Epstein-Barr virus (EBV), a member of the herpesvirus family, establishes lifelong latency following primary infection and may be reactivated under conditions of immunosuppression. EBV reactivation is classically associated with infectious mononucleosis and Burkitt lymphoma and rarely associated with cold agglutinin syndrome. Here, we describe a case of minimal change nephrotic syndrome complicated by cold agglutinin syndrome secondary to EBV reactivation in the setting of human immunodeficiency virus (HIV) infection and corticosteroid-induced immunosuppression. A 63-year-old man with well-controlled HIV infection owing to antiretroviral therapy was admitted for nephrotic syndrome. He was treated with prednisolone (80 mg/day), and renal biopsy performed on day 9 confirmed minimal change nephrotic syndrome. Complete remission was achieved by day 18; however, the patient subsequently developed hyperbilirubinemia, elevated transaminase and lactate dehydrogenase levels, progressive anemia, and thrombocytopenia, accompanied by pharyngitis, malaise, and fever. Laboratory investigations revealed a positive cold agglutinin test, positive direct Coombs test, reduced haptoglobin level, and positive urine urobilinogen, consistent with cold agglutinin syndrome. CMV reactivation was also suggested by transient CMV antigenemia positivity, although no organ-invasive CMV disease was evident. Although EBV serology indicated a past infection, the EBV DNA load was elevated, which suggested viral reactivation. The patient responded to supportive measures, along with early tapering of the corticosteroid dose to reduce immunosuppression. This case highlights that HIV infection in combination with corticosteroid therapy may create an immunosuppressive milieu, predisposing patients to EBV reactivation and subsequent development of cold agglutinin syndrome. Clinicians should be vigilant for EBV-related complications in patients with minimal change nephrotic syndrome requiring corticosteroid therapy, particularly in those with underlying HIV infection.

Inappropriate antibiotic prescribing for acute pharyngitis remains a key driver of antibiotic resistance and a persistent public health challenge. This study examined antibiotic prescribing patterns and their association with demographic characteristics and health insurance factors among acute pharyngitis visits in Saudi Arabian governmental primary healthcare centers. A cross-sectional analysis was conducted using anonymized electronic health records for 14,550 acute pharyngitis visits by Saudi nationals in 2023 within governmental primary healthcare centers. Descriptive statistics, chi-square tests, and multivariate logistic regression were used to assess predictors of antibiotic prescription, including age, gender, insurance scheme, and private insurance company. Antibiotics were prescribed in 84.7% of visits, with amoxicillin (62%) and azithromycin (37%) accounting for the majority of prescriptions. Younger age, particularly children aged 0-7 years, was significantly associated with higher odds of receiving antibiotics, while gender was not a significant predictor. Similarly, to age, the patient's insurance scheme was a predictor of antibiotic prescription, with patients covered by governmental insurance being 28.6% more likely to receive antibiotics than those under private insurance. These findings indicate a high prevalence of antibiotic use for acute pharyngitis in primary care and suggest that prescribing practices are primarily influenced by patient age and insurance scheme, underscoring the need for strengthened antibiotic stewardship and improved adherence to clinical guidelines.

Current pharyngitis treatment relies heavily on antibiotics and glucocorticoids, leading to increasing bacterial resistance and significant adverse drug reactions, while the traditional efficacy of Fructus Chebulae is to reduce swelling and relieve sore throat, yet its key components and mechanism against pharyngitis need systematic research. Therefore, this study aimed to integrate MALDI-MSI spatial metabolomics and network pharmacology to systematically analyze Fructus Chebulae's therapeutic mechanism against acute pharyngitis, identifying ellagic acid as the core component, along with key targets and spatial metabolic pathways. Using a 'disease-component-metabolic pathways' strategy, network pharmacology was combined with in vivo validation in an acute pharyngitis animal model induced by 5% ammonia oropharyngeal spray, followed by spatial metabolomics analysis. The results showed that network pharmacology identified ellagic acid and SRC protein as the core ingredient and key target. Ellagic acid spraying dose-dependently repaired pharyngeal damage, significantly reduced TNF-α and oxidative stress, and inhibited SRC protein expression. Furthermore, MALDI-MSI visualized metabolites, screening 376 differentially expressed metabolites and pinpointing 49 biomarkers. Specifically, ellagic acid inhibited inflammation, scavenged radicals, and promoted regeneration by regulating amino acid biosynthesis, riboflavin, and lipid metabolism. In conclusion, this study multidimensionally analyzed Fructus Chebulae's traditional efficacy using network pharmacology, confirming the anti-pharyngitis efficacy of ellagic acid, and for the first time via MALDI-MSI illustrated its core spatial metabolic pathways regulating inflammation, oxidative stress, and tissue repair.

Acute pharyngitis is a common upper respiratory tract infectious disease worldwide. The increasing prevalence of multidrug‑resistant pathogens, particularly methicillin‑resistant Staphylococcus aureus (MRSA), greatly hinders clinical treatment and predisposes patients to recurrent and persistent inflammation. Consequently, there is an urgent need for safe and effective alternative therapeutic agents.

Post-streptococcal pustulosis was first described in 1974 by Tan et al., and was only clearly distinguished from acute generalized exanthematous pustulosis in 1995. It is a rare neutrophilic dermatosis which usually arises following group A streptococcal infections, and is self-limited in time, typically resolving with 1 month. Clinical presentation includes a roughly symmetrical sterile pustular eruption arising in normal skin, most often affecting acral areas, like palms, soles, and legs. Up to this date, only 26 cases have been documented worldwide, making it a rare phenomenon. Differential diagnosis with other conditions, namely AGEP and pustular psoriasis (PP), might prove challenging. We present a case of a 52-year-old woman who came to our clinic with a 2-day pustular eruption of the acral areas that arose after a streptococcal pharyngitis. A skin biopsy was performed and revealed a dense neutrophilic infiltrate around the superficial dermis with microabscess formation in the dermal papillae, which was consistent with the diagnosis of post-streptococcal pustulosis. The patient was treated with topical steroids and the lesions resolved within 2 weeks. In this paper, we highlight this rare entity and provide some clinical clues that may help distinguish this disease from AGEP and PP.