The recurrent outbreaks of Nipah virus since its first emergence have intensified efforts to identify effective antiviral therapeutics. The matrix protein is a key structural protein that maintains virion architecture and plays a crucial role in anchoring the virus to the host plasma membrane. Binding of phosphatidylinositol-4,5-bisphosphate (PIP2) to the matrix protein promotes conformational changes that facilitate membrane association and initiate viral assembly. Therefore, an effective small-molecule inhibitor should not only compete with PIP2 for binding to the Nipah virus matrix protein (NiVM) but also disrupt its interaction with the host membrane. Using virtual screening of FDA-approved drugs combined with ensemble docking, we identified conivaptan as a potential inhibitor of the Nipah virus matrix protein. The multivalent interactions of conivaptan establish stable binding within the PIP2-binding pocket while simultaneously rewiring protein-membrane interactions. In the presence of PIP2, NiVM anchors to the membrane through multiple charged residues, resulting in pronounced local bilayer deformation, an early signature of membrane remodeling. In contrast, conivaptan binding weakens membrane anchoring and preserves a more ordered and compact bilayer, thereby suppressing membrane deformation. Together, these findings identify conivaptan as a promising repurposable inhibitor of the Nipah virus matrix protein and provide a mechanistic framework for targeting virus-membrane interactions during viral assembly.

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition in which fibroids diffusely grow in extrauterine locations. Given its low prevalence, the literature is limited, making evidence-based treatment particularly challenging, especially in premenopausal patients. This case report describes a 34-year-old nulligravid woman with a history of two prior myomectomies who presented with upper abdominal bulk symptoms. Abdominal and pelvic magnetic resonance imaging (MRI) revealed multiple mesenteric and omental masses concerning for recurrent DPL. She underwent exploratory laparotomy with removal of 13 abdominal fibroids ranging from 2 to 12 cm. Postoperatively, her symptoms improved, and she was treated with a gonadotropin-releasing hormone (GnRH) analog (relugolix/estradiol/ norethindrone acetate) with a favorable response and sustained remission on follow up. Our case report demonstrates the efficacy of a novel medical therapy and our scoping review highlights the importance of aggressive surgical management followed by medical therapy for the treatment of DPL in patients with future fertility desires.

Anti-cluster of differentiation 38 (Anti-CD38) monoclonal antibodies such as daratumumab are widely used in multiple myeloma (MM), yet the timing and magnitude of infectious risk remain incompletely defined. We performed an individual patient-level meta-analysis of six randomized trials (N = 2989) comparing daratumumab- versus non-daratumumab-containing regimens in newly diagnosed and relapsed/refractory MM, assessing infectious events over 2 years. Daratumumab-treated patients had higher rates of any-grade (79% vs. 61%) and grade ≥3 infections (29% vs. 20%) than controls, with risk peaking in the first 3 months (42% vs. 36%, p = 0.001) before plateauing. After adjustment, daratumumab was independently associated with grade ≥1 (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.10-1.57), respiratory (OR 1.38, 95% CI 1.11-1.71) and grade ≥3 (OR 1.47, 95% CI 1.08-2.00) infection by 3 months. Daratumumab-treated patients had a higher rate of infection over 2 years (adjusted incidence rate ratio 1.60, 95% CI 1.47-1.73) and more frequently experienced recurrent infections (33% vs. 22% with multiple any-grade infections; 11% vs. 7% with multiple grade ≥3 infections). Preventive strategies were underused, with <20% of patients with severe respiratory infections receiving immunoglobulin replacement. These findings identify an early window of infectious vulnerability with daratumumab and support temporally targeted prevention and monitoring strategies in contemporary MM care.

Fetal transient abnormal myelopoiesis (TAM) can rarely occur without prenatal ultrasonographic abnormalities. We describe a case in which fetal compromise was first detected by cardiotocography (CTG). A previously uncomplicated pregnancy showed normal fetal growth and no structural abnormalities on serial ultrasonography. At 38+1 weeks of gestation, CTG revealed markedly reduced baseline variability with recurrent late decelerations, prompting emergency cesarean delivery. The male neonate, who had features of trisomy 21, exhibited marked leukocytosis with circulating blasts. Placental examination revealed intravascular blasts within both chorionic villous and umbilical cord vessels, confirming fetal TAM. Although peripheral blasts initially regressed, acute megakaryoblastic leukemia developed during infancy and required chemotherapy. Fetal TAM may occur without characteristic prenatal sonographic findings, and sudden CTG deterioration may be the first sign of fetal compromise. Placental and umbilical cord pathology can provide crucial postnatal evidence of in utero hematologic disease.

Elastofibroma dorsi (ED) is a benign fibroelastic pseudotumor that classically arises in the deep infrascapular region. Although characteristic cross-sectional imaging may establish the diagnosis, a symptomatic subscapular mass may initially be approached as a more common benign soft-tissue lesion when imaging is limited to ultrasonography. We report a 63-year-old woman with a progressively enlarging left subscapular mass associated with persistent pain and discomfort. The initial clinical impression was a probable lipoma, and the patient requested removal because of ongoing symptoms. Targeted ultrasonography demonstrated a 35.3 × 8 mm heterogeneous, irregularly marginated, avascular lesion closely related to a rib. Its apparent dimensions varied with movement, and forward positioning of the arm was required to displace the scapula and obtain an adequate acoustic window. Because the lesion was readily localized and excision had already been selected for progressive growth and symptoms, computed tomography or magnetic resonance imaging was not obtained. At surgery, the lesion was firm, fibrous, poorly circumscribed, and tightly adherent to the deep muscular and costal planes rather than lipomatous, prompting intraoperative suspicion of ED. Muscle-sparing en bloc excision was completed without pleural entry or apparent intraoperative complication. Histopathology showed dense collagen, abnormal thick fragmented elastic fibers, and interspersed mature adipose tissue without atypia, mitotic activity, necrosis, or malignancy, confirming ED. At the documented postoperative follow-up visit, the patient had no pain, seroma, infection, or clinical evidence of recurrence. This case emphasizes that a growing, painful deep subscapular mass clinically presumed to be a lipoma warrants attention to scapulothoracic anatomy and dynamic sonographic behavior. When ultrasonographic findings are non-specific, cross-sectional imaging may improve preoperative recognition, while the characteristic intraoperative anatomy can provide an important diagnostic clue.

Ticagrelor is a reversible oral P2Y12 receptor inhibitor recommended in preference to clopidogrel for most patients with acute coronary syndrome. In addition to inhibiting platelets, it raises extracellular adenosine, which is thought to explain its underappreciated capacity to cause bradyarrhythmia. We report three consecutive patients with acute coronary syndrome who developed serious bradyarrhythmias after ticagrelor administration. The first, a 58-year-old woman treated with a drug-eluting stent to the left anterior descending artery, developed high-grade atrioventricular block with asystolic pauses that required a temporary pacing wire, after which ticagrelor was stopped, prasugrel was substituted, and she recovered. The second, a 48-year-old woman with an anterior myocardial infarction, had a cardiac arrest with complete heart block after ticagrelor loading, was resuscitated, paced temporarily, switched to prasugrel, and recovered. The third, a 77-year-old man with an inferoposterior and right ventricular myocardial infarction, had recurrent asystole and ventricular arrhythmia that persisted despite switching to prasugrel and required a permanent pacemaker. None of the patients were receiving an atrioventricular nodal blocking drug, and in every patient the treated coronary lesion was patent on a repeat angiogram, which made ongoing ischemia from stent failure an unlikely sole explanation. A formal Naranjo assessment rated the association as possible in each case. A ticagrelor-induced adverse effect should be considered in any patient who develops unexplained bradycardia or syncope after its administration. Early rhythm monitoring and prompt withdrawal are the key steps, and although the rhythm usually recovers, permanent pacing may be needed when conduction disease is superimposed on ischemic injury to the conduction system.

Gallbladder perforation during laparoscopic cholecystectomy is relatively common and may result in bile and gallstone spillage. Although most retained gallstones remain clinically silent, they can rarely serve as a nidus for delayed intra-abdominal or abdominal wall abscess formation. We report the case of a 68-year-old man who presented with recurrent fever and persistent right thoracic pain for two months, 11 years after laparoscopic cholecystectomy for acute cholecystitis. Computed tomography revealed a large 15 × 11 cm perihepatic collection located between the liver and intercostal muscles, containing a radiopaque foreign body. A limited open approach was performed through a 3-cm incision over the palpable collection. Purulent material was evacuated, and the foreign body was macroscopically identified as a gallstone. The patient remained asymptomatic at one-month follow-up. Retained gallstones may remain occult for several years and subsequently cause abscess formation in unusual locations. Imaging can provide an important diagnostic clue, particularly when a calcified stone is visible within an abscess. Management depends on the location and depth of the collection and generally requires drainage and removal of the retained stone to achieve definitive source control. A retained spilled gallstone should be considered in the differential diagnosis of a delayed perihepatic or abdominal wall abscess in patients with a history of laparoscopic cholecystectomy. Careful review of imaging and surgical history may facilitate diagnosis, while complete drainage and retrieval of the retained stone can provide definitive treatment.

Hypercalcemia is mostly caused by primary hyperparathyroidism (PHPT) or malignancy. Less commonly, hypercalcemia results from vitamin D-dependent mechanisms. Pathogenic variants in CYP24A1, which encodes the 24-hydroxylase responsible for inactivating 1,25(OH)2D3, can lead to hypercalciuria, nephrolithiasis/nephrocalcinosis, and hypercalcemia, typically with suppressed PTH. When CYP24A1-related disease coexists with PHPT, their biochemical features may overlap, potentially masking a vitamin D catabolic defect and complicating postoperative interpretation of hypercalcemia. We report 2 unrelated patients with moderate-to-severe hypercalcemia in whom PHPT and CYP24A1 variants coexisted. The first patient was a 26-yr-old man with longstanding nephrolithiasis who initially had hypercalcemia with an inappropriately normal PTH level and imaging consistent with a hyperfunctioning parathyroid lesion, treated with parathyroidectomy (PTx). Several years later, PTH-suppressed hypercalcemia and elevated 25(OH)D3 and 1,25(OH)2D3 concentrations was detected despite the absence of vitamin D supplementation. Genetic testing revealed a heterozygous pathogenic CYP24A1 variant (p.Leu409Ser), consistent with partial 24-hydroxylase deficiency. The second patient was a 59-yr-old woman with severe PHPT requiring surgery and later experienced life-threatening hypercalcemia (19.8 mg/dL) requiring hemodialysis, marked calcium fluctuations, particularly after calcium and calcitriol exposure following a second surgery, nephrocalcinosis, and progressive renal impairment. Genetic testing identified compound heterozygous CYP24A1 variants (p.Glu143del and p.Gln82Arg). These cases broaden the clinical spectrum of combined PHPT and CYP24A1-related disease and highlight that persistent or recurrent hypercalcemia after PTx, particularly when PTH is suppressed, may prompt evaluation for CYP24A1 defects, with potential implications for vitamin D avoidance and long-term renal surveillance.