Perianal Crohn's disease (pCD) is a challenging manifestation of CD. We present the case of a 17-year-old adolescent girl with severe, refractory pCD, complicated by a rectovaginal fistula, who failed multiple lines of therapy and required a temporary ileostomy. While on upadacitinib (UPA) monotherapy, she experienced a flare with magnetic resonance imaging (MRI)-confirmed perianal abscesses. The addition of ustekinumab (UST) to UPA resulted in marked improvement in clinical symptoms and radiographic resolution of perianal disease on follow-up MRI. No adverse events occurred. This case highlights dual UPA/UST therapy as a promising strategy for severe, refractory pCD in an adolescent.

Corneal abscesses remain an important cause of preventable monocular blindness, particularly where access to specialized eye care is limited. We report a 34-year-old man from the Democratic Republic of the Congo who presented with a severe corneal abscess after three weeks of symptoms and prior self-medication with unidentified topical eye drops. In the absence of microbiological investigations, intensive empirical medical treatment achieved infection control and partial visual recovery. This case highlights the importance of timely referral and clinically guided management when diagnostic resources are limited.

ObjectiveTo compare clinical characteristics, etiology, imaging findings, treatment, and in-hospital outcomes between patients with pyogenic liver abscess with and without diabetes to support individualized clinical management.MethodsThis retrospective study included 63 patients diagnosed with pyogenic liver abscess between February 2023 and December 2025 at a tertiary hospital in Xi'an, China. The patients were divided into diabetic and non-diabetic groups. Clinical data, laboratory findings, imaging features, pathogen distribution, treatment, and in-hospital outcomes were compared. Multivariate logistic regression was performed to determine risk factors for percutaneous drainage.ResultsIn total, 63 patients were enrolled; there were no significant differences in sex, age, and inflammatory indicators between the two groups. Alanine transaminase and aspartate transaminase levels were significantly higher in the non-diabetic group, whereas albumin levels were significantly lower in the diabetic group (p = 0.04). The detection rate of Klebsiella pneumoniae was significantly higher in the diabetic group (52.2% vs. 15.0%, p = 0.001). The proportion of patients undergoing puncture and drainage was significantly higher (47.8% vs. 22.5%, p = 0.04) and the length of hospital stay was significantly longer (14.0 (9.0, 17) vs. 10 (9.0, 12.75) days, p = 0.01) in the diabetic group. There was no significant difference in the incidence of sepsis between the two groups. Multivariate regression analysis revealed that K. pneumoniae infection was an independent risk factor for the need for percutaneous drainage (odds ratio = 8.73, 95% confidence interval: 2.36-32.34, p = 0.001).ConclusionDiabetic patients with pyogenic liver abscess characteristically exhibit a predominance of K. pneumoniae infection and a longer hospital stay. Non-diabetic patients present prominent transaminitis and higher Escherichia coli infection rates. K. pneumoniae infection, rather than diabetes itself, is an independent factor associated with drainage requirement in this cohort. Tailored therapeutic strategies are recommended for this patient population based on diabetes status.

Hidradenitis suppurativa (HS) is a painful, chronic inflammatory condition that forms recurring nodules and abscesses in skin folds, leading to severe scarring. While the exact pathogenesis is still being determined, it is thought to involve follicular occlusion and rupture, driven by multifactorial influences such as genetics, environment, hormones, microbiome, and immune dysregulation. The complex nature of this disease entails complicated management and has led to the development of various therapies targeting these different factors. While moderate-to-severe HS has seen growing therapeutic options in recent years, mild early-stage forms of the disease lack any approved treatments. This review examines the most recent developments in topical therapies specifically for mild HS, along with advancements in daily HS skin care and post de-roofing wound management. These emerging therapies offer the potential for more effective, personalized care to reduce the disease burden for patients living with HS.

Fournier's gangrene (FG) is a rapidly progressive necrotizing fasciitis of the perineal and genital regions associated with high mortality. Prompt intervention is crucial, particularly in patients with predisposing risk factors. A 75-year-old man with type 2 diabetes mellitus receiving long-term corticosteroid therapy presented with progressive scrotal pain and left thigh swelling. Physical examination revealed scrotal necrosis, and contrast-enhanced computed tomography demonstrated a perianal abscess with extensive subcutaneous emphysema. Emergency surgical debridement and bilateral orchiectomy were performed. Pus cultures demonstrated polymicrobial infection, whereas blood cultures yielded additional organisms, including Campylobacter ureolyticus, resulting in microbiological discordance between the two specimen types. The patient recovered without major complications following broad-spectrum antimicrobial therapy and intensive glycemic control. C. ureolyticus, which was identified in the present case, has previously been associated with necrotizing soft tissue infections, perianal abscesses, and bacteremia, and may cause severe infections, particularly in patients with underlying comorbidities or immunosuppression. The spatially heterogeneous and polymicrobial nature of FG may have contributed to the discordant culture results between the local specimen and blood cultures. This case highlights the complementary value of obtaining both pus and blood cultures for identifying uncommon pathogens in severe polymicrobial FG.

Melioidosis, caused by Burkholderia pseudomallei, produces a wide range of clinical manifestations and may be difficult to diagnose in the pediatric population. We describe the case of a 12-year-old girl with poorly controlled type 1 diabetes mellitus that posed diagnostic challenges. Over 4 months, she experienced relapsing fever, multiple splenic abscesses with a 'target sign' on ultrasonography, right-sided preseptal cellulitis, and a left thigh ulcer. Repeated cultures of superficial swabs and blood yielded no growth of bacteria. Radiological mimicry and culture-negative results raised concerns regarding a fungal etiology, leading to empiric amphotericin B therapy. The definitive diagnosis was made after incision and drainage of a 4 × 6 cm[2] frontal abscess. Pus culture isolated Burkholderia pseudomallei, identified by matrix‑assisted laser desorption/ionization time‑of‑flight mass spectrometry (MALDI‑ToF MS). Patient was treated with intravenous meropenem for 4 weeks followed by oral cotrimoxazole for a planned 3‑month eradication course. The patient recovered with no relapse on follow‑up. This case highlights the need to consider melioidosis in diabetic patients presenting with recurrent, culture-negative abscesses that display a target sign in endemic regions. Deep tissue culture remains essential for diagnosis, as superficial swabs may be misleading. Source control, coupled with dual-phase antimicrobial therapy, remain the cornerstones of effective management.

Fournier's gangrene is a rapidly progressive necrotizing soft tissue infection of the perineal and genital regions associated with significant morbidity and mortality. Patients with poorly controlled diabetes mellitus are at particularly high risk for severe disease and complications. We present the case of a 57-year-old Hispanic male with uncontrolled type 2 diabetes mellitus (hemoglobin A1c of 12.2%), hypertension, and alcohol use disorder who presented with a two-week history of worsening scrotal pain and swelling. Computed tomography demonstrated extensive subcutaneous emphysema involving the perineum, scrotum, penis, bilateral inguinal canals, and anterior abdominal wall. The patient underwent multiple operative debridements, end colostomy creation, and prolonged antimicrobial therapy for polymicrobial bacteremia and severe sepsis. His hospital course was further complicated by bilateral abdominal wall fluid and gas collections concerning for abscess formation, requiring image-guided drainage and subsequent readmission for persistent collections. After a cumulative hospital stay of approximately seven weeks, he was ultimately discharged in stable condition. This case highlights the aggressive nature of Fournier's gangrene and the importance of early surgical intervention, repeated source control, and close follow-up for persistent or delayed infectious complications.

Hypertriglyceridemia-induced acute pancreatitis and acute appendicitis are distinct clinical conditions rarely reported to occur concurrently. We present a case of hypertriglyceridemia-induced pancreatitis characterized by clinical deterioration despite a decline in serum triglyceride levels. While initial imaging demonstrated pancreatic inflammatory signatures, emergent exploratory laparotomy revealed a concomitant retrocecal appendicitis complicated by a pelvic abscess.