Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained human-to-human transmission, occurring via respiratory droplets and prolonged close contact with symptomatic individuals, with a median reproductive number exceeding 2 and an incubation period ranging from 9 to 40 days. ANDV infection can present with a wide range of clinical manifestations. Of them, the most feared is Hantavirus cardiopulmonary syndrome (HCPS), a severe condition characterised by acute respiratory failure, haemodynamic instability, acute kidney injury, hepatic involvement, and dysregulated cytokine release, with high lethality. Disease severity correlates with the degree of neutrophilia, leukocytosis, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase. No approved antiviral therapy or vaccine currently exists; management remains entirely supportive, centred on oxygen supplementation, haemodynamic stabilisation, and renal replacement therapy when indicated. Case fatality rates reached 32% in a 2018-2019 outbreak, with death occurring a mean of 6.7 days from symptom onset. The April 2026 outbreak aboard the MV Hondius cruise ship - involving passengers of 23 nationalities, with 8 cases (6 confirmed, 2 suspected), and 3 deaths reported as of 11 May 2026 (CFR 38%) - exemplifies how a zoonotic pathogen with limited human-to-human transmissibility can rapidly achieve global reach in the era of mass international travel, underscoring the urgent need for clinician awareness, prompt contact tracing, and internationally coordinated outbreak preparedness.

Porencephaly is a rare neurological disorder characterized by cerebrospinal fluid-filled cavities within the cerebral parenchyma. While typically diagnosed in infancy, silent cases may manifest later in life with new-onset seizures. We report a 14-year-old female with a remote history of encephalitis requiring neurosurgical intervention at 8 months of age who presented with her first generalized tonic-clonic seizure. Laboratory evaluation revealed post-ictal leukocytosis and neutrophilia with otherwise unremarkable serum studies. Neuroimaging demonstrated large bilateral porencephalic cysts communicating with the lateral ventricles, accompanied by surrounding gliosis and mild midline shift. The patient remained seizure-free without immediate antiseizure medication and was initiated on levetiracetam for secondary prophylaxis following multidisciplinary consultation. This case highlights that porencephalic cysts can remain clinically silent for over a decade before presenting first-time seizures in adolescence. A history of early brain insult should prompt thorough neuroimaging evaluation, and adherence to contemporary epilepsy terminology is essential for accurate reporting.

Hereditary angioedema (HAE) due to C1 esterase inhibitor (C1-INH) deficiency is a rare bradykinin-mediated disease characterized by recurrent episodes of angioedema. Gastrointestinal manifestations can resemble an acute abdomen and are often misdiagnosed, contributing to delayed recognition. We describe a 35-year-old man with two previous self-limited episodes of abdominal pain with diarrhea over the preceding year, beginning in August 2024, each lasting approximately five days, both of which were diagnosed as acute gastroenteritis and treated with symptomatic intravenous therapy. He presented with acute paroxysmal right lower quadrant abdominal pain and watery diarrhea, without fever, nausea, or vomiting. Contrast-enhanced abdominal computed tomography revealed segmental ileal wall edema with ascites, showing slight progression on repeat imaging later the same day. Laboratory analysis demonstrated leukocytosis with neutrophilia and significantly elevated D-dimer levels. Complement testing showed a significantly reduced C4 concentration (0.08 g/L) and a normal C3 level (0.84 g/L), raising suspicion of HAE. Further evaluation confirmed profoundly decreased functional C1-INH activity (<7%) and a reduced C1-INH antigen level (18.89 μg/mL), establishing a diagnosis of type I HAE. The patient improved following supportive and antispasmodic treatment, and no HAE-specific bradykinin-targeted therapy was administered during this admission. This case emphasizes that recurrent, self-limited abdominal pain accompanied by imaging evidence of transient small-bowel wall edema and ascites should prompt consideration of abdominal HAE. Early assessment of complement C4 is a practical screening strategy that enables timely confirmatory testing and minimizes the likelihood of repeated misdiagnosis.

Background/Objectives: Pancreatic adenocarcinoma remains one of the most lethal malignancies, largely due to aggressive biological behavior and limited available insight into biomarker-based prognostic stratification. The aim of our research was to investigate the role of macrophage migration inhibitory factors (MIFs), interleukin-8 (IL-8/CXCL8), and stem cell factors (SCFs) in pancreatic adenocarcinoma. Methods: In this single-center study, sixty hospitalized patients diagnosed with pancreatic adenocarcinoma were prospectively enrolled, and a cross-sectional analysis of baseline cytokine levels was performed. Serum MIF, IL-8/CXCL8, and SCF were assessed in a single analytical run using Luminex xMAP technology. Results: Elevated MIF and IL-8/CXCL8 levels characterized an inflammatory phenotype, associated with leukocytosis, neutrophilia, increased fibrinogen levels, and unequal prevalence of new-onset diabetes. Higher MIF levels were further associated with larger tumor dimension, while IL-8/CXCL8 was associated with increased bilirubin level and recent weight loss (p < 0.05). In contrast, increased SCF predicted a dissemination phenotype as defined by metastasis occurrence (65.4% vs. 28.6%, p = 0.012). SCF demonstrated significant discriminatory ability for metastasis (AUC 0.712, p = 0.013) and remained significantly associated in multivariable analysis. Conclusions: MIF and IL-8/CXCL8 primarily reflect inflammation-driven processes, whereas SCF identifies a dissemination-dominant phenotype, suggesting distinct biological pathways underlying disease progression in pancreatic cancer.

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe type IV hypersensitivity reaction, most commonly triggered by antibiotics, calcium channel blockers, or antifungal agents, while fluconazole-induced AGEP is exceptionally reported. Early recognition and prompt management are essential to prevent complications. We report the case of a 21-year-old female with no personal or family history of psoriasis who developed a sudden-onset, pruritic, erythematous pustular rash six days after a single 150 mg dose of fluconazole prescribed for vaginal candidiasis. On examination, she was febrile (39°C) and asthenic, with widespread non-follicular pustules initially involving intertriginous areas and subsequently extending to the trunk and limbs. The Nikolsky sign was negative, and mucosal surfaces were spared. Laboratory investigations revealed leukocytosis (10,400/mm[3]) with neutrophilia (7,800/mm[3]), and pustular cultures were sterile. Histopathological examination showed intraepidermal pustules associated with dermal neutrophilic and eosinophilic infiltrates. The European Study of Severe Cutaneous Adverse Reactions (EuroSCAR) score was 11, confirming the diagnosis of fluconazole-induced AGEP. Rapid clinical improvement was observed following discontinuation of fluconazole and supportive treatment with antihistamines and emollients; desquamation occurred within four days, and no systemic complications were noted. Although rare, fluconazole should be considered a potential cause of AGEP, and early diagnosis with prompt withdrawal of the offending drug remains essential to ensure a favorable prognosis.

Background: The early identification of high-risk patients is crucial in stratifying treatment algorithms for Kawasaki disease (KD). Our study aimed to develop a new scoring system to predict the risk of developing a coronary artery aneurysm (CAA) and the persistence of giant CAA during follow-up. Methods: A retrospective cohort study included 151 patients treated at our institute for KD between 2011 and 2025. Results: A total of 25 patients (16.5%) developed CAA, while, in the follow-up period, aneurysms were registered in nine patients. Based on the values obtained from the univariate analysis, a scoring system was developed. It included age <6 months, IVIG treatment for >7 days, refractory KD, leucocytosis (>17 × 109), neutrophilia (>16 × 109), thrombocytosis (>400 × 109), anaemia (<103 g/L), hypoproteinaemia (<54 g/L), and hypoalbuminaemia (<32 g/L). Patients with a score ≥5 had an almost nine-fold higher risk of developing CAA (OR 8.7, 95% CI 3.4-22.6; p < 0.001), while, if the score was ≥8, the risk for a chronic giant aneurysm was 71 times higher (OR 71.5, 95%CI 8.5-597.7; p < 0.001). Based on the ROC curve, a score ≥5 has 99% sensitivity and 70% specificity for the development of CAA (AUC = 0.87). A score ≥7 has 100% sensitivity and 85% specificity for the development of giant aneurysms (AUC = 0.87). Conclusions: The KawaCOR score is the first scoring system in our region specifically designed to predict the development of CAA and acute and chronic giant CAA.