搜索结果：Pain medicine case reports

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disorder characterized by demyelination and axonal damage in peripheral nerves, leading to progressive weakness and sensory impairment. Neurological complications have been reported in multiple COVID-19 cases, ranging from mild symptoms such as headaches to severe manifestations like demyelination and stroke. We report the case of a 20-year-old female who initially presented with feverish sensation, non-productive cough, generalized fatigue, arthralgia, and muscle pain. She tested positive for SARS-CoV-2 via polymerase chain reaction and received supportive treatment with home isolation for 20 days. While most symptoms resolved, muscle pain persisted. Over time, the patient developed progressive muscle pain and constant weakness in both upper and lower limbs, worsened by repetitive movement. Additional neurological symptoms included symmetrical foot drop, frequent falls, tremors, and difficulty performing fine motor tasks. Laboratory findings and nerve conduction studies were consistent with CIDP based on established diagnostic criteria. The patient received intravenous immunoglobulin therapy and had residual disability. Several case reports have associated CIDP with various infectious agents. With the advent of the COVID-19 pandemic, there has been an emergence of CIDP cases following SARS-CoV-2 infection or vaccination. This case adds to the growing body of evidence suggesting a link between COVID-19 and autoimmune neurological complications such as CIDP. This case highlights a rare instance of post-COVID-19 CIDP, underscoring the importance of considering autoimmune neuropathies in the differential diagnosis of patients presenting with progressive neuromuscular symptoms after COVID-19.

Ectopic pregnancy (EP) with implantation in the upper abdomen is exceptionally rare. It represents a challenging clinical scenario with very limited evidence confined to case reports. It seriously endangers maternal health and early diagnosis and treatment can significantly improve patient prognosis. We report a 25-year-old woman who was diagnosed several days ago with gastroenteritis was referred to our department because of worsened upper left abdominal pain. Contrast computerized tomography scan revealed a mass measuring ~46 mm × 40 mm × 56 mm in the upper left abdomen and her serum human chorionic gonadotropin level was 10,130.28 IU/L. EP was highly suspected on admission. Abdominal EP was confirmed by intraoperative findings and postoperative pathology. The patient underwent laparoscopic surgery which went smoothly after admission. An gastrointestinal surgeon was involved during the surgery and the excision of the EP lesion along with partial omentum was performed. The patient was discharged 5 days later after operation without complications. The serum human chorionic gonadotropin level declined to normal within 1 month follow-up. This case illustrates that although ultrasound is considered the first-line method for diagnosing EP, abdominal lesions with undefined nature detected by computerized tomography should also be pay attention to, especially for women of childbearing age presenting with gastrointestinal symptoms other than typical ones such as lower abdominal pain or vaginal bleeding. Close monitoring and timely management are pivotal to improve patient prognosis.

The fascial distortion model (FDM) is an anatomical perspective and treatment technique within the discipline of osteopathic manipulative treatment (OMT). The FDM is unique in that it elucidates a set of common gestures and body language for each of the six recognized FDM distortions. Fascia not only surrounds structures but also links them, transmitting mechanical forces throughout the body in a continuous three-dimensional network. Dysfunction within this system, whether local or distant, can contribute to distinct patterns of body morphology. Although fascial anatomy provides a framework for identifying chains of injury, variations in palpated tension may point toward different underlying pathologies and guide clinical interpretation. Thus, a skilled palpation can detect areas of functional conflict and pain without verbalization. This case study explores the application of FDM in treating chronic low back pain in a Panamanian agricultural worker, highlighting its utility across language barriers. B.P. presented with chronic low back pain, limited range of motion (ROM), and hypertonicity of the lumbar paraspinal muscles. Lumbar active ROM was assessed using visual estimation before, during, and after treatment. B.P.'s nonverbal gestures indicated two trigger bands and two herniated trigger points, which were treated using the appropriate FDM techniques. Post-treatment evaluations revealed improvement in functional mobility and complete resolution of pain. B.P. demonstrated increased lumbar ROM and reported relief without requiring extensive verbal communication. This case report demonstrates the effectiveness of using the FDM to treat chronic low back pain, while giving credence to the universal nature of the body language described by the model. In B.P.'s case, FDM treatments facilitated a successful and culturally competent intervention that improved both pain and function, reinforcing the value of this treatment modality in global and resource-limited contexts.

Background: Meralgia paresthetica is a neuropathic pain syndrome caused by compression of the lateral femoral cutaneous nerve (LFCN). While often self-limited, a subset of patients develops persistent symptoms requiring interventional management. Ultrasound guidance has improved accuracy and safety in peripheral nerve blocks, but evidence from Internal Medicine-led procedures remains limited. Methods: We performed a retrospective, observational case series including all patients aged ≥17 years who underwent ultrasound-guided LFCN blocks at Virgen del Rocío University Hospital between 2016 and 2024. Demographic data, comorbidities, procedural details, complications, and clinical outcomes were collected. Symptomatic response and recurrence were assessed descriptively. Results: Eleven patients were included (10 women; median age 56 years). The most frequent comorbidities were obesity (45.5%) and type 2 diabetes mellitus (18.2%). Clinical improvement following LFCN block was achieved in 10 of 11 patients (91%). Three patients (27%) experienced recurrence, with a median time to recurrence of 24 months; two underwent a second successful block, and one showed spontaneous resolution. No major complications occurred, and only one patient developed a mild, self-limited local reaction. Conclusions: Ultrasound-guided LFCN block is a safe, well-tolerated, and highly effective intervention for patients with persistent meralgia paresthetica. Outcomes achieved by an Internal Medicine specialist appear consistent with previously published reports from anesthesiology settings, underscoring the value of point-of-care ultrasound as a practical and precise tool for managing neuropathic pain within Internal Medicine settings.

Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease with unclear etiology and pathogenesis. Although most IMP patients have a long-term history of traditional Chinese herbal medicine use, this article reports a case without such a special medical history, which may provide new insights into the disease's etiology. A 59-year-old middle-aged man was admitted to the gastroenterology department due to recurrent upper abdominal pain for 1 month. The fecal occult blood test was weakly positive. No significant abnormalities were found in tumor markers, Epstein-Barr virus, cytomegalovirus, T-SPOT, tuberculosis antibodies, or coagulation function. Computed tomography revealed edema and thickening of the intestinal wall in the ascending colon and part of the transverse colon, accompanied by narrowing of the lumen. Multiple calcifications were observed in the right mesenteric vessels, associated with the affected areas. Colonoscopy findings: a circumferential ulcer was noted in the ascending colon at a distance of 75 to 60 cm from the anus, with partial cyanosis of the mucosa and nodular changes. During hospitalization, a series of tests was conducted, and the final diagnosis was IMP. The patient received conservative treatment during hospitalization. After conservative treatment, the patient's abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition. To date, the patient has not experienced any significant discomfort during follow-up. Diagnosing IMP requires familiarity with its characteristic features and the ability to interpret relevant imaging findings. It is important to note that long-term use of traditional Chinese herbal medicine is not always the cause. Further research, including the analysis of more clinical cases and the performance of animal experiments, is needed to fully understand the etiology and pathogenesis of IMP.

The incidences of herpes zoster, osteoporotic vertebral compression fractures, and infectious spondylitis is increasing worldwide owing to the aging population. Given the potential for multiple comorbid conditions with overlapping clinical presentations, thorough history-taking and physical examination are essential for accurate diagnoses. However, the coexistence of herpes zoster, osteoporotic vertebral compression fractures, and infectious spondylitis in a single patient is exceedingly rare, making timely diagnosis even more challenging. A 64-year-old woman with a medical history of hypertension, asthma, and right-sided hemiplegia secondary to a previous hemorrhagic stroke presented with painful vesicular lesions in the right T10 dermatome consistent with herpes zoster. Despite antiviral and antibiotic therapy, her pain worsened, and inflammatory markers increased significantly. Physical examination revealed midline spinal tenderness and pain, exacerbated by postural changes. Magnetic resonance imaging confirmed a collapsed L3 vertebral body consistent with Kummell's disease, along with paravertebral soft tissue changes and psoas muscle involvement, suggesting coexisting infectious spondylitis. Although the biopsy cultures were negative, empirical intravenous cefazolin therapy was initiated. After 2 weeks of intravenous antibiotic treatment, the C-reactive protein and procalcitonin levels normalized. Given the persistent mechanical back pain and stabilized infection, a vertebroplasty was performed. After the vertebroplasty, the patient experienced rapid pain relief without any signs of recurrent infection. Following a 5-week course of intravenous antibiotic therapy and an additional 2 months of oral administration, the patient achieved complete clinical resolution with full remission of both infectious manifestations and zoster-associated sequelae. This case underscores the importance of a comprehensive clinical assessment in older patients, even when a diagnosis of herpes zoster is apparent. Persistent or atypical symptoms warrant further evaluation to exclude concurrent diseases. Furthermore, vertebroplasty can be safely performed in select patients with infectious spondylitis following adequate antibiotic therapy, leading to pain reduction. A multidisciplinary, individualized approach is essential to achieve optimal outcomes in patients with complex spinal pathologies.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with 25-30% arising from the small intestine. While GISTs commonly present with abdominal pain or gastrointestinal bleeding, they may rarely manifest as acute surgical emergencies such as small bowel volvulus (SBV). Presentation with diffuse metastatic disease, including umbilical involvement (Sister Mary Joseph's nodule), at initial diagnosis is exceptionally uncommon. A 60-year-old woman presented with acute abdominal pain, vomiting, and obstipation for 2 days. Clinical examination revealed a soft, non-tender, distended abdomen with preserved bowel sounds. Imaging revealed small bowel obstruction with the characteristic whirlpool sign, a pelvic mass, diffuse peritoneal deposits, a Sister Mary Joseph's nodule, and a hepatic lesion. Emergency laparotomy revealed a 13.0 × 7.5 × 6.5 cm jejunal mesenteric mass causing a 180° anticlockwise volvulus with widespread peritoneal, omental, and umbilical nodules. Segmental jejunal resection with jejunojejunal anastomosis was performed for symptom palliation. Histopathology confirmed spindle-cell GIST, positive for CD117 and DOG1, with a mitotic count of 1/5 mm2 and a Ki-67 index of 3%. The tumor was staged as pT4 Nx M1 and categorized as high-risk. The patient recovered uneventfully and was started on treatment with imatinib mesylate. SBV secondary to GIST is rare and typically occurs in the presence of large extramural tumors that act as a lead point for mesenteric rotation. This case highlights the insidious biological behavior of GISTs, wherein prolonged asymptomatic growth may culminate in advanced metastatic disease at presentation, despite low proliferative indices. The presence of Sister Mary Joseph's nodule further signifies advanced intra-abdominal dissemination and poor prognostic implications. GISTs should be considered in cases of unexplained SBV. This case emphasizes the diagnostic challenges, the need for prompt surgical palliation, and the role of systemic tyrosine kinase inhibitors in advanced presentation of GIST.

This case highlights the importance of suspicion of pulmonary embolism (PE) even after low-dose combined oral contraceptive pills (LD-OCPs) and early diagnosis and prompt thrombolytic therapy administration, especially in resource-constrained settings such as Bangladesh. A 40-year-old female of Asian origin, Class I obese (BMI 32 kg/m2), presented to the emergency department with acute severe dyspnea, pleuritic chest pain, and palpitations. Her medical history was notable for obesity and hypertension, which had been managed with antihypertensive medication for the past 3 years. Additionally, she had been taking a LD-OCP for 4 months for menstrual irregularity. Despite initial management with low-molecular-weight heparin and supportive measures, the patient's condition rapidly deteriorated to severe cardiogenic shock, necessitating urgent intervention. Thrombolytic therapy with alteplase was administered, which significantly improved the patient's hemodynamic status. Follow-up imaging revealed a reduction in the thrombus burden and resolution of deep vein thrombosis. This case highlights the critical role of early diagnosis and prompt thrombolytic therapy, such as alteplase, in managing acute PE. Rapid intervention can prevent severe complications. Clinicians must maintain high suspicion in symptomatic patients, especially women on hormonal therapy, and use timely diagnostics like D-dimer and CT angiography. In resource-limited settings, the timely administration of thrombolytic agents such as alteplase can significantly improve patient outcomes, as demonstrated in this case.

Hiccups are commonly benign, self-limiting events often triggered by transient gastrointestinal or central nervous system irritants. However, when persistent, they may indicate underlying pathology involving the thoracic, gastrointestinal, or neurological systems. We report the case of a 65-year-old male smoker who presented with a 4-day history of persistent hiccups. He denied fever, chest pain, hemoptysis, or other systemic symptoms. Physical examination was largely unremarkable except for decreased air entry in the right middle and lower lung zones. Initial investigations, including gastroscopy and tumor markers, ruled out gastrointestinal causes. CT scan of the chest revealed a right lower lobe consolidation and cavitation with air fluid level and adjacent ground-glass opacities, along with enlarged subcarinal lymph nodes. Differential diagnoses included lung abscess, pneumonia, and tuberculosis cavitation. The patient was admitted for suspected lung abscess and received antibiotics. Bronchoscopy with bronchoalveolar lavage revealed no endobronchial lesions, and PCR testing and culture of the fluid was negative for tuberculosis but positive for klebsiella pneumonia. Despite radiologic regression of pneumonia, the cavitary lesion and lymphadenopathy persisted initially, but later started to regress. This case highlights an unusual presentation of lung abscess manifesting solely as persistent hiccups, without classic respiratory or systemic signs. We aim to emphasize the need to consider thoracic causes in patients with otherwise unexplained persistent hiccups, and undergo further evaluation in such cases.

We present the case of an immunocompetent, fully vaccinated 17-year-old female who developed severe, disseminated varicella-zoster virus (VZV) reactivation with visceral involvement, Ramsay Hunt Syndrome, and complications of suspected superimposed bacterial cellulitis, chronic pain, as well as postherpetic neuralgia. We aim to highlight the importance of early recognition and multidisciplinary management of varicella-zoster virus in immunocompetent patients to minimize disease complications. All data were obtained from the electronic medical record with permission from the patient and her parent. The patient underwent serial dermatologic examinations and a comprehensive immunologic workup. Positive VZV PCR testing of the lesion and blood confirmed active VZV infection. Despite an intensive multi-drug antiviral regimen, she developed suspected clinical drug resistance-although resistance testing was not performed-progressing to disseminated varicella with hepatic involvement. Inpatient complications included Ramsay Hunt Syndrome, suspected superimposed bacterial cellulitis, opioid withdrawal, and chronic pain. While outpatient, she developed postherpetic neuralgia and psychosocial impairment, preventing her from completing her academic year. This case illustrates a rare, but severe presentation of disseminated varicella-zoster virus with visceral involvement and concomitant Ramsay Hunt Syndrome in a healthy adolescent. It underscores the importance of considering VZV in the differential diagnosis of pediatric rash and neuropathy in all patients, irrespective of immune status.

Hydatid disease, caused by Echinococcus granulosus, is a zoonotic parasitic infection endemic in livestock-raising regions. While the liver and lungs are the most commonly affected organs, renal involvement accounts for only 2-4% of cases, and less than 2% in children. The rarity and nonspecific presentation of renal hydatid cysts make diagnosis challenging, often mimicking other cystic renal pathologies. The aim of this study is to report a rare case of isolated renal hydatid cyst in a pediatric patient and to highlight its clinical presentation, radiological features, diagnostic challenges, and surgical management. By integrating clinical, serological, and cross-sectional imaging findings, this case aims to emphasize the importance of considering hydatid disease in the differential diagnosis of complex renal cysts in children from endemic regions, and to reinforce the role of renal-sparing surgical techniques in achieving favorable outcomes while preserving renal function. A 12-year-old girl from a rural area presented with a 2-week history of dull, progressive left flank pain without urinary or systemic symptoms. Physical examination revealed a palpable, non-tender left flank mass. Laboratory findings were normal. Ultrasonography and contrast-enhanced CT of the kidneys revealed a well-circumscribed cystic lesion (10.5 × 9 cm) with internal septations, daughter cysts, and focal wall calcifications features suggestive of a hydatid cyst. Serology confirmed E. granulosus infection. The patient underwent successful cyst enucleation via a left flank incision, with intraoperative findings consistent with hydatid disease. Postoperative recovery was uneventful, and no recurrence was noted during follow-up. Renal hydatid disease in children is extremely rare and can clinically resemble multilocular cystic nephroma or cystic renal cell carcinoma. Cross-sectional imaging combined with serology enables accurate preoperative diagnosis, guiding surgical management and preventing cyst rupture or spillage. Renal-sparing procedures, such as cyst enucleation, are preferred in pediatric patients to preserve renal function. Isolated renal hydatid cysts, though rare in children, should be considered in endemic regions. Early recognition and renal-sparing surgery ensure favorable outcomes and functional preservation.

Endoscopic retrograde appendicitis therapy (ERAT) has emerged as a minimally invasive treatment option for acute uncomplicated appendicitis. However, its application in chronic appendicitis with giant appendicoliths is rarely reported. Such cases present a significant challenge for ERAT due to the difficult removal of large, impacted fecal stones using conventional techniques. A 40-year-old male presented with persistent right lower quadrant pain, tenderness, and elevated inflammatory markers. Abdominal computed tomography confirmed appendiceal dilation and a giant fecal stone, leading to a diagnosis of chronic appendicitis with a giant appendicolith. The patient underwent ERAT, during which electrohydraulic lithotripsy (EHL) was employed to fragment the large stone that was not amenable to direct extraction. ERAT combined with EHL successfully fragmented and removed the appendicolith, relieving the appendiceal obstruction. The patient's abdominal pain resolved promptly postoperatively, inflammatory markers normalized, and he was discharged on the second postoperative day. During a 12-month follow-up period, the patient remained asymptomatic, with follow-up imaging showing no signs of recurrence. ERAT combined with EHL is a safe and effective approach for managing chronic appendicitis with giant appendicoliths. This combined strategy overcomes the technical challenge of removing large, impacted stones via a minimally invasive, organ-preserving approach, avoiding the risks associated with surgical intervention. It represents a promising therapeutic alternative for these challenging cases.

Infectious spondylodiscitis, an infection that involves the intervertebral disc and adjacent vertebral body, often manifests as back pain, fever, and malaise. Although Staphylococcus aureus is the most commonly reported cause of infectious spondylodiscitis, other atypical organisms can also cause spinal infections. Salmonella enterica serovar Typhi has been rarely reported to cause spondylodiscitis. Retrospective single-record review with informed written consent from the patient. We present the case of an immunocompetent 67-year-old female patient with subacute intermittent back pain, weight loss, and a history of prolonged travel to India. MRI showed destructive T7-T8 spondylodiscitis with vertebral collapse, kyphotic deformity, and severe canal stenosis. Given the patient's presentation, epidemiology, and radiologic features, spinal tuberculosis was initially suspected. A biopsy of the spinal tissue grew S. Typhi by the third day of incubation. The patient was treated with a 6-week course of intravenous ceftriaxone. The patient's symptoms resolved over the course of treatment, and she remained clinically well with no signs of recurrent infection at 12-month follow-up. This case highlights S. Typhi as a rare cause of spondylodiscitis in immunocompetent individuals that can mimic Pott's disease clinically and radiographically. This case exemplifies the importance of maintaining a broad differential when evaluating spondylodiscitis, especially in patients who travel to regions that are endemic for atypical pathogens. La spondylodiscite infectieuse, une infection qui touche un disque intervertébral et le corps vertébral adjacent, se manifeste souvent par des douleurs dorsales, de la fièvre et un malaise général. Bien que Staphylococcus aureus soit la cause la plus fréquemment rapportée de spondylodiscite infectieuse, d'autres organismes atypiques peuvent également provoquer des infections rachidiennes. Salmonella enterica sérovar Typhi (S. Typhi) a rarement été signalée comme cause de spondylodiscite. Examen rétrospectif d'un seul dossier médical avec le consentement éclairé écrit du patient. Nous présentons le cas d'une patiente immunocompétente de 67 ans présentant des douleurs dorsales intermittentes subaiguës, une perte de poids et des antécédents de voyage prolongé en Inde. L'imagerie par résonance magnétique a révélé une spondylodiscite destructrice T7-T8 avec effondrement vertébral, déformation cyphotique et sténose sévère du canal. Compte tenu des symptômes, de l’épidémiologie et des caractéristiques radiologiques de la patiente, une tuberculose spinale a d'abord été suspectée. Une biopsie du tissu spinal a révélé la présence de S. Typhi au troisième jour d'incubation. La patiente a fait l'objet d'un traitement de 6 semaines de ceftriaxone administré par voie intraveineuse. Les symptômes de la patiente ont disparu au cours du traitement et elle est restée en bonne santé clinique, sans signe de récidive de l'infection, lors du suivi à 12 mois. Ce cas met en évidence S. Typhi comme cause rare de spondylodiscite chez les individus immunocompétents, l'infection pouvant imiter cliniquement et radiographiquement la maladie de Pott. Le cas illustre l'importance de maintenir un large diagnostic différentiel lors de l’évaluation d'une spondylodiscite, en particulier chez les patients qui voyagent dans des régions où des agents pathogènes atypiques sont endémiques.

Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy typically associated with asbestos exposure in older adults. Its occurrence in young individuals without asbestos exposure poses significant diagnostic challenges, particularly in tuberculosis-endemic regions. We report the case of a 23-year-old man with no history of asbestos exposure who presented with progressive pleuritic chest pain, dyspnea, fever, and weight loss. Initial evaluation suggested tuberculous pleuritis, and empirical therapy was initiated. Imaging revealed diffuse nodular pleural thickening with loculated effusion. Ultrasound-guided pleural biopsy demonstrated epithelioid MPM, confirmed by immunohistochemical positivity for calretinin and WT-1 with TTF-1 negativity. Despite supportive care, the patient experienced rapid clinical deterioration and died within 1 week of histopathological confirmation. Genetic testing for BAP1 mutation was recommended but could not be performed due to rapid disease progression. This case underscores the importance of considering MPM in the differential diagnosis of pleural effusion in young adults, even in the absence of asbestos exposure. Early pleural biopsy and immunohistochemical evaluation are essential to avoid diagnostic delay, particularly in tuberculosis-endemic settings.

Intradiscal platelet-rich plasma (PRP) has emerging evidence for the treatment of discogenic low back pain. However, procedural access becomes technically challenging at the L5-S1 level in the presence of severe disc collapse, steep lumbosacral lordosis, or high iliac crest morphology, which may preclude standard posterolateral or transforaminal trajectories. A 42-year-old man with chronic discogenic low back pain demonstrated severe L5-S1 degeneration (modified Pfirrmann grade 6) with approximately 3-mm residual disc height, rendering conventional intradiscal access unsafe or impossible. A modified computed tomography-guided interlaminar trajectory passing briefly through the thecal sac was used to achieve intradiscal access. Two milliliters of ultra-high cell-count PRP was injected into the disc nucleus. During controlled needle withdrawal, small aliquots of PRP were deposited at the dural puncture sites to biologically reinforce the needle tract. Our case describes a technically feasible intradiscal PRP delivery route for end-stage L5-S1 disc collapse when all conventional access methods are obstructed. No postprocedure cerebrospinal fluid leak symptoms or neurological complications occurred, and early symptomatic improvement was reported. Further investigation is warranted to evaluate safety, reproducibility, and broader clinical applicability.

Phalangeal fractures are the most common fractures in the foot, with the vast majority completely healing with conservative management. The overall nonunion rate for fractures of the lesser phalanges is not well documented in the literature due to their rarity. The following cases explore two unusual presentations of fifth toe closed fracture with delayed union, suggesting a potential link between infection and delayed healing in apparently closed fractures. The first patient, a 46-year-old female with a history of smoking and synphalangism, developed persistent pain and swelling following a toe fracture. Imaging confirmed atrophic nonunion, and cultures from her eventual amputation identified Clostridium species, suggesting occult infection as a contributing factor. The second patient, a 59-year-old female with anemia and synphalangism, presented with delayed healing of a similar fracture. Empirical antibiotic treatment resulted in complete resolution of symptoms and radiographic healing, further supporting a potential infectious etiology. Occult infection may be a contributing factor in cases of delayed union, even for closed toe fractures. Empirical antibiotic therapy may be a viable nonoperative approach in select patients. Further studies are needed to investigate infection as a potential etiology of atrophic nonunion in closed toe fracture healing in order to guide optimal management strategies.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoinflammatory disorder characterized by osteoarticular and cutaneous manifestations. While tumor necrosis factor-alpha (TNF-α) inhibitors such as adalimumab are increasingly used for refractory cases, some patients exhibit inadequate response. Janus kinase (JAK) inhibitors have emerged as a potential alternative, but data on the selective JAK1 inhibitor upadacitinib in SAPHO syndrome are lacking. An 18-year-old male presented with a 7-year history of recurrent facial acne since 2016. Whole-body bone scintigraphy revealed focally increased radiotracer uptake in the right clavicle, consistent with SAPHO syndrome. Initial treatment of acne with adapalene gel combined with oral minocycline failed to improve skin symptoms, leading to the decision to ultimately pursue biologic therapy. After four months of adalimumab therapy, the patient initially showed improvement in chest pain and dermatitis but subsequently experienced paradoxical worsening of facial acne accompanied by erythema and pruritus. No improvement was observed after an additional four weeks of continued adalimumab treatment. Following a transition to upadacitinib, facial lesions improved within 4 weeks and achieved marked resolution by 8 weeks. This report of upadacitinib in SAPHO syndrome demonstrates its rapid and substantial efficacy in a patient refractory to adalimumab. Upadacitinib may represent a promising treatment option for difficult-to-treat SAPHO syndrome, particularly in cases with inadequate response to TNF-α inhibition.

Kaposi sarcoma (KS) and diffuse large B-cell lymphoma (DLBCL) are AIDS-defining malignancies frequently linked to HIV-related immune dysregulation. Their sequential occurrence in a single patient is an uncommon and clinically significant phenomenon. Herein, we report a case of sequential occurrence of KS and DLBCL that underscores the complex interplay between HIV infection, immune suppression, and oncogenesis. At the time of HIV diagnosis (which prompted the immediate initiation of antiretroviral therapy), the patient, a 46-year-old man, exhibited symptoms (generalized rash, bowel movements) raising clinical suspicion for KS. This was confirmed through clinical examinations, including skin biopsy and colonoscopy. The patient received treatment with paclitaxel and doxorubicin for KS. One year later, he developed DLBCL, presenting with back and flank pain, and was subsequently treated with the R-CHOP regimen. The patient demonstrated a favorable therapeutic response to both treatment regimens. This case underscores the clinical challenges and importance of vigilance in managing sequential AIDS-defining malignancies. It also highlights the need for systematic guidelines for screening oncogenic viruses in HIV-infected individuals, particularly those with prior KS.

Paraneoplastic syndromes are indirect clinical manifestations of cancer, arising from immunological mechanisms or tumor-derived substances. The most common paraneoplastic syndromes associated with lung cancer are endocrine syndromes. We report the case of a 50- year-old woman with progressive ocular proptosis and orbital pain who was evaluated by multiple specialties with various diagnostic tests that did not explain her symptoms. She received immunosuppressive therapy without clinical improvement. A right paracardiac mass was subsequently identified on imaging, initially suspected to be a pericardial cyst, but prior studies over 3 years showed significant interval growth. The lesion was resected via thoracoscopic surgery, and the patient showed symptomatic improvement within a few days. Pathological results revealed a benign metastasizing leiomyoma. Given clinical presentation and postoperative evolution, a paraneoplastic mechanism is considered the most likely cause of the patient's ocular proptosis.