Left-sided acute appendicitis (LSAA) is a rare clinical entity, most commonly associated with midgut malrotation (MM) or situs viscerum inversus (SVI). Its atypical presentation poses a significant diagnostic challenge for emergency physicians, radiologists, and surgeons. We report the case of a 53-year-old man who presented with a two-day history of left-sided abdominal pain, fever, and vomiting. Laboratory investigations revealed marked leukocytosis. Abdominal ultrasonography identified an appendix-like structure with surrounding inflammation in the left iliac fossa. Contrast-enhanced computed tomography (CT) of the abdomen confirmed midgut nonrotation, with the ascending colon positioned on the left side and an abnormal superior mesenteric artery-to-vein relationship. The patient underwent open appendectomy through a midline incision. Intraoperative findings confirmed LSAA with large bowel nonrotation. The postoperative course was complicated by peritonitis, which was managed with surgical intervention and broad-spectrum antibiotics. At the 21-day follow-up, the patient was asymptomatic. This case highlights the importance of maintaining a high index of suspicion for LSAA in patients presenting with atypical left lower quadrant pain. Thorough preoperative imaging, particularly CT, is essential for accurate diagnosis and operative planning. Prompt surgical management remains the cornerstone of treatment to prevent life-threatening complications.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare mitochondrial disorder characterized by impaired oxidative phosphorylation and reduced ATP production, resulting in increased organ vulnerability to metabolic stress. Fluoropyrimidine agents, such as 5-fluorouracil (5-FU), are widely used to treat colorectal cancer and can induce gastrointestinal toxicity not only through inhibition of thymidylate synthase and suppression of nucleic acid synthesis but also via RNA misincorporation, translational defects, and mitochondrial dysfunction in intestinal epithelial cells. The coexistence of metabolic vulnerability associated with m.3243A>G-related mitochondrial dysfunction and drug-induced mitochondrial injury may synergistically exacerbate intestinal toxicity, potentially leading to severe enteritis. A 40-year-old woman with m.3243A>G-associated mitochondrial disease within the MELAS spectrum underwent radical resection for perforated rectal cancer with synchronous liver metastases. Her postoperative course was uneventful, and she was discharged without complications. CapeOX therapy (capecitabine plus oxaliplatin) was initiated as adjuvant chemotherapy. Ten days after the start of the third cycle, she developed intermittent fever, abdominal distension, and diarrhea. Computed tomography revealed diffuse edema throughout the small intestine with massive ascites. Malignant peritonitis was considered unlikely based on imaging, ascites analysis, and cytology, whereas infectious enteritis was not strongly suspected based on the clinical course. Chemotherapy-induced enteritis associated with CapeOX was therefore strongly suspected, and the regimen was discontinued. The gastrointestinal symptoms improved, and tumor marker levels normalized. This case suggests that underlying mitochondrial dysfunction may enhance fluoropyrimidine-related intestinal toxicity, indicating that careful risk assessment and close monitoring are required when administering chemotherapy to patients with underlying mitochondrial disorders.

Myeloid neoplasms post cytotoxic therapy (MN-pCT), a rare but severe complication of cytotoxic chemotherapy, is particularly associated with alkylating agents and topoisomerase II inhibitors. Although the risk of MN-pCT is well-recognized in BRCA2 variant carriers, its occurrence in BRCA1 carriers remains uncommon. Here, a woman in her late twenties was diagnosed with locally advanced triple-negative breast cancer (TNBC; estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor receptor 2-negative) (cT3N1M0, stage IIIA) and received neoadjuvant chemotherapy consisting of dose-dense doxorubicin and cyclophosphamide, followed by weekly paclitaxel. During treatment, a pathogenic germline BRCA1 variant was identified. The patient achieved a complete pathological response after mastectomy with axillary lymph node dissection and postoperative radiotherapy. Nine months after surgery, she presented with persistent fever and systemic symptoms and was diagnosed with MN-pCT harboring an 11q23 (KMT2A) rearrangement. The disease was refractory to the initial induction therapy; however, molecular remission was achieved with salvage chemotherapy, followed by successful allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling. This case highlights the importance of clinical awareness and prompt hematologic evaluation when suggestive symptoms develop after cytotoxic chemotherapy in patients with hereditary breast cancer..

Parapharyngeal infections may result in a pseudoaneurysm of the internal carotid artery, a rare but potentially fatal condition. Early recognition and multidisciplinary management are crucial to avoid catastrophic outcomes. We present a case of a twenty-two-year-old man with a parapharyngeal abscess complicated by an internal carotid artery pseudoaneurysm. The patient presented with painful left neck swelling, fever, dysphagia, and hoarseness. Examination revealed oropharyngeal asymmetry, ipsilateral vocal cord paralysis, and shoulder weakness findings consistent with jugular foramen syndrome. Imaging demonstrated a parapharyngeal abscess with a surrounding hematoma encasing the distal internal carotid artery, which appeared aneurysmal and was confirmed as pseudoaneurysm. Despite appropriate antibiotic therapy, the patient's neck pain progressively worsened, and repeat imaging demonstrated enlargement of the lesion. Urgent endovascular coil embolization was successfully performed. The patient was discharged on the second postoperative day and remained neurologically stable at six-month follow-up, with radiological improvement. Carotid pseudoaneurysm secondary to deep neck infection is exceedingly rare. Infection may spread from the parapharyngeal space to the carotid sheath, causing progressive arterial wall erosion. Early identification is crucial, as rupture carries high mortality without intervention. Recent evidence supports endovascular management as a safe and effective alternative to open surgery, particularly for lesions involving the skull base or petrous segment, where surgical exposure is hazardous. This case underscores that deep neck infections presenting with cranial neuropathies or opioid-refractory pain warrant prompt vascular imaging, and that endovascular occlusion represents a safe and effective treatment when collateral circulation is sufficient.

Graves' disease can be managed with antithyroid drugs (ATDs), radioactive iodine (RAI), or surgery. When ATDs are ineffective or poorly tolerated, RAI or surgery may be indicated. Methimazole (MMI) and propylthiouracil (PTU) are commonly used, sometimes with adjunctive agents such as potassium iodide (KI), β-blockers, or corticosteroids. Although ATDs are essential in management, rare but severe allergic reactions may occur, necessitating careful monitoring. We report a case of refractory Graves' disease with a history of ATD-induced hemophagocytic syndrome and multiple drug allergies. A 43-year-old woman was diagnosed with Graves' disease after presenting with thyrotoxicosis and was treated with MMI and KI. Following an increase in the MMI dosage, she developed a rash and was switched to PTU. Although the rash resolved, she developed fever requiring hospitalization. During admission, shock and abnormal vital signs prompted suspicion of PTU-induced hemophagocytic lymphohistiocytosis. Immunosuppressive therapy, plasma exchange, temporary hemodialysis, and corticosteroids led to improvement. She was discharged on corticosteroids, but thyroid function worsened during tapering, making ATDs unsuitable. Sixteen months later, RAI therapy was attempted; thyroid function worsened, and KI was continued. Eighteen months later, she was rehospitalized for fatigue; increasing corticosteroids improved thyroid hormone levels. Due to multiple drug allergies, a drug-induced lymphocyte stimulation test was performed preoperatively and was positive for levothyroxine (LT4), although patch and oral provocation tests were negative, confirming LT4 safety. After stabilization, total thyroidectomy was performed; postoperatively, she received powdered LT4 and calcium supplementation. The course was uneventful, without allergic manifestations, and she was discharged in good condition. This case highlights the risk of severe hematologic complications from PTU and demonstrates that, with careful preoperative evaluation and individualized perioperative management, safe surgical treatment of refractory Graves' disease is possible.

Aorto-left ventricular tunnel (ALVT) is a rare congenital cardiac defect consisting of an extracardiac communication between the ascending aorta and the left ventricle. It may mimic aortic regurgitation, particularly when an eccentric diastolic jet and a systodiastolic murmur are present. Accurate anatomical delineation is essential to distinguish tunnel flow from valvular regurgitation and to guide intervention.