Pernicious anemia (PA) is an autoimmune-mediated vitamin B12 deficiency that classically presents with macrocytic anemia and neurologic dysfunction. The case described highlights a rare variant of PA that paralleled concerns for microangiopathic hemolytic anemia (MAHA) like thrombotic thrombocytopenic purpura (TTP). A 40-year-old African American female with limited past medical history presented with progressive fatigue, lower-extremity weakness, gait instability, and ataxia, accompanied by chronic gastrointestinal symptoms, weight loss, and menorrhagia. Initial evaluation revealed profound macrocytosis, pancytopenia, laboratory evidence of hemolysis, including an elevated lactate dehydrogenase (LDH) and undetectable haptoglobin level without evidence of acute kidney injury (AKI), and neurologic deficits concerning for subacute combined degeneration. This case was complicated by right lower lobe pneumonia, urinary tract infection, and a left Bartholin cyst. Further testing demonstrated elevated methylmalonic acid and homocysteine levels, positive intrinsic factor (IF) antibodies, and only mildly reduced ADAMTS13 activity, which confirmed the diagnosis of PA. The patient was treated with parenteral vitamin B12, folate, and supportive care, resulting in gradual recovery. Although inpatient rehabilitation was recommended, the patient declined and was instead discharged home with arrangements for outpatient follow-up and lifelong intramuscular vitamin B12 replacement therapy. This case underscores the importance of recognizing that, in rare cases, PA can present as a mimicker of thrombotic microangiopathies such as TTP, as early identification can prevent unnecessary therapeutic intervention, reduce morbidity, and facilitate timely, disease-specific therapy.

Acquired facial defects can profoundly impair function, appearance, and psychosocial well-being. During the early phases of reconstruction, rapid tissue changes often limit definitive prosthetic rehabilitation, creating a therapeutic gap in patient care. This clinical report describes the sequential development of custom facial prostheses over a 5-year period for a 35-year-old man who developed a severe midfacial defect secondary to idiopathic purpura fulminans. Initial treatment focused on edema control, protection of healing tissues, and support of speech therapy through a custom compression mask, commissure splints, and intraoral prosthetic support. As the patient underwent multiple reconstructive procedures, repeated stereophotogrammetric acquisitions, digital superimposition, additive manufacturing, and analog sculpting techniques were used to fabricate successive prostheses that accommodated continual anatomical changes. Progressive incorporation of patient-specific digital data, including preinjury photographs and video-derived facial reconstructions, facilitated the development of increasingly realistic facial contours. The prostheses evolved from purely therapeutic devices into patient-centered restorations that addressed functional requirements (especially by promoting lymphatic draining and protecting the healing tissue from the external environment), surgical planning, and esthetic concerns. This clinical report demonstrates how iterative facial compression prostheses fabricated through combined digital and analog workflows can provide continuous functional and psychosocial support during prolonged multidisciplinary reconstruction. The described approach may offer a practical framework for rehabilitation of patients with complex facial defects undergoing staged surgical treatment.

Scurvy is an increasingly recognized but frequently overlooked nutritional deficiency in developed countries. We report a 55-year-old man with obesity and type 2 diabetes mellitus who presented with progressive petechiae and ecchymoses concerning for cutaneous vasculitis. Extensive hematologic, rheumatologic, infectious, and dermatologic evaluations, including skin biopsy, were unrevealing. Symptoms were initially attributed to aspirin use without improvement following dose reduction. Subsequent nutritional assessment revealed an undetectable plasma vitamin C level (<0.1 mg/dL) in the setting of chronically poor dietary quality with minimal fruit and vegetable intake. The patient was treated with vitamin C supplementation and nutrition counseling, with subsequent clinical improvement and normalization of vitamin C levels. This case highlights how micronutrient deficiencies may occur despite adequate food access and emphasizes the importance of dietary assessment in patients with unexplained bleeding manifestations to avoid diagnostic delay and unnecessary testing.

FLAIR-hyperintense lesions in anti-MOG-associated encephalitis with seizures (FLAMES) represent a rare and distinctive clinico-radiological syndrome. Here, we report the case of a 35-year-old man who presented with sudden-onset generalized tonic-clonic seizures. Brain magnetic resonance imaging revealed cortical FLAIR hyperintensities in the right parietal lobe. During hospitalization, he developed scattered petechiae over the neck and chest, accompanied by elevated creatine kinase (CK) levels, findings that initially raised concern for systemic vasculitis or inflammatory myopathy. Given the close temporal relationship to the seizures, together with negative autoimmune and infectious evaluations, these abnormalities were ultimately interpreted as postictal purpura and seizure-associated rhabdomyolysis. Subsequent investigations confirmed serum positivity for anti-MOG antibodies, while antinuclear antibody profiling, vasculitis-related markers, and microbiological screening were all negative. After high-dose intravenous methylprednisolone therapy, seizure activity was controlled, the petechial rash resolved, CK levels normalized, and the cortical lesions showed marked regression on follow-up imaging. This case highlights that FLAMES may be complicated by postictal purpura and rhabdomyolysis, underscoring the potential for diagnostic confusion with systemic inflammatory disease.

Objective: To describe the incidence of primary immune thrombocytopenia (ITP) among children ≤5 years in Chongqing from 2019 to 2024. Methods: A retrospective dynamic cohort of resident children aged ≤5 years was established using data from the Chongqing Health and Medical Big Data Platform between 2019 and 2024. ITP cases were identified using the International Classification of Diseases Tenth Revision (ICD-10) code "D69.3" and regular expression-based keywords matching of Chinese free-text clinical records. New-onset cases were defined using a 90-day washout period. The incidence density of ITP and its 95%CI were calculated using the Poisson distribution. Poisson regression models were used to estimate the associations between incidence density and risk factors including sex, age, residence type, calendar year, and season. Results: A total of 2 608 631 ≤5 years children were enrolled in the cohort, of whom 51.95% were males and 62.50% resided in urban areas. We identified 1 294 new-onset ITP cases, accounting for 1 468 incident episodes. The overall incidence density of ITP was 16.18 per 100 000 person-years (95%CI: 15.37 per 100 000 person-years - 17.03 per 100 000 person-years). The female-to-male incidence density ratio was 0.73, indicating a statistically significant difference (P<0.001). No statistically significant differences in incidence density were observed across calendar years, although a seasonal pattern was noted, with a higher incidence from April to June. The highest risk of ITP was observed among infants, with two peaks in incidence density occurring at 2-3 months and 9 months of age. Incidence density ratio for rural vs. urban children was 0.58 (95%CI: 0.51-0.65) (P<0.001). Conclusion: From 2019 to 2024, the incidence of ITP among children ≤5 years in Chongqing was characterized by a stable temporal trend, a male predominance, a peak in infancy with distinct early-life peaks, and higher incidence in urban populations, along with a moderate seasonal variation.

This guideline complements previous guidelines, focussing on the laboratory methods associated with testing for deficiency of the metalloproteinase ADAMTS13.

Objective: To summarize the clinical characteristics of pediatric pulmonary echinococcosis (PE). Methods: Case series study. Clinical data of 10 children with PE hospitalized in the Department of Respiratory Medicine and General and Thoracic Surgery at Beijing Children's Hospital Xinjiang Hospital from December 2022 to June 2025 were retrospectively collected, including general information, clinical manifestations, pulmonary imaging findings, laboratory test results, and treatment details. Results: Among the 10 children, there were 7 males and 3 females. Three cases were asymptomatic. Seven cases presented with cough, including 2 cases with chest pain, 1 case with fever, and 1 case with dyspnea. Elevated peripheral blood eosinophil counts were detected in 5 cases. One case initially presented with severe idiopathic thrombocytopenic purpura (ITP). Elevated C-reactive protein levels were noted in 3 cases. Pulmonary CT scans in all 10 children revealed solitary or multiple round or oval cystic fluid-density space-occupying lesions with high-density capsules visible at the margins and uniform density within the cysts. Two cases were complicated by obstructive emphysema, 2 cases by cystic cavities, 1 case by pyothorax. Five children had concurrent hepatic echinococcosis. All 10 children achieved complete intracapsular resection of pulmonary echinococcus cysts. Conclusions: Pediatric PE can be asymptomatic or present with cough, chest pain, and dyspnea. It can initially manifest as ITP. Imaging findings demonstrate solitary or multiple round or oval cystic space-occupying lesions with well-defined hyperdense capsule margins, which may be accompanied by obstructive emphysema.