Reactive infectious mucocutaneous eruption (RIME) is an infection-associated mucositis syndrome previously described under terms including incomplete Stevens-Johnson syndrome (SJS), Fuchs syndrome, and Mycoplasma pneumoniae-induced rash and mucositis (MIRM). It is characterised by an infectious prodrome, prominent mucosal involvement, and sparse or absent cutaneous disease. Severe ocular involvement may clinically mimic atypical Stevens-Johnson syndrome. We report the case of a previously healthy woman in her 20s who developed coryzal symptoms and self-treated with ibuprofen, paracetamol, and pseudoephedrine before presenting with worsening cough, pyrexia, odynophagia, and bilateral conjunctival discharge. She received doxycycline and topical chloramphenicol but re-presented overnight with rapidly progressive lip swelling, dysphagia, oral mucosal ulceration, and severe bilateral ocular inflammation without cutaneous lesions. Recent exposure to non-steroidal anti-inflammatory medication and doxycycline created initial diagnostic uncertainty, while the preceding respiratory prodrome and skin-sparing mucositis supported infection-associated RIME. Ophthalmological assessment demonstrated severe ocular surface inflammation with pseudomembrane formation, early symblepharon, and progressive corneal involvement, requiring tertiary transfer and amniotic membrane grafting. Initial chest radiography and respiratory multiplex polymerase chain reaction (PCR) testing were negative, including for Mycoplasma pneumoniae; however, subsequent serology returned positive for Mycoplasma pneumoniae IgM. Later drug challenge testing demonstrated tolerance to suspected medications, supporting an infection-associated rather than drug-induced aetiology. This case highlights that Mycoplasma pneumoniae-associated RIME may mimic atypical Stevens-Johnson syndrome, particularly when severe ocular and oral mucositis occurs after recent medication exposure. Early dermatology and ophthalmology involvement, combined molecular and serological testing, and prompt ocular treatment are essential to reduce long-term ocular morbidity.

Uvular necrosis is an uncommon complication following oesophagogastroduodenoscopy (OGD). We report a case involving a male in his 20s who developed uvular necrosis following a routine OGD performed under conscious sedation. The patient presented three days postprocedure with a worsening sore throat and odynophagia. Examination revealed an erythematous uvula with a necrotic tip. He was managed conservatively with simple analgesia, topical lidocaine and oral antibiotics with eventual full resolution of symptoms with no lasting sequelae. This case highlights a rare yet significant complication of OGD, emphasising the importance of clinician awareness, conservative management and patient reassurance.

Oropouche virus (OROV) is an emerging orthobunyavirus that causes increasingly severe and deadly disease in Brazil. However, coinfection with influenza A(H1N1)pdm09 has not been previously described in the published literature, to our knowledge. We report the first documented fatal case of OROV and influenza A(H1N1)pdm09 coinfection in a previously healthy 16-year-old female from rural Maranhão, Brazil. The patient presented with dyspnea, odynophagia, and hemoptysis and deteriorated rapidly, requiring orotracheal intubation on day three of illness due to massive endobronchial hemorrhage, followed by fatal hemodynamic collapse. Autopsy revealed bilateral serosanguineous pleural effusion, diffuse alveolar hemorrhage, pericardial petechiae, acute tubular necrosis, and cerebral edema with tonsillar herniation. Real-time reverse-transcriptase polymerase chain reaction confirmed OROV in lung, liver, spleen, and lymph node tissues, and influenza A(H1N1)pdm09 in both nasal swab and lung tissue; all other arboviruses and respiratory pathogens tested negative. The histopathological findings provide, to our knowledge, the first histopathological characterization of OROV-associated microvascular injury and suggest synergistic thromboinflammatory pathways with influenza A. This case broadens the recognized clinical spectrum of OROV and highlights the need for systematic coinfection screening and coagulation monitoring in severe arboviral presentations, even in young patients without comorbidities.

Esophageal emergencies include a heterogeneous group of conditions that, if not promptly recognized and treated, may progress rapidly to life-threatening complications including mediastinitis, sepsis, and multiorgan failure. The clinical presentation is typically non-specific, including symptoms such as chest pain, dysphagia, odynophagia, and dyspnea, which frequently overlap with more common cardiopulmonary pathologies, making the clinical diagnosis challenging. Imaging therefore occupies a central position in the diagnostic pathway. While fluoroscopic contrast esophagography has historically been the cornerstone examination for evaluating esophageal pathology, multidetector computed tomography (CT) has progressively established itself as the primary modality of choice in the emergency setting, owing to its speed, widespread availability, and unique capacity to simultaneously assess the esophageal lumen, the layered wall structure, and the surrounding mediastinal anatomy. A broad spectrum of pathologic processes may acutely involve the esophagus, ranging from caustic ingestion and spontaneous full-thickness rupture to traumatic injury, foreign body impaction, intramural hematoma, severe infectious esophagitis, iatrogenic perforation, and rare but life-threatening fistulous communications. This pictorial review aims to illustrate the imaging spectrum of esophageal emergencies with particular emphasis on CT findings, highlighting key diagnostic features, potential pitfalls, and the radiologist's role in guiding timely clinical management.

Disseminated histoplasmosis is a severe opportunistic infection in patients with human immunodeficiency virus (HIV) infection, particularly in those with CD4 lymphocyte counts of ≤50 cells/µL. Cutaneous involvement usually occurs as part of disseminated disease and, in some cases, may represent the first manifestation of systemic involvement. Cutaneous manifestations are highly variable, and these lesions are commonly associated with constitutional symptoms and pulmonary involvement. We present the case of a 53-year-old man with a history of HIV infection clinical stage C3, miliary tuberculosis with incomplete treatment, and poor therapeutic adherence. He developed a pruritic dermatosis characterized by erythematous lesions associated with fever, odynophagia, asthenia, and adynamia. At admission, generalized and symmetrical dermatosis was observed, consisting of innumerable erythematous-violaceous papules and macules coalescing into plaques, in addition to palmoplantar lesions with a collarette scale resembling the "Biett sign." Histopathological examination demonstrated histiocytes filled with multiple intra- and extracellular yeast-like structures consistent with Histoplasma capsulatum. HIV viral load was reported at 8,070 copies/mL and CD4 T-lymphocyte count at 46 cells/µL. Based on these findings, a diagnosis of disseminated cutaneous histoplasmosis was established. During hospitalization, the patient received liposomal amphotericin B, and upon discharge, antiretroviral therapy (ART) was initiated, resulting in favorable clinical evolution and the improvement of the cutaneous lesions during outpatient follow-up. This case illustrates the diagnostic complexity of disseminated cutaneous histoplasmosis in patients with advanced immunosuppression and highlights the value of skin biopsy and early histopathological identification in establishing a timely diagnosis and initiating prompt antifungal treatment.

Spontaneous pneumomediastinum is a rare complication of hyperemesis gravidarum and may present with alarming symptoms that mimic more serious conditions, particularly esophageal perforation. A 20-year-old primigravida in the first trimester (11 weeks of gestation) presented with severe vomiting, facial swelling, odynophagia, and cervical crepitus. Imaging studies revealed spontaneous pneumomediastinum, pneumorrhachis, and extensive subcutaneous emphysema. Esophageal perforation was excluded by contrast esophagography. The patient developed electrolyte disturbances and acute kidney injury secondary to hyperemesis gravidarum and was successfully managed with intravenous fluid replacement, oxygen therapy, and close maternal-fetal surveillance. Clinical improvement occurred within five days, allowing hospital discharge without complications. The remainder of the pregnancy was uneventful, and a healthy female infant was delivered at term. This case highlights the importance of recognizing spontaneous pneumomediastinum as a potential complication of severe hyperemesis gravidarum. Associated pneumorrhachis is exceptionally uncommon and may lead to diagnostic uncertainty. Early recognition, exclusion of esophageal injury, and conservative multidisciplinary management may result in favorable maternal and neonatal outcomes.

Laryngopharyngeal involvement in Behçet's syndrome is rare but clinically significant because it may cause severe odynophagia, dysphagia, and airway compromise. Optimal treatment has not been established, and irreversible structural sequelae, including laryngopharyngeal stenosis and ulcer scarring, may occur. We describe two men with Behçet's syndrome and symptomatic laryngopharyngeal involvement who showed rapid improvement after infliximab administration following an insufficient response to corticosteroids. In case 1, a 25-year-old man was classified as having suspected Behçet's syndrome based on recurrent oral ulcers, pharyngeal ulceration, arthritis, folliculitis-like skin lesions, and previous episodes of abdominal pain. He developed severe pharyngeal pain and dysphagia due to ulcerative lesions extending from the posterior pharyngeal wall to the esophageal inlet. Intravenous prednisolone resulted in limited endoscopic and symptomatic improvement, whereas infliximab promptly relieved pain and restored oral intake, with no recurrence over 14 years of follow-up. In case 2, a 29-year-old man presented with recurrent fever, oral aphthae, genital ulcers, arthritis, erythema nodosum-like lesions, and pharyngeal and laryngeal mucosal lesions associated with dysphagia. His symptoms and laryngoscopic abnormalities improved promptly after infliximab administration following an inadequate response to prednisolone. These cases underscore the importance of considering early anti-tumor necrosis factor-α therapy in steroid-refractory or relapsing laryngopharyngeal Behçet's syndrome, because progression to irreversible structural complications, including stenosis and adhesion, may necessitate surgical intervention if inflammation is not controlled before permanent damage occurs.

Most patients who present for evaluation of a foreign body in the esophagus do so after accidental ingestion of a known object, and the patient has mild symptoms and is in stable condition. The challenges come from patients who are unable or unwilling, for example, infants, children, mentally impaired, psychiatric, prisoners, to provide a history of the object ingested or when it occurred. Also, the wide range of possible symptoms and clinical presentations, plus the wide range of potential complications, can make this a difficult condition to evaluate and manage.

The esophagus is approximately 25-centimeter muscular tube that connects the pharynx to the stomach. Histologically it comprises of innermost mucosal layer, submucosal layer, muscular, and adventitial layer. submucosal layer. The second layer submucosa which connects the mucosal and muscular layer contains blood vessels, Meissner nerve plexus, and esophageal glands.  Intramural hematoma of the esophagus (IHE) or dissecting intramural hematoma is a very rare manifestation of acute mucosal and submucosal injuries resulting in an interlayer collection of blood. IHE can be spontaneous and secondary to trauma with foreign body, toxic substance ingestion, or iatrogenic intervention related.  Patients with IHE can present with symptoms mimicking other acute cardiopulmonary diseases. Classic triad associated with IHE is acute chest pain, odynophagia or dysphagia, and hematemesis. Usually, IHE is a very rare and benign condition. Prognosis is usually excellent with proper diagnosis and management.[1][2][3]