Hemophagocytic lymphohistiocytosis is a life-threatening inflammatory syndrome resulting from uncontrolled immune activation. Secondary hemophagocytic lymphohistiocytosis is typically triggered by infection, malignancy, or autoimmune disease, though diagnosis is often difficult due to nonspecific findings. We present the case of a 55-year-old man with pancytopenia and fever following a blood transfusion. There were no clear infectious, malignant, or autoimmune triggers identified. Bone marrow biopsy showed no hemophagocytosis, but laboratory workup revealed hypertriglyceridemia, hyperferritinemia, and elevated soluble IL-2 receptor. He met six hemophagocytic lymphohistiocytosis-2004 criteria and had a high H-score. He was treated with dexamethasone and etoposide, with rapid clinical improvement. This is a unique case of secondary hemophagocytic lymphohistiocytosis after a blood transfusion without other identifiable triggers, which has not yet been reported in the literature. This case underscores the importance of maintaining high clinical suspicion for hemophagocytic lymphohistiocytosis in adults with persistent fever and cytopenias, even in the absence of known triggers.

Ceruminous adenocarcinoma (CAC) represents an exceedingly rare malignant glandular neoplasm originating from the ceruminous glands within the external auditory canal (EAC), constituting approximately 5%–10% of all EAC malignancies. Owing to its insidious onset and nonspecific symptoms, diagnosis is frequently delayed. This report delineates a case of right EAC CAC in a 39-year-old male, focusing on the diagnostic trajectory, multimodal therapy, and short-term outcomes. The patient presented with a one-month history of recurrent bloody purulent discharge from the right ear, intermittent otalgia, and mild conductive hearing loss. Otoscopy revealed a cauliflower-like, ulcerated, and bleeding mass on the floor of the right EAC. Computed tomography (CT) showed a mass within the right EAC encroaching upon the superficial parotid lobe and the facial nerve’s vertical segment, with no intracranial extension. Cervical ultrasound demonstrated multiple enlarged lymph nodes in right levels 2–4. A pathological biopsy confirmed CAC, with immunohistochemical staining positive for CK7, EMA, and partially for S-100. The patient underwent radical surgery, including right subtotal temporal bone resection (with EAC and mastoid removal, reconstructed using temporalis fascia and a skin graft), right total parotidectomy, and right cervical level 2–4 lymph node dissection. Intraoperatively, the tumor infiltrated the facial nerve sheath, but the nerve parenchyma was preserved; the sheath was dissected free without nerve resection or anastomosis. Postoperative adjuvant radiotherapy (60 Gy in 30 fractions) was administered. Recovery was uneventful. At 3-month follow-up, the EAC wound had healed completely, and CT/magnetic resonance imaging showed no residual or recurrent tumor.

Esophageal nerve sheath tumors are the least common type of esophageal submucosal tumors, with fewer than 60 cases reported in the literature.1 These tumors typically occur as a solitary lesion in individuals aged 40–70, with a slight female predominance2 and possible links to genetic syndromes such as neurofibromatosis type 2.3 Due to their rarity, they are often poorly recognized clinically and misdiagnosed prior to surgery. We present a rare case of esophageal nerve sheath tumor, diagnosed on esophagogastroduodenoscopy in a 46-year-old male who presented with chronic iron deficiency anemia. The patient was successfully treated with endoscopic submucosal dissection. This case highlights diagnostic and therapeutic considerations of this uncommon entity.

Sebaceoma is a benign sebaceous neoplasm with rare potential for malignant transformation. We report a case of recurrent sebaceoma in a 70-year-old male with Muir–Torre syndrome, successfully treated with Mohs micrographic surgery. Despite its benign histology, the lesion demonstrated rapid growth and incomplete initial excision. Mohs micrographic surgery provided complete margin control with tissue preservation. This case highlights the value of Mohs micrographic surgery in managing select benign sebaceous neoplasms exhibiting concerning clinical behavior or diagnostic uncertainty, supporting its inclusion in treatment considerations for high-risk patients.

Multiple eruptive dermatofibroma is a rare variant of dermatofibroma and often occurs in association with systemic disease, particularly involving immune dysregulation. We present what may be the first reported case of multiple eruptive dermatofibroma in association with monoclonal gammopathy of undetermined significance, a premalignant plasma cell dyscrasia. A 66-year-old male with stable IgM monoclonal gammopathy of undetermined significance developed over 50 asymptomatic papulonodular lesions over two years. Histopathology confirmed dermatofibromas, the timeline of lesion development was consistent with multiple eruptive dermatofibroma, and laboratory evaluation revealed elevated IgM and a monoclonal paraprotein band. This case highlights a novel systemic association between multiple eruptive dermatofibroma and monoclonal gammopathy of undetermined significance. Given the frequent co-occurrence of immune dysregulation in patients with multiple eruptive dermatofibroma, evaluation for underlying systemic immunologic conditions in affected individuals is warranted. Recognition of such associations may facilitate earlier diagnosis and surveillance of systemic disease.

Acromegaly is a rare endocrine disorder caused by excessive secretion of growth hormone, resulting in elevated serum levels of hepatic insulin-like growth factor-1 (IGF-1). With an estimated annual incidence of approximately three cases per million individuals, the condition is associated with a significantly increased risk of cardiovascular complications, such as arrhythmias and acromegaly-induced cardiomyopathy. Heart failure secondary to acromegalic cardiomyopathy occurs in approximately 3% of affected patients and is recognized as the leading cause of mortality in individuals with this condition. This case report describes a 53-year-old male diagnosed with acromegalic cardiomyopathy caused by a pituitary adenoma.

Leprosy, or Hansen’s disease, is a chronic granulomatous infection caused by Mycobacterium leprae, with a broad spectrum of clinical and histopathological manifestations. Histological examination plays a pivotal role in accurately diagnosing its various subtypes. Elastophagocytosis (phagocytosis of elastic fibers by giant cells) is typically associated with annular elastolytic giant cell granuloma and other granulomatous conditions but has rarely been reported in leprosy. We report the case of an 85-year-old male who presented with a solitary, slowly enlarging annular plaque on the trunk. The lesion was asymptomatic and exhibited mild sensory loss without peripheral nerve involvement. Histopathological analysis of the skin biopsy showed granulomatous inflammation with Langhans-type giant cells and a striking feature of elastophagocytosis. Fite-Faraco staining confirmed the presence of acid-fast bacilli, establishing the diagnosis of borderline tuberculoid leprosy. The patient was treated with multibacillary multidrug therapy and demonstrated complete lesion resolution.

Denervation pseudohypertrophy is an important and well described, albeit rare, cause of limb swelling that is seldom encountered in the clinical setting. Careful history taking, reasonable clinical suspicion, and referral for magnetic resonance imaging are crucial to arriving at the diagnosis and recommending appropriate treatment. Although typically a slow, insidious process, we report a rare case of acute denervation pseudohypertrophy in a 76-year-old male with diabetic neuropathy, chronic venous insufficiency, and remote tibial fracture repair. Magnetic resonance imaging findings were significant for bilateral denervation pseudohypertrophy of the left greater than right calf muscles with associated diabetic neuropathy. We postulated that the latter is likely the main underlying etiology, particularly given the magnetic resonance imaging's bilateral findings. The case highlights the importance of considering denervation pseudohypertrophy in the differential diagnosis of acute limb swelling despite its rarity.

Cerebral arteriovenous malformations (AVMs) are congenital vascular abnormalities that can lead to neurological impairments following rupture. This proof-of-concept case report examines the integration of the Monitored Augmented Rehabilitation System (MARS), an immersive virtual gaming platform, into a multidisciplinary rehabilitation program for a 12-year-old female recovering from a ruptured AVM. MARS was used as an adjunct modality alongside conventional interventions over a 4-week period to target functional outcomes as assessed by the Neurocom Balance Manager®. Quantitative results demonstrated targeted functional gains: Directional Control during the Limits of Stability test increased from 66% to 73%, toes-up Adaptation Test scores improved from 104.2 to 116.2, and toes-down scores from 115.6 to 119.0. Clinically observed increases in engagement, motivation, and adherence were noted during therapy sessions. This report underscores the feasibility and clinical potential of MARS as a complementary tool for enhancing motor learning and functional outcomes in pediatric neurorehabilitation. Future research should focus on larger sample sizes and extended intervention periods to validate the efficacy of MARS in improving long-term recovery outcomes.

Leiomyosarcoma (LMS) of the skin is a rare malignant neoplasm that can have varied clinical presentations, even mimicking benign lesions, making diagnosis challenging. We describe a 74-year-old male with a history of subcutaneous LMS of the left leg treated successfully with surgery, chemotherapy, and radiation over 10 years prior, who presented with an incidental papule on the lower back resembling an accessory nipple. Biopsy revealed a spindle cell tumour with diffuse smooth muscle actin and desmin positivity and a high Ki-67 index, consistent with a non-metastatic subcutaneous LMS. Wide local excision confirmed dermal and subcutaneous involvement with negative margins. This case is notable for the occurrence of two distinct primary LMS lesions more than a decade apart, underscoring the importance of long-term surveillance in high-risk patients. Given the potential for recurrence or metastasis, careful histopathologic evaluation and ongoing monitoring remain critical in the management of LMS.