We report a 51-year-old female with rheumatoid arthritis (RA) on long-term methotrexate, hydroxychloroquine, and sulfasalazine, who self-administered multiple medications, including diclofenac 50 mg, without medical supervision. She presented with acute-onset shortness of breath, generalized pruritus, angioedema, and palpitations, and was found to be in severe anaphylaxis with cardiovascular collapse, with a blood pressure of 60/nil mmHg and a heart rate of 143 beats per minute. Diclofenac was considered the most likely trigger based on temporal association and known nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity risk; however, causality cannot be definitively proven as several medications were taken within the same exposure window. Investigations revealed leukocytosis, microcytic anemia, reactive thrombocytosis, and elevated alkaline phosphatase. The electrocardiogram showed no ischemic ST-segment changes or conduction abnormalities. Prompt resuscitation with intramuscular epinephrine resulted in hemodynamic stabilization within 15 minutes of the first dose, with complete angioedema resolution within 30 minutes. The patient was managed without intensive care unit admission and discharged in stable condition on day three. This case highlights the diagnostic and management challenges of severe hypersensitivity reactions occurring in the setting of polypharmacy and emphasizes the importance of individualized analgesic planning and careful medication counseling in patients with RA receiving chronic therapy.

Brucellosis is a zoonotic infection transmitted through contact with infected animals or consumption of unpasteurized dairy products and remains endemic in regions such as the Mediterranean, Middle East, Asia, and Africa. Its variable clinical manifestations often mimic other diseases, complicating diagnosis. We report a case of unilateral Brucella epididymo-orchitis in a middle-aged animal handler to highlight diagnostic and therapeutic challenges. A 32-year-old Indian man working with camels and goats presented with fever, body aches, fatigue, poor appetite, and a lip ulcer. Initial examination was unremarkable. Laboratory tests showed hypochromic microcytic anemia, leukocytosis, and positive Brucella serology. Scrotal ultrasonography demonstrated testicular enlargement with increased vascularity, while blood cultures grew Brucella canis. Although treatment adherence was initially poor due to medication side effects, clinical and laboratory parameters improved after completing antibiotics. The patient was discharged on doxycycline and cefuroxime with close follow-up.

Hemotropic mycoplasmas are Gram-negative bacteria and are recognized as primary causative agents of feline infectious anemia, with a worldwide distribution and variable pathogenicity. This case report describes an unusual clinical presentation of hemoplasmosis in a seventeen-year-old spayed female cat that presented with severe flea infestation accompanied by marked weakness and lethargy. It was febrile, tachycardic, and tachypnoic, with prominent pallor of the mucous membranes. Laboratory analysis revealed severe, non-regenerative, microcytic and (falsely) hyperchromic anemia, with mild lymphopenia and slightly increased plateletcrit. The cat also tested positive for feline immunodeficiency virus (FIV). Blood smear examination raised suspicion of hemoplasmosis, which was later confirmed and identified by polymerase chain reaction (PCR) as Candidatus Mycoplasma haematominutum. Following the treatment of ectoparasites, the cat was successfully treated with enrofloxacin and erythropoiesis-stimulating agents (ESAs), avoiding blood transfusion, and afterwards made a full clinical recovery. Although immunocompromised due to FIV, the cat lived for an additional five years without further relapses. To the best of the authors' knowledge, this is the first documented and PCR-confirmed case of feline hemoplasmosis in Bosnia and Herzegovina. It also highlights the need for conducting a larger study in this region to evaluate hemoplasma prevalence in this species.

This study aimed to assess the prevalence and characteristics of previously undiagnosed anemia among children in Taif. The objective was to estimate the prevalence of undiagnosed anemia in a broader pediatric population (aged 2-12 years) across 3 hospitals, and to evaluate severity and morphological patterns. A cross-sectional study was conducted across Taif region's main hospitals serving children; including Taif Children's Hospital, King Faisal Hospital, and Taif Armed Forces Hospitals. A total of 264 children aged 2 to 12 years, presenting to outpatient clinics or emergency departments for acute, non-hematological conditions, were included. Children with previously diagnosed anemia or chronic diseases were excluded. Blood samples were collected to measure hemoglobin (Hb) levels, and anemia was diagnosed based on age-specific Hb thresholds. Descriptive statistics, chi-square tests, and independent t tests were used for data analysis. Out of 264 children, 28 (10.6%) were found to have undiagnosed anemia. The majority (75%) were aged 2 to 5 years, and a higher prevalence was noted among males (67.9%) compared to females (32.1%), though the gender difference was not statistically significant. There was a significant association between younger age and anemia (P < .001). Mean Hb levels were significantly lower in anemic children (10.13 ± 0.90 g/dL) than in non-anemic children (13.11 ± 0.93 g/dL; P < .001). Most cases were mild (71.4%), followed by moderate anemia (28.6%). Normocytic normochromic anemia was the most common type (53.6%), followed by microcytic hypochromic (39.3%) and macrocytic anemia (7.1%). This study highlights a notable prevalence of undiagnosed anemia among children in Taif, particularly in the preschool age group. The findings underscore the need for routine screening in pediatric outpatient and emergency settings, even in the absence of overt symptoms. Early detection and intervention are essential to prevent long-term developmental complications. Public health efforts should focus on nutritional education, iron supplementation, and comprehensive diagnostic evaluations to address this hidden burden.

Pyodermatitis vegetans (PDV) is a rare, chronic inflammatory dermatosis associated with inflammatory bowel disease (IBD), particularly ulcerative colitis. Though PDV has been documented globally, it remains rare in pediatric populations and under-reported in Pakistan. This case highlights an adolescent male with suspected IBD presenting with extensive cutaneous manifestations consistent with PDV. A 17-year-old male presented with a 10-year history of recurrent vegetative skin lesions, which initially started behind the left ear and then involved the face, axillae, back, chest, buttocks, gluteal cleft, and genitals. He also reported red, itchy, ring-like lesions on the limbs with systemic complaints, including nausea, anorexia, constipation, painful defecation, and fresh rectal bleeding. Physical examination revealed multiple verrucous plaques, nodular eruptions, crusted lesions, and acne scars. Blood workup showed microcytic hypochromic anemia and elevated serum IgE (1375 IU/mL). Histopathological examination of the skin biopsy shows features diagnostic of PDV, including hyperkeratosis, parakeratosis, follicular plugging, elongation of rete ridges, and dermal fibrosis with lymphocytic infiltration. Considering the clinical features and laboratory findings, the final diagnosis made is pyodermatitis vegetans. This study emphasizes how crucial it is to treat PDV as an uncommon extraintestinal sign of IBD in teenagers who exhibit persistent vegetative skin lesions. Accurate diagnosis, mimicking exclusion, and prompt therapy intervention to address underlying systemic connections all depend on multidisciplinary collaboration and teamwork.