery of the left conchal bowl. The temporary complication resolved spontaneously without intervention and is suspected to have resulted from anesthetic diffusion to the facial nerve via the tragal region. This case highlights the importance of understanding facial nerve anatomy during procedures in the auricular area and the need to counsel patients regarding rare but benign complications of local anesthesia.

This study aims to evaluate treatments for actinic prurigo, a chronic, photosensitive dermatosis disproportionately affecting Indigenous populations. We present the case of a 49-year-old Indigenous woman with refractory actinic prurigo successfully managed with upadacitinib, a Janus kinase inhibitor. After inadequate responses to photoprotection and topical corticosteroids, the patient demonstrated substantial clinical improvement with systemic upadacitinib therapy, achieving marked symptom reduction and improved quality of life. A systematic review including 334 actinic prurigo patients from 38 studies found the highest complete resolution rates with Janus kinase inhibitors (100%), hydroxychloroquine (100%), and topical tacrolimus (100%). Treatment recurrence was common with thalidomide (34%), highlighting limitations of traditional therapies. Janus kinase inhibitors, targeting cytokine-driven inflammation, appear particularly promising. Although further large-scale studies are needed, our findings suggest Janus kinase inhibitors such as upadacitinib offer effective and safe treatment alternatives for refractory actinic prurigo, significantly enhancing patient outcomes and quality of life.

Guillain–Barré syndrome is a clinical syndrome manifesting as immune-mediated polyneuropathy. Approximately one-third of affected patients develop respiratory failure, necessitating intensive care unit admission and invasive mechanical ventilation. Multiple factors present at the onset and during intensive care unit stay are established predictors of the requirement for invasive mechanical ventilation. These include the rapid progression of motor weakness, concurrent involvement of peripheral limb and axial muscles, ineffective cough, bulbar muscle weakness, and the decline in rapid vital capacity. However, no reliable criteria currently exist to predict the duration of muscle weakness progression and plateau phases or the time to recovery. We herein report a case of a 55-year-old male admitted to the intensive care unit following a 5-day history of progressive ascending generalized weakness. His condition progressed to quadriplegia, diaphragmatic paralysis, and autonomic dysfunction. A diagnosis of Guillain–Barré syndrome–acute motor axonal neuropathy variant was confirmed via neurological examination, imaging, cerebrospinal fluid analysis, and nerve conduction studies. The patient exhibited no clinical improvement following two courses of five sessions each of plasma exchange and intravenous immunoglobulin. Owing to the refractory nature of his condition, he required more than 5 months of step-down intensive care unit care prior to transfer to a general medical ward and subsequent discharge home on hospital day 182.

Porencephaly is a rare neurological disorder characterized by cerebrospinal fluid-filled cavities within the cerebral parenchyma. While typically diagnosed in infancy, silent cases may manifest later in life with new-onset seizures. We report a 14-year-old female with a remote history of encephalitis requiring neurosurgical intervention at 8 months of age who presented with her first generalized tonic–clonic seizure. Laboratory evaluation revealed post-ictal leukocytosis and neutrophilia with otherwise unremarkable serum studies. Neuroimaging demonstrated large bilateral porencephalic cysts communicating with the lateral ventricles, accompanied by surrounding gliosis and mild midline shift. The patient remained seizure-free without immediate antiseizure medication and was initiated on levetiracetam for secondary prophylaxis following multidisciplinary consultation. This case highlights that porencephalic cysts can remain clinically silent for over a decade before presenting first-time seizures in adolescence. A history of early brain insult should prompt thorough neuroimaging evaluation, and adherence to contemporary epilepsy terminology is essential for accurate reporting.

We present a 63-year-old male with a history of chronic cystoprostatitis and urethral stricture with recurrent purpuric skin lesions and fulminant uroseptic shock. Initial treatment for suspected septic vasculitis with antibiotics and corticosteroids improved his condition, but vasculitis recurred after corticosteroid tapering. Repeated biopsies confirmed leukocytoclastic vasculitis (LCV) triggered by persistent prostate infection. To our knowledge, this is the first reported case of recurrent LCV triggered by chronic cystoprostatitis—a rare and underrecognized infectious etiology. Definitive resolution required addressing the underlying prostatitis, underscoring the importance of identifying and treating chronic infectious triggers in recurrent cutaneous vasculitis.

Gardner syndrome, a subtype of familial adenomatous polyposis, features colorectal polyposis, osteomas and soft-tissue tumors with elevated colorectal carcinoma risk, and abdominal masses in these patients are easily misdiagnosed as malignant recurrence, especially with concomitant bone lesions. We report a 33-year-old female familial adenomatous polyposis patient with a history of surgically treated stage IIIA colorectal adenocarcinoma, who presented with a 3-month abdominal mass. Contrast-enhanced computed tomography indicated a large cystic-solid mass with lymphadenopathy and peritoneal thickening, suggesting recurrence, while magnetic resonance imaging suggested a desmoid tumor and identified bilateral femoral head avascular necrosis. Surgical resection and pathogenic adenomatous polyposis coli gene mutation detection confirmed an abdominal desmoid tumor. This case highlights that Gardner syndrome can induce benign space-occupying desmoid tumors, and for familial adenomatous polyposis patients with bone lesions, combining advanced imaging, histopathology and genetic testing is critical to avoid misdiagnosis and unnecessary interventions for suspected cancer recurrence.

This report describes a rare case of a woman whose tubal pregnancy was unexpectedly identified during a caesarean section, resulting in the delivery of a live infant at a gestational age of 42 + 0 weeks. Despite multiple antenatal visits, three ultrasound examinations, and the presence of clinical signs, the tubal pregnancy was not recognized preoperatively. This case highlights the diagnostic challenges of advanced tubal pregnancy, the clinical overlap with abdominal pregnancies, and the importance of careful abdominal examination and improved ultrasonographic awareness, particularly in low-resource settings.

ST-segment elevation on electrocardiography is classically associated with acute myocardial infarction and often prompts urgent invasive evaluation. However, non-ischemic causes may complicate diagnostic decision-making, particularly in elderly patients with acute non-cardiac illnesses. We report a 95-year-old woman admitted with COVID-19–associated pneumonia and aspiration pneumonia, whose admission electrocardiogram demonstrated ST-segment elevation with T-wave inversion in the lateral precordial leads, mimicking ST-elevation myocardial infarction. She had no chest pain, no elevation of cardiac biomarkers, and preserved left ventricular systolic function without regional wall motion abnormalities on echocardiography. Review of prior records revealed that similar electrocardiographic abnormalities had been consistently present for more than a decade. Serial imaging demonstrated no overt structural heart disease. However, the electrocardiographic pattern—localized and persistent ST-segment elevation with repolarization abnormalities—is most consistent with chronic localized myocardial remodeling, possibly related to unrecognized myocardial fibrosis. This case highlights the importance of integrating clinical presentation, biomarkers, and longitudinal electrocardiographic findings. Persistent ST-segment elevation does not always indicate acute coronary occlusion, but may reflect an underlying structural myocardial substrate not detectable by routine imaging.

Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality, with Streptococcus pneumoniae as a leading cause. Chest radiography, the standard initial imaging modality, can miss early complications, which lead to delays in diagnosis and treatment. Computed tomography (CT) provides greater detail in identifying complications. We report a 67-year-old male with chest pain who was treated in an outpatient setting with oral antibiotics for suspected CAP; however, he experienced clinical deterioration, including fever, cough, weight loss, and worsening respiratory symptoms. Repeat chest X-ray revealed increased lung opacities, prompting a CT thorax, which revealed a large pulmonary abscess not visualized on prior imaging. Failure of outpatient management required inpatient admission with intravenous antibiotics and CT-guided percutaneous drainage. A total of 450 mL of purulent fluid was drained, and cultures grew Streptococcus intermedius. The patient improved and was given targeted antibiotics. This case highlights the importance of considering less common pathogens such as S. intermedius in patients with prolonged symptoms or failure of outpatient therapy. CT imaging should be considered in patients who fail to improve, thus expediting diagnosis and guiding management. S. pneumoniae typically causes acute pneumonia with lobar consolidation. S. intermedius often causes necrotizing abscesses and empyema, often with a longer, more subacute presentation. Differentiating the two on initial presentation is quite difficult, as in our patient’s case.

Encephalomyeloradiculoneuropathy is a rare inflammatory disorder for which rehabilitation strategies and functional prognosis are not well established. This report describes the clinical course of a patient with severe lower-limb paralysis caused by encephalomyeloradiculoneuropathy. A man in his 50s developed a fever, impaired consciousness, and respiratory failure requiring mechanical ventilation. Based on the combined involvement of the central and peripheral nervous systems, a clinical diagnosis of encephalomyeloradiculoneuropathy was made. Rehabilitation treatment was initiated early during mechanical ventilation in the acute-care hospital, at a time when he required total assistance for ambulation. Despite immunotherapy, near-complete paralysis of the trunk and bilateral lower limbs persisted with orthostatic hypotension. Rehabilitation treatment was continued in acute-care and rehabilitation hospitals with monthly goal setting. At 8 months, he achieved independent outdoor ambulation.

Subcutaneous emphysema is a rare but potentially serious complication in dentistry and oral surgery resulting from the introduction of air into soft tissues. Although commonly associated with forward venting air-driven handpieces, cases have also been reported in the absence of an identifiable air source. We report an 18-year-old female who developed extensive subcutaneous emphysema following routine extraction of four third molars performed without the use of forward venting air-driven instruments, after multiple episodes of postoperative retching and emesis. She presented with progressive facial swelling and was transferred to a tertiary care center. Imaging demonstrated widespread air tracking within the masticator and submandibular spaces without abscess. The patient was managed conservatively with intravenous antibiotics, sinus precautions, and supportive care, with gradual resolution. Although uncommon, subcutaneous emphysema warrants vigilance due to risks of mediastinal spread and airway compromise. This case highlights that postoperative nausea and emesis may introduce air into unhealed extraction sites and emphasizes the importance of early recognition and prompt management.

Fabry disease is a rare X-linked lysosomal storage disorder caused by GLA variants leading to α-galactosidase A deficiency. The heterozygous phenotype predominantly affects the heart. We report a heterozygous woman in her 70s with known Fabry disease presenting with chest pain and palpitations despite well-controlled cardiovascular risk factors. High-sensitivity troponin remained persistently elevated. Coronary angiography showed non-obstructive arteries, and echocardiography revealed left ventricular hypertrophy without outflow tract obstruction. In the absence of epicardial disease, troponin elevation was attributed to coronary microvascular dysfunction, underscoring its role as a key mechanism of ischaemic symptoms and ongoing myocardial injury in Fabry disease.

Intracranial vertebral artery dissecting aneurysm is a rare type of intracranial aneurysm characterized by outward protrusion of the vessel wall due to damage to the intima and elastic membrane. Aplastic anemia is a relatively rare and severe syndrome involving bone marrow failure leading to pancytopenia. No previously reported cases exist of intracranial vertebral artery dissecting aneurysm complicated by aplastic anemia. Due to thrombocytopenia and coagulation dysfunction, managing concomitant vascular lesions during neurointerventional therapy poses significant challenges. We report the case of a 40-year-old man who with a history of aplastic anemia. Computed tomography angiography revealed a dissecting aneurysm in the right vertebral artery segment IV, with a distal branch to the posterior inferior cerebellar artery. The patient demonstrated favorable outcomes following individualized neurointerventional surgery with no complications. This case underscores the importance of developing personalized neurointerventional strategies for patients with intracranial aneurysms complicated by hematologic disorders. Priority should be given to controlling bleeding risks while maintaining posterior circulation patency, providing crucial guidance for clinicians managing such conditions.

Due to anatomical limitations, the posterior region often lacks sufficient alveolar bone height for conventional implants. Bone augmentation techniques have drawbacks, while short implants offer a minimally invasive option. This case report details a 48-year-old male patient who received short implants in the posterior region. After 7 years of functional loading, the implants remained stable with no loss or mechanical complications. The clinical outcomes were closely associated with the implant design, Morse taper connection, and occlusal adjustment of the restoration. However, short dental implants necessitate rational utilization and design, along with regular follow-up visits and occlusal evaluations. The present case aims to provide supplementary evidence for the long-term clinical application of short dental implants in bone-deficient posterior regions.

Complete fused renal ectopia, also known as pancake kidney, is a rare congenital renal fusion anomaly characterized by complete fusion of both kidneys within the pelvis. Most patients remain asymptomatic and diagnosis is often incidental. I report a 49-year-old woman from a low-resource setting who presented with lower urinary tract symptoms and dyspareunia. Initial management was directed toward recurrent cystitis; however, further evaluation with computed tomography and intravenous urography revealed a pancake kidney located in the pelvis with two distinct collecting systems and normally draining ureters. No evidence of obstructive uropathy, renal mass lesion, or associated complications was identified. This case highlights the diagnostic challenge posed by nonspecific clinical presentation and limited access to advanced imaging in low-resource settings, which may contribute to delayed or incidental diagnosis of congenital renal anomalies.

Carcinoma en cuirasse is a rare form of cutaneous metastasis, typically presenting with a sclerodermoid, infiltrated plaque, most commonly associated with breast cancer. In rare circumstances, carcinoma en cuirasse can mimic alternate etiologies including infectious, inflammatory or treatment-related dermatoses. We present the case of a 58-year-old woman with a 2-year history of stage IV metastatic estrogen receptor positive, progesterone receptor negative, HER2 negative breast carcinoma who developed a pruritic dermatomal eruption of her right flank that was initially empirically treated as herpes zoster without success prior to dermatology consultation. Subsequent skin biopsy revealed a “single file” dermal infiltration of epithelial cells, while immunohistochemistry for estrogen receptor demonstrated strong nuclear positivity, confirming the diagnosis of cutaneous metastasis. This case underscores the importance of considering carcinoma en cuirasse in patients with dermatomal eruptions in the context of known malignancy to ensure timely dermatology evaluation, prevent diagnostic delay and allow treatment escalation when necessary.

Chilblain lupus erythematosus is a rare, cold-induced form of chronic cutaneous lupus that can occur in both genetic and sporadic forms. It is characterized by acral skin lesions and is commonly associated with autoimmunity and type I interferon pathway activation. Diagnosis is based on clinical features and histological findings. While topical and systemic therapies can be effective, the disease is often chronic and relapsing. We describe a case of a 48-year-old woman with chilblain lupus erythematosus who achieved almost complete clinical remission following treatment with hydroxychloroquine and methotrexate.