Adult-onset Still's disease (AOSD) is an auto inflammatory disorder with a variable clinical presentation, and without a pathognomonic diagnostic test, characterized by high spiking fever, arthralgia/arthritis, a suggestive skin rash, elevated white blood cell count 10 G/L (> 80% neutrophils), elevated ferritin, with glycosylated ferritin < 20% and high IL-18. Cutaneous manifestations are very frequent and the commonest description is an evanescent salmon-pink rash, although many atypical skin presentations have been described in literature. We present the case of an atypical cutaneous manifestation of clinically typical AOSD in a 30-year-old man presenting with a slightly pruritic maculopapular and urticarial erythematous rash on the face and limbs, with purpuric features on the lower limbs, which gradually spread to the whole body, associated with overlying nonfollicular pustules. The patient also presented with high spiking fever, odynophagia, diffuse arthralgia, and generalized asthenia. The histological analysis of a skin biopsy showed a few subcorneal collections of neutrophils, a slight epidermal spongiosis, many suprabasal necrotic keratinocytes, and a moderate mixed inflammatory infiltrate in the superficial dermis. Following various investigations ruling out any other diagnosis, we have diagnosed Still's disease, for which the patient has been prescribed corticosteroids, with good initial results.

While COVID-19 mortality was relatively low in many Sub-Saharan African countries during the first wave of the pandemic, SARS-CoV-2 transmission was extensive. We hypothesized that female sex workers (FSWs) would be at enhanced risk of acquisition of this novel respiratory viral infection, due to intimate contact with multiple sexual partners and solicitation of clients in crowded venues. Here we describe the seroincidence, socio-behavioural associations and clinical outcomes of SARS-CoV-2 infection in Kenyan FSWs early in the pandemic. A longitudinal cohort of 1003 FSWs (257 living with HIV) from Nairobi, Kenya was enrolled in mid-2019, just prior to the pandemic, and plasma was available for SARS-CoV-2 serology from 827 participants at clinical follow up approximately one year later. Socio-behavioural and respiratory symptom data were collected by questionnaire. We examined the association of SARS-CoV-2 infection with socio-behavioural factors. Follow-up was a median of 201 days (range; 92-342 days) after the declaration of the COVID-19 pandemic in Kenya, and 229 (27.7%) participants were SARS-CoV-2 seropositive. Seroprevalence increased steadily with time from pandemic declaration. Infection was not associated with behavioural or demographic parameters but was strongly associated with time since start of the pandemic (p < 0.0001). Respiratory symptoms during the past 6 months were reported by almost two-thirds of participants (510/821; 62.1%), with SARS-CoV-2 infection specifically associated with self-reported difficulty breathing, dizziness, fever, loss of smell, myalgia, rhinorrhea, and odynophagia; approximately half of the cases were completely asymptomatic. HIV status was not associated with differences in SARS-CoV-2 seroincidence or symptoms, and no behavioural or sociodemographic associations of infection were apparent. Pre-pandemic serology demonstrated antibodies recognizing one of SARS-CoV-2 Spike, RBD, or N in 151/994 participants (15.2%), but these were not associated with protection against subsequent SARS-CoV-2 infection. Overall, SARS-CoV-2 seroincidence was high early in the pandemic among Nairobi-based FSWs, with no clear socio-behavioural associations of infection.

Epiglottic abscess is a rare but potentially life-threatening complication of adult epiglottitis. Although airway compromise is a major concern, some patients may initially present with preserved airway patency despite significant supraglottic infection. We report the case of a 42-year-old woman who presented with a three-day history of worsening sore throat, dysphagia, odynophagia, fever, and inability to tolerate oral intake. Flexible nasendoscopy demonstrated marked supraglottic oedema and epiglottic enlargement without immediate airway compromise. Initial treatment with intravenous antibiotics, corticosteroids, analgesia, and supportive care resulted in minimal clinical improvement. Contrast-enhanced CT of the neck subsequently demonstrated a 3 cm rim-enhancing abscess within the epiglottis. The patient underwent microlaryngoscopy and operative drainage under general anaesthesia, with good postoperative recovery. This case highlights the importance of reconsidering the diagnosis in adult epiglottitis that fails to improve with medical therapy, even in the absence of overt airway obstruction. Early imaging and timely surgical intervention may be crucial in preventing further deterioration.

Paraquat (PQ) is a non-selective synthetic herbicide known as N, N'-dimethyl-4, 4'-bipyridinium dichloride. Toxic levels of PQ can be lethal, when ingested, as they can have potentially fatal effects on the heart, liver, kidneys, lungs, and gastrointestinal (GI) tract. To date, no known counter-dote exists, and none of the available therapies are effective. We present the case of a 30-year-old male who, after inadvertently consuming 20 ml of 24% PQ, experienced GI symptoms, such as vomiting, diarrhea, and odynophagia, as well as liver and kidney damage. Symptoms and organ involvement subsided, when prompt and appropriate supportive care was provided.

Esophageal neuroendocrine carcinoma (ENEC) is a rare, aggressive cancer that presents with nonspecific symptoms, often mimicking more common esophageal malignancies. We report the case of an 85-year-old man with progressive dysphagia and odynophagia who was found to have a high-grade small-cell neuroendocrine carcinoma (SCNEC) of the mid-esophagus. Diagnosis was confirmed through histopathology and immunohistochemistry (IHC), including synaptophysin, INSM1, and a Ki-67 index near 100%, consistent with a highly proliferative tumor and aggressive biologic behavior. Endoscopic ultrasound (EUS) played a critical role in locoregional staging, demonstrating a T3 lesion without nodal involvement, and providing key information that, together with other clinical factors, informed curative-intent management planning. A multidisciplinary approach enabled timely diagnosis and treatment planning. This case highlights the importance of maintaining a broad differential diagnosis and the value of EUS as an essential tool for accurate staging and management of rare esophageal tumors.

Peritonsillar abscess (PTA) is a common deep infection of the head and neck that can present with significant clinical symptoms. Patients typically present with fever, malaise, sore throat, otalgia, dysphagia, and the characteristic muffled "hot-potato" voice. Although PTA is generally managed effectively with antibiotics, analgesics, and abscess drainage, spontaneous rupture is uncommon and may falsely suggest clinical resolution, posing a diagnostic and management challenge. We present the case of a 25-year-old woman who presented with a five-day history of sore throat, fever, odynophagia, dysphagia, hot-potato voice, and foul taste in the mouth. Examination revealed right peritonsillar swelling with a mucosal opening consistent with spontaneous rupture of the abscess. The rupture was presumed to have occurred prior to presentation and was further supported by the patient's history of a sudden onset of a foul taste around the third day of symptoms, followed by partial symptomatic relief. Laboratory investigations demonstrated significant inflammation, with a C-reactive protein (CRP) level of 190 mg/L and neutrophilic leukocytosis. The patient was admitted for intravenous antibiotics, dexamethasone, and observation; however, she requested discharge against medical advice one day after admission due to reported symptomatic improvement and travel plans. Spontaneous rupture of a peritonsillar abscess is a rare event that may lead to transient symptom relief and a misleading impression of recovery due to possible incomplete drainage. This case highlights the importance of careful clinical evaluation and continued management despite apparent improvement, as persistent infection and complications may still occur.

Missed diagnosis and treatment of esophageal foreign bodies (FBs) carry a risk of severe, life-threatening complications. This case report details the diagnostic and therapeutic management of a 58-year-old woman with a minimally invasive penetrating FB (MIPFB) following fish bone ingestion, who presented with odynophagia. Initial clinical evaluation and electronic nasopharyngolaryngoscopy were unremarkable. A cervical computed tomography scan on day 6 post-ingestion revealed a penetrating FB at the C6 vertebral level. Initial flexible esophagoscopy and a subsequent surgical exploration failed to localize the object. The FB, an approximately 2.5-cm-long fish bone embedded in the right posterior wall of the esophageal inlet, was ultimately and successfully retrieved via a repeated, meticulous endoscopic procedure employing targeted mucosal manipulation. This case highlights that MIPFB cases are prone to diagnostic delay and emphasizes that repeated, careful endoscopy is a superior and less invasive therapeutic strategy compared to surgical exploration in such complex scenarios.

Amyloidosis is a rare and heterogeneous group of disorders characterized by extracellular deposition of misfolded proteins, which may present as either localized or systemic disease. In the head and neck region, the presentation of amyloidosis is uncommon and may clinically mimic neoplastic processes. We report the case of a 58-year-old man with a five-year history of progressive oropharyngeal symptoms, initially perceived as a foreign body sensation and intermittent odynophagia, later evolving to dysphagia to solids. Physical examination revealed marked asymmetry of the palatine tonsils due to a mass originating from the left tonsillar fossa. Imaging studies confirmed a well-defined lesion without clear signs of invasion. Given the progressive symptoms and the size of the lesion, surgical excision was performed. Histopathological analysis demonstrated amyloid deposition confirmed by Congo red staining, with immunophenotypic features consistent with a lambda-restricted plasma cell neoplasm. The patient was referred for further hematologic evaluation to exclude systemic disease, but declined additional workup. This case illustrates how localized amyloidosis may closely resemble neoplastic disease both clinically and radiologically, and highlights the central role of histopathological evaluation. It also emphasizes the importance of considering systemic involvement even in apparently localized presentations.

Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein and hematogenous dissemination of septic emboli. Although classically associated with oropharyngeal infections, atypical presentations from odontogenic sources are increasingly recognized and may complicate early diagnosis. We report the case of a 29-year-old male patient who developed Lemierre syndrome following lower third molar extraction. He presented with right cervical swelling, dysphonia, odynophagia, and cough. Laboratory findings showed leukocytosis with neutrophilia. Imaging studies revealed a deep cervical collection consistent with Ludwig's angina, extensive thrombosis of the right internal jugular vein with extension to the jugular bulb, sigmoid sinus, and subclavian vein, and multiple bilateral pulmonary lesions suggestive of septic emboli. The patient underwent surgical drainage and received broad-spectrum antibiotic therapy along with anticoagulation due to the extent of thrombosis. Microbiological cultures were negative, likely influenced by prior antibiotic exposure and the inherent difficulty in isolating anaerobic pathogens such as Fusobacterium species. Despite significant radiological involvement, clinical evolution was favorable, without hemodynamic instability or respiratory compromise. Follow-up demonstrated a reduction of pulmonary lesions and eventual resolution of thrombosis. This case highlights an uncommon odontogenic origin with unusually extensive venous propagation, including intracranial extension, in the setting of a relatively benign systemic course. It underscores the importance of considering Lemierre syndrome in deep cervicofacial infections after dental procedures, even in the absence of a preceding pharyngeal infection, and reinforces the need for early imaging and multidisciplinary management to enable timely diagnosis and appropriate treatment.