Laryngeal tuberculosis (TB), accounting for less than 1% of extrapulmonary TB cases, poses significant diagnostic challenges due to its mimicry of malignant lesions and high transmissibility. This case describes a 55-year-old male from a TB-endemic region in Colombia presenting with an 8-month history of progressive weight loss, odynophagia, dysphagia, and dysphonia, in whom nasolaryngoscopy revealed a tumor-like lesion occupying the epiglottis. Microbiological testing confirmed drug-sensitive Mycobacterium tuberculosis, and following a four-drug antituberculosis regimen, complete resolution of the lesion with preservation of laryngeal architecture was achieved. This case highlights that laryngeal TB should remain a key differential diagnosis in patients with laryngeal lesions in endemic areas, as early microbiological confirmation and prompt treatment can lead to full anatomical and functional recovery while minimizing transmission risk.

Hydatidosis, caused by Echinococcus granulosus, most commonly affects the liver and lungs, while thyroid involvement is exceptionally rare and can mimic other cystic thyroid lesions. We report a 40-year-old woman with no history of animal exposure who presented with anterior neck swelling, odynophagia, and abdominal discomfort. She had a prior history of hepatic hydatid cyst treated in 2018. Thyroid ultrasonography revealed a left subcapsular mass measuring 50 × 38 × 24 mm containing a bilobulated internal cyst (27 × 20 × 10 mm) without significant vascularity. Abdominal imaging demonstrated a large subhepatic multiseptated cyst (115 × 90 × 60 mm) with double-layered septations, suggestive of recurrent hydatidosis. The patient underwent left thyroid lobectomy, and histopathological examination confirmed a hydatid cyst characterized by a laminated membrane and germinal layer, along with surrounding granulation tissue, fibrosis, and multinucleated giant cell reaction in the adjacent thyroid parenchyma. Thyroid hydatid cysts are exceedingly uncommon and may be easily misdiagnosed as other cystic thyroid lesions based on clinical and radiologic findings. Therefore, in endemic regions, hydatid disease should be considered in the differential diagnosis to ensure accurate diagnosis and appropriate management.

Adult T-cell leukemia/lymphoma (ATLL) is a rare, human T-lymphotropic virus type 1 (HTLV-1)-driven neoplasm that is often underrecognized in low-endemic regions. We describe a 23-year-old man with an eight-year history of chronic dry cough who later developed weight loss, night sweats, odynophagia, and dyspnea. CT revealed cervical/supraclavicular lymphadenopathy with innumerable pulmonary micronodules, interlobular septal thickening, and ground-glass opacities; abdominal imaging showed hepatosplenomegaly, ascites, and extensive retroperitoneal/mesenteric adenopathy. HTLV-1 ELISA and confirmatory Western blot were positive. Excisional lymph node biopsy demonstrated diffuse architectural effacement by atypical T cells with a CD3+, CD4+, CD5+, CD25+, CD7-, granzyme B+ immunophenotype and a ~90% Ki-67 index, establishing lymphomatous-type ATLL with a cytotoxic profile. Despite rapid recognition, the patient deteriorated and died from respiratory failure 15 days after diagnosis, before chemotherapy could begin. This lung-predominant presentation in a young adult illustrates how ATLL can mimic chronic pulmonary disease and evade early detection outside endemic areas. Clinicians should prioritize early tissue acquisition and a minimal T-cell panel (CD3, CD4, CD25, CD7, Ki-67); a CD4+CD25+ phenotype with CD7 loss should prompt HTLV-1 testing irrespective of geography. Streamlined access to immunophenotyping and confirmatory HTLV-1 assays is essential to reduce diagnostic delays and improve outcomes.

Oral mucositis is a debilitating adverse effect of radiotherapy in head and neck cancer. It progresses from erythema to painful ulcerations, often causing infections, nutritional impairment, treatment interruption, and reduced survival. While treatment-related factors are well established, patient-related risk determinants remain insufficiently defined. Thus, this study investigated the association between the onset and peak severity of radiation-induced oral mucositis in patients with head and neck cancer and their clinicopathological, biobehavioral, and demographic characteristics. To carry out this study, patients diagnosed with head and neck cancer and undergoing mandatory radiotherapy treatment were recruited. Fifty patients undergoing radiotherapy were evaluated daily. The analysis focused on the onset and peak severity of oral mucositis. Chemotherapy was significantly associated (P = 0.034) with earlier oral mucositis onset. Diabetes (P = 0.017) and radiation dermatitis (P = 0.017) were statistically associated with the severity of mucositis at the time of onset, while hypertension (P = 0.030), diabetes (P = 0.016), mild and moderate alcohol consumption (P = 0.029), radiation dermatitis (P = 0.001), odynophagia (P = 0.022), burning mouth (P = 0.003), difficulty with hygiene (P = 0.020), and use of opioids (P = 0.045) were associated with the most severe degrees at the peak of lesion. Severe smokers were associated with a greater occurrence of mucositis lesions in the lip region at two times. This study demonstrated that the interaction between clinicopathological and biobehavioral factors exhibits distinct patterns depending on the stage of oral mucositis progression. A comprehensive understanding of these complex relationships is crucial for developing targeted strategies to prevent severe mucositis and optimize treatment outcomes.

BACKGROUND Stevens-Johnson syndrome (SJS) is a rare, immune-mediated mucocutaneous disorder usually triggered by medications or infections. It typically manifests with widespread epidermal detachment and mucosal ulcerations, but atypical cases can present with isolated mucosal involvement, leading to diagnostic uncertainty and delayed treatment. Recognizing such varying presentations is crucial to precent progression to more severe disease and improve outcomes. CASE REPORT We present the case of an 18-year-old male with no significant medical history who presented with severe odynophagia, oral ulcerations, conjunctivitis, and dysuria shortly after completing a course of cefdinir for an upper respiratory infection. Notably, he lacked the characteristic diffuse rash seen in classic SJS. Laboratory evaluation revealed elevated inflammatory markers, and imaging demonstrated non-specific soft tissue edema. Initial management included cessation of cefdinir, intravenous fluids, corticosteroids, and broad supportive care. During hospitalization, he developed macular lesions on the palms and soles and progressive mucosal sloughing. Serologic testing later confirmed elevated Mycoplasma pneumoniae IgM and IgG titers, leading to reclassification of this condition to Mycoplasma pneumoniae-associated SJS (MP-SJS). He was treated with intravenous immunoglobin and azithromycin, with gradual improvement and full recovery after a 2-week hospital course. CONCLUSIONS This case highlights an atypical, mucosal-predominant presentation of Mycoplasma pneumoniae-associated SJS in an adolescent male, initially mimicking severe oropharyngeal infection. Clinicians should maintain a high index of suspicion for SJS in patients presenting with acute mucositis and odynophagia following recent medication use or respiratory illness, even when the cutaneous findings are absent. Early identification, withdrawal of the offending agent, and prompt multidisciplinary care are critical to favorable outcomes.

Esophagitis dissecans superficialis (EDS), also referred to as "sloughing esophagitis," is an uncommon benign condition characterized by the desquamation of the superficial layer of the esophageal squamous mucosa. It is often underdiagnosed due to its rarity and nonspecific clinical presentation. Although several factors such as caustic ingestion, thermal injury, autoimmune disorders, and mechanical trauma have been implicated, medication-induced mucosal injury remains one of the most significant causes. Among these, bisphosphonates - a class of drugs widely prescribed for osteoporosis and other bone-related disorders - have been identified as a potential offending agent. We report the case of a 66-year-old woman with no significant comorbidities who presented with persistent retrosternal burning and pain for 2 months. There was no associated dysphagia, odynophagia, vomiting, hematemesis, weight loss, or history of nonsteroidal anti-inflammatory drug use. Physical and systemic examinations were unremarkable. Despite treatment with double-dose esomeprazole for 8 weeks, her symptoms persisted. Upper gastrointestinal endoscopy revealed a large area of whitish sloughed-off mucosa overlying a superficial ulcer with regular margins, extending from 26 cm to just above the gastroesophageal junction. A detailed drug history subsequently revealed the use of bisphosphonate gel for osteoporosis. Histopathological analysis demonstrated sloughed squamous epithelium with the features of superficial mucosal necrosis, confirming the diagnosis of EDS secondary to bisphosphonate-induced chemical injury. Discontinuation of the bisphosphonate and continuation of proton-pump inhibitor therapy led to complete symptom resolution within 2 weeks. This case underscores the importance of considering drug-induced esophageal injury in patients with refractory retrosternal pain unresponsive to acid suppression therapy. Bisphosphonates, although highly effective in osteoporosis management, may cause significant mucosal damage when not used properly. Clinicians should maintain a high index of suspicion for bisphosphonate-induced EDS, as timely recognition and withdrawal of the offending agent usually result in rapid clinical and endoscopic improvement.

The triticeal cartilage is a small cartilage found within the thyrohyoid membrane present in approximately 33%-53% of individuals. Rarely, calcification/ossification of this cartilage can occur, leading to symptoms of dysphagia, odynophagia, or globus sensation. Despite its clinical relevance, symptomatic triticeal cartilage calcification remains poorly characterized in the literature, with only isolated case reports and no established diagnostic or management framework. We present a case of a 44-year-old woman who presented with seven months of atypical throat and neck pain and globus sensation in the setting of prior esophagogastroduodenoscopy with dilation. Medical management, including nortriptyline and hyoscyamine provided no benefit. Physical examination and flexible laryngoscopy were unremarkable, except for focal left-sided neck tenderness. Contrast-enhanced computed tomography of the neck demonstrated a nonspecific 0.3 x 0.3 x 1.0 cm submucosal calcification at the thyrohyoid membrane, suspicious for retained foreign body. The patient underwent left neck exploration which revealed a calcified cartilaginous structure embedded within the pharyngeal constrictors and immediately adjacent to a pharyngeal plexus branch. Final pathology confirmed fibrous tissue and cartilage. The patient reported immediate, complete symptom resolution and remained symptom-free at 13-month follow-up. This case highlights calcified triticeal cartilage as a rare, often overlooked cause of persistent throat symptoms. Recognition of this pathology may prevent misdiagnosis and allow for timely, definitive treatment.

Fibromuscular dysplasia (FMD) is an uncommon condition that is seen most frequently in young females. We describe the case of a 28-year-old previously healthy U.S. Navy active duty male who presented to a civilian hospital with 3 days of persistent headache, odynophagia, and malaise and was subsequently found to have severe hypertension, tachycardia, and acute kidney injury. An extensive evaluation for secondary causes of hypertension was performed. A transthoracic echocardiogram was normal without evidence of aortic coarctation. Thyroid labs showed low thyrotropin level with normal total triiodothyronine and free thyroxine levels. Serum aldosterone and renin levels were elevated, as were 24-hour urine free cortisol and serum and urine metanephrines. Doppler renal ultrasound revealed right renal artery stenosis, attributed to focal FMD. The patient underwent successful balloon angioplasty of the right renal artery, resulting in significant improvement in blood pressure (BP). This case underscores the importance of a thorough evaluation for secondary hypertension in young patients with early-onset and severe hypertension, as well as the role of renal artery intervention in improving hemodynamic stability in patients with FMD. Moreover, it highlights the nuances of interpreting abnormal lab values in a secondary hypertension workup and the need for consistent BP screening in operational settings to prevent delayed diagnosis and end-organ injury.

Surveillance endoscopy in a 47-year-old woman with previous hypopharyngeal chemoradiotherapy and esophageal endoscopic submucosal dissection (ESD) revealed a 12-mm superficial squamous cell carcinoma at the cervical esophagus near the inlet. ESD achieved en bloc resection with a half-circumferential mucosal defect, and histopathology showed pT1a lamina propria mucosae with negative margins. For stricture prophylaxis, triamcinolone was injected into the post-ESD defect, oral prednisolone was tapered over several months, and prophylactic endoscopic balloon dilation was performed three times at 3-4-week intervals. Three months after ESD, a 10-mm white-coated lesion appeared at the inlet and progressively enlarged. Under intravenous sedation, detailed endoscopic assessments and biopsies were limited by the complex location, and the biopsy suggested neoplastic cells with marked degeneration. Due to progressive odynophagia and poor oral intake, endoscopic re-evaluation under general anesthesia was performed. Using Sato's curved laryngoscope, the lesion was clearly visualized as a semipedunculated mass arising from the post-ESD site and was completely resected for diagnosis and symptom relief. Histopathology revealed inflammatory granulation tissue without malignancy. Symptoms resolved promptly with no recurrence during 6 months of follow-up. This case highlights the development of exuberant granulation tissue at the post-ESD site in the cervical esophagus during intensive stricture prophylaxis. Although this rare finding likely reflects multiple overlapping factors, endoscopic evaluation and treatment were successfully performed while avoiding overtreatment.

Introduction Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory condition. Emapalumab, an IFNγ-directed antibody, is approved for use in the USA but not in Europe. Case A 15-year-old girl presented with fever, odynophagia and a transient rash. After 9 days of hospitalization under empirical antibiotics, she developed pancytopenia, hypofibrinogenaemia, elevated ALT, AST, LDH, triglycerides, soluble CD25, serum calprotectin and ferritin (peak 357,976 ng/ml), and hepatosplenomegaly. Infectious and immune workups were negative, and bone biopsy confirmed haemophagocytosis. MAS was diagnosed, which was complicated by acute respiratory distress and supraventricular tachycardia. High-dose corticosteroids, anakinra and ciclosporin were initiated, with transient improvement. Subsequent drug-induced hepatotoxicity and microangiopathy, and infections worsened her condition. Given refractoriness to standard therapy, emapalumab was started under compassionate use, leading to sustained clinical and laboratory remission. She was discharged and remains stable at six-month follow-up, off corticosteroids and on canakinumab maintenance. Discussion This case illustrates the challenges of treating severe, refractory MAS. Emapalumab, used for the first time in Portugal, was well tolerated and associated with complete and sustained remission after failure of multiple therapeutic lines.

The stag beetle (SB) knife, a unique scissor-shaped device with rotating insulated monopolar blades, is increasingly used in the endoscopic management of Zenker's diverticulum (ZD). This systematic review and meta-analysis aimed to evaluate its overall safety, efficacy, and feasibility. A thorough search of electronic databases and conference abstracts was conducted until November 2023. Meta-analysis utilized the random-effects model, with I2 (%) assessing heterogeneity. Subgroup analysis was based on sample size, employing the standard mean difference (SMD) and 95% confidence interval (CI) for continuous variables. Key outcomes included clinical success, recurrence rate, adverse events, and improvement in dysphagia score. Eight studies with 299 patients (60.5% males, mean age: 72.75±2.86 years, ZD size: 2.66±0.52 cm, and procedures lasted 23.06±10.00 min) were included. Clinical success was achieved in 86% (95% CI: 81-90; I2=0%) after 10.98 sessions, and 22.74% required multiple (up to four) sessions. The recurrence rate was 15% (95% CI: 11-20; I2=0%). Intraprocedural complications occurred in 9% (95% CI: 5-13; I2=29%), primarily minor bleeding (9.6%), micro-perforation (2%), odynophagia (1.3%), and fever (1.05%). Late-onset bleeding occurred in 3.2% after one week. Adverse events were conservatively managed, and subgroup analysis by sample size indicated a significant difference in mean sessions (p=0.02). Dysphagia scores showed significant improvement following treatment, with an SMD of -1.59 (95% CI: -2.27 to -0.91; p<0.01; I²=97%) over a mean follow-up of 22.23±11.47 months. The meta-analysis confirms the SB knife's success in ZD, displaying excellent safety and dysphagia improvement. However, further research is needed to define optimal patient cohorts and compare them with other management techniques.