搜索结果：Infection & chemotherapy

Rhino-orbito-cerebral infection is a rare but potentially life-threatening condition that usually occurs in immunocompromised patients. Identification of the causative organism is often challenging. A 71-year-old man without overt immunosuppression, such as corticosteroid use or chemotherapy, presented with visual loss in the left eye and was found to have internal carotid artery occlusion complicated by ischemic stroke. Despite extensive investigations, including surgical biopsy, a definitive diagnosis could not be established for nearly 4 months. Fungal infection was eventually confirmed by culturing a large volume (10 mL) of cerebrospinal fluid (CSF), which revealed a mixed infection with Cladosporium halotolerans and Penicillium corylophilum by Internal Transcribed Spacer rDNA sequencing and β-tubulin gene sequencing. The patient was treated with liposomal amphotericin B followed by voriconazole, resulting in gradual clinical and radiologic improvement. Clinicians should consider fungal infection in patients with unexplained carotid artery occlusion and stroke. Submitting an adequate volume of CSF may improve the diagnostic yield for identifying the causative fungi.

Pseudomonas oryzihabitans, a Gram-negative opportunistic pathogen, is associated with infected burn wounds in elderly patients with underlying diseases. Moxibustion patch-related deep burns in farmers (due to occupational exposure) often have nonspecific manifestations, causing diagnostic delays. This case highlights the synergistic role of microbiologically guided antimicrobial therapy and surgical intervention. A 71-year-old female farmer with type 2 diabetes and bilateral lower extremity arteriosclerotic occlusive disease developed left lower leg third-degree burn due to improper moxibustion patch use; wound infection occurred after self-treatment. Wound secretion culture confirmed Pseudomonas oryzihabitans (colony count ≥106 CFU/mL) sensitive to cefoperazone-sulbactam. She received microbiologically guided antimicrobial therapy combined with surgical debridement, negative pressure wound therapy (NPWT), and elective split-thickness skin grafting. Postoperatively, infection indicators decreased significantly, the wound healed well, and no recurrence or complications were observed. Elderly patients with underlying diseases are at high risk of such burns and infections. The synergistic application of microbiologically precise antimicrobial therapy and surgical intervention is key to improving efficacy and reducing recurrence.

Acute lung infection (ALI) represents a major global health challenge with high morbidity and mortality. The current clinical approach primarily relies on antibiotic therapy, yet the therapeutic efficacy is severely limited by poor drug targeted delivery. Here, we developed neutrophil-hijacking pH/enzyme dual-responsive rifampicin-loaded nanoparticles (RFP‑NENPs) composed of pH-sensitive polymer (mPEG2K-PAE) and enzyme-responsive polymer PCL-PEG2K decorated with neutrophil elastase-targeting peptide, which can self-assemble into nanoparticles. After intravenous injection, the RFP‑NENPs can specifically target and hijack neutrophils in vivo, and deposit at the infectious site due to inflammatory chemotaxis of pro-inflammatory neutrophils via the immune response, followed by releasing the cargos due to the low pH and bacterial enzymes in the infectious microenvironment. In a mouse model of acute lung infection by Staphylococcus aureus, RFP‑NENPs effectively cleared the bacteria and caused no detectable systemic toxicity. This work not only presents an effective therapeutic for enhanced acute lung infection treatment, but also offers a neutrophil-mediated drug delivery strategy.

Patients with peritoneal dialysis (PD) often develop exit-site infections (ESI) caused by nontuberculous mycobacteria. Antimicrobial therapy, including intravenous amikacin (AMK), is combined with PD catheter removal to control the source of infection. However, the efficiency of AMK removal using PD remains unclear. In this report, we describe AMK pharmacokinetics before and after PD catheter removal in a patient diagnosed with Mycobacterium abscessus from ESI. A 73-year-old female PD patient weighing 42.4 kg who received intravenous AMK + clarithromycin + imipenem/cilastatin for Mycobacterium abscessus ESI on day 1 under therapeutic drug monitoring. During hospitalization, the patient underwent a typical PD regimen including nocturnal continuous ambulatory PD with Reguneal HCa 1.5® (1.5% glucose) 1.5 L (2-hour storage) + Reguneal HCa 1.5® 1.5 L or Extraneal® (7.5% icodextrin) 1.5 L (11.5-hour storage). Dosing schedule of AMK was 200 mg every 48 h to maintain an AMK trough concentration around 10 µg/mL. On day 14, the PD catheter was removed and reinserted on the contralateral side for source control of the infection site and PD was discontinued until day 20. The elimination rate constant (Ke) of AMK was 0.027 h- 1 obtained from peak concentration (Cpeak) of 16.3 µg/mL on day 1 and trough concentration (Ctrough) of 4.5 µg/mL on day 3. In contrast, Ke was 0.020 h- 1 calculated from both Cpeak of 22.2 µg/mL on day 9 and Ctrough of 8.4 µg/mL on day 11, as well as Cpeak of 23.8 µg/mL on day 17 and Ctrough was 9.3 µg/mL on day 19. Combination antibiotic therapy was completed due to clinical improvement on day 27. Post-treatment, clofazimine and clarithromycin were administered orally, and the patient was discharged on day 32. The effect of PD on AMK concentration was limited during therapeutic drug monitoring.

Tuberculosis (TB) is still the most common cause of mortality among people living with HIV (PLHIV) worldwide. However, in Rwanda, no study has specifically assessed the survival and risk factors for mortality among patients with TB/HIV co-infection in urban settings such as Kigali city. This study aims to determine the survival probability and identify risk factors for mortality among patients with TB/HIV coinfection in Kigali City, Rwanda. A retrospective cohort study was conducted among 1,966 patients aged (&#x2265;&#x2009;15 years) with TB/HIV co-infection who were receiving antiretroviral therapy (ART) at the time of TB diagnosis and were enrolled at the initiation of treatment for drug-susceptible tuberculosis at 48 health facilities in Kigali between July 2019 and March 2024. Data were extracted from the e-TB system and patients' medical records. The survival probability up to 168 days was estimated via the Kaplan-Meier method. Cox proportional hazards regression was used to predict mortality. Statistical significance was set at p&#x2009;<&#x2009;0.05. The median age of the patients was 39 years (IQR: 33-46), and 66.0% were male. A total of 264 patients (13.4%, 95% CI: 11.9-15.0) died, and 78.8% of the deaths occurred within the first 56 days of follow-up. The overall survival probability was 86.6% (95% CI: 84.9-88.0). Significant predictors of mortality included age&#x2009;&#x2265;&#x2009;45 years (adjusted hazard ratio [aHR]&#x2009;=&#x2009;2.21; 95% CI: 1.18-4.11), no receipt of cotrimoxazole preventive therapy (CPT) (aHR: 1.65; 95% CI: 1.29-2.13), the presence of comorbidities(including diabetes mellitus, hypertension, asthma, chronic liver disease, chronic kidney disease, malignancy, and other chronic illnesses) (aHR: 3.18; 95% CI: 2.27-4.45), no receipt of tuberculosis preventive treatment (TPT) (aHR: 1.87; 95% CI: 1.38-2.54), undernutrition (aHR: 2.72; 95% CI: 2.12-3.50), fair ART adherence (aHR: 1.89; 95% CI: 1.25-2.87), low CD4 count&#x2009;<&#x2009;200 cells/mm&#xb3; (aHR: 2.30; 95% CI: 1.74-3.05) and extrapulmonary TB (aHR: 1.62; 95% CI: 1.15-2.28). Mortality among patients with TB/HIV-coinfected in Kigali remains high, particularly during the early treatment period. Predictors of mortality included older age, lack of TPT and CPT, comorbidities, undernutrition, fair ART adherence, low CD4 count and extrapulmonary TB. Increasing TB/HIV integrated care through improved adherence support, nutritional supplementation, comorbidity management, increased uptake of cotrimoxazole and TPT, and timely interventions are critical to reduce mortality. Not applicable.

Compared to the best available therapy, Sulbactam/Durlobactam plus carbapenems showed a trend toward improved 7-day microbiological clearance (62.5% (10/16) vs. 16.1% (5/31), Cohen's h =&#x202f;0.998, 0.983 CI [0.261, 1.735]) in carbapenem-resistant Acinetobacter baumannii pulmonary infection co-infected with carbapenem-resistant Enterobacterales (CRE) and/or carbapenem-resistant Pseudomonas aeruginosa (CRPA), yet no significant differences were observed in 14-day, end of treatment, or test of cure microbiological clearance and clinical cure rates, or in intensive care unit and 28-day mortality. Subgroup analysis demonstrated more improvements for patients co-infected with CRE than with CRPA.

Primary Amoebic Meningoencephalitis (PAM), caused by Naegleria fowleri, is a rare but highly devastating infection with a mortality rate exceeding 98%. Although historically sporadic, recent emerging cases and localized outbreaks have raised global concern. The disease's rapid progression and diagnostic complexity demand immediate and precise therapeutic intervention, as even minor medication errors can critically impact patient survival. Such medication errors, ranging from incorrect dosing to delayed administration,Primary Amoebic Meningoencephalitis (PAM), caused by Naegleria fowleri, is a rare but devastating infection with a mortality rate exceeding 98%. Although historically sporadic, recent emerging cases and localized outbreaks have heightened global concern. The disease's rapid progression and diagnostic complexity necessitate immediate, precise therapeutic intervention, where even minor medication discrepancies can critically affect survival outcomes. Medication errors ranging from incorrect dosing to delayed administration pose significant clinical and economic challenges, underscoring the need for robust strategic safeguards. Within this context, clinical pharmacists emerge as pivotal agents of patient safety. Their expertise in pharmacotherapy, drug interactions, and adherence to treatment protocols enables them to implement strategic solutions such as: Standardized treatment algorithms for anti-amoebic therapy to minimize dosing errors. Real-time medication reconciliation systems to prevent delays and ensure timely administration. Multidisciplinary coordination frameworks integrating pharmacists with physicians, microbiologists, and intensivists for rapid decision-making. Continuous training and simulation exercises to prepare healthcare teams for rare but high-stakes infections. Digital monitoring and AI-driven alerts to detect potential drug interactions or deviations from protocol. This article synthesizes case reports from the United States, Pakistan, and India, highlighting both historical and recent PAM instances. These narratives emphasize the evolving role of clinical pharmacists in identifying, preventing, and correcting medication-related issues. By bridging clinical insight with pharmaceutical precision, pharmacists not only enhance therapeutic accuracy but also strengthen institutional preparedness against rare infections. As global awareness grows, embedding clinical pharmacy into multidisciplinary care models represents a strategic solution essential not only for PAM but also for other emerging infectious threats where survival hinges on therapeutic precision.

Mucormycosis, a fungal infection, usually involves the rhino-orbital-cerebral cavities in immunocompromised patients. The upper limb is one of the most infrequent sites for mucormycosis infection. We present a rare and atypical case of upper limb mucormycosis in an immunocompromised patient undergoing chemotherapy for acute lymphoblastic leukemia. The diagnosis was confirmed through histopathological examination. Prompt and aggressive intervention - including extensive surgical debridement and intravenous antifungal therapy - led to the successful preservation of both the patient's life and limb. This case is notable for successful limb salvage without amputation, despite deep tissue involvement. Prompt recognition, early surgical intervention, and appropriate antifungal therapy were key to the favorable outcome. Considering mucormycosis in immunocompromised patients, along with early diagnostic workup, biopsy, specific fungal cultures (when available), antifungal therapy, and timely surgical intervention, can lead to limb and life salvage. The present study has revealed the importance of early diagnosis and management of uncommon site infections with mucormycosis in immunocompromised individuals, particularly in hematologic malignancies.

Urogenital schistosomiasis remains a major public health problem in irrigated areas of Sudan. We conducted a cross-sectional descriptive survey to determine the prevalence and intensity of Schistosoma haematobium infection and associated risk factors among basic schoolchildren in Althawra Mobi Village, Wad Madani Alkobra Locality, Gezira State. A total of 261 children aged 5-16 years were examined using urine centrifugation and microscopy. The overall prevalence was 44% (115/261), with most infections classified as light intensity (102/115). Infection was markedly higher among boys (96.5%) than among girls (3.5%). Frequent contact with irrigation canals for swimming, bathing, washing, and watering animals was significantly associated with infection, despite tap water being the main source of drinking water. These findings confirm ongoing transmission of urogenital schistosomiasis in irrigated communities of Gezira and highlight the need for sustained preventive chemotherapy, health education, and improved sanitation to reduce exposure among school-age children.

Immune checkpoint inhibitors (ICIs) have improved survival in extensive-stage small-cell lung cancer (SCLC) but may cause checkpoint inhibitor pneumonitis (CIP). Management of CIP often requires prolonged high-dose corticosteroids, leading to profound immunosuppression and increased risk of opportunistic infections. Among these, Pneumocystis jirovecii pneumonia (PJP) is a life-threatening complication in non-HIV patients and carries higher mortality than HIV-associated PJP. Early etiological diagnosis is therefore essential. We report a case of severe PJP diagnosed by metagenomic next-generation sequencing (mNGS) and successfully managed with comprehensive respiratory support. A 69-year-old HIV-negative man with extensive-stage SCLC received four cycles of etoposide-platinum chemotherapy plus adebrelimab. Subsequently, CIP developed and required prolonged high-dose methylprednisolone therapy. He was transferred to our hospital for progressive dyspnea. Evaluation showed severe hypoxemia (PaO&#x2082;/FiO&#x2082; 185&#x202f;mmHg) and markedly elevated serum 1,3-&#x3b2;-D-glucan (3327.99&#x202f;pg./mL). Bronchoalveolar lavage fluid mNGS identified P. jirovecii as the predominant pathogen, with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida albicans indicating mixed pulmonary infection. The patient received trimethoprim-sulfamethoxazole, cefoperazone-sulbactam, and caspofungin. Worsening respiratory failure required endotracheal intubation and mechanical ventilation. Lung recruitment maneuvers, individualized positive end-expiratory pressure titration, and adjunctive inhaled nitric oxide progressively improved oxygenation, allowing successful extubation and eventual discharge. Severe PJP should be considered in non-HIV patients receiving corticosteroids for CIP. mNGS enabled rapid pathogen identification and targeted therapy. Comprehensive respiratory support, including optimized mechanical ventilation and inhaled nitric oxide, may be valuable in managing life-threatening opportunistic infections in immunosuppressed patients.

Acute kidney injury and metabolic derangements are common after extracorporeal membrane oxygenation (ECMO), yet their potential contribution to urinary stone formation is rarely described. Critically ill patients may develop lithogenic conditions related to tubular injury, oliguria, prolonged immobilization, catabolism, infection, and alterations in urinary solute handling. We report the case of a 13-year-old girl with B-cell acute lymphoblastic leukemia undergoing induction chemotherapy who developed Pseudomonas septic shock requiring prolonged extracorporeal support with venoarterial ECMO followed by venovenous ECMO. Her course was further complicated by acute respiratory distress syndrome, bilateral pneumothoraces, and prolonged intensive care unit hospitalization. During recovery, computed tomography revealed bilateral renal and ureteral calculi with moderate left hydroureteronephrosis. Despite significant stone burden, the patient remained clinically stable without urinary tract infection, preserved renal function, and gradual radiographic improvement. Because of ongoing chemotherapy, immunosuppression, pulmonary risk, and fluctuating procedural candidacy, management required repeated multidisciplinary reassessment involving pediatric urology, oncology, pulmonology, nephrology, and the patient's family. Initial decompression and staged ureteroscopic intervention were considered; however, serial imaging demonstrated partial spontaneous migration of calculi, allowing temporary conservative management with tamsulosin and close surveillance. Persistent left-sided impaction and limited further migration ultimately supported definitive bilateral ureteroscopy with laser lithotripsy and short-term stenting once medically optimized. This case highlights the complex balance between surgical urgency and systemic risk in post-ECMO patients with urolithiasis. It also raises the possibility that ECMO-related renal injury and critical illness physiology may contribute to the formation of low-density or matrix-type stones. Individualized multidisciplinary decision-making is essential in medically fragile patients.

We reported stepwise evolution of a Methicillin-Resistant Staphylococcus epidermidis (MRSE) with reduced susceptibility to dalbavancin in a patient with recurrent episode of bloodstream infections (BSIs). (Single nucleotide polymorphism) SNPs and insert/deletions analysis between genomes of dalbavancin -susceptible and -non-susceptible strains was performed. Dalbavancin exposure and PK/PD target attainment was determined by TDM. In vitro synergy testing was performed by evaluating the fractional inhibitory concentration indices. Four clonally related MRSE isolates belonging to ST23 were recovered during recurrent bacteraemic episodes in a single patient treated with dalbavancin-based therapy over a 3-year period. Progressive increases of the dalbavancin MIC was observed and resistome analysis showed a conserved antimicrobial resistance genes among isolates. First dalbavancin non-susceptible strain carried an A414T substitution within walK, whereas the second non-susceptible MRSE strain harboured L957F and G470D mutations in rpoB and vraG, respectively. TDM analysis indicated optimal plasma exposure and prolonged PK/PD target attainment by considering clinical breakpoint and MIC of dalbavancin of the susceptible MRSE strains. Synergy testing demonstrated that dalbavancin combined with fosfomycin exhibited synergistic activity against 75% of isolates, whereas combinations with &#x3b2;-lactams were mostly indifferent. We described in vivo evolution of dalbavancin reduced susceptibility in MRSE during long-term dalbavancin therapy highlighting multiple genetic trajectories involving different genetic determinants. These findings underscore the risk of resistance selection despite adequate systemic exposure and support the need for optimized dosing strategies, source control in preventing recurrence in prosthetic infections, and combination regimens to prevent resistance during dalbavancin treatment of MRSE infections.

Onychomycosis is a prevalent nail infection, caused by dermatophytes, leading to nail thickening, discolouration, pain and discomfort. Existing topical therapies show limited efficacy due to poor nail penetration and inadequate drug release at the infection site. Current treatment methods include nail removal or laser therapy. To overcome these limitations, we formulated a Ciclopirox-Salicylic acid incorporated Chitosan lotion with penetration enhancers to eliminate the fungal pathogen from the nail bed. Ciclopirox (CX) exhibits both fungicidal and fungistatic activity by inhibiting fungal DNA, RNA and protein synthesis, while salicylic acid (SA) acts as a keratolytic agent that facilitates drug permeation through the nail layers. Tween-80 and poly ethylene glycol (PEG-400) is used as permeation enhancers to improve drug penetration and prevent drug precipitation, thereby enhancing formulation stability. The prepared lotion was characterized using FE-SEM, FT-IR and rheological analyses. The developed CSL-SA-CX shown effective antifungal activity against Candida albicans and Aspergillus niger. Ex vivo porcine skin permeation study demonstrated significantly enhanced ciclopirox permeation (14,308.34&#x202f;&#xb1;&#x202f;2.6&#x202f;&#x3bc;g/cm2) compared to formulations. In vivo antifungal activity in Drosophila melanogaster fly model validated the in vivo safety of the developed CSL-SA-CX against C. albicans. Thus, the prepared CSL-SA-CX lotion can be used to treat Onychomycosis as well as a wide range of nail fungal infections.

The study aim was to evaluate the effectiveness of anti-methicillin-resistant Staphylococcus aureus (MRSA) cephalosporins in combination with daptomycin (anti-MRSA Ceph + DAP) compared to other antimicrobial regimens (OARs) as initial treatment of MRSA bloodstream infection (BSI). This retrospective observational study enrolled patients with MRSA-BSI from 1 January 2020 to 31 December 2024 at 4 large Italian hospitals. The primary endpoint was 90-day all-cause mortality. Cox regression was used for primary endpoint analysis; results were confirmed with inverse probability of treatment weighting (IPTW). Treatment efficacy was also assessed using the desirability of outcome ranking (DOOR) approach, assigning 1 additional point beyond recovery for 1 of the following negative outcomes: (i) persistent MRSA infection, (ii) persistent bacteremia (&#x2265;5 days), (iii) drug resistance, (iv) any adverse event, and (v) 90-day relapse. A score of 7 was assigned for death at any time point. Overall, 465 patients were enrolled: Median age was 76 (IQR, 61-83) years, 59% male, with a Charlson Comorbidity Index score of 7 (IQR, 4-8). Of them, 50 (11%) and 116 (25%) patients had endocarditis and metastatic infection, respectively. Importantly, 90-day mortality occurred in 181 (39%) patients, while 260 (56%) experienced at least 1 negative outcome included in DOOR analysis. Overall, patients in the anti-MRSA Ceph + DAP arm had a 59.9% (95% CI, 52.4%-67.4%) probability of having a better outcome than those in the OAR arm. Particularly, anti-MRSA Ceph + DAP was associated with reduced mortality (aHR, 0.54 [95% CI, .34-.85]), confirmed after adjustment with IPTW analysis. Anti-MRSA Ceph + DAP could represent a valid initial therapy for MRSA-BSI, especially in patients with high risk of worse outcomes.

Virus-related cardiac diseases encompass a diverse spectrum of cardiovascular pathologies caused by direct viral infection and indirect immune-mediated injury. Major cardiotropic and cardioactive viruses-including severe acute respiratory syndrome coronavirus 2, influenza virus, human immunodeficiency virus, arboviruses (dengue virus, chikungunya virus, Zika virus), enteroviruses (coxsackievirus B3), and human cytomegalovirus-contribute to myocardial injury manifesting as myocarditis, pericarditis, arrhythmias, acute and chronic heart failure, and thromboembolic complications. Mechanisms of cardiac involvement are multifactorial, involving direct infection of cardiac cells leading to cytopathic effects and innate immune activation, dysregulated adaptive immune responses promoting myocardial inflammation and fibrosis, electrophysiological disturbances, and systemic effects such as endothelial dysfunction and prothrombotic states that precipitate ischemic events. Clinical manifestations range from subclinical injury to fulminant myocardial inflammation and may also include long-term sequelae, such as post-acute cardiovascular symptoms, as observed in long COVID cases. Therapeutic strategies emphasize early antiviral treatment when effective agents exist, judicious immunomodulation based on viral replication status, and supportive management of cardiac dysfunction and arrhythmias. Prevention through vaccination, personal protective measures, vector control, and optimization of cardiovascular risk factors remains pivotal to reduce the burden of virus-associated cardiovascular diseases. Future research requires improved diagnostic precision, mechanistic elucidation, and randomized trials to optimize antiviral and immunomodulatory interventions and to develop vaccines for currently unmet viral targets. An integrated, mechanism-informed approach across prevention, acute management, and long-term care is essential to mitigate the cardiovascular morbidity and mortality attributable to viral infections.

The rising prevalence of antifungal resistance poses a significant threat to global health, with Candida glabrata (C. glabrata) emerging as a particular concern due to its increasing incidence in clinical settings and the intrinsic low susceptibility to azoles. Salvianolic acid B (SAB), a major bioactive component extracted from Salvia miltiorrhiza, exhibits potent antioxidant properties; however, its potential as an antifungal remains unexplored. This study aimed to evaluate the antifungal efficacy of SAB alone and in combination with azoles against C. glabrata, both in vitro and in vivo, and to elucidate the underlying mechanisms. The antifungal efficacy of SAB alone and in combination with fluconazole (FLC), itraconazole (ITC), and voriconazole (VRC) was assessed against C. glabrata. Synergistic interactions were determined via checkerboard microdilution assays and time-kill studies. The cytotoxicity of SAB was evaluated using lactate dehydrogenase (LDH) release assays, while in vivo efficacy was examined using a Galleria mellonella (G. mellonella) infection model. Additionally, mechanistic insights were obtained through scanning and transmission electron microscopy (SEM/TEM) to visualize morphological and ultrastructural alterations. SAB exhibited marked synergistic activity with azoles against azole-resistant C. glabrata isolates. Importantly, SAB demonstrated negligible cytotoxicity toward mammalian cells. In the G. mellonella infection model, combination therapy with FLC and SAB significantly improved larval survival compared to FLC alone. SEM and TEM revealed extensive membrane disruption, cytoplasmic dissolution, and subcellular damage in SAB and FLC treated cells, consistent with the observed synergistic antifungal activity. SAB synergistically enhances azoles activity against drug-resistant C. glabrata both in vitro and in vivo, with mechanisms involving membrane disruption and ultrastructural damage. These findings position SAB as a promising natural adjuvant for combination therapy against drug-resistant Candida infections.

Severe drug-induced liver injury, dengue, and viral hepatitis are important causes of acute liver dysfunction, but their co-occurrence in young patients is extremely uncommon and can create diagnostic challenges. We report a 15-year-old boy who developed severe acute hepatitis while receiving antitubercular therapy (ATT). He presented with fever, vomiting, and myalgias 4 weeks after starting ATT and was initially diagnosed clinically as dengue. Laboratory tests showed markedly elevated transaminases [aspartate aminotransferase (AST) 4172&#xa0;U/l and alanine aminotransferase (ALT) 2139&#xa0;U/l], hyperbilirubinemia (total bilirubin 2.03 mg/dl), and progressive thrombocytopenia. Dengue serology later returned negative, and further evaluation confirmed acute hepatitis A infection. Prompt withholding of first-line ATT and initiation of supportive care led to steady clinical improvement, with recovery achieved after 1 week. The coexistence of acute viral hepatitis and tuberculosis in young individuals is rare and may be easily overlooked, particularly when a dominant clinical or laboratory abnormality directs diagnostic reasoning toward a single etiology. Such diagnostic overshadowing can delay recognition of concurrent pathologies, especially in resource-limited or high-burden settings where certain infections are more readily presumed. This case underscores the importance of considering overlapping hepatotoxic triggers in young patients and highlights the need for timely, broad diagnostic evaluation.

Early monitoring biomarkers for first-line chemoimmunotherapy in extensive-stage small-cell lung cancer (SCLC) remain limited. Dynamic blood-based changes may better reflect treatment-related alterations than static baseline values. We conducted a retrospective multicenter study comprising a 225-patient baseline cohort, a 148-patient dynamic development cohort of chemoimmunotherapy-treated patients with paired baseline/post-cycle 2 blood tests, and a 49-patient independent external validation cohort. Early relative changes in routine blood-based markers were analyzed for associations with objective response rate (ORR) and survival. A simplified ImmunoScore based on standardized changes in neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) was developed and externally validated. Elevated baseline NLR, platelet-to-lymphocyte ratio (PLR), LDH, and D-dimer were associated with shorter overall survival (OS), whereas only LDH remained independently prognostic. In the development cohort, &#x394;NLR showed the strongest association with ORR, and both &#x394;NLR and &#x394;LDH were associated with progression-free survival (PFS). The ImmunoScore achieved areas under the curve (AUCs) of 0.895 and 0.938 for ORR prediction in the development and external validation cohorts. The ImmunoScore may provide an interpretable post-cycle 2 framework for ORR prediction and subsequent survival stratification in SCLC. Given the small external validation cohort, these findings remain exploratory and require prospective multicenter validation. Small-cell lung cancer is a fast-growing lung cancer. Many patients now receive chemotherapy together with immunotherapy. This treatment can help some patients, but it does not work well for everyone. Doctors need simple ways to check early whether treatment is helping.In this study, we looked at routine blood tests from patients with small-cell lung cancer. We compared blood test results before treatment and after two treatment cycles. We focused on two common markers. One marker reflects the balance between infection-fighting cells and immune cells. The other marker may reflect tumor activity.We used these two markers to build a simple score called the ImmunoScore. Patients with better changes in these blood markers were more likely to respond to treatment. They also tended to have better survival outcomes.This score uses blood tests that are already common in clinical care. It may help doctors and researchers monitor treatment after two cycles. However, this study looked back at past patient records. The score also needs repeat blood tests after two cycles. It should not be used alone to make treatment decisions. Larger future studies are needed before it can be used in routine care.

A kidney transplant recipient developed spindle cell sarcoma within an abdominal aortic aneurysm following prior endovascular aneurysm repair (EVAR). The patient had undergone EVAR for abdominal aortic aneurysm before successful living-donor kidney transplantation and maintained stable graft function under immunosuppressive therapy. Two years after transplantation, he presented with back pain, elevated inflammatory marker, and aneurysm enlargement, initially suspected as an infected aneurysm. Despite antibiotic therapy, the lesion progressed. Positron emission tomography demonstrated increased fluorodeoxyglucose uptake, and computed tomography-guided biopsy revealed undifferentiated spindle cell sarcoma with unclear lineage differentiation. Surgical resection was not feasible, and systemic chemotherapy was initiated; however, disease progression continued, and the patient died 7 months after admission. Aortic sarcoma following EVAR is rare and may mimic infection or inflammatory complications. Clinicians should consider malignant etiologies when transplant recipients with prior EVAR present with atypical aneurysm enlargement or persistent inflammatory findings, and early tissue diagnosis may be necessary.