Reports doi: 10.3390/reports9030222

Authors: Satoko Minakawa Toshihide Higashino Daisuke Sawamura

Background and Clinical Significance: Varicella, caused by the varicella-zoster virus (VZV), is typically a childhood disease; however, adult cases carry substantially higher morbidity and mortality. Immunocompromised individuals are particularly vulnerable to severe outcomes. Many adults in Japan lack documented varicella vaccination, representing a missed opportunity for preventing primary VZV infection. None of the patients had documented prior varicella vaccination. Case Presentation: We conducted a retrospective review of varicella cases at Hirosaki University Hospital between April 2007 and March 2025. Ten patients (eight adults and two children) were identified. Among the eight adult patients, written informed consent for publication was obtained from five patients, whose clinical courses are described in detail in this report. Four patients had underlying conditions requiring immunosuppressive therapy, and two were undergoing cancer treatment. All immunocompromised patients exhibited hepatic dysfunction, with elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. All patients received antiviral therapy with valaciclovir or acyclovir, and some additionally received intravenous immunoglobulin. All five adult patients in this series recovered from varicella without long-term sequelae, although one later died from unrelated causes. We additionally note that one patient later died from cerebral embolism and pneumonia, unrelated to varicella. Conclusions: This retrospective case series illustrates the vulnerability of immunocompromised adults to severe varicella and aligns with current recommendations supporting the vaccination of susceptible high-risk adults. While antiviral therapy remains essential for clinical management, prevention through appropriate vaccination strategies—varicella vaccine for preventing primary infection in eligible individuals and RZV for preventing herpes zoster reactivation in immunocompromised adults—represent an important preventive strategy for reducing overall VZV-related morbidity and mortality. These findings reinforce the importance of preventive strategies, including vaccination and early recognition of varicella in high-risk adults.

Reports doi: 10.3390/reports9030221

Authors: Albara Dabroom Muhanad Alzahrani Mohammed Ayed M. Alshammari

Background/Objective: Adamantinoma is a rare, low-grade malignant primary bone tumour with a predilection for the tibial diaphysis. Despite decades of case series and institutional cohorts, the evidence base remains fragmented, and outcomes are inconsistently reported across studies. To synthesise the best available evidence on clinical outcomes, recurrence patterns, metastatic behaviour, and surgical management of skeletal adamantinoma and to appraise the methodological quality of the contributing literature. Methods: A structured narrative review was conducted searching PubMed (294 records) and Web of Science (397 records) from inception to April 2026, yielding approximately 532 unique records after deduplication. Case series of five or more patients with histologically confirmed skeletal adamantinoma were included. A risk-of-bias critique was applied across five domains to each included study. Results: In total, 17 studies, representing more than 900 reported patient entries with possible cohort overlap, formed the primary evidence base. Local recurrence rates for classic adamantinoma (AD) range from 15% to 31%, with metastatic rates from 10% to 27%, predominantly to the lung. The osteofibrous dysplasia-like subtype (OFD-AD) showed no metastases in any series that reports this subtype separately but carries a locally aggressive recurrence rate of 22–43%. Wide resection with uncontaminated margins is the most consistently protective surgical variable (hazard ratio 0.164; p < 0.001). Late recurrences beyond 15 years are documented in multiple series, supporting prolonged surveillance. An MRI-based model for metastatic risk stratification at diagnosis has been proposed but requires external validation. Conclusions: Adamantinoma is more dangerous over a longtime horizon than its low-grade designation implies. Subtype distinction, margin status, and lifelong surveillance are the cornerstones of management. The evidence base carries predominantly moderate to high risk of bias; all conclusions should be interpreted accordingly. A multinational prospective registry remains the most important unmet research need.

Reports doi: 10.3390/reports9030220

Authors: Mihai-Teodor Georgescu Andrada Maria Bărbuț

Background and Clinical Significance: Brain metastases in non-small cell lung cancer (NSCLC) carry a poor prognosis, particularly in patients lacking targetable driver mutations or significant programmed death-ligand 1 (PD-L1) expression. Durable intracranial control exceeding five years is uncommon in this population and the factors that determine exceptional therapeutic response remain incompletely understood; Case Presentation: We report a 59-year-old male with pathological stage pT3N1 solid-type pulmonary adenocarcinoma (EGFR wild-type, ALK wild-type, PD-L1 <1%) who developed two sequential brain metastases following right upper lobectomy and adjuvant pembrolizumab plus pemetrexed-carboplatin. The first lesion was treated with single-fraction stereotactic radiosurgery (SRS, 10 Gy); a second metastasis identified 18 months later was managed with focal radiotherapy (8 Gy, single fraction) followed by whole-brain radiotherapy (24 Gy in 12 fractions). Local progression of the second metastasis in 2024 prompted successful surgical resection via right occipital craniotomy. Over a follow-up exceeding five years, the patient achieved sustained intracranial disease control, preserved neurological function, and maintained quality of life. Notably, no clinically apparent neurocognitive deterioration was documented on routine clinical follow-up, despite whole-brain irradiation without hippocampal sparing; formal neuropsychological testing was not performed; Conclusions: This case demonstrates that durable intracranial control may be achievable through carefully sequenced multimodal therapy—including stereotactic radiosurgery, whole-brain radiotherapy, and neurosurgical resection—even in biologically unfavorable NSCLC. The absence of clinically apparent neurocognitive deterioration on routine follow-up after WBRT raises hypothesis-generating questions regarding interindividual variability in radiation tolerance; this observation must be interpreted in the absence of formal neuropsychological testing and prospective hippocampal dosimetry. A multidisciplinary, individualized approach integrating radiotherapy, systemic therapy, and neurosurgery remains essential in this setting.

Reports doi: 10.3390/reports9030219

Authors: Alexandra Caziuc Radu Alexandru Ilieș George Ionuț Golea Cristian-Florin Bibu-Monuș Andrada Larisa Deac George Călin Dindelegan

Background and Clinical Significance: Malignant melanoma with primary or metastatic intestinal involvement is a rare entity, often diagnosed late and associated with severe complications such as bowel obstruction and perforation. Differential diagnosis of primary intestinal lymphoma may be challenging in the absence of an identifiable primary lesion. Case Presentation: We report the case of a 35-year-old male with no significant medical history who was admitted for persistent abdominal symptoms. Contrast-enhanced abdominal CT revealed a giant circumferential jejunal mass (109/147/156 mm) causing marked luminal stenosis and mesenteric lymphadenopathy, initially raising suspicion of primary intestinal lymphoma. The patient subsequently developed upper intestinal obstruction and severe anemia (Hb 5.5 g/dL), requiring an emergency exploratory laparotomy. Intraoperatively, a voluminous unresectable tumor extending to the mesenteric root was identified, and a feeding jejunostomy was performed. The postoperative course was complicated by tumor perforation and generalized peritonitis, necessitating reoperation. Histopathological examination established the diagnosis of malignant melanoma, with no identifiable primary site, which is most consistent with metastatic melanoma (MUP). PET-CT staging demonstrated metastatic disease (mesenteric, retroperitoneal and supraclavicular lymph nodes, as well as subcutaneous nodules), consistent with a stage IV disease. Molecular analysis revealed a BRAF V600E mutation. Combined immunotherapy (Nivolumab + Ipilimumab) was initiated, resulting in a partial radiological response after three cycles. Conclusions: Intestinal involvement by malignant melanoma might mimic other gastrointestinal malignancies and be the cause of a delayed diagnosis and severe surgical complications. Multidisciplinary management is essential, and modern immunotherapy offers promising outcomes even in advanced-stage disease.

Reports doi: 10.3390/reports9030218

Authors: Narayan Dhimal Roberto Pili Joel B. Epstein Vipanchika Satheeshkumar Minu Ponnamma Mohan Kapil Meleveedu Poolakkad S. Satheeshkumar

Background: Neurological complications (NCs) are increasingly recognized as contributors to adverse outcomes in hospitalized cancer populations, yet their burden and associated disparities in patients with head and neck cancer (HNC) remain poorly characterized. This study evaluated the association between NCs and hospital outcomes in HNC and examined sociodemographic disparities. Methods: A retrospective cross-sectional study was conducted using the 2021 National Inpatient Sample, a nationally representative database of U.S. hospitalizations. Adult patients with a primary diagnosis of HNC were included. NCs were identified using ICD-10-CM codes. Survey-weighted multivariable regression models assessed associations with outcomes. Results: Among 57,615 weighted HNC hospitalizations, corresponding to 11,523 unweighted discharges, 6320 (unweighted n = 1328; 11%) had at least one NC. NCs were independently associated with higher hospital charges (adjusted geometric mean ratio [aGMR], 1.38, 95% CI 1.26–1.51), longer length of stay (aGMR, 1.25, 95% CI 1.17–1.34), and increased in-hospital mortality (aOR 2.42, 95% CI 1.96–2.98). NCs were also associated with higher odds of hospital-acquired complications (aOR 1.92), septicemia (1.90), fluid and electrolyte disorders (1.65), COVID-19 infection (1.66), and emergency department admission (1.33). Disparities were observed, with Hispanic and Other race patients incurring higher charges and Black and Hispanic patients experiencing longer hospital stays; Medicaid and self-pay patients had higher mortality compared with those on Medicare. Conclusions: NCs are associated with worse outcomes and increased healthcare utilization among hospitalized HNC patients; however, given NIS limitations, including lack of cancer stage, treatment history, performance status, and brain metastasis data, these findings should be interpreted as non-causal associations. Early NC recognition and disparity-focused interventions may improve inpatient cancer care.

Reports doi: 10.3390/reports9030217

Authors: Abdullah Addar Mishari Alanezi Nouf Alabdulkarim Razan Alshatwi Fahad Alshayhan Fahad Alhuzaimi

Background and Clinical Significance: Reconstruction of large segmental bone defects following oncologic resection in pediatric patients remains a major challenge. Although distraction osteogenesis with bone transport is a well-established biological reconstructive option, regenerate formation may be compromised in patients receiving chemotherapy. The accordion maneuver, consisting of alternating cycles of compression and distraction, has been described as a method to stimulate bone regeneration, primarily in association with external fixation systems. However, its use in internal bone transport systems using intramedullary lengthening nails following oncologic resection, particularly in the setting of perioperative chemotherapy, remains rarely reported. Case Presentation: We report a case of a 12-year-old boy with high-grade telangiectatic osteosarcoma of the distal femur who underwent neoadjuvant chemotherapy followed by limb-salvage surgery, resulting in a 14 cm segmental bone defect. Reconstruction was performed using plate-assisted bone transport with a motorized intramedullary magnetic nail. During distraction osteogenesis, delayed and asymmetric regenerate formation developed. An accordion maneuver was subsequently initiated, resulting in progressive improvement in regenerate density and corticalization without the need for revision surgery. Conclusions: This case highlights the successful application of the accordion maneuver using internal bone transport following oncologic resection. It represents a minimally invasive technique to stimulate bone healing and may reduce the need for revision surgery; however, larger series are needed to confirm this potential benefit, particularly in biologically compromised patients receiving chemotherapy.

Reports doi: 10.3390/reports9030216

Authors: Thomas Ferenc Darko Blašković Karolina Krstanac Mislav Rakić Mateja Vujica Ferenc Vinko Vidjak

Background and Clinical Significance: Abdominal wall endometriosis (AWE) is an ectopic endometrial tissue embedded into the anterior abdominal wall, mainly infiltrating the rectus abdominis or oblique muscles and subcutaneous tissue. In most cases, AWE is associated with surgical scars after obstetrical and gynecological, as well as non-gynecological surgeries. Case Presentation: A 51-year-old female patient presented to the ultrasound outpatient clinic with a non-cyclic painful, palpable nodular mass located in the postoperative scar in the right lower abdominal quadrant. She underwent an appendectomy at the age of 9 (premenarchal period). The patient had regular menstrual cycles, one cesarean section and two vaginal deliveries, denied any trauma to that abdominal region, and had no history of pelvic endometriosis. Her past medical history was also remarkable for left-sided breast cancer, and she was worried it could be metastasis. Following imaging evaluation, a preliminary diagnosis was a benign lesion in the post-appendectomy scar, most likely a suture granuloma, also known as Schloffer’s tumor. Fine-needle aspiration was performed, and findings were primarily suspicious for AWE. The patient was then referred to an abdominal surgeon for excision of the affected area, and subsequent histopathological analysis confirmed that the mass was AWE. Conclusions: Imaging findings of a mass in the abdominal wall are not pathognomonic for AWE; only histopathological examination can confirm the diagnosis. If a painful nodular mass is located adjacent to a surgical scar in a female patient, AWE should be a leading consideration in the differential diagnosis, along with suture granuloma in cases of old surgical scars.

Reports doi: 10.3390/reports9030215

Authors: Bartosz Stangiewicz Lukasz Korzep

Background and Clinical Significance: Streptococcus pyogenes (group A Streptococcus, GAS) can cause rapidly progressive invasive infections, including necrotizing soft tissue infection (NSTI) and streptococcal toxic shock syndrome (STSS). Although invasive GAS disease is often associated with skin barrier disruption, severe infection may also follow blunt trauma without visible skin injury. Case Presentation: A 22-year-old woman presented with persistent right hip and groin pain four days after a blunt fall during recreational sports activity, without disruption of skin integrity. On admission, she was hypotensive, tachycardic, and intermittently hypoxemic, with local hematoma, swelling, and inflammatory infiltration of the right groin. Laboratory tests showed marked inflammation, acidosis, acute kidney injury (AKI), elevated lactate, creatine kinase, and myoglobin levels. She was admitted to the intensive care unit with septic shock. Empirical antimicrobial therapy was initiated with piperacillin/tazobactam, clindamycin, and linezolid. Computed tomography showed inflammatory changes extending from the right groin to the thigh fascia. On day 3, the patient’s condition deteriorated with respiratory failure necessitating endotracheal intubation and mechanical ventilation. Surgical incision revealed inflamed and necrotic subcutaneous tissue with superficial muscle involvement. Deep tissue cultures yielded GAS, whereas blood and urine cultures remained negative; probable STSS was diagnosed. Therapy was de-escalated to penicillin plus clindamycin. Continuous renal replacement therapy with an adsorptive acrylonitrile 69 surface-treated (AN69ST) membrane was initiated for AKI. The patient gradually improved and was transferred to the surgical ward on day 16. Conclusions: Minor blunt trauma without skin disruption may precede life-threatening invasive GAS infection. Rapid recognition, surgical source control, antitoxin antimicrobial therapy, and intensive organ support are essential in suspected STSS.

Reports doi: 10.3390/reports9030214

Authors: Iva Prodanova Preslava Gatseva Hristiana Delvarska Todor Vasilev Victor Donev

Background and Clinical Significance: Lues remains a global health concern despite the well-known nature of its symptoms, the availability of diagnostic methods, and the existence of effective therapy. The recent increase in maternal syphilis has been accompanied by a rise in congenital infections, which are associated with stillbirth, prematurity, neonatal mortality, and severe multisystemic disorder. In newborns, it may present with highly variable clinical manifestations, making timely diagnosis and treatment essential. We report a case of severe early congenital syphilis in a premature newborn with extensive multiorgan involvement; Case Presentation: We present a case of a male infant born at 31 + 6 weeks of gestation to a 26-year-old mother with inadequate antenatal care and no documented screening or treatment for syphilis during pregnancy. Prenatal ultrasound revealed fetal ascites. At birth, the infant presented with severe respiratory failure requiring immediate resuscitation, endotracheal intubation, and intensive care support. Clinical findings included hepatosplenomegaly, generalized edema, ascites, petechial rash, palmoplantar desquamation, severe thrombocytopenia, anemia, coagulopathy, liver dysfunction, and hemorrhagic syndrome. Maternal and neonatal serologic testing confirmed syphilis infection. The clinical course was complicated by pneumonia with prolonged mechanical ventilation, cardiovascular involvement impairing cardiac function, and heart failure. Treatment consisted of intravenous penicillin G, broad-spectrum antimicrobial therapy, antifungal medication, respiratory support, transfusion therapy, cardiovascular management, and intensive multidisciplinary care; Conclusions: This report presents consequences of untreated maternal syphilis and underscores the importance of timely diagnosis, early initiation of penicillin therapy, and close multidisciplinary follow-up to optimize outcomes in neonates.

Reports doi: 10.3390/reports9030213

Authors: Margarida André Francisco Vara-Luiz Luísa Moreira João Paulo Rosa Miguel Carvalho

Metastatic involvement of the male genitourinary tract by lung cancer is exceedingly rare. We report a 56-year-old man with metastatic lung adenocarcinoma (initial stage T3N2M1b) under pembrolizumab, who presented with severe pelvic pain. Pelvic magnetic resonance imaging and computed tomography demonstrated a large mass with an imaging epicentre favouring the left seminal vesicle, involving the prostate and fistulising to the distal rectum, without pelvic ascites or peritoneal disease. A total PSA of 0.81 ng/mL and a previous negative prostate biopsy made a primary prostatic malignancy less likely. Biopsy of the rectal component revealed a poorly differentiated carcinoma with an immunophenotype (CK7+, TTF-1+, p40−, CDX2−, NKX3.1−, PAX8−) consistent with metastatic adenocarcinoma of pulmonary origin. The patient underwent palliative pelvic radiotherapy, with improvement of pelvic pain; he subsequently developed pneumaturia and faecaluria and died eight months later from disease progression. Seminal vesicle metastasis from lung carcinoma has been reported previously; to our knowledge, however, this is the first report presenting with rectal fistulisation. This case highlights a diagnostically challenging presentation and the need to consider metastatic disease when evaluating atypical seminal vesicle masses in oncological patients.

Reports doi: 10.3390/reports9030212

Authors: Konstantina Dinaki Rafail Ioannidis Panagiotis Theodorou Aristidis Delis Constantinos Papadopoulos

Background and Clinical Significance: To report an unusual case of a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern following spinal anesthesia and discuss a possible underlying mechanism; Case Presentation: A 56-year-old man underwent elective inguinal hernia repair under spinal anesthesia. On the second postoperative day, he developed a severe postural headache followed by bilateral hearing loss. Otoscopic examination was normal. Tuning fork tests and pure-tone audiometry demonstrated a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern. Laboratory findings were unremarkable. The patient was managed conservatively with bed rest, hydration and systemic corticosteroids, resulting in gradual clinical improvement; Conclusions: Hearing loss after spinal anesthesia is typically sensorineural and attributed to cerebrospinal fluid pressure alterations. This case highlights a rare apparent conductive audiometric pattern in the absence of clinically evident middle-ear pathology. A possible mechanism may involve altered inner-ear pressure dynamics leading to transient mechanical restriction of stapes mobility. Awareness of this atypical presentation may facilitate prompt recognition and appropriate management.

Reports doi: 10.3390/reports9030211

Authors: Oscar Arturo Benítez-Cárdenas Elhi Manuel Torres-Hernández Miguel Angel Noyola-Frías Ricardo Martínez-Rider Marlen Vitales-Noyola

Background and Clinical Significance: Odontogenic myxoma (OM) is a rare benign neoplasm of the jawbones characterized by spindle-shaped cells embedded in a myxoid stroma. Despite its benign histological nature, it demonstrates locally aggressive behavior, significant invasiveness, and a high risk of recurrence. OM ranks as the third most common odontogenic tumor after odontoma and ameloblastoma. It affects both sexes and occurs more frequently in the mandible than in the maxilla, typically during the second to fourth decades of life. Macroscopically, OM is non-encapsulated, whitish-gray, and gelatinous. Radiographically, it usually presents as a radiolucent lesion with fine bony trabeculae, producing a characteristic “tennis racket” appearance. Case Presentation: We report a case of a 27-year-old male diagnosed with maxillary odontogenic myxoma measuring 2.3 × 1.7 cm. Clinical, radiographic, and histopathological findings were evaluated, and the lesion was treated conservatively by surgical enucleation and curettage. Results: The surgical procedure was completed without complications. Histopathological analysis confirmed the diagnosis of odontogenic myxoma. The patient showed satisfactory postoperative healing, and no evidence of recurrence was observed during a 10-month follow-up period. Conclusions: Although odontogenic myxoma is benign, its locally aggressive nature and recurrence potential require accurate diagnosis and appropriate management. Conservative treatment by enucleation and curettage may be effective for small, well-defined lesions, provided that careful long-term follow-up is maintained to monitor for recurrence.

Reports doi: 10.3390/reports9030210

Authors: Seung Hwan Chung Hussein Ali-Ahmad Andrew Zwyghuizen Linda Qu

Background and Clinical Significance: Cutaneous squamous cell carcinoma (CSCC) is a common non-melanoma skin cancer, and while most cases are curable, a small proportion progresses to locally advanced or metastatic disease. As neoadjuvant immunotherapy with PD-1 inhibitors such as cemiplimab becomes more widely adopted, understanding real-world patterns of response remains essential. Case Presentation: We report a case of a man in his 50s with a large, locally advanced CSCC of the left hand in whom neoadjuvant cemiplimab was chosen to reduce tumor burden and preserve hand function when margin-negative resection was unlikely. The patient received four cycles of cemiplimab and demonstrated marked clinical improvement followed by complete pathological response at the primary site upon wide local excision. However, metastatic involvement of the epitrochlear and axillary lymph nodes was identified at surgery despite initial benign imaging. Postoperative PET/CT showed no additional disease, and the patient subsequently underwent axillary dissection and adjuvant cemiplimab with good functional recovery. Conclusions: This case highlights the potential for neoadjuvant cemiplimab to achieve substantial local tumor control and functional preservation while emphasizing the need for careful nodal assessment and ongoing surveillance in patients with very-high-risk CSCC. In cases where baseline cross-sectional staging is not performed, pre-existing occult nodal disease cannot be excluded.

Reports doi: 10.3390/reports9030209

Authors: Tomonori Kai Keiko Tominaga Atsumi Matsunaga Hiroshi Shimizu Kazuhiro Iwama Keisuke Ishizawa

Background and Clinical Significance: Beta-propeller protein–associated neurodegeneration (BPAN), also known as static encephalopathy of childhood with neurodegeneration in adulthood (SENDA), is a subtype of neurodegeneration with brain iron accumulation caused by pathogenic variants in WDR45. Although its clinical course and neuroimaging features are increasingly recognized, detailed neuropathological characterization, especially at its terminal stage, remains limited. Case presentation: We report a 68-year-old woman with a heterozygous WDR45 splice-site variant (NM_007075.4:c.830+1G>A), representing the longest-surviving case of SENDA/BPAN described to date. After static developmental delay in childhood, she rapidly developed progressive parkinsonism, dystonia, and cognitive decline in early adulthood, ultimately becoming bedridden with profound motor and autonomic dysfunction. Serial MRI demonstrated progressive cerebral and cerebellar atrophy with iron-related signal changes in the globus pallidus and substantia nigra. She died of sepsis at the age of 68 and was subjected to an autopsy including the brain. Neuropathological findings: Autopsy revealed severe, diffuse neuronal loss and gliosis throughout the central nervous system, with marked iron deposition and complete neuronal loss in the globus pallidus and substantia nigra. Immunohistochemistry demonstrated widespread tau pathology. Notably, neuronal tau inclusions contained both four-repeat (4R) and three-repeat (3R) isoforms, whereas glial tau was predominantly 4R-positive, indicating a mixed neuronal 4R/3R and glial 4R-dominant tauopathy. Perivascular and subpial 4R-tau–dominant deposits consistent with aging-related tau astrogliopathy were also present. LC3-positive and ferritin-positive cells suggested impaired autophagic flux, supporting the proposed autophagy-related pathogenesis of SENDA/BPAN. Conclusions: This case provides comprehensive clinicopathological insight into end-stage SENDA/BPAN, highlighting distinctive tau isoform patterns in neurons versus glia and pathological evidence of autophagy dysfunction. These findings expand the neuropathological spectrum of SENDA/BPAN and may inform future mechanistic and therapeutic research.

Reports doi: 10.3390/reports9030208

Authors: Lexi Frankel Courtney Marie VanderMeersch Jeffrey Morgan Denney

Background and Clinical Significance: Superficial postoperative wound dehiscence after cesarean delivery is insufficiently described in the literature, and evidence guiding management in high-risk patients remains limited. Case Presentation: We report a case of superficial wound dehiscence in a patient who underwent cesarean delivery following a motor vehicle accident with non-reassuring fetal heart tones and placental abruption. Her medical history included Hepatitis C infection, methadone dependence, endocarditis, and a prior episode of rapid wound dehiscence after laparoscopic surgery incisions closed with absorbable suture. Conclusions: Although many studies demonstrate no significant difference in dehiscence rates across closure methods, including suture, metal staples, and absorbable staples, clinicians should recognize that underlying medical conditions associated with inflammation or a history of prior wound dehiscence may increase the risk of complications when absorbable suture or absorbable staples are used. Careful assessment of patient-specific risk factors may help guide optimal closure technique in high-risk obstetric populations.

Reports doi: 10.3390/reports9030207

Authors: Gabriela Rybka Andrzej Boryczko Radosław Dziedzic Łukasz Chmura Joanna Kosałka-Węgiel

Background and Clinical Significance: Hyperviscosity syndrome (HVS) is a rare complication of primary Sjögren’s syndrome (pSS). While therapeutic plasma exchange (TPE) is the standard treatment to clear pathogenic immunoglobulins, its execution can trigger severe, atypical systemic risks. Case Presentation: A 60-year-old woman with pSS and extreme polyclonal hypergammaglobulinemia (total protein 100 g/L, IgM 41 g/L) presented with an acute hyperviscosity crisis, causing retinopathy, neurological deficits, and skin ischemia. Emergency TPE with 5% albumin replacement successfully reduced IgM by ~90% (to 6.39 g/L), resolving HVS symptoms. However, 20 min post-procedure, the patient suffered sudden hemodynamic collapse (BP 50/30 mmHg) and developed multiple massive, expanding soft-tissue hematomas. Laboratory tests revealed a coagulopathy consistent with plasma protein depletion following therapeutic plasma exchange, characterized by severe hypofibrinogenemia (1.35 g/L) and a 50% reduction in total serum protein. TPE was permanently discontinued. The patient was successfully stabilized using aggressive fluid resuscitation, vasopressors, and fresh frozen plasma (FFP) transfusions, followed by maintenance therapy with rituximab. Conclusions: In conclusion, clinicians should remain vigilant that severe hyperviscosity syndrome can be driven by a polyclonal increase in immunoglobulins rather than just monoclonal entities; furthermore, managing this condition requires careful balancing of TPE efficacy against its potential to trigger profound depletion coagulopathy.

Reports doi: 10.3390/reports9030206

Authors: Georgios-Eleftherios Anagnostopoulos Theodoros Spinos Vasileios Tatanis Angelis Peteinaris Evangelos Liatsikos Panagiotis Kallidonis

Background and Clinical Significance: Metallic stents represent a breakthrough in the treatment of ureteric obstruction, improving patient quality of life. Despite their advantages, management of encrustation remains a difficult complication to address. This case series highlights the rare occurrence of permanent ureteral Wallstents remaining indwelling for over 20 years. It emphasizes that the function of these older devices can be successfully preserved using minimally invasive techniques. Case Presentation: This case series details three patients, two males, aged 75 and 69 years, diagnosed with colon cancer, and one female, aged 67 years, with cervical cancer, who presented with obstructive uropathy due to extrinsic malignant compression. As a therapeutic strategy, permanent ureteral Wallstents were placed in all three patients. Over time, the stents developed significant encrustation, leading to secondary obstruction. Clinical manifestations of this complication varied, ranging from asymptomatic hydronephrosis to acute symptomatic uropathy characterized by fever and localized pain. All cases were treated endoscopically with Ho:YAG laser lithotripsy, and urine flow was successfully restored. During the follow-up period, one patient experienced two recurrences that were managed with the same technique, another remained completely symptom-free, and the third was lost to long-term follow-up. Remarkably, the stents have remained functional for over 20 years post-implantation. Conclusions: This is a rare report documenting permanent ureteral Wallstents with such prolonged indwelling time. Furthermore, our findings suggest that through minimally invasive techniques, the function of these devices can be successfully preserved.

Reports doi: 10.3390/reports9030205

Authors: Georgiana Ciobanu Daniel Pichler Benjamin Hutter Thomas Münzer

Background and Clinical Significance: When diverse clinical presentations coincide with complex laboratory findings, particularly in older adults, the diagnostic process can be especially challenging. Case Presentation: We report the case of a geriatric patient who was hospitalized with initial gastrointestinal and respiratory symptoms, followed by progressive chest pain and profound weakness, accompanied by elevated transaminases, troponin elevation, and hyponatremia, initially suggesting multiple competing diagnostic entities. During the clinical course, the patient developed neurological symptoms. Ultimately, careful history-taking, including detailed exposure assessment, raised suspicion for tick-borne encephalitis, which was subsequently confirmed by serological testing. Conclusions: This case highlights the diagnostic complexity of tick-borne encephalitis in older adults, where atypical and multisystem presentations may obscure the underlying etiology and delay recognition of a neuroinfectious disease.

Reports doi: 10.3390/reports9030204

Authors: Kunitaro Watanabe Chihiro Akizawa Ryuji Sawada Mieko Chinzei Kiyoshi Moriyama

Background and Clinical Significance: Proximal hamstring tendinopathy can occur not only in athletes but also in nonathletes when daily activities impose repetitive tensile or compressive loading at the ischial tuberosity. Because symptoms often resemble piriformis syndrome or lumbar pathology, diagnosis may be delayed; Case Presentation: A woman in her twenties developed buttock pain during desk work. Lumbar MRI was normal, and piriformis blocks provided only temporary relief. Localized tenderness at the ischial tuberosity, pain provocation during sitting, and positive provocation tests suggested proximal hamstring tendinopathy. Ultrasound showed a mildly hypoechoic area at the tendon insertion without definite thickening or tear. Ultrasound-guided injection of levobupivacaine and dexamethasone produced immediate but temporary relief. She continued receiving injections every two weeks, combined with stretching, hip-lift strengthening, and reduced sitting. After 18 injections, her pain improved from a numerical rating scale score of 10 to 0–1; Conclusions: This case demonstrates that proximal hamstring tendinopathy can develop in nonathletes due to lifestyle-related mechanical loading. Characteristic clinical findings and ultrasound evaluation are essential for diagnosis, and ultrasound-guided injection combined with exercise and activity modification provided sustained symptom improvement.

Reports doi: 10.3390/reports9030203

Authors: Lauryn Rudin Roberto Pili Joel B. Epstein Karrar Aljanahi Diggory Cordova Richa Rajesh Kapil Meleveedu Poolakkad S. Satheeshkumar

Background: Cancer treatment-induced ulcerative mucositis (UM) is a debilitating toxicity in patients with cancers of the lip, oral cavity, and pharynx (CLOP). This study evaluated the association of chemotherapy-induced (CT-UM) and radiotherapy-induced ulcerative mucositis (RT-UM) with burden of illness (BOI), focusing on hospital length of stay (LOS) and total charges, and examined disparities in outcomes. Methods: This retrospective cohort study analyzed 2019 National Inpatient Sample (NIS) data. Adult patients (≥18 years) hospitalized with CLOP (ICD-10-CM C00–C14) undergoing inpatient surgery, chemotherapy, or radiotherapy were included. CT-UM (K12.31) and RT-UM (K12.33) were identified as secondary diagnoses. Survey-weighted generalized linear models (negative binomial for LOS; gamma for charges) adjusted for demographics, comorbidities (Elixhauser score), insurance, income, and Diagnosis-Related Groups (DRG; surgical vs. medical) were used. Results: Among 59,710 weighted CLOP hospitalizations, 820 had CT-UM and 1010 had RT-UM. Patients with UM were younger and had varying comorbidity burdens. Unadjusted analyses showed prolonged geometric mean LOS for CT-UM (5.66 vs. 3.81 days, p < 0.001) and RT-UM (4.95 vs. 3.81 days, p = 0.001), with lower total charges ($48,645 and $42,938 vs. $56,267). Multivariable analyses confirmed RT-UM was associated with increased LOS (adjusted coefficient 1.33, 95% CI 1.14–1.55) but lower charges (0.67, 95% CI 0.56–0.81). In patients >50 years, CT-UM showed stronger effects (LOS 1.80, 95% CI 1.49–2.15; charges 0.79, 95% CI 0.65–0.98). Significant disparities were observed: females, Black and Hispanic patients, and Medicaid beneficiaries experienced greater BOI (prolonged LOS and/or higher charges in subgroups). Associations persisted in DRG- and procedure-stratified sensitivity analyses, suggesting treatment interruptions as a key driver. Conclusions: Ulcerative mucositis in hospitalized CLOP patients is associated with prolonged LOS but lower charges, likely due to treatment modifications, and disproportionately affects vulnerable populations. These findings highlight the need for proactive oral care protocols, multidisciplinary integration, and equity-focused interventions to reduce the burden of this toxicity and improve cancer treatment outcomes.

Reports doi: 10.3390/reports9030202

Authors: Ibrahim S. Alshaygy Mishari N. Alanezi Omar A. Aldosari Safana M. Alomar Hatim A. Khoja

Background and Clinical Significance: Malignant transformation of giant cell tumor of bone (GCTB) is a rare but clinically significant event, most commonly associated with radiotherapy, denosumab therapy, or recurrent disease. Secondary malignant transformation occurring in the absence of recognized risk factors is exceptionally uncommon. We report a rare case of high-grade sarcomatous transformation of proximal humeral GCTB after a prolonged latency period without prior radiotherapy, denosumab exposure, or documented recurrence; Case Presentation: A 27-year-old female initially presented with right shoulder pain and was diagnosed with proximal humeral GCTB. She underwent intralesional curettage and bone grafting, with histopathological confirmation of benign GCTB. Nine years later, she developed progressive shoulder pain, functional limitation, and systemic symptoms. Imaging demonstrated an aggressive lytic lesion with cortical destruction and soft-tissue extension involving the proximal humerus. Repeat curettage and histopathological evaluation revealed high-grade spindle cell sarcoma consistent with malignant transformation of GCTB. The patient received neoadjuvant chemotherapy followed by wide resection and endoprosthetic reconstruction of the proximal humerus, with additional adjuvant chemotherapy postoperatively. At two-year follow-up, she remained disease-free with excellent functional recovery and satisfactory quality of life; Conclusions: This case highlights the potential for delayed malignant transformation of GCTB even in the absence of established predisposing factors. Clinicians should maintain long-term vigilance in patients treated for GCTB, particularly when new pain, functional decline, or aggressive radiologic features develop years after initial treatment. Early recognition and multidisciplinary management are essential to optimize oncologic and functional outcomes.

Reports doi: 10.3390/reports9030201

Authors: Hasan Obeidat Mahyar Toofantabrizi Katie Li Sarah J. Silva Hibba Tul Rehman

Background and Clinical Significance: Cardiac and mediastinal angiosarcomas are rare, aggressive malignancies that often present with nonspecific symptoms and pose significant diagnostic challenges. Tumor heterogeneity and necrosis may lead to false-negative biopsy results; Case Presentation: We report a 64-year-old man who initially presented with cardiac tamponade of unclear etiology. Despite an extensive workup, the patient remained asymptomatic for five months before re-presenting with dyspnea and a large mediastinal mass compressing the right heart, along with a lytic rib lesion. Initial ultrasound-guided biopsy of the rib lesion demonstrated a benign vascular proliferation consistent with Masson tumor (intravascular papillary endothelial hyperplasia), which was discordant with aggressive imaging findings. Further evaluation with positron emission tomography–computed tomography (PET-CT) revealed peripheral metabolic activity, and cardiac magnetic resonance imaging (MRI) demonstrated a heterogeneous mass with central necrosis and peripheral enhancement. A repeat CT-guided biopsy targeting the metabolically active region confirmed angiosarcoma, with immunohistochemical staining demonstrating diffuse positivity for ERG, CD31, and CD34. The patient was treated with palliative radiation and paclitaxel-based chemotherapy but experienced rapid clinical decline and transitioned to comfort-focused care; Conclusions: This case highlights the importance of correlating imaging with pathology and emphasizes the risk of sampling error in necrotic tumors. PET-guided biopsy targeting viable tumor regions is essential in cases with discordant findings.

Reports doi: 10.3390/reports9030200

Authors: Athanasios Vlachodimitropoulos Nicholas S. Mastronikolis Gerasimos Danielides Foteini Tsapardoni Georgios Batsaouras Spyridon Lygeros

Background and Clinical Significance: Choanal atresia is a rare congenital obstruction of the posterior nasal aperture, with an estimated incidence of one in 5000 to one in 8000 live births. Bilateral disease typically presents as a neonatal emergency, whereas unilateral disease is more frequent and may remain undiagnosed for years or decades, presenting in adolescence or adulthood with chronic unilateral nasal obstruction and ipsilateral mucopurulent rhinorrhoea. Optimal surgical management remains debated, particularly with regard to mucosal-flap reconstruction and the choice of postoperative stent. Case Presentation: A 22-year-old male was referred for chronic left-sided nasal obstruction, persistent ipsilateral mucopurulent rhinorrhoea and reduced ipsilateral olfaction. Nasal endoscopy and high-resolution computed tomography demonstrated an isolated, non-syndromic, mixed bony–membranous left choanal atresia. The patient underwent transnasal endoscopic choanoplasty with posterior septectomy and removal of the atretic plate and posterior vomer. An ipsilateral superiorly based septal mucoperichondrial flap was raised first and later transposed over the sphenoid rostrum; following drilling, the contralateral septal mucosa was approached and incised horizontally to generate a superior and an inferior leaflet, which were rotated to cover the corresponding portions of the residual posterior septal ridge. A bioabsorbable mometasone-furoate-eluting sinus implant (PROPEL®, Medtronic) was deployed across the neo-choana. The follow-up endoscopy at two months demonstrated a widely patent, well-mucosalized neo-choana with complete resolution of symptoms. Conclusions: Transnasal endoscopic posterior septectomy combined with mucosal-flap reconstruction and a bioabsorbable steroid-eluting stent is a technically feasible and biologically rational approach to adult unilateral CA. To our knowledge, this is among the first reports describing the off-label intraoperative use of a PROPEL® stent in a young adult with isolated unilateral choanal atresia.

Reports doi: 10.3390/reports9030199

Authors: Yurena Rodríguez Francisco Montes de Oca Idaira Dorta Ricardo Reyes Aixa R. Bello

Uterine leiomyosarcoma (LMS) is a rare and aggressive malignancy with diagnostic challenges, particularly in cases with overlapping histological features with atypical leiomyoma or smooth muscle tumors of uncertain malignant potential. We report a comparative immunohistochemical analysis of LMS, leiomyoma, and adjacent myometrium obtained from a 40-year-old woman with discordant pathological diagnoses. LMS tissue showed increased Ki67 and NTS/NTSR1 immunoreactivity together with a distinctive cytoplasmic localization of estrogen receptor beta (ERβ), in contrast to the predominantly nuclear localization observed in leiomyoma and normal myometrium. Importantly, focal areas within adjacent morphologically non-neoplastic myometrium exhibited an immunophenotype resembling LMS, including cytoplasmic ERβ localization and increased Ki67 and NTS/NTSR1 expression. These observations suggest a potential association between ERβ subcellular localization, NTS/NTSR1 signaling, and molecular alterations occurring during uterine smooth muscle tumorigenesis. However, given the single-case nature of this report, these findings should be considered exploratory and require validation in larger studies. The diagnostic message conveyed by these images may assist in the interpretation of diagnostically challenging cases and provide a basis for future investigation.

Reports doi: 10.3390/reports9030198

Authors: Zlatko Zlatev Tanya Peshleevska-Vicheva Angel Angelov George Stoyanov Hristo Popov

Background and Clinical Significance: Osteonevi, originally described by Heidingsfeld in 1908 and later by Nanta in 1911, because of whom it is known as osteonevus of Nanta, is a rare condition with not yet fully established etiopathogenesis; Case Presentation: Herein, we report a case of a 33-year-old female patient who presented to our institution with a papilliform pigmented lesion located on the projection of the left mandibular angle, measuring 2 × 1.5 cm. The lesion had been present since childhood; however, it had increased in size by approximately 5 mm over the previous month and had become painful. Surgical excision was performed, which went uncomplicated. Histology of the resected specimen showed a dermally based, symmetrical melanocytic proliferation, without signs of dysplasia, and an underlying keratocyst with rupture, accompanied by a surrounding foreign-body-type granulomatous reaction around inert keratin flakes. A third component of the lesion was also noted, represented by foci of osteoid and myeloid metaplasia underneath the melanocytic proliferation, without direct relation to the ruptured keratocyst. Based on the morphological findings, the diagnosis of osteonevus of Nanta was established; Conclusions: Oseonevus of Nanta is an extremely rare, benign morphological finding. The etiopathogenesis of these rare lesions is not yet fully established, despite several proposed mechanisms. The differential diagnosis, while typically straightforward, is broad.

Reports doi: 10.3390/reports9030197

Authors: Gianluca Pagnoni Alberto Monello Luca Rossi Daniela Aschieri Marco Loffi

Background and Clinical Significance: The Coronary Sinus Reducer (CSR) is a percutaneous therapeutic option for patients with refractory angina who are unsuitable for further myocardial revascularization. The procedure has a generally favorable safety profile, with a low rate of reported procedural complications. To our knowledge, major atrioventricular (AV) conduction disturbances during CSR implantation have not been previously described. This case highlights a rare but clinically relevant intraprocedural complication; Case Presentation: A 71-year-old man with multivessel coronary artery disease and previous coronary artery bypass grafting was referred for CSR implantation because of refractory angina despite optimal medical therapy and lack of further revascularization options. The procedure was performed via a right jugular venous approach. Baseline electrocardiography showed right bundle branch block and findings consistent with previous inferior myocardial infarction, without definite criteria for left anterior fascicular block. During coronary sinus cannulation, the patient developed transient complete AV block, resulting in an approximately 8–10-second ventricular pause without a stable ventricular escape rhythm. The conduction disturbance resolved after catheter withdrawal and repositioning. Given the severity of the event, a temporary transvenous pacemaker was inserted via the right femoral vein, allowing safe completion of CSR implantation. At three-month follow-up, angina had improved from Canadian Cardiovascular Society class III to class I, and no recurrent advanced AV block was documented; Conclusions: Transient complete AV block may occur during CSR implantation, particularly during coronary sinus manipulation and possibly in patients with pre-existing conduction disease. Careful catheter handling, prompt recognition of conduction disturbances, and immediate availability of temporary pacing support should be considered in selected high-risk patients undergoing CSR implantation.

Reports doi: 10.3390/reports9030196

Authors: Bomonyo Fente Ahmad El-Said Hilda Yuson Gavin Galasko

Background and Clinical Significance: Ischaemia with non-obstructive coronary arteries (INOCA) has attained more recognition in recent decades. These patients may present with typical cardiac sounding chest pain but have no evidence of obstructed coronary arteries on coronary angiography. This presents a challenge to clinicians in terms of diagnosis and management. Coronary microvascular dysfunction (CMD), or coronary spasm (whether epicardial or microvascular) may be the cause of their presentation, and they usually require further invasive investigations of their coronary microvascular circulation to determine the cause. Case Presentation: This case involves a male patient in his 60s presenting with recurrent nocturnal chest pain, clinical and ECG evidence of ischaemia, and diagnostic findings from invasive coronary angiography and a microvascular study. These findings confirmed an absence of obstructive coronary artery disease (CAD) but demonstrated significant microvascular dysfunction, consistent with a diagnosis of microvascular angina according to the COVADIS criteria, as well as epicardial coronary artery spasm leading to complete vessel closure. This case highlights the clinical and diagnostic complexities of microvascular angina and coronary artery spasm. It also emphasises the importance of advanced diagnostic testing in confirming this challenging diagnosis. This case was interesting due to the patient having a final diagnosis of microvascular angina and coronary artery spasm at the same time. This case also demonstrates how 300 mcg of intracoronary nitrate was given to dilate a vessel in coronary spasm with positive effect. This finding was supportive of the final diagnosis given the clinical context of this patient. Conclusions: This case report demonstrates the diagnostic steps, from symptom assessment through to angiography and microvascular testing and would add to the existing knowledge of INOCA and aid in the understanding and management of these patients especially in centres where acetylcholine testing to confirm inducible epicardial coronary spasm is not available, like it was not in our centre (Blackpool Victoria Hospital).

Reports doi: 10.3390/reports9020195

Authors: Calin Romulus Fodor Marta Bieńkowska Bartosz Dalewski Łukasz Pałka

Background/Objectives: Advanced implant anchorage techniques are increasingly used to manage severe maxillary bone deficiency and to avoid extensive bone augmentation procedures. This case series report aimed to describe the canine bypass anchorage technique and to evaluate the short- to medium-term clinical outcomes and survival of implants placed using this approach. Materials and Methods: Thirteen patients presenting with missing maxillary premolars or posterior segments and insufficient alveolar bone height for conventional axial implant placement were treated using the canine bypass technique. A total of 19 long one-piece implants were inserted palatally to the canine root, engaging distant cortical bone of the nasal cavity and/or palatal alveolar process. Pre- and postoperative cone-beam computed tomography (CBCT) examinations were performed to assess implant positioning and anchorage. Patients were followed up to 3.5 years. Results: The mean follow-up period was 26.1 ± 10.8 months. Nasal cortical anchorage was achieved in 84.2% of implants, and palatal cortical anchorage in 73.7%; both anchorage types were obtained simultaneously in 57.9% of cases. The mean distance between the implant and canine root was 1.27 ± 1.4 mm (range: −1.0 to 4.5 mm), including cases of direct implant–tooth contact and periodontal ligament space transgression. All implants remained functional throughout the observation period, yielding a cumulative survival rate of 100%. Canine pulp vitality was preserved in all non-endodontically treated teeth. Conclusions: Within the limitations of this case series report, the canine bypass anchorage technique appears to be a feasible and minimally invasive treatment option for maxillary rehabilitation with implant-supported restoration in selected patients with severe bone deficiency, potentially allowing avoidance of sinus augmentation procedures. Further prospective studies with larger patient cohorts and longer follow-up periods are required to confirm the long-term safety, predictability, and clinical applicability of this approach.

Reports doi: 10.3390/reports9020194

Authors: Hiroshi Tanabe Mari Ogawa Mari Kita Takeshi Kotake

Background and Clinical Significance: Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum, most commonly associated with inflammatory bowel disease or haematologic disorders. Its occurrence in patients with solid malignancies is uncommon. PPG in an oncologic setting poses diagnostic and therapeutic challenges because systemic immunosuppressive therapy, wound care, and ongoing chemotherapy must be carefully balanced; Case Presentation: We report the case of a Japanese man in his 50s with stage IVB rectal adenocarcinoma who developed rapidly progressive peristomal ulceration clinically consistent with PPG around a colostomy 12 weeks after initiation of panitumumab-containing systemic chemotherapy. The diagnosis was made on clinical grounds and was strongly supported by the clinical morphology, exclusion of major mimickers, and response to systemic corticosteroid therapy, although histopathological confirmation was not obtained. Because existing diagnostic criteria for pyoderma gangrenosum are not specifically designed for peristomal disease, they were used as supportive rather than definitive diagnostic tools. Skin biopsy was avoided due to the risk of pathergy at the peristomal site. Superficial cultures were not obtained because frequent cleansing and faecal contamination were likely to compromise diagnostic accuracy. To minimise mechanical pathergy, the stoma appliance was changed from a one-piece soft convex system to a two-piece flat system. Multidisciplinary management, including systemic corticosteroids, meticulous stoma care, and selective ultrasonic debridement, resulted in complete epithelialisation by Week 26. Chemotherapy was temporarily withheld during the active inflammatory phase and later resumed. Despite successful control of the peristomal ulceration, the patient died from progressive malignancy at Week 34; Conclusions: This case highlights the clinical challenge of balancing immunosuppressive therapy for clinically suspected PPG with ongoing oncologic treatment. Mechanical pathergy related to stoma appliance use was considered a more likely precipitating factor than chemotherapy alone, although panitumumab may have contributed to impaired cutaneous repair. Close collaboration among dermatologists, oncologists, surgeons, WOC nurses, and family caregivers is essential for multidisciplinary decision-making in complex oncologic settings.

Reports doi: 10.3390/reports9020193

Authors: Hala Jasim Orhan K. Öz Joseph Frankl

Background and Clinical Significance: Many diagnostic radiopharmaceuticals are excreted in the urine. This can pose a diagnostic challenge when urine-containing structures are in atypical locations, particularly in review of planar imaging without anatomical details from cross-sectional imaging. This case highlights a challenging 99mTc-methylene diphosphonate (99mTc-MDP) bone scan in a patient with an inguinal hernia containing a portion of the urinary bladder. Subsequently, we review diagnostic challenges on conventional and molecular imaging following surgical repair of the inguinal hernia. Case Presentation: A 79-year-old man with prostate cancer underwent initial staging prior to prostatectomy with 99mTc-MDP bone scintigraphy. Anterior and posterior images showed focal uptake overlying the pubic symphysis. Lateral views showed that the activity was extraosseous. Follow-up CT urography showed a bladder hernia as the cause of the abnormality on bone scan. Prostatectomy and inguinal hernia repair were performed as a combination case. Four years postoperatively, follow-up 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) showed no recurrence. The CT component of the exam showed an intermediate-density focus at the right inguinal hernia repair site, corresponding to a plugoma related to a polypropylene mesh plug, and a hyperattenuating Gore-Tex mesh repair of the left inguinal hernia. Conclusions: This case highlights the importance of lateral projections in resolving scintigraphic pitfalls and recognizing mesh-related imaging appearances to prevent misinterpretation.

Reports doi: 10.3390/reports9020192

Authors: Niall Leahy Sandra Quinn Derek Crinion

Background and Clinical Significance: Inflammatory myopericardial syndrome is an umbrella term recently introduced by the European Society of Cardiology, which encapsulates the overlap that exists in clinical practice between myocardial and pericardial disease. It has a heterogeneous aetiology and a broad spectrum of severity in terms of its clinical features. Toxoplasma gondii is a rare but recognised infectious cause of myopericarditis and is typically seen in immunocompromised individuals. Case Presentation: We present the case of a young, immunocompetent male, presenting with pleuritic chest pain following a recent flu-like illness. Investigations revealed an acute myocardial injury based on elevated troponin T levels, in the absence of ventricular dysfunction. Toxoplasma immunoserology was consistent with primary toxoplasma infection. The remainder of his viral panel was negative. There was prompt symptom improvement following commencement of treatment with colchicine and a non-steroidal anti-inflammatory agent. Cardiac magnetic resonance imaging post-discharge revealed findings consistent with prior myocarditis. Conclusions: This case is an example of the rare occurrence of toxoplasma myopericarditis in an immunocompetent individual. Cardiac MRI is an invaluable imaging modality used to evaluate myocardial function and tissue characteristics in patients presenting with inflammatory myopericardial syndrome.

Reports doi: 10.3390/reports9020191

Authors: Riana Tarabocchia Kiran Javaid Rahul Mittal Maria Balabanian Rory Ulloque

Background and Clinical Significance: Cerebral amyloid angiopathy (CAA) is a neurovascular disorder characterized by the deposition of amyloid beta (Aβ) peptides within the walls of small-to-medium-sized cerebral vessels, leading to vascular fragility and an increased risk of lobar intracerebral hemorrhage (ICH), cognitive decline, and recurrent stroke. CAA is an important cause of spontaneous ICH in elderly patients and may be underrecognized, particularly when presenting with acute neurologic symptoms that mimic ischemic stroke. Early identification has significant implications for management, prognosis, and secondary prevention. Case Presentation: An 80-year-old male presented to the emergency department with incoherent speech, rambling, and severe headache concerning for acute stroke. His medical history was notable for a prior cerebrovascular accident, hypertension, diabetes mellitus, benign prostatic hyperplasia, and recent evaluation for dementia-like symptoms. Initial neuroimaging revealed a 3.2 cm intraparenchymal hemorrhage in the left occipital lobe with surrounding edema. Subsequent MRI demonstrated a lobar hemorrhage pattern suggestive of CAA based on imaging findings and clinical context. The patient was admitted to the intensive care unit (ICU) for close neurologic monitoring. He remained hemodynamically stable with no new motor or sensory deficits. Over a three-day hospital course, his speech and visual deficits improved. Blood pressure was carefully controlled, and repeat imaging demonstrated stable hemorrhage without progression. He was diagnosed with probable CAA and discharged home with supportive services. Conclusions: This case highlights the importance of considering cerebral amyloid angiopathy in elderly patients presenting with spontaneous lobar intracerebral hemorrhage and cognitive symptoms. Prompt recognition and appropriate neuroimaging are critical for diagnosis, risk stratification, and guiding management.

Reports doi: 10.3390/reports9020190

Authors: Līna Petrova Jūlija Ustiča Elīna Rasčevska Shaju Jacob Pulikkotil

Background and Clinical Significance: Pre-eruptive intracoronal resorption is a rare developmental anomaly resembling occlusal caries despite the absence of an external breach. Case Presentation: We report of two cases. The first case involves a 9-year-old girl with PEIR of tooth 24 that was not identified on a panoramic radiograph taken one year earlier. The lesion later became clinically evident, presenting with symptoms and discoloration, and progressed to irreversible pulpitis requiring pulpotomy. This case highlights the importance of careful interpretation of paediatric panoramic radiographs and timely intervention to preserve pulp vitality in developing permanent teeth. The second case concerns a 16-year-old girl in whom PEIR was incidentally detected on cone-beam computed tomography (CBCT) in tooth 38. As the tooth has not yet erupted, its future clinical presentation and progression remain uncertain. To the best of the authors’ knowledge, there are no published reports specifically describing PEIR in patients from the Baltic region. Conclusions: Early radiographic detection of pre-eruptive intracoronal resorption is essential to prevent pulpal involvement and improve treatment outcomes, particularly when combined with careful interpretation of routine paediatric radiographs to minimize the risk of delayed diagnosis. This case emphasizes the importance of recognizing asymptomatic disease progression and integrating multidisciplinary approach to provide individualized treatment planning.

Reports doi: 10.3390/reports9020189

Authors: Gursan Gunes Yenidogan Nagihan Duran Yakar Enise Alioglu Salim Taner Gözükızıl Aysegul Bilen

Objectives: To evaluate the clinical impact and treatment adaptations during the immediate-release oxycodone hydrochloride shortage. Methods: This retrospective, observational study was conducted during the oxycodone shortage period (May 2024–March 2025) in patients with cancer pain. Pain intensity was assessed using the Numerical Rating Scale (NRS) at baseline (prior to switching, while receiving oxycodone) and at follow-up (after switching to alternative analgesics). Changes in pain intensity were evaluated using within-patient differences (ΔNRS), with clinically meaningful worsening defined as an increase of ≥2 points. Descriptive and inferential statistics were used to summarize patient characteristics and outcomes. Results: Of 300 patients screened, 55 met inclusion criteria (mean age 65.2 ± 11.0 years; 63.6% male). Pain intensity increased significantly following treatment modification during the period of oxycodone unavailability, with mean NRS scores rising from 4.3 ± 1.7 to 5.9 ± 2.5 (p < 0.001). The mean ΔNRS was +1.56 (95% CI 0.79–2.34), with clinically meaningful worsening observed in 36 patients (65.5%). No statistically significant association was observed between substitute analgesic type and clinically meaningful worsening (p = 0.11). Conclusions: The oxycodone shortage was associated with worsened pain control and increased need for treatment modifications in cancer patients, highlighting the importance of uninterrupted access to essential opioids.

Reports doi: 10.3390/reports9020188

Authors: Maria P. Fernandez-Gomez Luis Rafael Moscote-Salazar Jesus Francisco Saltaren Fonseca Guillermo de Jesus Aguirre Vera Willem Calderon Miranda Jose Valerio

Background and Clinical Significance: Tumefactive Multiple Sclerosis (TMS) represents a rare and diagnostically challenging form of demyelinating disease characterized by large space-occupying lesions that can closely mimic intracranial neoplasms, abscesses, and other inflammatory or vascular conditions. Case Presentation: The case highlights the overlapping radiologic features that frequently lead to diagnostic uncertainty and underscores the importance of careful interpretation of multimodal imaging and ancillary studies. Overall a comprehensive multidisciplinary evaluation is essential to reduce the risk of misdiagnosis and avoid unnecessary invasive interventions. Conclusions: This review summarizes current evidence regarding the diagnostic approach, imaging characteristics, and therapeutic strategies for tumefactive demyelinating lesions. Additionally, we present a clinical case that illustrates the diagnostic complexity of this entity, in which neuroimaging findings and cerebrospinal fluid analysis supported a demyelinating rather than neoplastic process.

Reports doi: 10.3390/reports9020187

Authors: Jordan Santos Faraz Behzadi S. Mozammil Alam Thomas C. Varkey David C. Maeng Ghassan J. Ibrahim Trent H. Smith Alan Wang

Background and Clinical Significance: Giant cell arteritis (GCA) is an autoimmune vasculitis of both medium and large-sized vessels typically affecting females 50 years of age or older. Severe complications can include permanent visual loss, acute coronary syndrome, or stroke. This case will present an atypical presentation of bilateral OPN which can be a rare manifestation of GCA; Case Presentation: Our patient developed acute, painful worsening central vision loss progressing from right eye to left with bilateral extraocular motility restriction and magnetic resonance image (MRI) revealed bilateral, circumferential optic nerve sheath enhancement suggesting optic perineuritis (OPN). Temporal artery biopsy confirmed GCA with bilateral temporal arteritis. The patient was treated with a high dose course of corticosteroids followed by a taper and was started on upadacitinib with symptomatic improvement; Conclusions: This case underscores OPN as a rarer manifestation of giant cell arteritis that can present with bilateral painful eye movements and vision loss. Early recognition and prompt corticosteroid therapy are essential to prevent irreversible visual impairment.

Reports doi: 10.3390/reports9020186

Authors: Hani T. Fadel

Background and Clinical Significance: Advanced periodontitis destroys tooth-supporting structures and causes pathologic tooth migration (PTM) and functional and esthetic repercussions. This report illustrates how non-surgical periodontal therapy (NSPT) addresses such concerns. Case Presentation: A 34-year-old woman (healthy, who quit smoking) complained of a space between her upper front teeth. Based on clinical and radiographic data, she had localized periodontitis stage III grade C with intrabony defects, deep pockets, and a diastema between teeth # 12 and 11. The treatment plan involved improvement of self-performed oral hygiene measures and NSPT. Initially, improvements in plaque, bleeding, and pocket depth scores were observed. Non-surgical re-treatment of residual sites was associated with further improvements and complete closure of the diastema, along with patient satisfaction with the outcome. Conclusions: The potential of NSPT in improving periodontal clinical parameters and the association with spontaneous tooth repositioning and apparent filling of intrabony defects radiographically is demonstrated, ultimately addressing the patient’s functional and esthetic concerns.

Reports doi: 10.3390/reports9020185

Authors: Hassan Al-Thani Husham Abdelrahman Maryam Al-Sulaiti Abdelhakem Tabeb Mahir Petkar Noora Al-Thani Ayman El-Menyar

Background and Clinical Significance: Thyroid cancer is increasing, particularly the differentiated type, with decreasing incidence of the anaplastic type. Anaplastic thyroid carcinoma (ATC) is a rare, aggressive, and often lethal form. It frequently presents with metastatic disease, regional and systemic, with common distant metastasis to the lung, bone, brain, and adrenal, and rarely to other places; Case presentation: A 74-year-old Arab male presented with symptomatic anemia and melena and was admitted for investigation of the cause. The patient was found to have a large retrosternal goiter and gastric tumor. CT scan showed a pedunculated, nonobstructive mass, suggestive of a GIST or leiomyoma. The neck mass presented with compressive symptoms. He underwent a combined neck and abdominal surgical resection based on a multidisciplinary team decision, as prior biopsies were not conclusive. The final pathology report identified similar tumors in the two specimens and suggested an anaplastic thyroid carcinoma as the primary tumor with metastasis to the stomach. Furthermore, the workup, including a PET scan 2 weeks post-surgery, revealed widespread metastases in the bone, lung, and liver, and the treatment was palliative. He was followed up in the outpatient clinic for 4 and a half months post-operatively. The patient developed sepsis and cardiopulmonary arrest and died; Conclusions: ATC can metastasize to many places in the body, including the stomach (as shown in our case), which can cause significant upper gastrointestinal bleeding and anemia. Metastatic ATC carries a poor prognosis; thus, physicians need to keep a high index of suspicion in approaching similar cases. A multidisciplinary approach for the management is of utmost importance for appropriate treatment. This disease’s pathology, behavior, and targeted new treatment modalities must be explored further.

Reports doi: 10.3390/reports9020184

Authors: Timoleon Giannakas Dimitrios Deligiannis Panagiotis Mitsos Anna Papakonstantinou Marios Stavropoulos Aris Kaltsas

Background and Clinical Significance: Spontaneous renal forniceal rupture is an uncommon complication of obstructive uropathy and is classically associated with ureteric calculi rather than distal urinary retention. Bilateral retention-related rupture appears to be exceptionally rare and may be diagnostically challenging when renal function begins to improve after bladder decompression; Case Presentation: An 82-year-old man with a history of prostate cancer treated five years earlier with external beam radiotherapy and androgen deprivation therapy presented with acute abdominal pain radiating to both flanks and inability to void. Bedside ultrasonography showed urinary retention and bilateral hydronephrosis, and a 16-Fr Foley catheter drained 900 mL of urine. Admission evaluation showed severe acute kidney injury, microscopic hematuria, minimal leukocyturia, and elevated inflammatory markers. Post-obstructive diuresis developed after bladder decompression. CT urography with excretory-phase imaging on hospital day 3 demonstrated severe bilateral hydroureteronephrosis with bilateral renal forniceal rupture and associated urinomas, including a larger left-sided collection extending toward the psoas compartment. Bilateral percutaneous nephrostomies were placed on hospital day 4 for upper-tract diversion. Immediate nephrostography showed no active contrast extravasation. At one-month follow-up, combined CT and nephrostographic assessment confirmed complete resolution of the bilateral urinomas without persistent leak, and the nephrostomy tubes were removed; Conclusions: This case suggests that urinary retention in an older man with prior prostate radiotherapy may reflect radiation-associated outlet pathology and/or impaired detrusor function rather than simple prostate enlargement. Delayed-phase CT urography was essential for diagnosis, and active bilateral diversion was justified by bilateral rupture, acute kidney injury, and the extent of urinary extravasation. The report expands the limited PubMed-indexed literature on retention-related upper urinary tract rupture and supports cautious follow-up aimed at defining the underlying mechanism of retention.

Reports doi: 10.3390/reports9020183

Authors: Mikie Ebihara Miwa Yoshida Kohei Handa Katsuharu Yano Tomoko Omiya Kei Nakamura

Background and Clinical Significance: “Hikikomori”—a state of prolonged social withdrawal affecting an estimated 2% of Japan’s working-age population—is frequently associated with underlying anxiety disorders, such as gaze phobia, and contributes to the socio-economic burden known as the “8050 problem,” in which aging parents support their socially isolated adult children. While Morita therapy is effective for such conditions, nursing support has historically lacked a systematic theoretical framework. This case report presents a novel nursing model analyzing the transformation process from toraware (mental preoccupation) toward mokuteki-hon-i (purpose-driven action). It proposes the ‘side-by-side’ nursing approach as a potentially important element in supporting patient autonomy in similar clinical settings. Case Presentation: A man in his 20s, diagnosed with gaze phobia and experiencing long-term withdrawal following traumatic bullying, was referred to our specialized short-care program. After initial preparation through structured psychoeducation regarding Morita therapy principles (toraware, sei-no-yokubo, mokuteki-hon-i), he participated in a 14-month Morita therapy-based short-care program combining individual and group interventions. Initially, the patient exhibited severe social avoidance and was trapped in a cycle of seishin-kogo-sayo (psychic interaction). Nurses applied ‘Strategic Inattention to Symptoms’ (shojo-fumon) and provided specific role suggestions, such as serving as a secretary in group discussions, to elicit his sei-no-yokubo (desire for life). Through the reframing of his anxiety as a constructive drive, the patient shifted to a purpose-driven stance. Outcomes showed improved self-adjustment skills in public spaces and successful social reintegration through sustained part-time employment. Conclusions: Nursing care characterized by ‘intentional non-intervention’—which involves waiting in a ‘side-by-side’ manner within a minimally structured environment—may contribute to fostering patient autonomy in similar clinical contexts. This ‘experience-oriented’ approach appeared to elicit inner strengths and support self-regulation in this case, warranting further investigation in multi-case designs. The relative contributions of individual nursing support and group therapeutic milieu cannot be disentangled in a single-case design.

Reports doi: 10.3390/reports9020182

Authors: Paul Tchouala Tchakoute Alin Iuhas Vlad-Ionuț Nechita Andrei Vasile Pașcalău Ion Cosmin Puia

Background and Clinical Significance: Torsion of the vermiform appendix is a rare condition with a clinical presentation closely resembling acute appendicitis, while preoperative investigations are of limited value in distinguishing between the two entities. In most cases, the definitive diagnosis is made incidentally during surgery. Case Presentation: The authors present the case of an 18-day-old female neonate who presented with marked abdominal distension, diffuse spontaneous and palpation-induced abdominal pain, guarding, and signs of peritoneal irritation. The clinical manifestations and paraclinical findings mimicked a neonatal intestinal obstruction; however, intraoperative exploration revealed a gangrenous vermiform appendix twisted 240° anticlockwise, associated with a fibrinous pseudomembrane and multiple enlarged mesenteric lymph nodes. Although the initial therapeutic strategy was to perform a laparoscopy, severe abdominal distension caused by marked aerocolia necessitated conversion to a supra- and infraumbilical midline laparotomy. We thus describe, to the best of our knowledge, one of the youngest neonatal cases of appendiceal torsion reported in the literature. Conclusions: Although rare, appendiceal torsion should be considered in the differential diagnosis of neonatal acute abdomen, and timely surgical exploration is key to achieving a favorable outcome.

Reports doi: 10.3390/reports9020181

Authors: Lissethkaren Alvarez Vargas Celia Rodríguez Tudero Elena Jiménez Mayor Avinash Chandu Nanwani Esperanza Moral Berrio Juan Daniel Díaz Díaz García Arturo Villalobos Navarro Emily Rosario Chamorro Chamorro Asto Michael Cieza Terrones José C. De La Flor

Background and Clinical Significance: IgG4-related disease (IgG4-RD) is a chronic fibroinflammatory, immune-mediated multisystem disorder that can mimic neoplastic, infectious, or autoimmune conditions. Among its head-and-neck manifestations, IgG4-related dacryoadenitis and sialadenitis, historically referred to as Mikulicz disease, should be distinguished from the classical Mikulicz syndrome, which describes secondary lacrimal and salivary gland enlargement due to other systemic disorders. Renal involvement, most commonly in the form of IgG4-related tubulointerstitial nephritis (IgG4-TIN), is less frequent but carries major prognostic implications because delayed diagnosis may lead to irreversible kidney damage. Case Presentation: A 49-year-old man with no relevant past medical history presented with a 2-year history of intermittent polyuria and foamy urine. Laboratory testing revealed advanced kidney dysfunction, with serum creatinine of 4.2 mg/dL, estimated glomerular filtration rate of 16 mL/min/1.73 m2, and proteinuria of 2874 mg/day. Physical examination showed bilateral parotid enlargement, upper eyelid edema, lacrimal gland enlargement, and sicca symptoms, raising suspicion for IgG4-related dacryoadenitis and sialadenitis (Mikulicz disease). Further work-up demonstrated marked eosinophilia, polyclonal hypergammaglobulinemia, and significantly elevated serum IgG4 levels (3180 mg/dL), while infectious serologies and autoimmune studies were negative. Kidney biopsy revealed plasma cell-rich tubulointerstitial nephritis with lymphoplasmacytic and eosinophilic infiltrates, interstitial fibrosis, tubular atrophy, and more than 40 IgG4-positive plasma cells per high-power field, supporting the diagnosis of IgG4-related tubulointerstitial nephritis in the setting of systemic IgG4-RD. Treatment with prednisone followed by mycophenolate mofetil led to improvement in glandular manifestations and a partial reduction in proteinuria, but renal recovery remained incomplete. The patient subsequently developed a severe pulmonary infection complicated by sepsis and oligoanuric acute kidney injury superimposed on chronic kidney disease, and ultimately progressed to end-stage kidney disease requiring chronic maintenance hemodialysis. Conclusions: This case highlights that a Mikulicz disease phenotype may represent the initial manifestation of systemic IgG4-RD and should prompt evaluation for extraglandular involvement, particularly renal disease. In patients with glandular enlargement, eosinophilia, hypergammaglobulinemia, and unexplained renal dysfunction, IgG4-RD should be actively considered. Kidney biopsy remains essential for diagnostic confirmation and prognostic assessment, as delayed recognition may result in irreversible renal damage and progression to end-stage kidney disease.

Reports doi: 10.3390/reports9020180

Authors: Abdulmonem Alsiddiky Mishari Alanezi Nouf Alabdulkarim Bandar Aljammaz Othman Alabdullah Saad Alkahtani Razan Alshatwi Abdulrahman Alrajhi

Background and Clinical Significance: Acute compartment syndrome is a rare but limb-threatening emergency in pediatric patients. While most cases follow high-energy trauma or displaced fractures, acute compartment syndrome precipitated by initially underestimated forearm injuries is uncommon and may create a significant diagnostic challenge, particularly in young children who exhibit atypical clinical presentations, such as escalating anxiety and analgesic requirements, rather than classic ischemic signs. Case Presentation: We report the case of a 4-year-old girl who developed severe forearm and hand compartment syndrome following a delayed presentation after a fall from a height of 2–2.5 m onto the left upper extremity. Initial evaluation revealed progressive tense swelling, severe pain with passive stretch, diminished distal perfusion, and radiographic evidence of distal radius-ulna buckle fractures associated with a proximal ulna fracture. Emergent surgical decompression via extensive volar and dorsal fasciotomies revealed markedly elevated compartment pressures. Intraoperatively, deep volar muscle ischemia and necrosis were identified, requiring carpal tunnel release, serial debridements, and complex staged wound management. Multidisciplinary care and ongoing rehabilitation were essential for limb salvage and functional recovery. Conclusions: This case underscores the profound unpredictability of pediatric compartment syndrome and demonstrates that even classically stable, benign fractures can initiate a devastating ischemic cascade. A high index of suspicion, regardless of the injury mechanism, along with early recognition and prompt surgical intervention, is absolutely critical for preventing irreversible myoneural damage and optimizing management outcomes in pediatric patients.

Reports doi: 10.3390/reports9020179

Authors: Navanita Biswas Carolin Schmidt Shoja Rahimian

Background/Objectives: Central nervous system (CNS) metastases are a frequent and morbid complication of small cell lung cancer (SCLC), with limited effective systemic treatment options. Lurbinectedin has demonstrated systemic activity in relapsed SCLC; however, its intracranial efficacy remains unclear because patients with active CNS disease were underrepresented in pivotal trials. We evaluated real-world intracranial outcomes of lurbinectedin in patients with SCLC and CNS metastases. Methods: A single-institution retrospective case series was conducted among adult patients with histologically confirmed SCLC and radiologic CNS metastases treated with lurbinectedin between July 2020 and April 2025. Primary endpoints were CNS disease control rate (CNS-DCR), defined as radiographic stability or improvement lasting ≥8 weeks, and intracranial progression-free survival (iPFS), defined as time from lurbinectedin initiation to clinical or radiographic CNS progression or death. Results: Thirty patients received lurbinectedin; 14 (46.7%) had CNS metastases at any time. Five patients (16.7%) had baseline CNS metastases prior to lurbinectedin initiation, while nine (30.0%) developed CNS metastases during treatment. Among patients with baseline CNS disease, one patient demonstrated radiographic intracranial improvement at approximately 4 months; however, systemic progression at 5 months limited further assessment of response duration. The remaining four patients experienced intracranial progression within 2–4 months. One of five patients with baseline CNS metastases met the predefined CNS disease control endpoint; this descriptive proportion corresponds to 20% within our small sample. Median iPFS was approximately 2.5 months. No CNS-specific adverse events attributable to lurbinectedin were observed. Conclusions: In this single-institution retrospective case series, limited intracranial disease control was observed among SCLC patients with baseline CNS metastases treated with lurbinectedin. Given the small number of evaluable patients, these findings should be interpreted as descriptive and hypothesis-generating rather than a conclusive efficacy analysis. Prospective studies incorporating CNS-specific endpoints are needed to better define the role of lurbinectedin and other systemic therapies in intracranial disease management.

Reports doi: 10.3390/reports9020178

Authors: Sohyeon Kim Hyesoo Kwon Hung Youl Seok

Background and Clinical Significance: Recurrent peripheral facial palsy is most often attributed to idiopathic Bell’s palsy (BP), yet a minority of patients harbor underlying structural lesions. Early recognition of such lesions is essential for timely and appropriate management. Case Presentation: We retrospectively reviewed recurrent unilateral facial palsy at a single tertiary center and selected two illustrative patients in whom serial clinical, electrodiagnostic, and magnetic resonance imaging (MRI) findings ultimately indicated structural pathology. The first patient experienced three strictly right-sided episodes over 3.5 years, with worsening House–Brackmann grades (II → III → V) and progressive axonal loss on serial facial nerve conduction studies, culminating in a mass-like enhancing lesion at the geniculate ganglion consistent with schwannoma. The second patient had two left-sided recurrences within seven months. MRI evolved from a subtle intrameatal nodular suspicion without enhancement to a clearly enhancing intrameatal nodule with dural thickening. Additional intracranial nodular enhancements were discovered later and the patient was diagnosed with leptomeningeal metastasis. Conclusions: These cases illustrate that strictly ipsilateral recurrences, progressive electrophysiologic deterioration, and atypical or evolving MRI enhancement patterns should prompt thorough re-evaluation for structural causes rather than repeated labeling as idiopathic BP.

Reports doi: 10.3390/reports9020177

Authors: Enrico Caporali Paolo Toninello Monia Maritan Alessandro Gatti Giorgio Berna

Background and Clinical Significance: Hidradenitis suppurativa (HS) is a chronic, debilitating skin disorder that often affects the inframammary fold (IMF). While surgical management, particularly wide local excision (WLE), is the gold standard for severe cases, less is known about the role of breast surgery techniques in treating HS in this area; Case Presentation: This report presents two cases of female patients with bilateral inframammary HS and mammary hypertrophy, both treated with reduction mammaplasty to excise diseased tissue while addressing breast volume and contour. Both patients had experienced inadequate response to medical therapies, including biologic treatments, and presented with distinct clinical features—one with significant asymmetry and active disease, and the other with more scarring and hypertrophic lesions. During follow-up, no recurrence of disease was observed and both patients reported improved breast appearance and satisfaction; Conclusions: These cases underscore the importance of a multidisciplinary approach, with dermatologists and surgeons both playing a key role in the management of this complex condition.

Reports doi: 10.3390/reports9020176

Authors: Noor Albusta Mohamed Abdulla Sara Isa Rehab Almarzooq

Background/Objectives: Spontaneous bacterial peritonitis (SBP) is a serious complication of decompensated cirrhosis and is associated with acute kidney injury (AKI), organ failure, and death. Intravenous albumin is recommended in SBP because it reduces renal impairment and mortality, particularly in patients at higher risk of circulatory dysfunction and hepatorenal complications. However, the prognostic impact of early albumin administration on clinical outcomes in hospitalized SBP patients remains incompletely characterized in real-world practice. This study aimed to assess the association between early albumin administration and clinical outcomes in patients hospitalized with SBP compared to those without early albumin. Methods: A retrospective cohort study was conducted using the TriNetX US Collaborative Research Network, including adults hospitalized with SBP through February 2026. Patients were divided into those receiving early albumin administration (n = 1248) and those without early albumin (n = 4932) within 24 h of index SBP diagnosis. Propensity score matching (1:1) balanced cohorts (n = 1230 each) for demographics, comorbidities, liver disease severity surrogates, medications, and laboratory values. Relative risks (RR), risk differences (RD), and hazard ratios (HR) were calculated using propensity-matched and Cox proportional hazard models. Results: Early albumin administration was associated with significantly lower all-cause mortality (RR 0.620; 95% CI: 0.441–0.871; p = 0.005 at 5 days; RR 0.770; 95% CI: 0.651–0.910; p = 0.002 at 90 days). Secondary outcomes showed reduced risks for acute kidney injury (RR 0.654; 95% CI: 0.553–0.774; p < 0.001 at 5 days; RR 0.798; 95% CI: 0.706–0.903; p < 0.001 at 90 days), hepatorenal syndrome–AKI (RR 0.598; 95% CI: 0.445–0.804; p < 0.001 at 5 days; RR 0.756; 95% CI: 0.613–0.932; p = 0.009 at 90 days), vasopressor requirement (RR 0.633; 95% CI: 0.489–0.820; p < 0.001 at 5 days; RR 0.712; 95% CI: 0.572–0.887; p = 0.002 at 30 days), and renal replacement therapy (RR 0.533; 95% CI: 0.324–0.878; p = 0.011 at 5 days; RR 0.642; 95% CI: 0.442–0.932; p = 0.019 at 30 days). Cox models confirmed statistically significant risk reductions for all primary and secondary outcomes, including ICU admission (HR 0.82; 95% CI: 0.73–0.92; p = 0.001) and 30-day readmission (HR 0.84; 95% CI: 0.73–0.97; p = 0.015). Associations were strongest in the early period and attenuated over time. Conclusions: Early albumin administration was associated with reduced risks of mortality, AKI, HRS-AKI, and hemodynamic instability in patients hospitalized with SBP, with attenuation over time. These findings support timely implementation of guideline-concordant albumin therapy, although residual confounding cannot be excluded.

Reports doi: 10.3390/reports9020175

Authors: Tatiana-Maria Coman Simion Bran Andrei-Mario Bădărău-Șuster Mariana Păcurar Sorin-Claudiu Popșor

Background and Clinical Significance: Severe skeletal Class II malocclusion associated with periodontal compromise and posterior edentulism requires a carefully sequenced interdisciplinary treatment approach integrating orthodontic, surgical, periodontal, and prosthetic rehabilitation. Case Presentation: This case report describes the comprehensive interdisciplinary management of a 21-year-old female patient presenting with skeletal Class II malocclusion, severe mandibular retrognathia, vertical maxillary excess, labial incompetence, temporomandibular joint (TMJ) dysfunction and periodontal deficiencies. The treatment sequence involved occlusal splint therapy, pre-surgical orthodontic decompensation, bimaxillary orthognathic surgery using a segmental Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), postoperative orthodontic refinement with aligners, periodontal plastic surgery using the Zucchelli technique and guided bone regeneration (GBR) with implant placement in the posterior mandible. At the four-year follow-up, the patient demonstrated complete root coverage, stable skeletal correction, and satisfactory implant integration, with maintenance of functional and aesthetic outcomes over time. Conclusions: This report highlights the importance of precise preoperative planning and the synergy between orthodontics, orthognathic surgery and periodontics in achieving optimal functional and aesthetic results.

Reports doi: 10.3390/reports9020174

Authors: Marios Theologou Nikolaos Syrmos Vaitsa Giannouli

Background and Clinical Significance: Chronic subdural hematomas (cSDHs) present characteristic imaging findings, making the diagnosis straightforward. In rare cases, arachnoid cysts (ACs) may be associated with their formation. There is still no consensus regarding their treatment; Case Presentation: A young adult male presented with occipital headache. Neurological examination was normal. Laboratory investigations were within physiological limits. A CT scan revealed the presence of a Galassi Grade III temporo-parietal AC accompanied by a parietal epidural hematoma (EDH) on the right side. His medical history was significant for treated hypertension. There was no use of anticoagulants, antiplatelets, or history of trauma. Vascular pathology was excluded by MRA/MRV. He was discharged for home care and was readmitted 10 days later after a repeat CT scan. A brief cognitive assessment with the Mini-Mental State Examination (MMSE) revealed mild cognitive impairment. A burr-hole evacuation was performed, and a drainage catheter was left in place for 24 h. Intraoperative findings were consistent with a chronic subdural hematoma. The patient was discharged with complete resolution of symptoms. A follow-up CT scan performed one month postoperatively confirmed the favorable result. Cognitive functions were normal on follow-up; Conclusions: A SDH may mimic the characteristics of an EDH in the presence of an AC. The most common symptom is cephalalgia. Neurocognitive impairment may occur secondary to elevated intracranial pressure. A burr-hole hematoma evacuation may be sufficient. Further treatment should be considered only in the case of complications associated with ACs.

Reports doi: 10.3390/reports9020173

Authors: Lucy T. Liu Xiaoyi Zhang Samira Hayee Muhammad Fahimuddin

Background and Clinical Significance: Giardia lamblia is a protozoan parasite that causes giardiasis, a gastrointestinal disease. The disease commonly manifests with abdominal pain, diarrhea, and emesis. Many giardia infections, however, are asymptomatic and can be easily spread to others. Bupropion, a norepinephrine and dopamine reuptake inhibitor, can have side effects of nausea and abdominal pain, which can mimic or overlap with symptoms of a Giardia lamblia infection. Case Presentation: We present a 39-year-old man who has sex with men (MSM) who presented with abdominal pain with nausea and vomiting. His symptoms began 3 months after returning from a trip to Peru and 1 month after starting bupropion. Bupropion was discontinued upon admission due to suspicion of medication-induced adverse effects. CT imaging revealed thickening of the transverse colon, suggestive of an infectious or inflammatory etiology. The patient’s GI-PCR returned positive for Giardia lamblia, and the patient was treated with metronidazole. While the temporal relationship suggests an association, it remains unclear whether the clinical presentation was primarily driven by bupropion, the Giardia infection, or a synergistic effect of both. A norovirus result was indeterminate, and the patient improved after bupropion discontinuation but before metronidazole initiation, leaving open the possibility of a self-limited viral gastroenteritis. Conclusions: This case highlights a possible association between bupropion initiation and the temporal association between bupropion initiation and the detection of symptomatic giardiasis in an MSM patient. Clinicians may consider stool testing for Giardia before attributing gastrointestinal symptoms solely to medication effects. Giardia lamblia should be considered in the differential diagnosis of gastrointestinal symptoms for MSM patients, particularly when compatible exposure history, travel history, or enteric infection risk factors are present.

Reports doi: 10.3390/reports9020172

Authors: Francesco Fiore Salvatore Stilo Luca Tarotto Emanuela Federico Noemi Brignola Gaetano Sicuranza Roberto D’Angelo

Background and Clinical Significance: Bone involvement is a common and debilitating manifestation of advanced malignancies, with a substantial negative impact on patients’ functional status, quality of life, and overall prognosis. Management is primarily palliative and may include several locoregional approaches such as radiotherapy, surgical stabilization, cementoplasty, thermal or cryoablation, and high-intensity focused ultrasound. Electrochemotherapy (ECT) is an emerging non-thermal ablative technique that combines limited invasiveness with short procedural times and a favorable safety profile. Case Presentation: We report the case of a patient with oligometastatic lung cancer presenting with a painful rib metastasis refractory to radiotherapy. The patient had previously undergone radiotherapy to the right femoral head and the eighth rib, followed by cryoablation combined with cementoplasty for the femoral lesion and cryoablation of the rib. At one-year follow-up after cryoablation combined with bone cementoplasty, computed tomography demonstrated progression with the appearance of a new symptomatic rib lesion unresponsive to further radiotherapy. Percutaneous ECT was therefore performed under general anesthesia, supplemented with an erector spinae plane block. A total of twelve 18-gauge needle electrodes were accurately positioned under fluoroscopic guidance. Follow-up imaging at three months showed complete local tumor resolution, accompanied by marked and sustained pain relief. Conclusions: This experience supports the role of ECT as an effective salvage locoregional treatment option in selected patients with bone metastases resistant to conventional therapies.

Reports doi: 10.3390/reports9020171

Authors: Vasileios Petrakis Periklis Panagopoulos Maria Panopoulou Dimitrios Papazoglou Antonios Karpouzis

Background and Clinical Significance: Herpes zoster (HZ), caused by the reactivation of the latent Varicella-Zoster virus (VZV), typically is confined to a single dermatome in immunocompetent individuals. Thus, multidermatomal involvement, particularly simultaneous reactivation across all three branches of the trigeminal nerve, is exceedingly rare without history of immunosuppression. Case Presentation: We present the case of a 60-year-old immunocompetent male who presented to the Emergency Department with a two-day history of a rapidly progressive, painful vesicular eruption over the entire left side of his face, including the intraoral mucosa. Clinical evaluation, polymerase chain reaction (PCR) and serology testing confirmed VZV reactivation across the V1, V2, and V3 dermatomes. Extensive diagnostic workup, including HIV serology and whole-body computed tomography, revealed no underlying immunodeficiency or occult malignancy. The patient was treated promptly with oral valacyclovir and topical ointments, resulting in rapid crusting and healing within one week without severe complications. Conclusions: This case highlights that multidermatomal trigeminal HZ can occur in healthy individuals and emphasizes the importance of prompt diagnostic workup and antiviral therapy to prevent devastating ocular and neurological sequelae.

Reports doi: 10.3390/reports9020170

Authors: Koji Hayashi Mamiko Sato Hiroki Tsukamoto Eiju Negoro Takahiro Yamauchi

An 81-year-old woman with follicular lymphoma treated with obinutuzumab and bendamustine developed cognitive impairment and dysarthria. Three months before death, neurological exams showed dysarthria, right hemiparesis, and gait disturbance. Blood tests showed lymphocytopenia (lymphocyte 10.4%). Cerebrospinal fluid (CSF) findings were unremarkable, including with respect to cytology. Brain MRI demonstrated a mass-like hyperintense lesion in the left parietal lobe and band-like abnormalities in the left fronto-temporal white matter that lacked contrast enhancement. Symptoms progressed to hemiplegia and mutism; severe dysphagia eventually necessitated intravenous fluid management. Follow-up MRI one month before death revealed a lesion encompassing nearly the entire left hemisphere, with hyperperfusion observed during arterial spin labeling (ASL). JC virus was detected in CSF (221 copy/mL), confirming that the patient had progressive multifocal leukoencephalopathy (PML). Subsequently, she exhibited poor arousal, followed by death. Here, lymphoma recurrence or PML was suspected due to a post-chemotherapy unilateral expanding brain lesion. These conditions are usually differentiated by contrast-enhancement patterns, but PML can also enhance during immune reconstitution. Moreover, lesions rarely cause a mass effect and more often exhibit hyperperfusion, which may aid in diagnosis. While unilateral PML has been reported, especially in the early stage, such an extensive lesion involving nearly an entire single hemisphere, as seen in our case, is rare.

Reports doi: 10.3390/reports9020169

Authors: Mbaya Buankuna Joseph B. Sempa Olive P. Khaliq Michael A. Pienaar

Background: Extubation failure (EF) is a significant complication, and it is associated with increased mortality, prolonged hospital stays and extended mechanical ventilation (MV). Determining reliable predictors of EF could improve the clinical decision-making and outcomes. Objectives: Determine the outcomes and predictors of EF in a paediatric intensive care unit (PICU) and develop predictive models using machine learning algorithms. Methods: A retrospective cohort study (n = 824) was conducted in two PICUs in participants who underwent planned extubation (January 2018–December 2022). Demographic characteristics, clinical parameters, ventilator setting, laboratory findings and extubation outcomes were collected. Univariate and multivariate analysis were performed to identify significant predictors of EF. Six machine learning algorithms—Logistic Regression (LR), Artificial Neural Network (ANN), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM) and Decision Tree (DT)—were developed and validated for prediction of EF. Results: The overall EF rate was 231 (28%). Multivariate analysis identified a mechanical ventilation for a duration of 3 days or more (aOR 4.49, 95% CI 3.24–6.57, p < 0.001), use of neuromuscular blockade (aOR 1.32, 95% CI 1.07–1.63, p = 0.009), and administration of vasopressors (aOR 1.57, 95% CI 1.24–2.01, p < 0.001) as significant independent predictors of EF. The ANN and LR models demonstrated the highest performance with AUCROC of 0.87 ± 0.04 and 0.86 ± 0.02, respectively. Conclusions: Extubation failure was common in our setting (28%) compared to other studies. Days of ventilation, undernutrition, use of neuromuscular blockade, use of vasopressors or inotropes and CNS comorbidity were associated with EF. The main cause of EF was upper airway obstruction.

Reports doi: 10.3390/reports9020168

Authors: Zuzanna Wilk Olga Kaczmarek Sławomir Liberski Danuta Nikratowicz Szczepan Cofta Goran Petrovski Jarosław Kocięcki

Background and Clinical Significance: Susac syndrome is a rare autoimmune-mediated microangiopathy characterized by the triad of encephalopathy, branch retinal artery occlusion (BRAO), and sensorineural hearing loss. Due to its variable onset and protean manifestations, the syndrome is frequently misdiagnosed, potentially leading to delayed treatment and irreversible organ damage. Ocular involvement is common and often provides the first diagnostic clue. Multimodal imaging, particularly fluorescein angiography (FA) and optical coherence tomography (OCT) as well as optical coherence tomography angiography (OCT-A), enables the detection of both acute and chronic ischemic retinal changes. Their complementary application yields critical insights into disease activity, supports monitoring of relapses, and guides therapeutic strategies. Case Presentation: We describe two patients with Susac syndrome presenting with distinct ocular and neurological features. A 43-year-old male developed recurrent BRAOs in both eyes, documented by FA, OCT, and OCT-A, with preserved best-corrected visual acuity (BCVA) of 0.00 logMAR in both eyes (OU). OCT demonstrated progressive thinning of the retinal nerve fiber layer (RNFL) and inner retinal layers, consistent with sequelae of microinfarctions, while FA revealed focal arteriolar wall hyperfluorescence. Immunosuppressive therapy with corticosteroids and mycophenolate mofetil stabilized his condition. A 31-year-old female with a history of migraine and encephalopathy showed thinning of the RNFL and ganglion cell layer (GCL) with macular atrophy on OCT. FA demonstrated peripheral arteriolar wall hyperfluorescence and microaneurysms. Despite these structural alterations, visual acuity remained unaffected. Serial imaging initially demonstrated mild progression on OCT and OCT-A, followed by disease stabilization under systemic immunosuppressive therapy. Conclusions: These cases highlight the pivotal role of multimodal imaging in the early recognition and long-term monitoring of Susac syndrome. OCT provides a detailed assessment of retinal microinfarctions and chronic atrophy, while FA remains indispensable for detecting vascular leakage and disease activity. The complementary use of OCT, OCT-A, and FA enhances diagnostic accuracy, facilitates timely therapeutic interventions, and supports individualized management. Regular ophthalmological monitoring, including advanced imaging modalities, should be considered an essential component of care in Susac syndrome.

Reports doi: 10.3390/reports9020167

Authors: Soobin Lee Nari Kim Myung Shin Shin Haeyoun Kang Sang Hee Jung

Background and Clinical Significance: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Among its various etiologies, uterine atony accounts for approximately 70% of cases, while other causes include genital tract trauma, pathologic placentation, and intrapelvic arterial injury. Uterine artery embolization (UAE) has emerged as a preferred management option for severe PPH due to its high success rates of 89–98% and fertility preservation benefit. Despite its efficacy, UAE can lead to complications, such as pain, re-bleeding, infection, persistent vaginal discharge, ovarian insufficiency, and uterine necrosis—a rare but serious complication occurring in 1.4–2.7% of cases. Case Presentation: We present three cases of uterine necrosis following UAE from a single center (CHA Bundang Medical Center) between 2003 and 2024. All patients developed persistent high-grade fever approximately two weeks after the procedure, despite an initial response to antibiotic therapy. Imaging studies, including contrast-enhanced CT and MRI, revealed uterine ischemia and necrosis, and all patients ultimately required total hysterectomy. Conclusions: Uterine necrosis is a rare but potentially life-threatening complication of UAE that should be suspected in patients with persistent high-grade fever beyond the typical post-procedural course. Early imaging evaluation, particularly with contrast-enhanced modalities, is essential for prompt diagnosis. Timely surgical intervention, including hysterectomy, may be required to prevent severe morbidity.

Reports doi: 10.3390/reports9020166

Authors: Simona Maria Borta Adrian Silviu Crișan Imola Miklos Dana Zdremtan Roxana Andra Coman

Background and Clinical Significance: The coexistence of synchronous urologic malignancies may present diagnostic and therapeutic challenges, particularly when symptoms are minimal or nonspecific. This case illustrates the role of multimodal diagnostic correlation in identifying a second primary urologic malignancy during the evaluation of incidental PSA elevation. Case presentation: Case Presentation: We report the case of a 56-year-old male presenting with minimal lower urinary tract symptoms who underwent stepwise diagnostic evaluation including PSA (prostate specific antigen), free PSA, urinary SelectMDx RT-PCR testing (reverse transcription polymerase chain reaction), multiparametric MRI (magnetic resonance imaging), transrectal biopsy and inflammatory biomarker assessment. PSA was 17.69 ng/mL with a free PSA ratio of 6.56%. SelectMDx indicated a 90% probability of prostate cancer and a 65% risk of Gleason ≥ 7 disease. mpMRI demonstrated two suspicious lesions without extracapsular extension. Biopsy confirmed acinar adenocarcinoma Gleason 7 (3 + 4), Grade Group 2. Persistent post-biopsy hematuria led to additional imaging that revealed bladder wall thickening, and cystoscopy confirmed multifocal carcinoma in situ. Radical cystoprostatectomy with orthotopic ileal neobladder reconstruction was performed. Conclusions: This case illustrates the importance of diagnostic vigilance and multimodal correlation in a minimally symptomatic patient, particularly when persistent clinical findings are not fully explained by the initial diagnosis. The findings should be interpreted as illustrative and cannot be generalized beyond the single-case context.

Reports doi: 10.3390/reports9020165

Authors: Konstantinos Gkialas Anna Papakonstantinou Dimitrios Deligiannis Aris Kaltsas Panagiotis Mitsos

Background and clinical significance: Catheter knotting is a rare but potentially serious complication of urethral catheterization in neonates and infants, particularly when feeding tubes are used due to small urethral caliber. Case Presentation: We report the case of a 6-month-old male infant with Crouzon syndrome who underwent cranioplasty. Intraoperatively, a 6 Fr feeding tube was inserted for bladder drainage. On postoperative day 6, resistance was encountered during catheter removal. Radiography revealed a double knot in the distal urethra and a single knot in the proximal urethra. The catheter was successfully removed surgically via cystotomy, and the infant recovered uneventfully with normal voiding function. Conclusions: This case demonstrates the exceptional occurrence of simultaneous double and single knots in a urinary catheter. Awareness of this rare complication, careful control of insertion length, and prompt intervention upon resistance are essential to prevent urethral trauma and ensure patient safety.

Reports doi: 10.3390/reports9020164

Authors: Biagio Scotti Cosimo Misciali Martina D’Onghia Alberto Gualandi Sabina Vaccari Federico Venturi Elisabetta Magnaterra Elisa Cinotti Emi Dika

Background and Clinical Significance: Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is a CD30-positive T-cell lymphoproliferative disorder that can clinically resemble various non-melanoma skin cancers, making diagnosis challenging. Although histopathology remains the diagnostic gold standard, non-invasive imaging modalities such as dermoscopy and reflectance confocal microscopy (RCM) are increasingly used as complementary tools to support the differential diagnosis. To date, no data on RCM features of C-ALCL have been described. Case Presentation: We report the case of an 80-year-old man presenting with a rapidly enlarging nodule on the lateral aspect of his right eyelid, providing a detailed account of dermoscopic and RCM findings integrated with clinicopathological correlation. Dermoscopy revealed a red-orange homogeneous background with white streaks, and polymorphic vascular structures, while subsequent RCM (Vivascope 3000 probe) demonstrated marked architectural disarray of the epidermis and dermoepidemal junction, with prominent epidermal involvement characterized by aggregates of highly reflective cells. In the absence of alternative diagnostic patterns, these features raised suspicion for a cutaneous lymphoproliferative disorder, which was later confirmed by histopathological and immunohistochemical analyses. Conclusions: Our findings support the value of RCM as a practical tool in guiding differential diagnosis and biopsy, particularly for rapidly growing lesions located in anatomically sensitive areas.

Reports doi: 10.3390/reports9020163

Authors: Douglas Jaxon Vadner Sidney Smith

Background and Clinical Significance: Extramammary Paget disease (EMPD) is a rare cutaneous adenocarcinoma that frequently involves apocrine-rich regions and may extend beyond clinically apparent margins through adnexal structures. Surgical excision remains the standard of care; however, management can be challenging in elderly patients and in anatomically sensitive areas such as the scrotum, where morbidity and functional impairment are significant concerns. Despite increasing use of radiation-based therapies, optimal superficial radiation therapy (SRT) parameters, particularly with respect to depth of penetration, remain poorly standardized. Case Presentation: An 88-year-old male with a history of melanoma, non-melanoma skin cancer, and remote prostate cancer presented with biopsy-proven EMPD involving the scrotum and perineum. Imaging demonstrated no evidence of underlying or metastatic malignancy. Given lesion size (9 × 4 cm), anatomic location, and patient preference to avoid surgery, SRT was selected. The patient underwent treatment with 70 kV energy, delivering a total dose of 5440 cGy in 17 fractions (320 cGy per fraction) administered twice weekly. Energy selection was guided by the known propensity of EMPD for adnexal extension, with the aim of improving treatment coverage of potential subclinical disease. Conclusions: This case highlights the importance of incorporating tumor depth and adnexal involvement into treatment planning for EMPD. Depth-guided SRT may represent a viable non-surgical management strategy in carefully selected patients, particularly when surgical morbidity is a concern. These findings support a more individualized, mechanism-based approach to optimizing radiation therapy in cutaneous malignancies.

Reports doi: 10.3390/reports9020162

Authors: Ivan Pesic Ilija Golubovic Milorad Pavlovic Milica Nestorovic Ivan Ilic

Background and Clinical Significance: Familial gastric polyposis is a rare condition associated with an increased risk of malignant transformation, particularly in patients with a strong family history of gastrointestinal malignancies. Case Presentation: We report the case of a 46-year-old female presenting with severe epigastric pain, persistent vomiting, and significant weight loss. Endoscopic and histopathological evaluation confirmed diffuse fundic gland polyposis with intestinal metaplasia involving the entire gastric mucosa. Given the extensive disease, pronounced symptoms, and significant familial cancer burden, the patient underwent total gastrectomy with Roux-en-Y esophagojejunostomy. The postoperative course was uneventful, with satisfactory recovery and favorable functional outcomes during follow-up. This case highlights the clinical challenges associated with diffuse symptomatic familial gastric polyposis and underscores the importance of timely surgical intervention in high-risk patients. Conclusions: Due to clinical complexity of such presentations, detailed case descriptions remain important for guiding clinical practice.

Reports doi: 10.3390/reports9020161

Authors: Evangelos Kostares Athina Chatzigavriil Georgia Kostare Domna Efthymiou Charikleia Kouvidou Ourania Schoinohoriti Christos Perisanidis Stavroula Diamantopoulou

Background and Clinical Significance: Histiocytic sarcoma is a rare and aggressive hematopoietic malignancy, which is particularly uncommon in the head and neck region and exceedingly rare within lymph nodes associated with salivary glands. The present study aims to describe the clinical, radiologic, histopathologic, and immunophenotypic features of a primary histiocytic sarcoma, arising in a lymph node within the submandibular gland, and to highlight the diagnostic challenges and management considerations through a correlation with the existing literature. Case presentation: This case report was conducted according to the CARE guidelines. A 93-year-old male presented with a progressively enlarging mass at the right submandibular region. Clinical examination, magnetic resonance imaging, and fine-needle aspiration cytology were performed, raising suspicion for a malignancy. The patient underwent surgical excision of the right submandibular gland with limited level Ib lymph node dissection. Histopathological evaluation combined with an extensive immunohistochemical panel established the diagnosis of histiocytic sarcoma. The tumor was composed of pleomorphic epithelioid and spindle-shaped cells with marked cytologic atypia and high mitotic activity. Immunohistochemistry demonstrated strong positivity for histiocytic markers (CD163, CD68, CD14) and negativity for epithelial, lymphoid, and dendritic cell markers, allowing for the exclusion of major differential diagnoses. The proliferative index (Ki-67) was approximately 90%, indicating aggressive biological potential. FDG PET-CT performed two months after surgery showed no evidence of residual, regional, or distant disease. Considering the localized presentation and the patient’s advanced age, no adjuvant therapy was administered. During follow-up, no evidence of recurrence or disease progression was observed. Conclusions: Primary histiocytic sarcoma involving a lymph node within the submandibular gland is extremely rare and may clinically and cytologically mimic other malignancies. Accurate diagnosis relies on comprehensive immunohistochemical evaluation and exclusion of phenotypic mimickers. A review of previously reported cases of cervical lymph node histiocytic sarcoma demonstrated an age range from 35 to 80 years, with a male predominance and a higher incidence in Asian countries. Most cases presented with localized cervical lymph node disease. Surgical excision was the most commonly applied treatment, and was frequently associated with favorable outcomes, with several patients remaining disease-free during follow-up periods ranging from 24 to 48 months. The accumulation of additional well-documented cases is essential to improve diagnostic accuracy and guide evidence-based treatment strategies for this uncommon entity.

Reports doi: 10.3390/reports9020160

Authors: Mustafa Mohamed Guillaume Fahrni

We report an unusual case of simultaneous left and right atrial appendage thrombosis identified on contrast-enhanced cardiac computed tomography angiography (CT) during pre-procedural evaluation in a patient with permanent atrial fibrillation and structural heart disease. Cardiac CT demonstrated well-defined filling defects within both atrial appendages on arterial and delayed phases, consistent with intracavitary thrombi. The patient was already receiving long-term oral anticoagulation for atrial fibrillation. In this case, antithrombotic management was not modified after multidisciplinary clinical assessment, as the patient remained asymptomatic and at high bleeding risk. This case highlights the diagnostic value of multiphasic cardiac CT in pre-procedural imaging, and underscores that systematic bilateral appendage assessment is essential, as right atrial appendage thrombus may otherwise go undetected.

Reports doi: 10.3390/reports9020159

Authors: Noriko Miyagawa Satoshi Yamanouchi Hideaki Fujimoto Eichi Uchikanezaki Yoshinobu Kameyama Yugo Ashino Toshio Hattori

Background and Clinical Significance: COVID-19 may worsen in patients receiving immunosuppressants. Furthermore, drug–drug interactions and concomitant use of anti-inflammatory drugs complicate treatment. We report the clinical course of severe COVID-19 pneumonia in a 74-year-old Japanese male kidney transplant recipient. Case Presentation: The patient had been taking tacrolimus (TAC) (2.5 mg/day), mycophenolate mofetil (1000 mg/day), and prednisone (5 mg/day) since his kidney transplant 7 years earlier. Twenty days before admission, he tested positive for SARS-CoV-2 antigen and was administered molnupiravir for 5 days. At admission, real-time PCR testing of a nasopharyngeal specimen revealed high viral loads, with Ct values of 22.2 and 27.9 for the E and N2 genes, respectively. An oxygen flow rate of 15 L/min was required to maintain arterial oxygen saturation above 90%. TAC was continued, and antibiotics, steroids, anti-interleukin-6 receptor antibodies, intravenous immunoglobulin, and ensitrelvir (ESV) were administered. With invasive positive-pressure ventilation, positive end-expiratory pressure (PEEP), and prone positioning, the arterial oxygen tension/inspired oxygen tension (P/F) improved from 61.3 to 386 within 7 h. The patient was extubated 30 h after admission. The TAC dose was adjusted from 2.5 mg/day to 1 mg/day to achieve the target trough level. The patient was discharged on hospital day 8. PCR testing at discharge showed a decrease in viral load. Conclusions: This study provides insights into the treatment of COVID-19 in patients receiving immunosuppressants. Combination therapy of ESV and TAC was feasible in kidney transplant recipients with dose adjustment. The use of other anti-inflammatory drugs should also be considered.

Reports doi: 10.3390/reports9020158

Authors: Yeshua Aguilar-Salgado Antonio Hernández-Bastida María de la Paz Lara-Martínez Blanca Estela García-Pérez Lorena García-Morales Alejandra Valdivia-Flores

Background and Clinical Significance: Kinesio tape (KT) has gained popularity as an adjunctive approach for treating edema during the rehabilitation phase, following traumatic events, as well as for managing edema in breast cancer patients. Its goal is to reduce swelling and improve mobility in the affected extremity; however, its use in critically ill patients remains limited. To our knowledge, this is the first report of its application in this population. Case presentation: This case series involved three patients in the Intensive Care Unit (ICU) who presented with lower extremity edema. One patient developed a cerebrovascular event secondary to moderate traumatic brain injury and two patients experienced sepsis. KT was applied, and extremity circumference, Godet sign, and Stemmer sign were assessed. The bandage was reapplied every 24 h over a 5-day period, with daily evaluations performed by the same nursing staff to ensure measurement consistency. All three patients exhibited a reduction in extremity circumference, along with improvement or resolution of the Godet and Stemmer signs. No adverse effects associated with KT were observed. Conclusions: Our results suggest that KT may be a beneficial adjunctive therapy for edema reduction in ICU patients. Larger-scale studies are needed to confirm its clinical value.

Reports doi: 10.3390/reports9020156

Authors: Piotr Machowiec Piotr Przybylski Elżbieta Czekajska-Chehab

Background and Clinical Significance: Bicuspid aortic valve (BAV) is the most common congenital heart defect and may coexist with other cardiovascular anomalies. Among these is a single coronary artery (SCA), a rare congenital condition in which the entire coronary circulation originates from a single coronary ostium. Cardiac computed tomography (CCT) enables simultaneous evaluation of coronary artery anatomy and aortic valve morphology with high spatial resolution, which may influence procedural strategy in patients undergoing valve interventions. Case Presentation: This report represents the first documented case of a 59-year-old male with mixed aortic valve disease in whom preoperative CCT revealed the coexistence of BAV, SCA (Lipton type L-I), and myocardial bridging (MB) involving the mid segment of the left anterior descending artery (LAD). Identification of these findings was crucial for preoperative assessment and contributed to the selection of an appropriate surgical strategy. Conclusions: CCT plays a key role in the preoperative evaluation of valvular heart disease, including in patients with coexisting BAV and SCA. It enables individualized procedural planning and minimizes the risk of perioperative complications.

Reports doi: 10.3390/reports9020157

Authors: Elena Lanfranchi Roberto Tedeschi Milva Battaglia

Background and Clinical Significance: This case highlights the management of chronic extensor carpi ulnaris (ECU) tenosynovitis in a patient exposed to non-traditional wrist-loading activities. Exercise therapy rehabilitation is well established in shoulder and knee tendinopathies, although it remains less well described for wrist tendinopathies beyond De Quervain’s disease. Moreover, the patient’s active engagement in non-traditional, wrist-intensive sports such as handstands, slacklining, and yoga may have contributed to the development and persistence of chronic extensor carpi ulnaris (ECU) tenosynovitis. Unlike more common ECU injuries observed in tennis or golf players, this case demonstrates how ECU tenosynovitis can develop in less conventional sports. It adds to the scientific literature by showing that chronic ECU tenosynovitis can be effectively managed through non-surgical rehabilitation tailored to the specific needs of the patient, in particular by using exercise therapy. Case Presentation: The patient presented with chronic left wrist pain, especially during ulnar deviation and resisted ECU testing, following two traumatic events. Examination revealed limited range of motion caused by pain, particularly in flexion, extension, and both ulnar and radial deviations. Ultrasound imaging confirmed ECU tenosynovitis with mild inflammation of other wrist tendons and a small synovial cyst on radio-scapho-lunate level. ECU stability during forearm rotation was confirmed both clinically and by ultrasound.  The diagnosis of chronic ECU tenosynovitis was managed conservatively with a targeted rehabilitation program focused on isometric strengthening and progressive resistance exercises. Over one month, the patient demonstrated marked improvement in wrist strength, pain reduction, and functional capacity, allowing for a gradual return to sporting activities. Conclusions: The main takeaway from this case is that chronic ECU tenosynovitis can be successfully managed through individualized, conservative treatment based on exercise therapy. Early intervention, patient adherence, and rehabilitation tailored to the athlete’s specific demands are crucial for recovery, even in chronic cases, without the need for surgical intervention.

Reports doi: 10.3390/reports9020155

Authors: Pietro Dioni Francesco Colamaria Alessandro Grandi Gabriele Piffaretti Stefano Bonardelli Luca Bertoglio

Background and Clinical Significance: Treatment options for chronic type B aortic dissections (TBADs) remain a topic of ongoing debate. Patients with post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs) are typically younger than those with degenerative TAAAs, and their aortas undergo continuous remodeling over their lifetime. Fenestrated/branched endovascular aortic repair (F/B-EVAR) has shown promising results, but it can be challenged by the presence of a narrow true lumen, which hinders navigation and deployment of bridging components. Moreover, the presence of patent segmental arteries originating from the false lumen may prevent aneurysm shrinkage due to persistent flow, which may also result in insufficient spinal cord protection strategies and an increased risk of spinal cord ischemia. Consequently, multiple endovascular interventions are often necessary to address the persistent anatomical changes in these patients. Case Presentation: We present the case of a patient affected by a post-dissecting TAAA who underwent multiple open and endovascular treatment attempts. The presence of prior multiple laparotomies discouraged a new open surgical repair, while the hypertrophic segmental arteries and the presence of a narrow true lumen made standard F/B-EVAR unfeasible. The patient was successfully treated using a combination of different adjunctive advanced endovascular techniques, including minimally invasive segmental artery coil embolization (MiSACE) as a spinal cord preconditioning strategy and prevention of type II endoleak. Moreover, transcatheter electrosurgical septotomy (TES) was used to create a single aortic channel in the presence of a narrow true lumen, which allowed the deployment of a multifeatured, custom-made branched endograft. Conclusions: Endovascular repair of post-dissection TAAAs requires a thorough understanding of advanced endovascular adjuncts, which are often combined to overcome the complex anatomical challenges inherent to this disease. Although encouraging results have been reported, both segmental artery embolization for the indications described here and TES warrant further evaluation in prospective multicenter studies to confirm their safety and efficacy.

Reports doi: 10.3390/reports9020154

Authors: Niharika Singh James Petrancosta Sunjida Ahmed Nicholas Ahn

Background and Clinical Significance: Cystic mesenteric lymphangiomas are rare benign growths of the mesenteric lymphatic vessels. This entity poses a diagnostic dilemma due to the wide array of symptoms with which patients present. Usually, these patients are diagnosed before the age of 5 years old. Case Presentation: In this report, we present a young adult male with longstanding gastrointestinal complaints and a small bowel obstruction who subsequently underwent exploratory laparotomy with significant bowel resection, and pathology revealed a diagnosis of cystic mesenteric lymphangioma. Conclusions: The presence of small bowel obstruction without prior abdominal surgeries should raise suspicion of congenital pathologies and warrants prompt surgical intervention.

Reports doi: 10.3390/reports9020153

Authors: Djendji Siladji Lazar Ljubotin Jelena Amidzic Dusan Kuljancic Nemanja Stankovic Stevanovic

Background and Clinical Significance: NMDAR autoimmune encephalitis is a rare but potentially life-threatening autoimmune disorder that can be hard to recognize initially because it has nonspecific symptoms. In the early phase of the disease, clinical presentation is often dominated by psychiatric symptoms, which can be misleading. A diagnosis is established by demonstrating specific anti-NMDA receptor antibodies, with cerebrospinal fluid analysis considered the most reliable diagnostic method. Timely initiation of immunomodulatory therapy, including corticosteroids, intravenous immunoglobulins, and therapeutic plasmapheresis, significantly improves disease outcomes, while second-line therapies are used in refractory cases. Case Presentation: A 21-year-old female patient (M.B.) was admitted to the Psychiatry Clinic at the University Clinical Center of Vojvodina due to the sudden onset of behavioral changes, including social withdrawal, absence of verbal communication, and unusual orofacial grimacing. During hospitalization, the patient was intermittently in a state of severe psychomotor agitation and poorly communicative, with pronounced orofacial dyskinesias and involuntary tongue movements. Anti-NMDA receptor autoantibodies were detected in both serum and cerebrospinal fluid, and the patient was subsequently transferred to the Intensive Care Unit of the Neurology Clinic. Due to the lack of an adequate clinical response to pulse corticosteroid therapy, six cycles of therapeutic plasmapheresis were performed. Following this treatment, significant clinical improvement was observed. Conclusions: Timely recognition of this condition and a multidisciplinary approach allow for early initiation of immunomodulatory therapy and significantly improve treatment outcomes.

Reports doi: 10.3390/reports9020152

Authors: Joe Mehanna Steffen-Heinrich Schulz Sascha Gravius Franz-Joseph Dally Frederic Bludau

Background and Clinical Significance: Osteoblastomas are rare, benign but locally aggressive bone tumors with a predilection for the posterior elements of the spine. Their clinical, radiological and histopathological presentation often overlaps with that of osteoid osteomas, leading to diagnostic and therapeutic challenges—particularly in atypical locations such as the anterior thoracic spine. Case Presentation: We report two cases of young female patients (aged 35 and 30 years) presenting with persistent thoracic back pain unresponsive to NSAIDs. In the first case, imaging revealed a lesion at the right T7 pedicle initially attributed to osteoid osteoma; CT-guided thermoablation was declined due to proximity to neural structures. At this stage, we chose percutaneous transpedicular ablation by drilling through the centrum of the lesion (Nidus) surgically. After this transpedicular resection with initial symptom improvement, the patient developed recurrence with lesion progression into both anterior and posterior columns, requiring a second, open, surgical intervention. In the second case, a lesion at the left T11 pedicle and transverse process was identified directly as osteoblastoma due to size and radiological morphology; initial biopsy was non-diagnostic due to specimen fragmentation. In both cases, histopathology was inconclusive or misleading, while clinical and radiological features—including NSAID unresponsiveness, lesion size, and anatomical extent—favored osteoblastoma. Both patients underwent surgical resection via posterior costotransversectomy, partial hemivertebrectomy, expandable cage placement, and posterior instrumentation (T5–T8 and T10–T12, respectively). The postoperative courses were complicated by thoracic events—hemothorax in the first case and pulmonary embolism in the second—both of which were managed successfully. At follow-up, both patients were neurologically intact and pain-free. Conclusions: These cases emphasize the diagnostic overlap between osteoid osteoma and osteoblastoma and highlight the importance of clinical and radiographic correlation when histopathology is inconclusive. A posterior-only approach with costotransversectomy may be a valid strategy in selected cases of thoracic spinal tumors, although specific complications such as hemothorax must be considered.

Reports doi: 10.3390/reports9020151

Authors: Cathérine Van Den Plas Toon van Genechten Marie-Berthe Maes Kathleen Deiteren Catharina van der Heijden

Background and Clinical Significance: Vitamin B12 deficiency in infancy is an uncommon but reversible cause of severe hematologic abnormalities and potential neurologic injury, particularly in exclusively breastfed infants whose vitamin B12 status depends on maternal stores. Because its clinical presentation may mimic bone marrow failure syndromes or hematologic malignancies, diagnosis can be challenging and delayed; Case Presentation: We report a case of early infantile pancytopenia ultimately attributed to profound vitamin B12 deficiency secondary to maternal celiac disease. Prompt recognition and treatment with cobalamin supplementation resulted in rapid hematologic recovery and a favorable clinical outcome; Conclusions: This case underscores the importance of considering vitamin B12 deficiency in the differential diagnosis of unexplained cytopenias in infants and highlights the critical role of maternal nutritional status in neonatal health. Improved awareness and targeted screening of at-risk mothers during pregnancy and lactation may prevent severe but readily treatable complications in affected infants.

Reports doi: 10.3390/reports9020150

Authors: Ioannis Katsarelas Alexandra Panagiotou Mohammad Husamieh Ismini Kountouri Periklis Dimasis

Spigelian hernias represent infrequent abdominal wall defects, and the incarceration of an inflamed appendix within the hernia sac is an even rarer clinical finding. We report an uncommon case in which a long-standing herniated appendix eventually progressed to perforation and abscess formation. Our report aims to illustrate this clinical transition to an atypical surgical emergency, while emphasizing that early Computed Tomography (CT) is vital for resolving diagnostic uncertainty and avoiding potential pitfalls in complex abdominal wall pathologies. Following prompt surgical intervention and hernia repair, the patient had an uneventful recovery and remained asymptomatic at the six-month follow-up.

Reports doi: 10.3390/reports9020149

Authors: Francisco de Asís Bartol-Puyal Carlos Santana Plata Carmen Bilbao Porta Claudia Sanz Pozo Silvia Méndez-Martínez Luis Pablo

Background and Clinical Significance: Acute retinal pigment epitheliitis is a retinal disorder considered as part of a larger group named idiopathic choroidopathies. Little gray round macular lesions at the retinal pigment epithelium can be found, which are self-limited, resolving within 6–12 weeks. It can decrease best corrected visual acuity (BCVA), but visual quality has not been studied yet. Case Presentation: A 17-year-old Caucasian boy who came to our ophthalmology department and presented with acute retinal pigment epitheliitis in his right eye (OD). BCVA under mesopic lighting was 0.18 logMAR in his OD and −0.18 in his OS. With a neutral density filter, it was 0.52 and 0.04, respectively. Contrast sensitivity was assessed with the CSV-1000E test, but OD outcomes were worse only in the case of mesopic lighting. Chromatic discrimination was assessed with the Farnsworth–Munsell 100 test and revealed marked impairment of both red-green and yellow-blue axes. No central scotoma was detected on a 10.2 visual field, nor was any halo perception detected with the Halometer test. Conclusions: BCVA under low illumination and color perception in the yellow-blue axis may be affected in patients with acute retinal pigment epitheliitis to a greater extent than previously described. Contrast sensitivity may also be altered, but to a lesser extent.

Reports doi: 10.3390/reports9020148

Authors: Bryce Kassalow Soha Kazmi Said Shukri Zachary N. London

Background and Clinical Significance: Dermato-neuro syndrome is a rare, potentially fatal complication of scleromyxedema, characterized by a prodrome of flu-like symptoms, and a triad of fever, confusion, and seizures. Intravenous immunoglobulin (IVIG) has become first-line treatment for both scleromyxedema and dermato-neuro syndrome based on case reports and case series data showing variable treatment responses. Case Presentation: In this report, we describe a Black, female patient with scleromyxedema and lambda-restricted IgG monoclonal gammopathy who developed suspected dermato-neuro syndrome within a week of her first round of IVIG infusions. Conclusions: To our knowledge, this is the second case report of dermato-neuro syndrome temporally linked to a recent IVIG infusion, a paradoxical reaction that may complicate clinical decision making. Furthermore, we highlight the dermatologic manifestations of scleromyxedema in dark skin tones and emphasize the need for heightened clinical suspicion of dermato-neuro syndrome in patients with scleromyxedema presenting with acute neurological symptoms.

Reports doi: 10.3390/reports9020147

Authors: Lazaros K. Yofoglu Georgios Zervas Christina Konstantaki Chrysoula Moustou Evaggelia K. Aissopou Petros P. Sfikakis Irini Chatziralli Kimon Stamatelopoulos Athanase D. Protogerou Antonios A. Argyris

Objectives: The aim of this study was to compare a widely applied table-top digital non-mydriatic camera (Topcon TRC-NW-8) with a handheld digital non-mydriatic camera (Optomed Aurora IQ) regarding the quantitative assessment of the retinal microcirculation using established biomarkers: central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) and arterio-venous ratio (AVR). Methods: The present cross-sectional study included 26 randomly selected participants (51 eyes) who underwent retinal imaging of both eyes with the two devices and were analyzed using a static retinal vessel analyzer. Results: The mean differences in CRAE, CRVE and AVR between the two devices (Topcon/Aurora) were 24.96 ± 11.7, 22.7 ± 11.7 and 0.026 ± 0.045, respectively. Strong correlations were observed between devices (r = 0.84 for CRAE, 0.75 for CRVE and 0.83 for AVR; all p < 0.001), with high agreement as indicated by ICC values (0.91, 0.85, and 0.90, respectively). Bland–Altman plots indicated evidence of systemic bias (95% within 2 SD) with no proportional bias, as the differences were consistently distributed across the range of average values. Regression-based equations were derived to approximate the transformation of measurements between devices. Conclusions: The handheld fundus camera demonstrates strong correlation and good relative agreement with the table-top device; however, a consistent device-dependent bias limits the direct interchangeability of absolute measurements. The derived transformation equations may facilitate approximate cross-device comparison, although external validation is required. These findings support the complementary use of handheld devices and highlight the need for calibration strategies when integrating measurements across platforms.

Reports doi: 10.3390/reports9020146

Authors: Maria-Mirabela Mihailescu-Marin Maria-Daniela Chindris

Background and Clinical Significance: Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related death. Skeletal muscle metastases are extremely rare and typically occur in advanced or poorly differentiated tumors. In selected oligometastatic cases, surgical excision can provide symptom relief and requires a multidisciplinary approach. Case Presentation: We report a 73-year-old female patient with colonic adenocarcinoma treated with right hemicolectomy and side-to-side mechanical anastomosis, followed by adjuvant CAPOX chemotherapy. The tumor was characterized by MSI-H (microsatellite instability-high) status. During adjuvant treatment (less than 6 months after surgery), she developed progressive right thigh pain, later diagnosed as an intramuscular skeletal muscle metastasis measuring approximately 16 × 13 × 8 cm. The patient underwent en bloc resection of the tumor, followed by adjuvant chemotherapy after metastasectomy. Upon disease progression, first-line chemotherapy in combination with targeted therapy (bevacizumab) was administered. Conclusions: Skeletal muscle metastases from colorectal adenocarcinoma are rare. This case emphasizes the importance of recognizing atypical metastatic patterns and suggests that, in selected oligometastatic cases, surgical excision combined with a multidisciplinary approach may improve symptom control and clinical outcomes.

Reports doi: 10.3390/reports9020145

Authors: Francesco Cannone Gianfranco Morreale Martina Billeci Ferdinando Antonio Gulino

Uterine fibroids are among the most common benign tumors affecting women, with a prevalence reaching up to 50–60% in those over 40 years of age, although often underestimated due to asymptomatic cases. Radiofrequency ablation (RFA) represents a minimally invasive alternative to surgery for selected patients. We report the case of a 41-year-old woman with symptomatic uterine fibroids (FIGO type 4, size of 5 cm) treated with transvaginal RFA. One month post- treatment, the fibroid showed partial volume reduction. Two months after the procedure, the patient presented with foul-smelling discharge and heavy bleeding. Ultrasound confirmed complete fibroid migration into the cervical canal. Vaginal removal was performed without complications. Fibroid expulsion after RFA is a rare event that may represent either a complication or a therapeutic outcome. A balanced interpretation and appropriate clinical management are required. Further studies are needed to clarify its clinical significance.

Reports doi: 10.3390/reports9020144

Authors: Lina Chen Lai Mun Wang Runjan Chetty Sangeetha N. Kalimuthu

Background: The term “pseudo-signet ring cell” in the gastrointestinal and biliary tract refers to benign cells with signet ring-like morphology that resemble the malignant counterpart seen in poorly differentiated adenocarcinomas; Clinical Significance: Given this close resemblance to malignant cells, they can pose a diagnostic challenge for pathologists. Awareness of this diagnostic pitfall is crucial to avoid misdiagnoses and overtreatment of patients; Case Presentation: Herein, we provide an overview of an array of clinical presentations of pseudo-signet ring cells, particularly focusing on the three most frequent clinical scenarios, and briefly discuss the possible etiologies for this phenomenon; Conclusions: Pseudo-signet ring cells are a rare but important diagnostic pitfall that require careful morphological evaluation, contextual awareness, and clinicopathologic correlation to avoid misdiagnosis.

Reports doi: 10.3390/reports9020143

Authors: Nicoleta Maria Crăciun Ciorba Ilie Marius Ciorba

Background and clinical significance: Autoimmune hepatitis (AIH) and ankylosing spondylitis (AS) are distinct immune-mediated disorders that only rarely coexist. Diagnostic interpretation becomes especially challenging when the liver biochemistry is not classically hepatocellular and the histology is unavailable. Case presentation: We report a 51-year-old man with inflammatory back pain, polyarthralgia, weight loss, fatigue, night sweats and fever. Laboratory tests showed marked systemic inflammation, anemia and a cholestatic-predominant liver profile with associated aminotransferase elevation. Imaging demonstrated bilateral sacroiliitis and syndesmophytosis. Liver workup excluded viral, obstructive, metabolic, hereditary and inflammatory bowel disease-associated cholangiopathic causes. Antinuclear antiboidies (ANA) and anti liver cyotsole 1 antiboidies (anti-LC-1) were positive, IgG was mildly elevated, magnetic resonance cholangio-pancreatography (MRCP) was negative for primary sclerosing cholangitis and the simplified AIH score was six. A liver biopsy was proposed but refused. The patient received a short course of prednisone for rheumatologic flare control, followed by nonsteroidal anti-inflammatory treatment and sulfasalazine, with normalization of liver tests during follow-up. Conclusions: This case is suggestive, but not diagnostic, of autoimmune hepatitis in a patient with ankylosing spondylitis. In the absence of histology and in the setting of a cholestatic-predominant biochemical profile, the findings may be more appropriately interpreted as an autoimmune hepatitis-like syndrome. The main teaching point is that abnormal liver tests in AS warrant structured evaluation beyond drug toxicity and viral hepatitis, particularly when autoimmune serology is positive, even in a cholestatic-predominant presentation.

Reports doi: 10.3390/reports9020142

Authors: Filip Miłosz Tkaczyk

Background: Erectile dysfunction (ED) is a common complication of type 2 diabetes and obesity and significantly affects patients’ quality of life. Nursing care for patients with metabolic multimorbidity requires a holistic, structured approach. The International Classification for Nursing Practice (ICNP®) enables standardized formulation of nursing diagnoses, interventions, and outcomes and supports structured and individualized ICNP®-based care planning. Aim: This study aimed to develop and present an ICNP®-based nursing care plan for a patient with erectile dysfunction associated with type 2 diabetes and obesity and to demonstrate the applicability of ICNP® in holistic nursing management of chronic disease. Methods: A descriptive single-case study was conducted in 2025 in a cardiology ward in Poland. Data were collected using a nursing interview, observation, medical documentation analysis, and standardized tools (IIEF-5, SF-36v2). Based on a comprehensive assessment of physical, psychological, and social status, nursing diagnoses, interventions, and expected outcomes were formulated according to ICNP® terminology. Results: The patient presented with poorly controlled diabetes, class I obesity, moderate erectile dysfunction, reduced testosterone levels, and decreased quality of life, particularly in psychosocial domains. Key ICNP® nursing diagnoses included erectile dysfunction, deficient knowledge, obesity, disturbed psychological status, impaired endocrine function, impaired cardiovascular function, and impaired adaptation. Individualized ICNP®-based interventions focused on metabolic control, lifestyle modification, sexual health support, education, and psychosocial support. Implementation of the care plan was associated with improvements in health behaviors, disease knowledge, and psychological well-being. Conclusions: ICNP® provides a useful framework for structured and comprehensive nursing care in patients with diabetes-related erectile dysfunction and multimorbidity. Case-based ICNP® care planning supports holistic management, interdisciplinary collaboration, and quality improvement in chronic disease nursing.

Reports doi: 10.3390/reports9020141

Authors: Stylianos Kopanos Ulrich J. Knappe Nasreddin Abolmaali Joachim Feldkamp

Background and Clinical Significance: Osmotic demyelination syndrome (ODS) and pituitary apoplexy are rare but potentially severe neurological and endocrine complications that can arise in the context of profound metabolic stress. Case Presentation: We describe the case of a previously healthy 34-year-old man who developed severe symptomatic hyponatremia shortly after receiving his second dose of an mRNA COVID-19 vaccine. Initial laboratory findings and clinical assessment were consistent with syndrome of inappropriate antidiuretic hormone secretion. Following correction of serum sodium, the patient experienced neurological deterioration with gait disturbance, dysarthria, and cognitive impairment. Follow-up brain MRI demonstrated extrapontine osmotic demyelination involving the basal ganglia and thalamus, despite initially normal imaging. During subsequent endocrinological follow-up, pituitary MRI revealed pituitary apoplexy in a previously unrecognized adenoma, accompanied by evolving partial hypopituitarism. The patient was managed with careful electrolyte control and long-term hormone replacement therapy, including hydrocortisone, levothyroxine, and recombinant growth hormone, resulting in gradual functional and cognitive improvement. Conclusions: This case highlights the interaction between severe hyponatremia, osmotic stress, and pituitary vulnerability, and emphasizes the need for cautious sodium correction, careful interpretation of temporal associations, and continued clinical vigilance in the context of COVID-19 vaccination programs.

Reports doi: 10.3390/reports9020140

Authors: Tanya G. K. Bentley Gina M. D’Andrea-Penna Emily L. Hightower

Background and Clinical Significance: Migraine is a common yet debilitating condition that significantly impacts personal lives, productivity, and the healthcare system. Pharmacological interventions provide relief for some migraine sufferers, but for others, are ineffective or accompanied by side effects. Emerging evidence implicates autonomic nervous system dysfunction in migraine pathophysiology, suggesting that mind–body interventions may offer a simple, cost-free therapeutic option. Case Presentation: A 61-year-old woman presented with severe daily migraines that had persisted for years despite medication and dietary changes. Upon starting a regular 10 min slow diaphragmatic breathing practice, her migraines ceased immediately. At a 12-month follow-up, she had only experienced two minor headaches and reported improvements in both daily functioning and quality of life. Conclusions: These findings underscore the potential role of autonomic imbalance in chronic migraine and the preliminary feasibility of breathing interventions as an accessible, low-risk treatment that may, for some, surpass medication in efficacy. Breathing practices may offer a viable alternative to pharmaceutical interventions that benefits both patients and healthcare systems alike.

Reports doi: 10.3390/reports9020139

Authors: Ishith Seth Sai-Vignesh Ashok Omar Shadid Warren Rozen Snehal Shah

Background and Clinical Significance: Dupuytren’s disease (DD) typically affects the palmar fascia and proximal digital structures, with distal interphalangeal joint (DIPJ) involvement considered rare. True extension of DD into the volar pulp has not been previously documented. Distal lesions may be misdiagnosed as neoplastic or inflammatory masses, and optimal management of isolated distal cords remains uncertain. We present the first histologically confirmed case of DD extending beyond the DIPJ into the volar pulp, accompanied by a systematic review of reported DIPJ-dominant DD. Case Presentation: A 30-year-old right-hand-dominant male presented with a two-year history of progressive flexion deformity of the little finger. Examination demonstrated a 90° proximal interphalangeal joint and 55° DIPJ contracture. Ultrasound and MRI showed a well-circumscribed soft-tissue lesion along the radial middle phalanx but did not suggest DD. Open exploration via an ulnar digital approach revealed a discrete DD cord extending distally beyond the DIPJ into the volar pulp, closely associated with the ulnar neurovascular bundle. Limited fasciectomy achieved full correction without neurovascular compromise. Histopathology confirmed classic DD. At the twelve-month follow-up, the patient maintained full extension and function with no recurrence. Conclusions: This study reports the first confirmed case of DD extending into the volar pulp and highlights that atypical distal DD can occur even in young patients. Imaging may fail to identify DD in uncommon sites, reinforcing the importance of clinical suspicion. Limited fasciectomy remains safe and effective in the distal phalanx. Recognition of this phenotype or histopathological examination may improve diagnostic accuracy and guide tailored operative planning.

Reports doi: 10.3390/reports9020138

Authors: Jacob Allen Saunders Sadiq Shakir Patel Thomas Chandy Varkey Sara Shaikh Anthony Conforti Ganesh Murthy

Background and Clinical Significance: Guillain–Barré syndrome (GBS) can rarely progress to fulminant paralysis with loss of brainstem reflexes, mimicking coma or brain death despite preserved cortical function. Case Presentation: A 38-year-old man developed rapidly progressive weakness following a diarrheal illness, culminating in quadriplegia, areflexia, respiratory failure, and complete loss of brainstem reflexes within 72 h. Neuroimaging was unrevealing. EEG demonstrated preserved cerebral activity with an alpha coma pattern. Despite initial intravenous immunoglobulin therapy, neurological deterioration continued, prompting escalation to plasma exchange. Gradual recovery of brainstem reflexes and motor function ensued, followed by substantial functional improvement over nine months. This case highlights the diagnostic and prognostic challenges of fulminant GBS at the interface of peripheral and brainstem dysfunction. Neurophysiologic assessment and disciplined exclusion of central etiologies are essential. Timely immunotherapy and supportive care can lead to meaningful recovery even in extreme presentations. Conclusions: Fulminant GBS should be recognized as a potentially reversible cause of apparent coma, underscoring the importance of early diagnosis and aggressive treatment.

Reports doi: 10.3390/reports9020137

Authors: Fulvio Cacciapuoti Antonietta Buonomo Salvatore Crispo Massimo Russo Ciro Mauro

Background and Clinical Significance: Early loss of pacing capture after pacemaker generator replacement is an uncommon but potentially life-threatening event, especially in pacemaker-dependent patients. In this setting, device malfunction is often initially attributed to intrinsic lead damage, prompting consideration of invasive lead revision or extraction. However, not all early failures reflect true structural lead dysfunction. Careful interpretation of device interrogation findings, particularly in relation to pacing configuration, may uncover reversible causes and support a more targeted diagnostic and management approach; Case Presentation: A 61-year-old man with complete atrioventricular block presented with recurrent syncope six days after elective pacemaker generator replacement. The electrocardiogram showed absence of effective ventricular pacing with a slow escape rhythm. Device interrogation revealed loss of ventricular capture in bipolar configuration associated with markedly elevated impedance, initially raising concern for lead malfunction. However, switching to unipolar pacing restored effective capture with normal electrical parameters, suggesting preserved lead integrity and prompting reconsideration of the underlying mechanism. Further diagnostic evaluation, including imaging and intraoperative assessment, was therefore undertaken to clarify the cause and guide management; Conclusions: Early pacing failure should not automatically be equated with lead damage. Beyond documenting a reversible lead–header interface problem, this case highlights the diagnostic value of a stepwise approach integrating pacing configuration behavior, targeted imaging, and intraoperative header-independent testing. Such an approach may facilitate rapid localization of reversible defects and help avoid unnecessary lead revision.

Reports doi: 10.3390/reports9020136

Authors: Alin Tatu Tiberiu Tebeica Mihaela Denisa Pirvu Cristian Constantin Popa Valeriu Ardeleanu

Background and Clinical Significance: Chondroid syringoma is a very rare tumor arising from the sweat glands, with an incidence described in the literature of 0.01% of all primary skin tumors. Case presentation: This paper aims to present the case of a patient treated in our clinic for a large cyst located at the inner corner of the left eye, which appeared two years ago and progressively increased in size. The patient presented for cosmetic reasons and discomfort, especially when wearing glasses. The diagnosis of chondroid syringoma is generally established clinically. The differential diagnosis includes other benign cutaneous lesions (pleomorphic adenoma, lipoma, neurofibroma, a dermoid cyst, dermatofibroma, pleomorphic adenoma of the salivary glands, a sebaceous cyst, or hemangioma) or malignant lesions (basal cell carcinoma, squamous cell carcinoma, or adenocarcinoma). Additional imaging investigations—CT and MRI—are rarely required and would mainly assess the extent of the lesion. Dermoscopy is an early differential diagnostic method, especially for small lesions of 1–3 mm, such as xanthelasma, milia, or basal cell carcinoma. Chondroid syringoma may be treated using minimally invasive methods such as fractional CO2 laser, radiofrequency, or electrocautery, but only when the lesion is superficial and small. For larger and deeper tumors, such as in our case, multiple treatment sessions would be required, increasing the cost, and complete removal would not be guaranteed. Conclusions: The chosen treatment is surgical excision with oncologic margins, followed by histopathological and immunohistochemical examination to prevent recurrence and assess the risk of malignancy.

Reports doi: 10.3390/reports9020135

Authors: Răzvan Alexandru Dănău Răzvan-Ionuț Popescu Aida Petca Viorel Jinga Răzvan-Cosmin Petca

Background and Clinical Significance: Over recent decades, percutaneous nephrolithotomy (PCNL) has emerged as a primary treatment, firmly establishing itself as the cornerstone approach for managing large kidney stones. Postoperative bleeding commonly stems from an arteriovenous fistula (AVF), a connection between a damaged artery with high flow and a damaged vein with low flow, or from a pseudoaneurysm (PA), which involves arterial blood leaking into the tissue, causing a localized hematoma. The preferred technique for addressing such vascular complications is selective trans-arterial angioembolization, widely regarded as the gold standard. Case Presentation: In this article, we present the case of a 42-year-old woman who experienced delayed bleeding eight years after PCNL and a previous angioembolization. The patient presented with macroscopic hematuria, and further investigations, including cystoscopy, contrast-enhanced abdominal-pelvic CT, and angiography, were performed. To stop the bleeding, we identified and performed selective angioembolization (SAE) of a small arterial branch arising from an inferior branch of the right renal artery. Conclusions: To the best of our knowledge, this is the initial documented instance of delayed bleeding manifesting eight years post-PCNL and angioembolization. This occurrence is exceptionally rare, given that the patient exhibited no urological signs or symptoms over the intervening years, and no predictive or risk factors were identified.

Reports doi: 10.3390/reports9020134

Authors: Ziyad Gunga Mario Verdugo-Merchese Matthias Kirsch René Prêtre

Background and Clinical Significance: Revascularization of the circumflex territory remains technically challenging because of its anatomical position and the frequent need for distal branch grafting. Case presentation: We report the case of a 76-year-old man in whom the proximal circumflex trunk was used as the target for an in situ right internal thoracic artery routed through the transverse sinus during combined coronary and ascending aortic surgery. This approach allowed antegrade perfusion of the circumflex territory while avoiding multiple distal anastomoses. In this selected anatomical setting, the technique proved feasible and was associated with excellent intraoperative flow and 1-year radiological patency. Conclusions: Direct grafting of the circumflex trunk is not a new concept, but this case revisits it using a contemporary total arterial revascularization strategy. This approach may represent a useful adjunctive option in carefully selected patients with favorable circumflex anatomy.

Reports doi: 10.3390/reports9020133

Authors: Sergiu Băjan Anastasia Kateryna Sikora-Medvid Simona Claudia Tămășan Alina Murariu Virgil Radu Enătescu

Background and clinical significance: Autoimmune encephalitis (AE) is an inflammatory brain disorder that manifests through a diverse, unspecific range of neuropsychiatric symptoms. When AE occurs alongside a primary neurodegenerative disorder, the shared symptoms can create a mixed clinical profile, making diagnosis more difficult and potentially postponing effective management and treatment. Case presentation: We describe the case of a 58-year-old female with a one-year history of progressive behavioral and personality changes who presented a subacute confusional state, psychomotor retardation alternating with psychomotor agitation, apathy, visual hallucinations, and motor symptoms. Examination revealed Parkinsonian symptoms and frontal lobe signs. Neuroimaging showed frontotemporal atrophy, while cerebrospinal fluid analysis excluded infection but demonstrated elevated phosphorylated tau, supporting an underlying neurodegenerative process. An electroencephalogram revealed asymmetric temporal slowing without overt epileptiform activity. An initial diagnosis of behavioral variant frontotemporal dementia (bvFTD) was established. Due to rapid clinical deterioration and fluctuating cognition, autoimmune testing was expanded to a full antibody panel, which identified elevated serum anti-glutamic acid decarboxylase 65 (anti-GAD65) antibodies (60 UI/mL, reference range 0–5 UI/mL), establishing a possible coexisting diagnosis of anti-GAD65 autoimmune encephalitis. Initial treatment with intravenous immunoglobulin produced minimal improvement; however, therapeutic plasma exchange led to the remission of psychosis and significant improvement in rigidity, bradykinesia, and attention, with modest amelioration in global cognition. Conclusions: This case highlights the diagnostic challenges posed by overlapping AE and bvFTD clinical pictures, especially when neurodegenerative features obscure an underlying autoimmune process. Early, panel-based neural antibody testing—and consideration of AE even in patients already diagnosed with a major neurocognitive disorder—is critical for avoiding delays in immunotherapy. Prompt recognition and treatment of AE may substantially improve clinical outcomes, even in complex cases with suspected overlap.

Reports doi: 10.3390/reports9020132

Authors: Yordanka Diaz-Saez Anandu Mathews Anto Ruchita Kodakandla Sanjana Voonna Misbahuddin Khaja

Background: Low-dose CT scanning is a key tool in lung cancer screening, enabling the detection of clinically significant abnormalities in asymptomatic individuals and often prompting further diagnostic evaluation. Case Presentation: We describe the case of an 80-year-old man with a heavy smoking history who was found to have a new right middle lobe collapse on screening CT. Subsequent positron emission tomography-computed tomography (PET/CT) imaging demonstrated mild fluorodeoxyglucose (FDG) uptake (SUVmax 2.7), raising concern for a low-grade endobronchial malignancy versus mucoid impaction. Flexible fiberoptic bronchoscopy revealed a large exophytic endobronchial mass occluding the airway. Histopathologic examination of the biopsy sample unexpectedly revealed vegetable material, consistent with chronic foreign-body aspiration. Discussion: Unrecognized aspiration events are relatively common in elderly adults and can mimic malignancy on imaging. This case highlights an important diagnostic pitfall: inflammatory endobronchial processes, including foreign-body granulomas, can demonstrate FDG uptake and mimic malignancy. Conclusion: Clinicians should maintain a broad differential diagnosis when evaluating PET-avid endobronchial lesions, especially in elderly patients.

Reports doi: 10.3390/reports9020131

Authors: Sofia Makrydima Charalampos Milionis

Background and Clinical Significance: The management of large benign ovarian cysts in women of reproductive age requires balancing minimally invasive surgery with oncologic safety and preservation of ovarian function. Laparoscopic cystectomy for large cysts is technically challenging and carries an increased risk of intraoperative rupture and spillage; Case Presentation: We describe a novel hybrid laparoscopic–extracorporeal technique in which controlled cyst decompression is performed using a balloon-tipped trocar through a suprapubic port under direct laparoscopic visualization. The ovary is then carefully mobilized and exteriorized through the same incision, allowing extracorporeal cystectomy and ovarian reconstruction before returning the adnexa to the abdominal cavity. This approach was applied in a series of six patients with large benign-appearing ovarian cysts, including one 42-year-old patient with an 18 cm multilocular mature cystic teratoma. There were no intraoperative or postoperative complications, no conversions to laparotomy, and all patients were discharged on postoperative day 1. Follow-up at six weeks and subsequent imaging at nine months demonstrated preserved ovarian architecture, normal menstrual function, and high patient satisfaction; Conclusions: The hybrid laparoscopic–extracorporeal approach appears feasible and may offer a safe surgical option in carefully selected patients, allowing fertility preservation while minimizing the risk of spillage. Further studies are needed to evaluate reproducibility, oncologic safety, and long-term reproductive outcomes.

Reports doi: 10.3390/reports9020130

Authors: Evgeniy Aleksiev Darina Lyudmilova Kachakova-Yordanova Vanyo Mitev Martin Marinov Georgiev Zornitsa Mihaylova

Oral squamous cell carcinoma (OSCC) typically develops in individuals with established risk factors such as tobacco and alcohol use, yet an increasing number of cases occur in young non-smoking, non-drinking (NSND) patients. We report a case of oral tongue OSCC in a 33-year-old woman who is a never-smoker and never-drinker without identifiable environmental or local risk factors. The patient underwent surgical treatment followed by adjuvant radiotherapy and remains disease-free 15 months after therapy. Whole-exome sequencing (WES) revealed a pathogenic truncating TP53 mutation together with additional somatic alterations affecting genes involved in DNA repair, hypoxia adaptation, mitochondrial function, and epigenetic regulation. The heterogeneous mutational profile suggests branched tumor evolution and the involvement of non-classical tumorigenic pathways. This report contributes to the growing evidence that OSCC in young NSND patients represents a biologically distinct subgroup and demonstrates the value of comprehensive genomic profiling for improving understanding of tumor heterogeneity and potential molecular drivers in the absence of traditional carcinogenic exposures.

Reports doi: 10.3390/reports9020129

Authors: Libardo Rueda Prada Alejandro Fabrega Gerbaud Marta Berguido de la Guardia Juan C. Martinez Morales Carlos A. Velandia-Carrillo Carlos Vergara Sanchez

Background and Clinical Significance: Nonbacterial thrombotic endocarditis (NBTE) is a sterile fibrin-platelet valvular condition associated with malignancy and hypercoagulable states. It produces friable vegetations prone to systemic embolization, often presenting as multifocal ischemic stroke. While modestly linked to advanced adenocarcinomas, its association with melanoma is exceedingly rare; Case Presentation: We present a 43-year-old man with recently diagnosed metastatic melanoma who presented with fever, confusion and abdominal pain. Brain magnetic resonance imaging (MRI) revealed multifocal bilateral acute infarcts. Additional imaging demonstrated splenic and bilateral renal infarcts. Transesophageal echocardiography (TEE) revealed an 8 mm × 7 mm multilobar lesion on the posterior mitral valve leaflet. Blood cultures remained persistently negative; autoimmune and infectious workup were unrevealing, and positron emission tomography-computed tomography (PET-CT) showed no cardiac hypermetabolism. Despite empiric antibiotics for suspected infective endocarditis (IE), progressive embolic infarcts occurred. After exclusion of infection, NBTE was considered, and therapeutic enoxaparin was initiated, resulting in clinical stabilization without hemorrhagic conversion; Conclusions: Distinguishing NBTE from IE remains challenging due to overlapping and nonspecific imaging findings. TEE is the preferred diagnostic modality because of its high sensitivity for detecting small valvular vegetations. Adjunctive imaging modalities such as brain MRI and PET-CT may support the diagnosis by demonstrating embolic patterns or excluding metabolically active infectious vegetations. Management primarily relies on systemic anticoagulation, while percutaneous vegetation aspiration may represent a potential diagnostic and therapeutic strategy. Clinicians should maintain high suspicion of this condition in patients with advanced melanoma and other malignancies presenting with multifocal embolic phenomena and negative cultures to enable timely anticoagulation.

Reports doi: 10.3390/reports9020128

Authors: Joel Shah Emily Shah

Background: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated necrotizing vasculitis primarily affecting small and medium-sized vessels. The typical presentation commonly includes upper and/or lower respiratory tract and renal involvement. GPA has a particularly strong association with proteinase-3 (PR3) ANCA. Though well defined, GPA may be clinically difficult to recognize, particularly in early disease. Initial presentations may include nonspecific symptoms, including but not limited to fatigue, fever, and sinus congestion or sinusitis, which may be mistaken for infection. Though initial ANCA testing is useful, it is not definitive as early stages of disease may be negative, thus delaying diagnosis; Clinical Significance: This case highlights the importance of including GPA in the differential diagnosis of patients with unremitting upper or lower respiratory and constitutional symptoms despite negative ANCA testing. Though atypical, GPA cases may lack renal involvement and even have negative ANCA serologies, leading to a delay in diagnosis and increased morbidity. ANCA positivity can be as low as 60% in limited GPA cases, and less than 20% of individuals have renal involvement at presentation. If GPA suspicion is high, repeat testing and biopsy are warranted; Case Presentation: A woman in her 50s initially presented to the emergency department with recurrent/persistent fever with nonspecific sinus symptoms that remained unresolved despite multiple outpatient treatments and tests. Infectious work-up was negative. She was found to have multiple pulmonary nodules on various scans. Initial testing on admission was unremarkable or nondiagnostic, including anti-neutrophil cytoplasmic antibody (ANCA) serologies. The patient’s hospital course was complicated by acute hypoxic respiratory failure with distributive shock during bronchoscopy. Repeat serological testing was positive for PR3-ANCA, and lung biopsy demonstrated necrotizing granulomatous vasculitis consistent with a diagnosis of granulomatosis with polyangiitis (GPA). The patient demonstrated clinical improvement with avacopan, glucocorticoids, and rituximab; Conclusions: The diagnosis of GPA should be suspected in all patients with nonspecific constitutional symptoms along with clinical evidence of upper/lower respiratory tract involvement, regardless of renal function. Physicians with a strong suspicion of an autoimmune disease, such as GPA, should utilize a thorough clinical history, physical exam, and other labs in the setting of a negative autoimmune marker and/or negative imaging. Clinical judgment is required to not rule out GPA despite a negative workup when other more serious causes have been excluded, as the diagnosis may be life-threatening.

Reports doi: 10.3390/reports9020127

Authors: Stefano Auriemma Riccardo Gherli Lorenzo Giacometti Annalisa Roveta Pietro Rinaldi

Background and Clinical Significance: Intrapericardial ectopic thyroid tissue is extremely rare and can mimic vascular mediastinal or cardiac lesions. Case Presentation: We describe a 62-year-old woman with dyspnea, palpitations, and flushing for several months, progressively worsening, associated with nonspecific ST-segment abnormalities on ECG. Contrast-enhanced CT revealed a small, highly vascularized epicardial mass anterior to the ascending aorta. 18F-FDG PET/TC findings were inconclusive, and biopsy was not feasible due to the anatomical location. Surgical excision via upper ministernotomy was performed, leading to resolution of symptoms. Histology confirmed benign ectopic thyroid tissue. Conclusions: With fewer than ten similar intrapericardial cases reported in the English-language medical literature, this presentation underlines the diagnostic difficulty of such lesions and the importance of including ectopic thyroid tissue among the less common differential diagnostic considerations for intrapericardial masses, particularly in patients with prior thyroid disease.

Reports doi: 10.3390/reports9020126

Authors: Eva Jūlija Tirāne Edgars Tirāns

Background and Clinical Significance: Angiotensin-converting enzyme inhibitors (ACE-Is) are commonly used for treatment of hypertension and are well known among primary care specialists. ACE-I-induced angioedema is a rare, yet possible side effect. It should not be taken lightly, as it can be life-threatening. It is characterized by erythematous or skin-coloured, self-limiting, localized, non-pitting swelling of the submucosal and/or subcutaneous layers of tissue. Usually, it develops in the first year of using the medication, although it can also start several years after using it. Herein, we describe a late-onset ACE-I-induced angioedema, which developed 7 years after using the ACE-I. This case report depicts the challenges of diagnosing ACE-I-induced angioedema, especially if it is late-onset. It highlights the importance of actively asking patients questions about possible side effects of medication even several years after using it and the patients themselves not having any complaints. Case Presentation: We present a 61-year-old Caucasian male with recurring swelling of the lips, tongue and an uncomfortable feeling in the throat, which started 7 years after using an ACE-I: perindopril. There was no airway obstruction or urticaria in any of the episodes. Hereditary angioedema was ruled out by blood analysis. Based on the clinical presentation, images and blood analysis, it was diagnosed as late-onset ACE-I-induced angioedema. After discontinuing the ACE-I, there were two more episodes of angioedema reported, which were a lot milder in symptoms and lasted a shorter time period. Since then, there have been no other episodes of angioedema. Conclusions: It is important to keep in mind angioedema as a possible side effect for patients on ACE-Is. Patients should be regularly and actively questioned about side effects, even if the medication has been started several years ago and no complaints are brought up by the patient.

Reports doi: 10.3390/reports9020125

Authors: Jessica Kenia Jim Marschalek Timothy Dillingham

Background and Clinical Significance: Conventional hard sockets are reported to result in skin breakdown for almost half of transtibial prosthesis users. Adjustable sockets have been developed to better accommodate residual limb shape and volume changes. They have demonstrated optimal skin health in prospective adult clinical studies. Case Presentation: We present the case of a 57-year-old male with a transtibial amputation who enrolled in a research study at the University of Pennsylvania. In the year before enrollment, he experienced frequent, near-constant skin breakdown of the distal residual limb at the anterior tibia due to limb volume fluctuations and excessive pressure from a conventional hard socket and was frequently unable to use his socket due to skin breakdown. The subject was fit with an adjustable, immediate fit transtibial prosthesis (iFIT Prosthetics®). After a two-week home trial, he rated the adjustable prosthesis 62 out of 70 on an adapted Prosthetic Evaluation Questionnaire, compared with a score of 20 for his conventional prosthesis. Due to improved comfort, he discontinued the use of his conventional device. The subject was followed for over one year and wore the adjustable prosthesis exclusively without a recurrence of skin breakdown. Residual limb volume changes commonly lead to poor socket fit and skin irritation in conventionally fabricated hard sockets, often progressing to skin breakdown. In individuals with diabetes, wound healing can be prolonged and functionally limiting. In this case, an adjustable prosthesis successfully eliminated anterior tibial skin breakdown in a subject predisposed to this injury when using conventional hard sockets. Conclusions: Adjustable sockets can prevent skin breakdown in individuals with transtibial limb loss.

Reports doi: 10.3390/reports9020124

Authors: Georgios E. Zakynthinos George Makavos Nikolaos K. Kokkinos Ourania Katsarou Evangelos Oikonomou Gerasimos Siasos

Background and Clinical Significance: Mechanical complications and intracavitary thrombus are both recognized causes of clinical deterioration following acute myocardial infarction, yet they require fundamentally different therapeutic approaches. Distinguishing between these entities is critical, as misdiagnosis may lead to unnecessary surgical intervention or delayed anticoagulation with serious consequences. Left ventricular (LV) thrombus typically appears as a well-defined mass; however, atypical and highly mobile morphologies may closely mimic catastrophic post-infarction mechanical complications, creating significant diagnostic uncertainty. This case highlights the pivotal role of contrast-enhanced echocardiography in resolving such ambiguity and guiding appropriate management in a high-stakes clinical setting. Case Presentation: A 60-year-old man presented with acute dyspnea and pulmonary edema ten days after an anterior myocardial infarction treated with percutaneous coronary intervention, complicated by ischemic stroke. Transthoracic echocardiography demonstrated severe LV systolic dysfunction with moderate-to-severe mitral regurgitation and an unexpected, highly mobile, irregular mass protruding into the LV apex. The mass exhibited a shredded, tissue-like appearance, raising urgent concern for post-infarction mechanical complications, including papillary muscle rupture or apical myocardial disruption, and prompting immediate consideration of surgical intervention. Contrast-enhanced echocardiography was performed and revealed a mobile LV apical thrombus. Surgical management was avoided, and systemic anticoagulation was initiated, followed by transition to rivaroxaban in combination with ongoing dual antiplatelet therapy. The patient demonstrated rapid clinical improvement with optimized heart failure treatment and was discharged after four days, with planned follow-up imaging to assess thrombus resolution. Conclusions: Left ventricular thrombus may present with atypical, misleading morphologies that closely resemble life-threatening mechanical complications after myocardial infarction.

Reports doi: 10.3390/reports9020123

Authors: Simone Giusti Edoardo De Fenu Simona Cerulli Ezio Adriani

Background and Clinical Significance: Multiligamentous knee injuries (MLKIs) are uncommon but severe injuries associated with instability, neurovascular compromise, and long-term functional impairment. Irreducible knee dislocations are a distinct subgroup requiring urgent intervention because soft-tissue interposition may prevent closed reduction and place the limb at risk of skin necrosis and vascular compromise. This report reviews current concepts in MLKI management and presents a complex KD-IV irreducible knee dislocation treated with a staged surgical strategy. Case Presentation: A 56-year-old woman presented 24 h after a skiing injury with a grossly deformed knee, multidirectional instability, and an anteromedial “pucker sign”. Magnetic resonance imaging demonstrated a KD-IV injury with complete rupture of the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament, associated with capsular disruption and intra-articular soft-tissue interposition causing irreducibility. Urgent open reduction was performed. The first stage included reduction of the incarcerated capsule, capsular repair, and reconstruction of the posteromedial corner and medial collateral ligament using a semitendinosus autograft. Delayed reassessment at 6 months demonstrated satisfactory stability, minimal residual anterior laxity, and no subjective instability; therefore, anterior cruciate ligament reconstruction was not performed. At final follow-up, the patient had near-full range of motion, no significant valgus instability, and no arthrofibrosis or vascular complications. Conclusions: Management of MLKIs should be individualized according to reducibility, soft-tissue condition, neurovascular status, and functional demands. Irreducible KD-IV dislocations with a pucker sign require urgent open reduction. In selected patients, staged reconstruction may reduce postoperative stiffness and allow selective omission of cruciate ligament reconstruction when satisfactory functional stability is achieved.