Coats disease diagnosed in adulthood is a rare idiopathic retinal telangiectatic vasculopathy that may differ in phenotype from childhood-diagnosed cases. This systematic review synthesizes current evidence to characterize its clinical spectrum, imaging features, treatment outcomes and underlying mechanisms, with a focus on immunovascular pathways. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, PubMed, Scopus and Web of Science were searched through October 2025 for studies including patients ≥18 years with confirmed Coats disease. Clinical and imaging findings, treatment strategies and outcomes were extracted and narratively synthesized. When possible, random-effects meta-analysis was performed. Thirty-five studies comprising 240 patients (250 eyes) were included. Disease presentation was predominantly unilateral and diagnosed at Shields Stage 2 or 3. Laser photocoagulation and anti-vascular endothelial growth factor (VEGF) agents were the most frequently described therapies, with anatomical stabilization or regression of exudation reported in approximately half of treated eyes across heterogeneous studies, and better outcomes in earlier stages. Visual acuity was stabilized or improved in 57.1% of treated eyes, while recurrence occurred in 19.3%. Multimodal imaging consistently identified peripheral telangiectasia, lipid exudation and localized capillary nonperfusion. Aqueous cytokine profiling in small cohorts has reported elevated inflammatory mediators (e.g. interleukin [IL]-6 and IL-1β) in some adults, suggesting that inflammatory signalling may contribute to blood-retina barrier dysfunction and macular oedema alongside VEGF-related permeability. Current evidence supports Coats disease diagnosed in adulthood as a chronic telangiectatic retinal vasculopathy with frequent macular involvement. Therapeutic outcomes appear to favour individualized, imaging-guided combination strategies and prospective studies with standardized endpoints are needed to refine management.

Pleural effusions can be manifestations of heart failure, pulmonary embolism, infection, and malignancy. Symptom assessment, imaging, and pleural fluid analysis serve as key determinants in guiding clinical management. We present the case of a 75-year-old woman with a history of heart failure who developed worsening dyspnea and lower extremity edema. Initial imaging revealed a large unilateral pleural effusion, initially presumed to be secondary to heart failure exacerbation. Pleural fluid analysis demonstrated a discordant exudative effusion by Light's criteria. Following thoracentesis, the development of a tension pneumothorax improved radiographic clarity, revealing previously obscured metastatic osseous lesions that had been masked by the pleural effusion and adjacent lung parenchyma on prior imaging. This prompted further advanced cytologic evaluation which identified dysplastic breast ductal epithelial cells consistent with a malignant pleural effusion. This case underscores the importance of maintaining a broad differential diagnosis, even when pleural fluid analysis is only marginally exudative. Moreover, the occurrence of tension pneumothorax facilitated the identification of occult metastatic lesions, highlighting the essential role of post-procedural imaging in detecting concealed malignancy. This case further emphasizes that even mildly positive exudative effusions necessitate comprehensive investigation for malignancy, as subtle presentations may still indicate significant underlying pathology.

Carpal coalition, the union of at least two carpals, is a rare and often incidental finding. Although typically asymptomatic, symptoms may arise from altered biomechanics, degenerative arthritis, or increased fracture risk. Nearly all combinations of carpal coalitions have been reported, with lunate-triquetrum coalitions being the most common. We present the case of a 62-year-old woman with left radial wrist pain after a ground-level fall whose initial radiographs were negative for fracture; however, careful review of the radiographs revealed an unusual articulation between the capitate, trapezoid, and trapezium. Magnetic resonance imaging confirmed an incomplete capitate-trapezoid-trapezium coalition, and an isolated nondisplaced trapezoid fracture with edema. She was treated conservatively with splinting and fully recovered within 2 months. An incomplete capitate-trapezoid-trapezium coalition has not been previously documented and given the rarity of isolated trapezoid fractures, this case highlights a unique presentation in which abnormal carpal kinematics likely predisposed the trapezoid to fracture.

Pulmonary embolism is an uncommon complication of snake envenomation. While venom-induced consumption coagulopathy typically produces hemorrhagic manifestations, thrombotic complications can paradoxically develop, requiring careful timing of anticoagulation given competing hemorrhagic risks. We report a 65-year-old woman without thromboembolic risk factors who presented 3 days after a snake bite with progressive lower limb swelling and dyspnea. Physical examination revealed unilateral edema with visible fang marks. Despite normalized coagulation parameters, markedly elevated D-dimers prompted computed tomography pulmonary angiography, which demonstrated bilateral segmental pulmonary embolism without detectable lower extremity deep vein thrombosis. The patient was treated with therapeutic anticoagulation using low-molecular-weight heparin followed by rivaroxaban for 6 months, achieving complete resolution without hemorrhagic complications. Snake venom disrupts hemostasis through a biphasic response: initial consumption coagulopathy depleting factors and platelets, potentially followed by a compensatory prothrombotic phase with hyperfibrinogenemia and thrombocytosis. Additionally, specific venom proteases directly cleave fibrinopeptides A and B from fibrinogen while activating factor XIII, creating stable cross-linked fibrin deposits resistant to fibrinolysis. The absence of deep vein thrombosis suggests thrombogenesis occurs through in situ pulmonary mechanisms or undetectable microemboli. The favorable outcome supports safe initiation of therapeutic anticoagulation once acute coagulopathy resolves. Pulmonary embolism, though rare, can complicate snake envenomation even when coagulation parameters are normalized and deep vein thrombosis is absent. After coagulopathy resolves, anticoagulation is safe. Monitoring for thromboembolic events beyond the acute hemorrhagic phase remains essential.

Unilateral leg edema in elderly patients is often attributed to deep vein thrombosis (DVT), particularly when D-dimer levels are elevated. We report an unusual case of an elderly woman with subacute unilateral leg edema caused by compression of the external iliac vein by a traumatic hematoma following a minor fall. Contrast-enhanced computed tomography excluded DVT and revealed venous obstruction due to the hematoma. Percutaneous aspiration led to prompt resolution of the edema without the need for anticoagulation. This case underscores the importance of appropriate imaging to identify alternative etiologies of unilateral leg edema and avoid potentially harmful empiric anticoagulant therapy. J. Med. Invest. 73 : 291-293, February, 2026.

Loiasis is known for two main clinical manifestations: eyeworm and Calabar swellings. Calabar swellings are non-pitting edemas, often on the upper limbs or presenting as unilateral orbital swelling. They are described as itchy or painful, limit mobility, and cause notable morbidity. Although adult Loa loa filariae (macrofilariae) are known to migrate widely through host tissues, their exact pathways and tissue preference (tropism) remain unclear. Whilst the exact mechanisms remain unclear, Calabar swellings are considered to be localized allergic reactions to worm antigens, resulting in angioedema. Leveraging advances in portable ultrasound, this project aimed to characterize Calabar swellings via ultrasound to better understand the pathophysiology behind them. This study was conducted in the Lékoumou department, Republic of Congo, as an ancillary investigation within the MorLo (Morbidity due to Loiasis) project. During a follow-up visit in September 2023, participants and interested villagers were invited to present if they had Calabar swellings. Participants completed a standardized questionnaire and were examined by a physician who also performed ultrasound imaging. Twenty-two individuals presented with visible swellings; 8 (36.4%) were classified as "not typical", 12 (54.5%) as "typical" Calabar swellings and fourteen (63.6%) had subcutaneous nodules on the forearms or wrists, with 8 (36.4%) having both simultaneous swellings and nodules. Ultrasound videos of typical swellings showed nonspecific angioedema, whereas videos of nodules revealed subcutaneous trans-fascial, possibly fluid filled, retentions extending through fascia and crossing anatomical boundaries with mixed-echogenic content. Within these retentions, hyperechoic thread-like structures were visible, displaying autonomous movement in two videos. Their measured diameters corresponded to L. loa macrofilariae. The ultrasound findings are most consistent with trans-fascial migration of adult L. loa filaria, associated with fascial lesions and fluid retention. The classical Calabar swelling appears closely related to-but not directly over-the underlying lesions. Migration of adult L. loa filaria causes a destructive and disabling process that warrants research and public health responses to ensure appropriate care for affected individuals.

BACKGROUND Cases of cat-scratch disease involving both systemic and ocular manifestations typically have a favorable prognosis and usually resolve spontaneously within 1-2 months. However, rare cases with severe ocular involvement may result in irreversible visual impairment. We report a pediatric case in which severe optic neuroretinitis and vitreous hemorrhage developed unilaterally, leading to poor visual recovery. CASE REPORT A 6-year-old girl presented with decreased vision in her right eye 2 months after a febrile illness. Best-corrected visual acuity was counting fingers at 10 cm in the right eye. Fundus examination revealed optic disc edema, serous retinal detachment, vitreous hemorrhage, and multiple exudates extending to the periphery. Magnetic resonance imaging, blood tests, and fluorescein angiography were performed to differentiate optic neuroretinitis, but no disease-specific findings were identified. Due to a history of cat scratches, cat-scratch disease was suspected, and treatment with oral azithromycin (300 mg/day) and prednisolone (0.5 mg/kg/day) was initiated. The vitreous hemorrhage, serous detachment, and exudates gradually improved. Serological testing subsequently confirmed Bartonella henselae infection (IgM 1: 40, IgG ≥1: 1024). After 19 months, her best-corrected visual acuity improved to 20/100, but a central relative scotoma remained. CONCLUSIONS This case highlights that a delayed recognition of visual loss in pediatric patients with cat-scratch disease may allow severe inflammation to persist, ultimately leading to irreversible visual impairment, despite administering combined antibiotic and corticosteroid therapy.

Isolated hypoglossal nerve injury is an infrequent occurrence in clinical and forensic traumatology practice. Its etiology includes trauma, malignancy, vascular events, autoimmune diseases, and complications of surgical procedures. Clinical manifestations resulting from nerve damage may present early or be delayed. We present the case of a 44-year-old woman who sustained a fracture of the third cervical vertebra following a traffic accident. An anterior approach was employed for instrumentation using an anterior plate spanning two cervical segments. The patient developed dysphagia and swallowing difficulties and subsequently underwent evaluation for disability status. Physical examination revealed significant atrophy and asymmetry of the right half of the tongue body, slight rightward deviation of the tongue apex at rest, and fasciculations. Electromyography performed 22 months after the injury demonstrated chronic axonal injury of the right hypoglossal nerve. Causality assessment favored the traffic accident as the initiating event, with postoperative edema and retraction likely contributing to progression. The condition was classified as permanent, and a 25% functional loss was assigned for tongue paralysis according to national disability criteria. This report highlights the diagnostic, prognostic, and legal complexities of delayed hypoglossal nerve palsy following cervical trauma and underscores the importance of a multidisciplinary approach in determining the etiology and prognosis of isolated hypoglossal nerve paralysis, as well as in establishing medical causality.