Persistent Median Artery Thrombosis Presenting as a Mobile Volar Hand Mass: A Rare Case with Surgical Considerations

Iatrogenic Calciphylaxis: A Rare Cause of Calciphylaxis – A Case Report

IntroductionChronic inducible urticaria (CIndU) is a heterogeneous disorder characterized by the development of transient wheals or angioedema in response to specific environmental or physical stimuli[1]. Among the various subtypes, touch-induced urticaria is defined by the appearance of erythematous, pruritic wheals after minimal mechanical stimulation, such as stroking the skin, friction from clothing, or pressure from surfaces[1]. These lesions typically arise within minutes and resolve spontaneously within a few hours[1]; however, recurrent episodes can significantly impair quality of life and disrupt daily activities, particularly in young adults and students[2].Management of CIndU is challenging due to its variable response to standard therapy[3]. Non-sedating H1 antihistamines constitute the first-line treatment, with doses escalated up to fourfold in refractory cases[4]. H2 blockers or short courses of systemic corticosteroids may be added when antihistamines fail to control symptoms[1]. Despite these interventions, a subset of patients continues to experience severe disease manifestations, underscoring the need for alternative treatment strategies, including biologic therapy[1]Omalizumab, a monoclonal antibody targeting IgE, has demonstrated efficacy in chronic spontaneous urticaria (CSU) and select cases of CIndU that are refractory to antihistamines[5]. While elevated serum IgE is often considered a predictor of response, evidence suggests that some patients with normal or fluctuating IgE levels may still benefit from anti-IgE therapy[6]. This raises important questions about the pathophysiological role of IgE in CIndU and the mechanisms underlying omalizumab’s clinical effects, which may extend beyond IgE neutralization to include mast cell stabilization and modulation of autoreactive immune pathways[7].In this report, we describe a 20-year-old male with touch-induced CIndU and a history of childhood atopy, whose serum IgE levels fluctuated over time and whose disease severity remained consistently high. The case illustrates the limitations of relying solely on IgE to guide therapy and emphasizes the importance of phenotype-driven management strategies in refractory urticaria.

A document by Na Li. Click on the document to view its contents.

Title:Pneumatosis Intestinalis Mimicking Perforated Viscus in an Ankylosing Spondylitis Patient Undergoing Adalimumab Therapy: A Case ReportAuthors:Ali Soltaniyan¹, Armin Tajik²*, Alireza Shakerpour³, Pegah Azarimanesh⁴, Sarah Mohabbi²¹ Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran² Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran³ Department of General Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran⁴ Department of Obstetrics and Gynecology, School of Medicine, Alborz University of Medical Sciences, Karaj, IranCorresponding author:Armin Tajik,Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, IranEmail: armintajik.srgn@gmail.com

A document by Jahin Ahmed. Click on the document to view its contents.

INTRODUCTIONNeuroendocrine tumors (NETs) of the head and neck are rare and aggressive neoplasms, accounting for less than 1% of all tumors in this anatomical region (1,2). The estimated 5-year survival rate is below 20%. These tumors most predominantly affect males in the 5th-6th decades of life and are most commonly located in the larynx and sinonasal tract.(1,3,4) NETs typically exhibit immunohistochemical positivity for synaptophysin and chromogranin and are characterized by a markedly elevated proliferative index. (3,5-8)Neuroendocrine carcinomas are a more aggressive known histological subtype. According to the World Health Organization, these tumors are currently classified into two major histological subtypes: small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC). (4,6,9) Both subtyped are considered highly aggressive tumors, with poor prognosis and frequent regional and/or distant metastasis. (3,4,6, 9-11).Management of head and neck neuroendocrine carcinomas is challenging and requires a multimodal approach (1,2,5,9). Achieving locoregional control is essential due to high risk of metastatic spread.Neuroendocrine tumors of the tongue are exceptionally rare, with very few cases documented in literature. They account for less than 1% of all tongue malignancies. (1,3,12) These tumors are associated with a poor prognosis, high recurrence rated and a significant risk of metastasis.

Non-operative management of a complete ACL rupture with the Cross Bracing Protocol in an elite Australian rules football athleteKeiley Mead1, Matthew Dowsett², Zoe Cass3, Stephanie Filbay41 Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, AUS; Email: Keiley.mead@sydney.edu.au² Department of Orthopaedic and Trauma Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK; Email: mjmdowsett@gmail.com3 The Stadium Sports Medicine Clinic, Sydney, AUS; Email: Zoe@stadiumclinic.com.au4 Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, AUS; Email: stephanie.filbay@unimelb.edu.au

Introduction:Chylothorax, a rare cause of pleural effusion, is the result of chyle leakage into the pleural space from the thoracic duct, with causes divided between traumatic and non-traumatic, with malignant and surgical trauma causes being the most common. A diagnosis is made following diagnostic thoracentesis, which reveals a transudative effusion per Light’s criteria, a fluid cholesterol level below 200 mg/dL, and a pleural fluid triglyceride level above 110 mg/dL [1]. Although rare, idiopathic chylothorax can be diagnosed after ruling out all other causes [2]. We present a case of idiopathic chylothorax diagnosed in a challenging patient.Case presentation :

Successful Use of Tofacitinib in Pregnancy-Associated Linear IgA Bullous Dermatosis Refractory to Conventional Therapy：A Case ReportYing Fanga,b,c,d, Ranran Zhanga,b,c,d, Fang Wanga,b,c,d, Peiguang Wanga,b,c,d,*,#, Min Gaoa,b,c,d,*,#a Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, 230032 Anhui, China.b Institute of Dermatology, Anhui Medical University, Hefei, 230032 Anhui, China.c Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, 230032 Anhui, China.d Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, 230032 Anhui, China.*Corr: Peiguang Wang, Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, 230032 Anhui, China. Email: wpg2370@163.com(Peiguang Wang); Min Gao, Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, 230032 Anhui, China. Email: ahhngm@126.com(Min Gao).#Peiguang Wang and Min Gao contributed equally to this article.Key Clinical Message: The present study reports the world’s first successful treatment of linear IgA bullous dermatosis of pregnancy with tofacitinib, suggesting that this may represent a potentially safe and effective therapeutic option, particularly for cases refractory to or complicated by adverse effects from conventional therapies.Acknowledgments: NoneData Availability Statement: The data that support the findings of this study are available from the corresponding author, Min Gao, upon reasonable request.Funding Statement: The authors received no financial support for the research.Conflict of Interest Disclosure: The author and the co- author do not have any conflict of interests.Ethical Statement: The manuscript has been submitted solely to this journal and is not published, in press, or currently submitted elsewhere. Written informed consent was obtained from the patient for publication of this case report and accompanying images.Patient Consent Statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

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AbstractLemmel syndrome is a rare cause of obstructive jaundice in the absence of choledocholithiasis or malignancy, resulting from extrinsic compression of the common bile duct by a periampullary duodenal diverticulum (Figure 1). We present the case of a 50-year-old male with recurrent episodes of abdominal pain and cholangitis with progressive jaundice. Initial imaging suggested distal common bile duct thickening without stones, and MRCP confirmed the presence of a periampullary duodenal diverticulum causing biliary compression. The first ERCP attempt achieved only papillotomy, providing transient symptomatic relief. Recurrent cholangitis prompted a repeat ERCP, during which selective cannulation was achieved and a biliary stent was successfully placed (Figure 3 and 4), leading to marked biochemical and clinical improvement (Table 1). This case highlights the importance of high clinical suspicion for Lemmel syndrome in cases of unexplained biliary obstruction and the role of repeat ERCP in experienced hands as a minimally invasive and effective therapeutic option.

The patient is a 64-year-old woman who was admitted to the hospital as an emergency with a complaint of epistaxis. The patient had also been admitted to the hospital 13 days ago due to epistaxis and was a candidate for endoscopic nasal surgery due to the frequent recurrence of this bleeding.

A document by YASHITA GUPTA. Click on the document to view its contents.

Lead Toxicity Mimicking Haemolysis Associated with Ayurvedic Supplement UseKey Clinical MessageLead toxicity can mimic autoimmune haemolytic anaemia and should be considered in patients with unexplained anaemia and reticulocytosis. This case highlights the diagnostic importance of reviewing peripheral blood smears for basophilic stippling and obtaining detailed exposure histories, especially regarding complementary or traditional medicine use.

A document by yuan wang. Click on the document to view its contents.

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Acute Suppurative Thyroiditis Due to Nocardia in an Immunocompetent Adult: A Comprehensive Case Report and Mini-Review of Fungal and Actinomycete Thyroid InfectionsAuthors: Mete Ucdal1,2, Evren Ekingen2, Karya Yurtsever Ucdal1,Sibel Soyupek2