Wiskott-aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency characterized by thrombocytopenia, eczema, and recurrent infections. Live vaccines, such as Bacillus Calmette-Guérin (BCG), routinely administered in tuberculosis-endemic regions, may cause severe complications in undiagnosed patients. We report a 2-year-old boy with genetically confirmed WAS who developed a rare BCG-related brain abscess. The patient initially presented with neonatal thrombocytopenia and eczema, followed by recurrent respiratory and gastrointestinal infections. Whole exome sequencing identified a pathogenic mutation in the WAS gene. During pre-hematopoietic stem cell transplantation (HSCT) evaluation, brain imaging revealed a large multiloculated right parieto-occipital abscess with significant mass effect. Surgical drainage was performed, and polymerase chain reaction confirmed Mycobacterium bovis (BCG strain). Antitubercular therapy was initiated. Severe thrombocytopenia complicated management and necessitated splenectomy. Although platelet counts improved and infection was partially controlled, HSCT was postponed due to active infection. The patient subsequently died following a severe COVID-19 infection. This case highlights the diagnostic and therapeutic challenges of BCG-related brain abscess in patients with WAS and underscores the importance of early genetic diagnosis, avoidance of live vaccines, and timely definitive treatment in primary immunodeficiencies.

Metastatic involvement of the prostate and bladder trigone from gastric adenocarcinoma is exceedingly rare. We report the case of a 38-year-old man with previously treated diffuse-type gastric adenocarcinoma who developed bilateral hydroureteronephrosis during surveillance. Cystoscopy demonstrated an Inflamed prostatic urethra with early papillary changes and abnormal trigonal mucosa with bilaterally narrowed ureteric orifices. Retrograde studies revealed bilateral mid-ureteric strictures without intraluminal lesions. Biopsies from the prostatic urethra and trigone confirmed metastatic gastric adenocarcinoma. Ureteric stents failed to provide adequate drainage, necessitating bilateral nephrostomy insertion. This case highlights an unusual pattern of lower genitourinary metastasis from diffuse gastric cancer and underscores the importance of histological confirmation and multidisciplinary management.

Nabothian cysts are common benign retention cysts of the uterine cervix and are usually small, asymptomatic, and incidentally detected. Giant nabothian cysts are rare and may become clinically significant because of mass effect, cervical distortion, symptoms, diagnostic uncertainty, or possible interference with fertility in selected patients. We report the case of a 32-year-old woman with secondary infertility for two years and no significant medical, surgical, or gynecologic history. Before referral, she had not undergone a complete infertility evaluation or detailed per-speculum cervical examination and had waited for spontaneous conception. At our department, speculum examination revealed a large translucent and tense cystic mass occupying almost the entire vaginal cavity and arising from the anterior cervical lip. Pelvic ultrasonography showed a well-circumscribed unilocular anechoic cervical cyst measuring 53 x 50 mm, with regular contours and no solid or complex components. A standard infertility work-up performed after referral was otherwise unremarkable, including ovulation and hormonal assessment, tubal patency evaluation, pelvic ultrasound, and partner semen analysis. The patient was not receiving ovulation induction or hormonal infertility treatment at the time of drainage. Conservative puncture under local anesthesia aspirated 100 mL of viscous mucoid fluid, and a biopsy of the cyst wall was performed. Cytologic examination showed benign endocervical-type epithelial elements without atypia or malignant cells. Histopathologic examination showed mucin-filled cystic spaces lined by benign columnar, cuboidal, or flattened epithelial cells, without cytologic atypia, notable mitotic activity, dysplasia, or malignancy, confirming a nabothian cyst. Clinical and ultrasound follow-up showed resolution of the cyst without recurrence. The patient conceived spontaneously two months after treatment, and the pregnancy resulted in a live birth according to available follow-up. This case highlights a temporal association between conservative treatment of a giant nabothian cyst and subsequent conception, without proving direct causality. Large cervical masses require careful clinical examination, appropriate imaging, broad differential diagnosis including cystic and non-cystic lesions, and cytologic or histopathologic confirmation when diagnostic uncertainty exists.

Amivantamab is an epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition (MET) antibody. Lazertinib is an EGFR tyrosine kinase inhibitor with central nervous system penetration. Used in combination, this targeted therapy is effective in treating non-small cell lung cancer (NSCLC). However, it has been associated with severe dermatologic adverse reactions. A 61-year-old woman with a history of EGFR-mutated NSCLC with brain metastases on amivantamab-lazertinib therapy presented for follow-up with drainage from her scalp incision after undergoing a right parietal craniotomy and mass excision five months prior. The patient denied constitutional and neurologic symptoms, but reported yellow staining on her pillow. Examination initially demonstrated yellow fibrinous exudate and hair matting along the surgical incision. Computed tomography (CT) of the head revealed overlying scalp swelling and minimal extra-axial dural thickening over the prior right parietal craniotomy site with stable intracranial metastatic lesions. Due to concern for dehiscence, her biologic therapy was paused, and she was taken to the operating suite where no evidence of infection, delayed healing, or wound dehiscence was noted. A 10 × 5 cm area of patchy granulation tissue and ulceration was observed along the right parietal scalp. Biopsy revealed granulation tissue and multinucleated giant cells and was negative for tumor. Given the risk of malignant progression with all targeted therapy paused, the patient was restarted on amivantamab monotherapy. Following disease progression two months later, she was transitioned to carboplatin and etoposide. EGFR is widely expressed in skin keratinocytes and intimately involved in epithelial differentiation. Therapies targeting EGFR, such as amivantamab plus lazertinib, are associated with adverse dermatologic reactions, ranging from dry skin to severe scalp ulceration, which can interrupt treatment, contribute to poorer clinical outcomes, and reduce quality of life. Standard of care includes limiting sun exposure and avoiding alcohol-based topical agents. The use of daily prophylactic antibiotics, such as oral doxycycline, topical clindamycin, chlorhexidine wash, and ceramide moisturizer, may significantly reduce the risk of adverse skin reactions. Implementation of this multicomponent regimen reduced the rate of severe scalp reactions from 26% to 10% relative to the standard of care, with sustained benefit observed for at least six months.

Aneurysms of the pancreaticoduodenal arcade are uncommon visceral artery aneurysms that are strongly associated with stenosis or occlusion of the celiac axis and that may rupture irrespective of size. Rupture produces a peripancreatic or retroperitoneal hematoma, and duodenal stenosis is a recognized sequela; biliary complications have rarely been reported. An 84-year-old man admitted with an acute Stanford type B aortic dissection with a thrombosed false lumen was managed conservatively with strict blood pressure control. Surveillance non-contrast computed tomography (CT) on day 7 incidentally showed a periduodenal hematoma, absent on day 5, in a patient who had no abdominal pain. Contrast-enhanced CT on day 8 demonstrated a 5-mm aneurysm of the anterior inferior pancreaticoduodenal artery (AIPDA) adjacent to the hematoma, together with severe celiac origin stenosis. The same narrowing was present on the day 0 study, as demonstrated on retrospective review. Coil embolization on day 12 occluded the aneurysm, and the arcade remained patent, maintaining collateral blood flow to the liver; the celiac origin stenosis was not treated. Postprandial vomiting began on day 16, and imaging on day 19 confirmed high-grade stenosis at the distal descending duodenum. He was managed with nasogastric decompression and parenteral nutrition, and endoscopy showed a short, tight stenosis of extrinsic appearance with normal mucosa. On day 37, he developed septic shock with direct-predominant hyperbilirubinemia, and CT showed a dilated biliary tree with severe narrowing of the common bile duct at the level of the coils. According to the Tokyo Guidelines 2018, grade III acute cholangitis was diagnosed, and an endoscopic nasobiliary drainage catheter was placed without sphincterotomy; blood and bile grew extended-spectrum beta-lactamase-producing Escherichia coli. The duodenal stenosis improved sufficiently for an oral elemental diet on day 45 and a full oral diet on day 47, and he was discharged home walking unaided on day 60. Rupture of an AIPDA aneurysm may be painless, although this is not the usual presentation, and may be detected only on surveillance imaging; severe cholangitis may follow in a patient with a persistent periduodenal hematoma and duodenal obstruction. Both complications were managed nonoperatively.

The periocular contour is one of the most complex and vulnerable anatomical regions of the face and is highly prone to complications following the injection of biomaterials such as liquid polycaprolactone (PCL), hyaluronic acid (HA), and polylactic acid (PLA). These complications include persistent hyperpigmentation, malar edema, fibrosis, sensation of pressure, structural irregularities, and lymphatic dysfunction. Periocular adipostructuring is a specialized variant of facial adipostructuring. The technique uses blunt-tipped cannulas (25G and 27G × 50 mm), precise maneuvers for controlled tissue dissection, and localized delivery of the active components of the FaceStructure® Kit (Mioface Harmony, Cúcuta, Colombia), together with adjuvant agents such as Melilotus officinalis and organic silicon. Through this approach, fibrosis is released, mechanotransduction is activated, the clearance of ferric pigments is promoted, and lymphatic drainage is stimulated, thereby restoring the anatomical architecture without inducing additional volume or trauma. This is a retrospective experimental study in which 30 patients presenting with clinical complications of the periocular region secondary to the placement of PCL, PLA, and HA fillers were treated, distributed as follows: PCL = 12; PLA = 10; and HA = 8. The study included 22 females and eight males aged between 35 and 60 years. The results show that, despite involving complications in the periocular contour, most patients achieved clinical recovery, and the treatment was associated with a histological shift consistent with the remodeling of localized fibrosis into a more organized and functional dermal tissue. Using this technique in complicated patients has allowed the development of a functional regenerative intervention model focused on restoring optimal anatomical conditions so that the tissue can recover autonomously, providing a reproducible, safe solution that is applicable to a broad spectrum of complications.

Electrical alternans is an uncommon electrocardiographic finding classically associated with significant pericardial effusion and may raise suspicion for cardiac tamponade in the appropriate clinical context. We report the case of a 65-year-old man who presented with 3 days of progressive dyspnea 10 days after hospitalization for acute pericarditis, during which transthoracic echocardiography showed no pericardial effusion. On presentation, he was tachycardic at 110 beats/min and had jugular venous distension, while electrocardiography demonstrated prominent electrical alternans. Although he was not hypotensive and had no overt evidence of hemodynamic compromise, the combination of recent pericarditis, progressive dyspnea, venous congestion, and electrical alternans raised immediate concern for a rapidly evolving large pericardial effusion with clinical features suggestive of cardiac tamponade. Point-of-care ultrasound rapidly demonstrated a large pericardial effusion, prompting urgent transfer for definitive evaluation and management. Within minutes of transfer, the patient's respiratory distress worsened despite persistently preserved vital signs, and urgent pericardial drainage was performed. Approximately 1,200 mL of grossly hemorrhagic pericardial fluid was evacuated, resulting in rapid and marked clinical improvement. This case highlights electrical alternans as an important early clinical clue to significant pericardial effusion and emphasizes the value of immediate point-of-care ultrasound in the emergency department when cardiac tamponade is clinically suspected. It also demonstrates the dynamic nature of pericardial disease, showing that a large pericardial effusion with clinical features suggestive of cardiac tamponade may develop within a short interval after a previously negative echocardiographic examination. Integrating electrocardiographic findings with rapid bedside ultrasound assessment may facilitate earlier recognition of evolving clinically significant pericardial disease and timely definitive intervention.

Amyand's hernia is defined as the presence of the vermiform appendix within an inguinal hernia and becomes particularly challenging when appendicitis progresses to perforation and extra-abdominal sepsis. We report a 60-year-old man with one week of progressive abdominal pain, reduced appetite, constipation, and impaired ambulation followed by three days of painful right inguinoscrotal enlargement. Examination showed an irreducible, inflamed right inguinoscrotal mass. Laboratory testing demonstrated leukocytes of 19.35 × 10[3]/µL, neutrophils of 92%, and bands of 13%. Ultrasonography showed a right inguinal wall defect with non-reducing omentum and bowel and complex scrotal contents. Emergency inguinal exploration drained approximately 400 mL of frank purulent material and demonstrated severe ischemic changes of the right spermatic cord and testis. Given the extent of the operative findings, midline laparotomy was performed; a retroperitoneal abscess communicating with the inguinal region and a gangrenous perforated appendix were identified, with the perforation approximately 1.5 cm from the appendiceal base. Appendectomy, retroperitoneal and scrotal drainage, Penrose drain placement, right orchiectomy for nonviability, and Shouldice tissue repair without mesh were performed. Recovery was favorable without known immediate complications. This case illustrates a severe Type III Amyand's hernia with simultaneous retroperitoneal and inguinoscrotal septic extension and irreversible testicular ischemia. In grossly contaminated presentations, prompt source control, excision of nonviable tissue, and nonprosthetic hernia repair remain pragmatic priorities.

Tuberculosis (TB) remains a major global health concern, particularly among immunologically and nutritionally vulnerable individuals. Although celiac disease (CD) has been associated with an increased risk of TB, extensive and complicated forms remain rarely reported. We report the case of a 27-year-old man with CD, poor adherence to a gluten-free- diet (GFD), schizophrenia, and substance use disorders, who presented with extensive cavitary pulmonary TB (PT) complicated by pyopneumothorax and severe undernutrition. Concerns were raised regarding anti-TB drug absorption. In the absence of injectable anti-TB agents, standard oral treatment was initiated alongside a strict GFD, nutritional rehabilitation, and cessation of substance use. The patient showed very gradual general health improvement and required prolonged chest drainage, ultimately resulting in clinical recovery with residual pleuroparenchymal sequelae. This case highlights that PT in active CD can achieve recovery with oral anti-TB therapy when associated malabsorption is strictly managed.

Ureteral diverticulum is an exceptionally rare abnormality that may be congenital or acquired secondary to chronic obstruction, calculi, infection, or prior instrumentation. While often asymptomatic, complicated cases can present with hematuria, recurrent UTIs, or sepsis. A 60-year-old bedridden woman with morbid obesity and a history of multiple endourological procedures presented with urosepsis and hematuria. Computed tomography demonstrated mild hydroureteronephrosis and a periureteric fluid collection with gas locules and contrast extravasation, initially raising suspicion of an infected urinoma. Subsequent retrograde pyelography and rigid ureteroscopy confirmed a narrow-necked ureteral diverticulum at the level of the sacroiliac joint. Following antibiotic therapy and urinary drainage, the patient improved clinically and was managed conservatively due to her high operative risk, remaining asymptomatic at follow-up. Acquired ureteral diverticulum should be considered in patients with hematuria, urosepsis, and a history of prior endourological procedures when cross-sectional imaging shows periureteric collections or contrast leakage. Retrograde pyelography and ureteroscopy are essential for distinguishing a diverticulum from free ureteral perforation. Conservative management with urinary drainage is a viable approach in selected high-risk patients.

Pilar cysts, also known as trichilemmal cysts, are benign keratin-filled lesions that arise from the outer root sheath of the hair follicle. Pilar cysts account for a small minority of cutaneous cysts and are most commonly found on the scalp, particularly in middle-aged women. Because they overwhelmingly occur on the scalp, presentation in other anatomical locations is uncommon and can create diagnostic uncertainty. We present the case of an 81-year-old male with a slowly enlarging, painless mass on the left upper arm that had been present for nearly eight years. The lesion was well-circumscribed and firm on examination, without associated erythema, drainage, or tenderness. Given its gradual growth, surgical excision was performed. Grossly, the mass was encapsulated and measured approximately 1.5 cm in diameter. Histopathologic evaluation demonstrated a keratin-filled cyst lined by stratified squamous epithelium with abrupt trichilemmal keratinization and absence of a granular layer, confirming the diagnosis of a benign pilar cyst. There was no evidence of proliferative or malignant transformation. The patient tolerated the procedure well and had an uncomplicated postoperative course. Although pilar cysts are benign, their presence in atypical locations such as the upper extremity may broaden the differential diagnosis to include epidermoid cysts, lipomas, and other soft tissue neoplasms. This case highlights the importance of maintaining clinical suspicion for pilar cysts outside of the scalp and emphasizes the role of histopathologic confirmation in establishing an accurate diagnosis. Recognizing these rare presentations can help prevent misdiagnosis and ensure appropriate surgical management.

Huntington's disease (HD) is characterized by progressive accumulation of mutant huntingtin (mHTT), neurodegeneration and motor dysfunction. Increasing evidence implicates impaired glymphatic function and loss of perivascular aquaporin-4 (AQP4) polarization in HD, suggesting that defective brain waste clearance may contribute to disease pathogenesis. Whether restoration of AQP4-mediated glymphatic transport can ameliorate HD pathology remains unknown. We tested whether genetic restoration of AQP4 improves glymphatic function and HD-associated phenotypes in heterozygous zQ175 knock-in mice. At 2 months of age, premanifest zQ175 mice received a single retro-orbital injection of BBB-penetrant AAV9-PHP.eB encoding the AQP4 (M1 isoform). Glymphatic transport was assessed by intracisternal injection of fluorescent BSA-647 and quantification of parenchymal influx and drainage to the deep cervical lymph nodes. Perivascular AQP4 localization, mHTT aggregation, gliosis, DARPP32 immunoreactivity, CSF neurofilament light chain (NfL) and total Tau, structural brain volumes by 11.7-T MRI, and motor behavior were assessed longitudinally through 12 months of age. AAV9-PHP.eB-AQP4 produced widespread brain expression and restored perivascular AQP4 localization in the striatum and cortex of zQ175 mice. AQP4 overexpression significantly increased glymphatic tracer influx into brain parenchyma and BSA-647 drainage to the deep cervical lymph nodes. At 12 months, AQP4 restoration reduced CSF NfL and total Tau concentrations, mHTT aggregate number and mean aggregate size, and striatal Iba1-positive microglia and GFAP-positive astrocytes (P < 0.05). AQP4 overexpression also preserved striatal DARPP32 immunoreactivity and significantly attenuated striatal atrophy measured by MRI. Female zQ175 mice showed improved balance-beam performance and locomotor activity, while effects on motor performance in males did not reach statistical significance. AQP4 overexpression attenuated body-weight loss in both sexes. No detectable structural, behavioral or body-weight abnormalities were observed following sustained AQP4 overexpression in wild-type mice. In summary, restoration of AQP4 enhances glymphatic-lymphatic transport and is associated with reduced proteopathic, neuroinflammatory and neurodegenerative phenotypes in zQ175 HD mice. These findings provide proof-of-concept that impaired glymphatic function is a modifiable component of HD pathology and support AQP4-mediated restoration of brain waste-clearance pathways as a potential disease-modifying therapeutic strategy.

Pulmonary lymphatic vessels are essential for interstitial fluid balance and macromolecular clearance, yet the endothelial mechanisms regulating lymphatic vessel function during chronic fibroproliferative lung injury remain undefined. Here, we demonstrate that the lineage-defining transcription factor ERG in lymphatic endothelial cells (LECs) governs junctional plasticity and fluid drainage in pulmonary fibrosis. In human idiopathic pulmonary fibrosis (IPF) lungs, lymphatic ERG expression is markedly downregulated. Lineage-specific inducible deletion of Erg in murine LECs (Erg-CKO) unexpectedly conferred robust protection against bleomycin-induced pulmonary fibrosis, significantly dampening acute inflammation, reducing edema, and preserving pulmonary compliance. Mechanistically, loss of ERG enhanced lymphatic drainage capacity in vivo. Transcriptomic profiling of isolated LECs revealed that ERG deficiency activates actomyosin contractile pathways and selectively upregulates Endothelin Receptor Type B ( Ednrb ), driving junctional remodeling from continuous zippers into discontinuous button-like configurations that facilitate interstitial fluid entry. Pharmacological blockade of EDNRB with BQ-788 abolished junctional reorganization, eliminated the enhanced lymphatic drainage, and completely reversed the anti-fibrotic protection in Erg-CKO mice. Together, our findings identify an endothelial ERG-EDNRB regulatory axis that controls lymphatic junctional architecture and demonstrate that promoting lymphatic clearance via endothelial junctional remodeling represents a viable therapeutic strategy for fibrotic vascular remodeling.

Quinone-based conductive materials promote extracellular electron transfer and methanogenesis during anaerobic digestion, in which the materials mediates the transfer of electrons produced by exoelectrogens to electrotrophic methanogens. However, the electron transfer mechanism between quinone and electrotrophic methanogens at the biotic-abiotic interface remains elusive. In this study, an interface between reduced anthraquinone and Methanosarcina barkeri is established in a microbial electrolysis cell. Biomimetic experiments and characterization of isolated extracellular polymeric substances reveal electronic complementarity between the electron-donating π-system of reduced anthraquinone and the electron-accepting iron-porphyrin ring of heme, which may be released by cell lysis and retained within extracellular polymeric substances. This complementarity may promote π-π interactions that retain redox-active heme and facilitate electron transfer, consistent with lower interfacial resistance (34.3 versus 225 Ω) and 10.6-fold enhancement in cathodic methanogenesis. This study provides insight into quinone-mediated electron transfer at the biotic-abiotic interface and supports the design of electrode materials for bioelectrochemical systems.