BACKGROUND Angioedema is a rare manifestation of systemic lupus erythematosus (SLE) that can lead to life-threatening complications, including airway compromise. Acquired angioedema is classically associated with C1 esterase inhibitor (C1-INH) deficiency caused either by increased consumption of C1-INH or the development of autoantibodies against C1-INH. However, emerging reports describe patients with active SLE who develop recurrent angioedema despite preserved C1-INH levels and function, suggesting a possible complement-mediated or bradykinin-associated inflammatory phenotype that remains incompletely characterized. CASE REPORT We report the case of a woman in her early 20s with SLE and lupus nephritis who presented with a urinary tract infection and unilateral periorbital edema. Initial laboratory evaluation revealed anemia, thrombocytopenia, and acute-on-chronic kidney injury. She was treated with antibiotics for presumed urinary tract infection and preseptal cellulitis. During hospitalization, she developed laryngeal edema requiring prompt treatment with intravenous dexamethasone, with rapid clinical improvement. Further evaluation demonstrated low C4 and C1q complement levels, elevated C1q complement binding levels, elevated anti-C1q antibodies, and preserved C1-INH antigen and functional levels, raising suspicion for complement-mediated angioedema occurring in the setting of active SLE. Over the ensuing 6 months, she experienced recurrent episodes of angioedema with progressive renal dysfunction and concern for evolving macrophage activation syndrome or severe hyperinflammatory immune activation. CONCLUSIONS This case highlights a rare presentation of recurrent angioedema associated with active SLE and complement activation despite preserved C1-INH levels and function. The case underscores the importance of early recognition of airway involvement in patients with lupus and illustrates the diagnostic challenges surrounding complement-mediated angioedema phenotypes in autoimmune disease.

This retrospective case series aimed to evaluate clinical and MRI-based changes after temporomandibular joint (TMJ) disc anchorage surgery in adolescents with anterior disc displacement without reduction and condylar resorption, and to explore factors associated with postoperative condylar remodeling. Seventy adolescent patients (11-20 years old) diagnosed with anterior disc displacement without reduction were treated with temporomandibular joint disc anchorage followed by occlusal splint therapy. All 70 patients completed the 6-month postoperative follow-up, while 65 patients reached the 12-month follow-up; the remaining 5 patients had not yet reached the 12-month postoperative time point. Clinical and MRI assessments included maximum mouth opening (MMO), visual analog scale (VAS), Helkimo index, disc length (DL), condylar height (CH), bone marrow edema (BME), and occlusal classification. At 6 months, MMO, DL, and CH increased significantly, while VAS and Helkimo index decreased significantly. In the 12-month subgroup, clinical improvement and DL were maintained, and CH continued to increase significantly. Univariable GEE analyses indicated that bruxism, unilateral mastication, and BME were associated with increased odds of non-remodeling at 6 months, whereas splint wear was associated with reduced odds. At 12 months, only three sides showed decreased CH; therefore, associations with potential factors were evaluated descriptively because of the sparse number of events. Open TMJ disc anchorage with postoperative splint therapy was associated with symptom improvement, stable disc repositioning, and favorable MRI-based condylar remodeling. However, causal inference and treatment superiority cannot be established due to the retrospective design, absence of control groups, and limited 12-month follow-up.

Lower leg lipodystrophy can be distressing to patients. Liposuction can contour the ankle, calf, and medial knee areas but requires the understanding of anatomy, thorough preoperative evaluation, and diligent postoperative care. Previous studies focused on a single liposuction technique. In this preliminary report, the authors presented a multimodal technique for lower leg liposculpture for aesthetic lower leg contouring and discussed lessons learned. The authors performed a retrospective review of patients undergoing bilateral liposculpture contouring using a combination of laser, power-assisted, and fine-cannula liposuction of the ankles and calves with or without medial knee contouring between 2021 and 2025. Patients undergoing unilateral procedures, revision surgery, or surgery for lipedema were excluded, as were cases involving liposuction limited to the ankles or knees. Of 40 cases undergoing lower leg liposuction procedures, 30 involved liposculpture of the ankles, calves, and medial knees. The average lipoaspirate was 793 ± 418 cc (range, 300-2700 cc) from each leg. The mean operative duration was 115 ± 33 min (range, 72-200 min), including concurrent procedures. The mean follow-up was 4.2 ± 4.3 months (range, 1 week to 20.5 months). Three patients experienced complications: one developing skin hyperpigmentation, one with scar thickening, and one with pressure injury with cellulitis and prolonged edema. The application of lower leg liposuction has been limited by concerns about complications. The authors present a multimodal approach to lower leg liposculpture. With appropriate preoperative assessment, patient counseling, and postoperative care, this approach can improve lower leg aesthetics with limited adverse events. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.

Peripheral edema in thyrotoxicosis is uncommon and is typically associated with cardiac dysfunction. Unilateral edema without overt heart failure is rarely reported. We present the case of a 40-year-old female patient who presented with edema involving the right lower limb and suprapubic and genital regions. Investigations revealed thyrotoxicosis associated with atrial fibrillation (AF). The patient demonstrated significant clinical improvement following treatment with antithyroid therapy, beta-blocker, glucocorticoids, and supportive management. This case highlights the importance of considering thyroid dysfunction in the differential diagnosis of unexplained unilateral edema after exclusion of more common vascular, infectious, and systemic causes.