Granulomatosis with polyangiitis is a necrotizing granulomatous vasculitis that predominantly involves the upper and lower respiratory tracts and the kidneys. Although sinonasal manifestations are common, they are often nonspecific and can mimic benign inflammatory conditions, leading to delayed diagnosis. In contrast, strictly localized disease limited to the nasal septum without systemic involvement is exceptionally rare. We report the case of a 27-year-old woman presenting with persistent nasal obstruction and rhinorrhea. Nasal endoscopy revealed a septal perforation. Computed tomography demonstrated focal nasal septal lysis without paranasal sinus involvement. Laboratory investigations showed markedly elevated c-ANCA levels, and histopathological examination of a septal biopsy confirmed granulomatosis with polyangiitis. Systemic imaging revealed no pulmonary or renal involvement, supporting a localized form of the disease. The patient was treated with systemic corticosteroids and methotrexate, resulting in clinical remission at 5 months. This case highlights the crucial role of imaging in detecting early structural abnormalities and guiding biopsy in atypical presentations of GPA. Early recognition of localized disease is essential to initiate appropriate immunosuppressive therapy and prevent progression to systemic involvement.

Rhinophyma is a deforming disease that affects the nose mainly of Caucasian men. Progressive nasal skin thickening, telangiectasias, and hypertrophy of sebaceous appendages are frequently found in these patients. Many therapeutic modalities have been reported with good results. Among these, tangential excision is established as the surgical modality of choice. In advanced cases, it is not possible to distinguish nasal deformities resulting from rhinophyma from those resulting from malposition of the anatomic components that make up the nasal framework. We describe the use of a mixed technique in which the tangential excision and the open approach complement each other satisfactorily, restoring both shape and structure of the nose. This approach may represent a safe alternative for the simultaneous treatment of rhinophyma and a structured rhinoplasty, and further studies are needed for its full validation in clinical practice.

A 23-y-old female rhesus macaque (Macaca mulatta) from a long-term research colony developed progressive clinical decline, with lethargy, nasal discharge, and hematologic abnormalities, including persistent leukocytosis, neutrophilia, thrombocytopenia, and anemia. Despite treatment with enrofloxacin, deterioration led to euthanasia. Autopsy revealed severe vegetative endocarditis of the left atrioventricular (mitral) valve with intralesional gram-positive cocci, confirmed immunohistochemically as Staphylococcus aureus. Histologically, disseminated thromboembolic arterial disease was present in the lungs, tracheobronchial lymph node, kidneys, and spleen, with concurrent hepatic central vein thrombosis and coagulative necrosis of hepatocytes, supporting a concurrent hypercoagulable state. A PCR assay of the mitral valve tissue targeting the bacterial 16S ribosomal RNA gene was negative for S. aureus (interpreted as a false-negative result), acknowledging the limitation of PCR testing of formalin-fixed tissues caused by DNA damage and fragmentation. The absence of heart-failure cells and pulmonary edema made primary congestive heart failure unlikely and instead supported systemic inflammatory response syndrome with secondary multi-organ ischemic injury as the cause of death. In infective endocarditis, sustained bacteremia and inflammatory mediator release drive endothelial dysfunction, a hypercoagulable state, and widespread microvascular thrombosis, resulting in impaired tissue perfusion and organ failure.[8,22] Accordingly, the dominant life-threatening process in our case was not mechanical cardiac failure, but disseminated thromboembolic disease and ischemic injury to downstream organs. This pattern is well recognized in both human and veterinary literature; morbidity and mortality in infective endocarditis are frequently driven by septic embolization and systemic complications, rather than intrinsic cardiac dysfunction.

BackgroundEvidence suggests that thrombo-inflammation underlies post-acute sequelae of SARS CoV-2 (PASC). Rotational Thromboelastometry (ROTEM) identifies hypercoagulability related to thrombo-inflammation in hospitalized patients. We sought to determine whether COVID-19 acute lung injury/acute respiratory distress syndrome (ALI/ARDS) survivors with PASC have evidence of hypercoagulability identifiable on ROTEM at 15 months after discharge.MethodsWe conducted a single-center prospective cohort study of 93 adults hospitalized for COVID-19 ALI/ARDS in 2020. At 15-month follow-up, participants not receiving dual antiplatelet therapy or anticoagulation and without genetic coagulation disorders underwent ROTEM testing and completed symptom questionnaires. Cross-sectional associations between ROTEM parameters and PASC using the 12 symptoms and scoring from the RECOVER definition were tested using generalized additive models with propensity score adjustment for demographics, comorbidities, and aspirin use. Sensitivity analyses evaluated associations with specific PASC symptom phenotypes: patient-reported moderate or greater post-exertional malaise (PEM), fatigue, or brain fog.ResultsParticipants had a mean age of 55 years (SD, 11); 40% were women; 54% required mechanical ventilation, 18% received non-rebreather mask or non-invasive ventilation only, and 28% received nasal cannula oxygen only. At 15-month follow-up, 24% had PASC, 43% had PEM, 27% had fatigue, and 20% had brain fog. In adjusted analyses, increased fibrinogen contribution to clot strength (FIBTEM maximum clot firmness [MCF]), showed direct, linear associations with PASC risk. FIBTEM MCF values above reference ranges were more common in those with PASC (13 [59%] vs 20 [28%], p < 0.01). Similar associations were observed for PEM and fatigue, but not brain fog.ConclusionsAmong survivors of COVID-19 ALI/ARDS, at 15 months after hospitalization, PASC, PEM, and fatigue, but not brain fog, are associated with subclinical hypercoagulable clotting characteristics identified on ROTEM that are driven by fibrinogen dysregulation. Further work is needed to evaluate the role of long-term coagulation abnormalities in persistent post-COVID physical symptoms and to explore potential therapeutic approaches.

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), represents a chronic immune-mediated disorder frequently associated with extraintestinal manifestations. While musculoskeletal, dermatologic, and ocular complications are well recognized, ear, nose, and throat (ENT) involvement remains underrecognized despite its potential morbidity. Objective: To systematically evaluate the spectrum of ENT manifestations in IBD, focusing on clinical presentation, diagnostic approaches, and outcomes. Methods: A systematic literature search was conducted in PubMed and Scopus in accordance with PRISMA 2020 guidelines. Eligible studies included English-language human studies (2015-2026) reporting ENT manifestations in UC or CD. Following screening, 23 studies were included in the qualitative synthesis. Extracted data comprised study design, IBD subtype, patient demographics, ENT manifestations, diagnostic methods, and clinical outcomes. Results: The majority of studies consisted of case reports and small observational series. Sensorineural hearing loss (SNHL) was the most frequently reported manifestation in both adult and pediatric populations, with evidence suggesting immune-mediated mechanisms and variable responsiveness to corticosteroids. Nasal involvement included pyoderma gangrenosum, pyoderma vegetans, and aseptic nasal septal abscess, occasionally resulting in severe structural complications such as saddle-nose deformity. Laryngeal and airway involvement included dysphonia, tracheitis, and rare but potentially life-threatening inflammatory airway disease. Additional findings included associations with chronic rhinosinusitis. Diagnosis relied on audiometry, imaging, endoscopy, and histopathology. Systemic corticosteroids were frequently effective; however, delayed recognition may lead to irreversible sequelae. Conclusions: ENT manifestations in IBD constitute a clinically heterogeneous but important group of extraintestinal complications. Increased awareness of ENT manifestations may support earlier diagnosis and multidisciplinary management of IBD, potentially reducing irreversible complications.

This study focuses on the issue of maxillary bone developmental abnormalities in cleft palate patients, breaking through the traditional cognitive limitation of attributing the condition solely to surgical scar effects. Clinical observations revealed that maxillary retrusion also exists in unoperated cleft palate patients, leading to the hypothesis that nasal cavity pressure may have an influence on maxillary bone development in these patients. Using finite element analysis techniques, a 3-dimensional model of the soft palate-trachea region was constructed to simulate the pressure changes on the nasal surface of the maxillary bone under different velopharyngeal closure states (velopharyngeal insufficiency, excessive velopharyngeal closure, and normal state). The results showed that the size of the velopharyngeal gap is closely related to the airflow pressure stimulation received by the maxillary bone. The larger the velopharyngeal distance, the stronger the negative pressure on the surface of the maxillary bone, which may inhibit its development; the smaller the velopharyngeal distance, the weaker the negative pressure, which helps to reduce the inhibitory effect. This study provides a new perspective for understanding the mechanism of maxillary bone development in cleft palate patients and offers important guidance for optimizing cleft palate treatment strategies.