Background and Clinical Significance: Carbimazole is a widely used medication to treat Graves' disease, although it can rarely cause acquired aplastic anemia, a complication that happens in less than 0.01% of people. Case Presentation: We report a 36-year-old woman treated with supratherapeutic dose carbimazole who, after approximately six months of treatment, developed high grade fever, severe menorrhagia, spontaneous epistaxis, and pancytopenia. Her bone marrow biopsy showed severe bone marrow failure with only 5% cellularity and trilineage hypoplasia. Other potential causes were ruled out. Immediate discontinuation of carbimazole was done, and supportive care, including blood transfusions, broad-spectrum antibiotics, G-CSF, and eltrombopag, was started. The patient deteriorated during her hospital stay, developed neutropenic sepsis and acute respiratory failure from diffuse alveolar hemorrhage, which required intubation and pulse steroid therapy. She was stabilized and discharged, with a referral to a tertiary medical center for starting antithymocyte globulin (ATG) immunosuppressive therapy, which she subsequently completed; two months after discharge she was transfusion independent with near-normalization of her blood counts. Conclusions: This case serves as a stark reminder of how lethal thionamide-induced bone marrow failure can be, highlighting the vital need for immediate drug cessation, swift intensive care, and thorough patient education on early warning signs.

Total body irradiation (TBI) is commonly used for myeloablative conditioning prior to allogeneic hematopoietic stem cell transplantation (HSCT) in high-risk, relapsed, or refractory hematologic malignancies. Pulmonary toxicity (PT)-including pneumonia, diffuse alveolar hemorrhage, and interstitial pneumonitis-is a serious complication after HSCT. Idiopathic pneumonia syndrome (IPS), defined as widespread alveolar injury without cardiogenic or infectious causes, represents a non-infectious form of PT. This study characterizes PT and IPS and explores associated factors following TBI-based HSCT in adults. We conducted a retrospective review of a prospectively collected database of adult patients treated with TBI-based HSCT from 2015 to 2022. Clinical records and chest imaging were reviewed to identify PT and IPS. IPS occurred in 20 patients (18%) of the cohort, with 8 patients (7%) within 100 days and 13 patients (13%) after 100 days. One patient experienced both early- and late-onset IPS and was counted once in the cumulative analysis. Early pulmonary infection was associated with reduced overall survival in both univariable (p = 0.002) and multivariable 100-day landmark analyses (p = 0.047). Acute graft-versus-host disease (GVHD) was independently associated with improved survival (p = 0.017), whereas chronic GVHD was not statistically significant in the landmark analyses. PT and IPS incidences were consistent with previously published adult TBI cohorts. While no significant clinical or radiation-related predictors of IPS were identified, pulmonary infection emerged as a predictor of inferior overall survival.

Anti-glomerular basement membrane disease (anti-GBMD) is a rare small-vessel vasculitis presenting as rapidly progressive glomerulonephritis and/or diffuse alveolar hemorrhage. A third of patients with anti-GBMD have antineutrophil cytoplasmic antibodies and are known as double-positive patients. There are a limited number of pediatric double-positive cases published in the literature. In this case report, we summarize the presentation, treatment, and outcome of a patient with anti-GBMD with both anti-myeloperoxidase and anti-GBM antibodies, highlighting the safe use of rituximab. We also describe atypical complications in our case, including significant weight loss of unclear etiology and development of recurrent episodes of acute pericalcific arthritis.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many systems, such as the central nervous system (CNS), cardiovascular, musculocutaneous, renal, and respiratory systems, etc. SLE can occur alone or in association with other autoimmune diseases, especially antiphospholipid syndrome (APS). Hydrocephalus and diffuse alveolar hemorrhage (DAH) are infrequent manifestations of SLE and APS and increase the risk of mortality and morbidity in these patients. A 48-year-old man was hospitalized due to fever, hemoptysis, and headache, which had not been examined for diagnosis and treatment for a long period of time because of his negligence. After imaging and autoimmune tests were performed, hydrocephalus and DAH were diagnosed as initial manifestations of SLE in association with APS according to the SLE/APS criteria. Additionally, lupus nephritis was confirmed via renal biopsy. The hydrocephalus was due to sigmoid sinus thrombosis in the context of a hypercoagulable state of SLE and APS. The initiation of steroid and immunosuppressive treatments has yielded positive results, negating the need for any invasive procedures. The coexistence of SLE and hydrocephalus, although uncommon, has been documented in the literature. Hydrocephalus, a rare complication of SLE, necessitates timely decision-making regarding treatment based on the patient's clinical symptoms and the degree of ventricular dilation, which may involve either conservative medical management or surgical procedures such as a VP shunt. In patients with multiorgan involvement, rheumatological and autoimmune diseases are among our most important differential diagnoses. Importantly, neurological symptoms, particularly headaches, should not be underestimated, even though they are commonly observed in patients with SLE or APS. A detailed medical history, a comprehensive examination, and strong clinical suspicion are essential when patients present with neurological symptoms, and physicians must consider autoimmune diseases in their differential diagnoses.

Familicide represents one of the most complex forms of domestic violence in forensic practice. Among intrafamilial homicides, filicide and matricide pose major medico-legal and criminological challenges, particularly when autopsy findings are nonspecific or severely altered by post-mortem changes. We report an unusual forensic case involving the deaths of a 3-year-old child and his grandmother, both initially characterized by uncertain manners of death. The child was found dead by his mother while sleeping in a shared bed with multiple pillows. Autopsy examination revealed facial injuries and histological findings consistent with mechanical asphyxia, including diffuse alveolar hemorrhage, pulmonary emphysema, and rupture of the alveolar septa. Toxicological analyses were negative. Genetic investigations identified variants of uncertain significance associated with cardiomyopathies; however, parental testing demonstrated inherited variants, making a genetic arrhythmic cause unlikely. Circumstantial inconsistencies and internet searches performed by the mother regarding suffocation methods further supported homicidal smothering. Epidemiological evidence indicating that accidental sleep-related suffocation occurs predominantly during infancy made the child's age atypical for an accidental mechanism. Five months later, the dismembered and partially skeletonized body of the child's grandmother was discovered inside the family home. Autopsy and histological findings suggested death due to neck compression, although advanced putrefaction and extensive post-mortem dismemberment prevented definitive differentiation between suicidal hanging and homicidal strangulation. This case highlights the critical importance of integrating autopsy, histological, toxicological, genetic, and investigative findings in complex intrafamilial deaths, particularly when traumatic signs are limited or post-mortem destruction compromises forensic interpretation.

Diffuse alveolar hemorrhage (DAH) is a lethal, female-biased complication of systemic lupus erythematosus (SLE). While adaptive immunity is a known driver, the role of innate lymphoid cells (ILCs) in DAH and the contribution of sex hormones to this process remain unclear. To characterize pulmonary ILC remodeling during DAH and evaluate whether androgen signaling modulates natural killer (NK) cell homeostasis and disease severity. A pristane-induced DAH model was established in C57BL/6J and Rag2 [-/-] mice. Pulmonary ILCs were profiled by single-cell transcriptomics and flow cytometry. Baseline sex differences were compared between healthy humans and mice. In vivo interventions included male castration, female testosterone propionate (TP) administration, and antibody-mediated NK cell depletion. DAH was accompanied by a marked reduction in pulmonary NK cell frequency in both C57BL/6J and Rag2 [-/-] mice, indicating an innate feature independent of adaptive lymphocytes. DAH-associated NK cells displayed an activated but constrained state, showing increased expression of effector-associated genes Prf1 and Ifng, together with the inhibitory receptor gene Lag3. At baseline, healthy human females and female mice exhibited lower NK cell frequencies than males. While male castration did not significantly alter DAH severity, TP administration in females restored pulmonary NK cell dominance and significantly attenuated disease severity. NK cell depletion prior to challenge led to a trend toward more severe hemorrhage (p = 0.084). Pulmonary NK cells are reduced in a lupus-associated DAH model and may participate in disease development. Androgen treatment restores pulmonary NK cell predominance and attenuates DAH severity, supporting further investigation of strategies aimed at restoring or preserving pulmonary NK cell homeostasis and function as potential therapeutic approaches for DAH.

Diffuse alveolar hemorrhage is a rare and serious complication of thrombolytic therapy. We describe 2 patients with ST-segment elevation myocardial infarction who received streptokinase, developed diffuse alveolar hemorrhage, and survived. The first patient was a 46-year-old man with an inferior infarction. He later needed bypass grafting for triple-vessel disease. After receiving streptokinase, he experienced hemoptysis, decreasing hemoglobin, and bilateral ground-glass opacities on computed tomography. The second patient was a 52-year-old woman with anterior infarction. She experienced cardiac arrest during thrombolysis and underwent rescue angioplasty for failed thrombolysis. While on strong dual antiplatelet therapy for her stent, she developed a similar pulmonary syndrome, which was identified as blood-tinged endotracheal secretions during ventilation. Both patients received corticosteroids, temporary changes in their antithrombotic therapy, and supportive care. They achieved full recovery while their coronary disease was treated further. These cases highlight the careful diagnosis and treatment needed when hemorrhagic and ischemic processes occur together.