This case report describes a rare instance of drug-induced acute lung injury in a 16-year-old male patient following circumcision performed under sevoflurane-based general anesthesia. Although sevoflurane is a widely used inhalational anesthetic with a favorable safety and tolerability profile, this case demonstrates that it may, in rare instances, precipitate acute lung injury. The clinical features, imaging findings, and laboratory findings of this case were analyzed alongside a systematic review of the relevant literature to clarify the diagnostic basis and differential diagnoses. This case report aims to raise clinicians' awareness of sevoflurane-induced acute lung injury.

Neuromyelitis optica spectrum disorder (NMOSD) is a recurrent demyelinating disease of the central nervous system (CNS)characterized by inflammatory attacks on the CNS. This article reports a 56-year-old male patient admitted with over a year history of shortness of breath, a 2-week history of decreased vision in the right eye, and a 1-week history of hiccups. Physical examination revealed digital clubbing of both hands and bilateral lower lung Velcro rales. The patient had concurrent anti-aquaporin-4 (AQP4) antibody-positive NMOSD, primary Sjögren's syndrome (pSS), and interstitial lung disease (ILD), which were confirmed by characteristic clinical features, serological antibody testing, high-resolution chest CT, cranial and optic nerve MRI, and labial gland biopsy. Treatment included high-dose glucocorticoid pulse therapy combined with efgartigimod for pathogenic autoantibody clearance, inebilizumab targeted therapy, and mycophenolate mofetil (MMF) for long-term immunosuppression. After discharge, sequential maintenance therapy with oral prednisone and MMF tablets was administered. The patient's visual acuity and neurological symptoms improved. At follow-up >2 months after discharge, dyspnea recurred and worsened. After intensifying anti-infective therapy while maintaining the immunomodulatory regimen, the condition was effectively controlled, with follow-up high-resolution CT showing marked resolution of pulmonary interstitial exudates. This case suggests that anti-AQP4 antibodies may co-mediate pathological processes in both the central nervous system and peripheral organs. For patients with anti-AQP4 antibody-positive NMOSD, further screening for ILD or pSS is warranted. Early neurological assessment and antibody screening are crucial, facilitating early diagnosis and individualized treatment under multidisciplinary collaboration.

STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by mutations in TMEM173 gene encoding STING (stimulator of interferon genes). It typically presents in infancy and is mainly characterized by interstitial lung disease, skin rash, and systemic inflammation. This report presents the case of adult-onset SAVI:A 28-year-old male patient was admitted with recurrent episode of cough, expectoration, chest tightness with shortness of breath and erythematous rashes on the extremities, chest, and back.His CT revealed bilateral diffuse fine reticular opacities and irregular reticular shadows, with focal areas of honeycombing. Further inquiry into the family history revealed that the patient's mother had been diagnosed with interstitial lung disease (ILD).Thus, a genetic etiology should be highly suspected.Later, whole-exome sequencing identified a heterozygous mutation in the STING1 gene: c.842G>A (p.R281Q), establishing the diagnosis of SAVI. The patient was subsequently referred to a tertiary care hospital for specialized management. During one year of follow-up, the patient underwent lung transplantation in August 2025 and had since received long-term immunosuppressive therapy for rejection prophylaxis. Cough and expectoration improved markedly, although exertional dyspnea persisted; the cutaneous rash had resolved completely.

This case report presents a young female patient whose chief complaint was exertional dyspnea. Right heart catheterization confirmed severe pulmonary hypertension. Concurrently, chest CT showed atypical pulmonary parenchymal and interstitial lesions, and pulmonary function tests indicated severe impairment of diffusion capacity. To clarify whether an association existed between the lung disease and pulmonary hypertension, transbronchial lung cryobiopsy was performed, which revealed multinucleated giant cell aggregates within the alveolar spaces, with cholesterol clefts in the cytoplasm of some of them. Together with a 1-year history of pigeon exposure, the final pulmonary diagnosis was extrinsic allergic alveolitis (hypersensitivity pneumonitis).With respect to the pulmonary hypertension, genetic testing showed no significant abnormalities, thereby ruling out heritable pulmonary hypertension. After oral imatinib combined with macitentan was administered, the patient's pulmonary artery pressure gradually decreased and her symptoms recovered well; however, follow-up chest CT and pulmonary function tests showed no apparent improvement. Because the elevated pulmonary artery pressure was inconsistent with the pulmonary disease, the patient was ultimately diagnosed with idiopathic pulmonary hypertension complicated by allergic alveolitis.

Rare adverse events after COVID-19 vaccination among Swedish older adults-evidence from a nationwide register-based study.

Heart transplantation continues to be the definitive treatment for end-stage heart failure, but organ availability limits access nationwide. Donation after circulatory death (DCD) hearts have shown tremendous promise as a viable avenue for expanding the donor pool. Still, the expanded utilization of DCD hearts has introduced new challenges that evaluating centers must work to address. Among these is the frequently variable and incomplete diagnostic information available on DCD donors before organ procurement. In this case report, we highlight the role of intraoperative surface echocardiography as a practical strategy for confirming organ suitability for transplant during DCD heart recovery with thoracoabdominal normothermic regional perfusion (TA-NRP). In specific circumstances where preoperative echocardiography is not feasible, but other diagnostic data support organ suitability for transplant, intraoperative surface echocardiography may serve as a valuable tool to increase organ utilization and improve access to life-saving transplantation.

BackgroundAn established publication type in medicine, case reports allow clinicians to share novel or unusual observations. Their strengths include the ability to identify new phenomena, facilitate communication between practice and research, generate hypotheses, and provide insights into conditions that it may be unethical or impractical to study directly. Architecture and environmental design lack an equivalent method for systematically sharing practice-based insights.PurposeThis paper establishes clear, structured guidelines for documenting and preparing case reports in architecture and environmental design.MethodsUsing a comparative and conceptual approach, this study adapts the CARE Guidelines-developed for case reporting in medicine-to the context of design practice. The study draws conceptual parallels between stages of clinical care (e.g., diagnosis, treatment, outcomes) and those of the design process (e.g., problem identification, interventions, post-occupancy evaluations). Building on this comparison, it introduces a new set of guidelines for architectural case reports.FindingsThe resulting framework, the SCALE Guidelines (Standardized Case reports for Architecture and the buiLt Environment), consists of 12 components that provide a standardized structure for writing design case reports. The guidelines will help practitioners share real-world insights in a format suitable for scholarly dissemination that promotes consistency, completeness, and rigor in reporting.ConclusionsAlthough evidence-based design aims to inform design decisions in practice through research, case reports serve the opposite function: informing research decisions through insights from practice. The formal recognition of case reports in design as a distinct publication type can help bridge the gap between design practice and research.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that can occur as an idiopathic condition or in association with various systemic diseases. The association with Sjögren's syndrome (SS) is extremely rare, with only a few cases reported in the literature where PG developed in patients with established SS. We report the unique case of a 39-year-old female who presented with painful hemorrhagic bullae affecting the lower extremities, upper lip, and back, which rapidly evolved from nonpruritic papules. The patient also complained of arthralgia in small joints of both hands and had a history of dry mouth and eyes. Laboratory investigations revealed elevated inflammatory markers, positive antinuclear antibodies, and strongly positive anti-SSA/Ro and anti-SSB/La antibodies. Histopathological examination confirmed neutrophilic dermatosis compatible with PG. Schirmer's test was markedly positive, and salivary gland biopsy showed minimal inflammation, confirming the diagnosis of SS according to established classification criteria. The patient was initially treated with high-dose intravenous methylprednisolone and colchicine with good initial response. The patient showed excellent response with significant improvement in skin lesions and control of SS symptoms at a 3-month follow-up. This case highlights the importance of screening for underlying autoimmune connective tissue diseases in patients presenting with neutrophilic dermatoses.

The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the perioperative setting may lead to SGLT2i-associated postoperative ketoacidosis (SAPKA) in patients with type 2 diabetes (T2D). Therefore, cessation of this drug is recommended before surgery. We aimed to study reported cases to assess the causality of SGLT2i, identify common characteristics, potential risk factors, treatment and outcomes of SAPKA. We conducted a systematic literature search to identify case reports of patients with metabolic acidosis and the presence of ketones who used SGLT2i in the perioperative setting. Case reports were summarised for common characteristics, assessed for quality and distributed to a panel of diabetes experts, who evaluated the likelihood of SAPKA using a questionnaire. Ninety-three papers containing 128 case reports fulfilled the inclusion criteria. The expert panel found SAPKA to be 'likely' in 53 (41%), 'possible' in 38 (30%) and 'unlikely' in 27 (21%) cases; 10 cases (8%) could not be validated due to insufficient data or implausible timing. SAPKA was therefore considered likely or possible in 71% (91/128) of cases. Common factors identified in the SAPKA reports included a diagnosis of T2D mellitus (n = 115), impaired perioperative intake (n = 30) and insufficient insulin supplementation (n = 10). Treatment with insulin was effective, and ketoacidosis resolved in all surviving patients, although significant morbidity, including ICU admission, was reported in a substantial proportion of cases. Confirming a SAPKA diagnosis is challenging due to the variable reporting quality and numerous confounding factors present during the perioperative period. Clinicians should remain aware of SAPKA given the increasing prevalence of SGLT2i use. Focusing on early recognition and treatment represents a potential alternative strategy to routine preoperative SGLT2i discontinuation, though this requires further prospective evaluation. This systematic review presents an overview and discussion of the many, to date, case reports of ketoacidosis thought to be associated with perioperative SGLT2 inhibitor treatment.

Idiopathic intracranial hypertension (IIH) features elevated intracranial pressure (ICP) without a secondary cause. Trigeminal neuralgia (TN), usually attributed to neurovascular conflict (NVC), has been reported only rarely in association with IIH. We reviewed the literature and present three institutional cases to better characterize this association while explicitly acknowledging the limits of case-based causal inference. We systematically searched PubMed, Ovid Medline, Ovid Embase, Scopus, and Web of Science from inception through August 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The core search combined terms for idiopathic intracranial hypertension or pseudotumor cerebri with trigeminal neuralgia, trigeminal neuropathy, and facial pain. Because causal attribution from case reports is limited, we applied a qualitative framework based on temporality, objective evidence of raised ICP, exclusion of more convincing alternative causes, especially definite NVC, and response to ICP-lowering therapy. Methodological quality was appraised using the Joanna Briggs Institute case report checklist. Quantitative summaries were restricted to published TN phenotypes; trigeminal neuropathy without pain and persistent idiopathic facial pain were summarized separately. Out of 1302 records, 12 case reports met the criteria. Nine described TN, two involved trigeminal neuropathy without pain, and one involved a persistent idiopathic facial pain phenotype. Across the nine TN cases, all patients were female (mean age 38.7 ± 12.5 years). Reported opening pressure ranged from 220 to 480 mmH2O (mean 393.0 ± 89.2 mmH2O), although diagnostic certainty varied, and not all cases fulfilled the full Friedman criteria for definite IIH. Maxillary (V2) and mandibular (V3) involvement predominated, and multidivisional pain was common. Imaging features of raised ICP and improvement after ICP-lowering therapy were recurrent themes, but standardized high-resolution trigeminal magnetic resonance imaging (MRI) sequences were inconsistently reported, limiting exclusion of coexisting classical TN. We additionally describe three institutional cases: two with documented elevated opening pressure (290 and 320 mmH2O) and one probable ICP-related case with suggestive imaging but unavailable opening pressure. In the institutional cohort, dedicated Constructive Interference in Steady State (CISS) or Fast Imaging Employing Steady-state Acquisition (FIESTA) assessment was not uniformly available; in one case, venous contact was of uncertain significance, and in another, microvascular decompression was performed without operative confirmation of arterial compression or pain relief. TN associated with IIH is a rarely reported association. Given the limited case-based evidence, the available data should be regarded as hypothesis-generating rather than definitively causal. When objective intracranial hypertension is present, careful evaluation of both ICP-related markers and alternative TN mechanisms, including NVC, is essential. ICP-lowering therapy has been reported to improve pain in some cases and may address a potential contributing mechanism.

Esophageal button battery impactions are pediatric emergencies with clear guidelines for pre-extraction management, but post-extraction care remains highly variable. Common practices include ICU admission, prolonged NPO, antibiotics, and extensive imaging, though the supporting evidence is unclear. We performed a scoping review, searching PubMed, Embase, and Scopus for pediatric esophageal button battery injuries reporting post-extraction management. Variables included imaging strategy and impact, ICU admission, feeding practices, and complications. Case reports, case series, and retrospective cohorts were included. Variables included imaging strategy and impact, ICU admission, feeding practices, and complications. Case reports, case series, and retrospective cohorts were included. Of 37 studies with 713 patients, complications included 47 esophageal perforations, 37 tracheoesophageal fistulas, 28 esophageal strictures, 26 mediastinitis, 23 esophageal stenoses, 11 vocal cord injuries, 4 aortoesophageal fistulas, and 3 deaths. Post-extraction imaging was reported in 83.8 % of studies with 610 patients; esophagram was most common. In studies that reported imaging details, imaging influenced postoperative management in 12/23 studies using esophagram, 5/12 studies using CXR, 4/6 studies using CT, and 2/3 studies using MRI/MRA. (These were study-level proportions as patient-level counts could not be consistently extracted and modalities overlapped).Time to feeding ranged from 1 h to 233 days via multiple routes. Among 24 studies with known timing, 12/18 resuming <7 days and 2/6 resuming ≥7 days reported morbidity or mortality. Antibiotics were explicitly given in 24 studies. Routine ICU admission, prolonged NPO, universal antibiotics, and multi-modality imaging are not standard after esophageal button battery removal. We propose a risk-stratified framework for imaging, ICU use, and feeding that reserves advanced imaging, ICU level care, and delayed feedings for patients at highest risk for complications based on their presentation and injury severity.

This case reports the successful replantation of the distal phalanx of the right index finger in a 9-month-old male infant. The patient sustained a complete distal interphalangeal (DIP)-level amputation due to accidental injury and underwent immediate microsurgical replantation after emergency assessment. The surgical procedure involved meticulous vascular anastomosis and nerve repair, followed by postoperative management, including infection control, anticoagulation, and circulation promotion. A 6-month follow-up demonstrated satisfactory outcomes, with good blood supply, preserved finger contour, and no gross functional impairment. Given the technical challenges of digital replantation in infants and the limited number of such cases reported, this may be among the youngest cases of successful digital replantation to date. This case provides valuable insight into surgical strategies and postoperative care for replantation in very young children.

Liver transplantation remains the treatment of choice for hepatopulmonary syndrome (HPS) with severe hypoxemia, but portopulmonary hypertension (PoPH) has traditionally been viewed as a contraindication to liver transplantation owing to its frequent posttransplant deterioration. We describe here the sequential presence of both pulmonary vascular disorders in a cirrhotic patient in the pretransplant period. Liver transplantation was made possible following effective management of pulmonary hypertension, with favorable outcome 3 years post-liver transplantation. Finally, our case report and literature review suggest that the coexistence of HPS and PoPH in patients with advanced liver disease could be more common than previously recognized.

Integrative management of microvascular spasm-driven Raynaud's-like digital ischemia in an elderly smoker with mixed-pattern vasculopathy: A case report.

This is the first global report of a successful case of lenvatinib treatment for a rare sebaceous carcinoma originating in the external auditory canal. The patient experienced local recurrence and pulmonary metastasis despite undergoing surgery and radiotherapy. Initial chemotherapy combined with immune checkpoint inhibitors achieved short-term stability, but the disease eventually progressed. Genetic testing revealed an Fibroblast growth factor receptor 2 (FGFR2) mutation, leading to a switch to targeted therapy with lenvatinib combined with capecitabine, demonstrating the value of targeted therapy in the management of rare, refractory sebaceous carcinoma.

The authors described a novel technique to achieve the stability of the implant immediately placed in compromised sockets without osteotomy. Digital planning of the implant and customized zirconia membrane (CZM) design and milling were previously performed in the maxilla and the mandible. The study involved two healthy patients with alveolar bone defect. The CZM was created as a single continuous piece, and uniquely dimensioned to fit the zone of the bone defect after tooth extraction. An extension was created at the inner surface of the CZM to serve as a connector or abutment used to connect the implant to the CZM, secured with an abutment screw. As no osteotomy was performed in the two cases, the assembly CZM/Implant was stabilized with fixation screws to the cortical bone. In the first case, a crestal sinus lift was performed in the maxilla, using bovine bone graft, with immediate placement of the assembly CZM/Implant after extraction of the first molar. In the second case, immediate implantation was performed after the extraction of the second molar with a large periapical lesion. A CBCT scan confirmed the good osseointegration of the implants at 2 years. As this novel technique is promising, a research study is planned to better assess clinical outcomes and validate the new concept.

Liquid-Based Cytology of SMARCA4-Deficient Undifferentiated Tumor: A Case Report.

Combined Heart Transplantion and Aortic Arch Replacement in Acute Aortic Syndrome: A Case Report

Sotatercept for Right Ventricular Failure Following Heart Transplantation in a Patient with Elevated Pulmonary Vascular Resistance: A Case Report

Cystic fibrosis (CF) is a monogenic disorder leading to pulmonary disease, pancreatic insufficiency and cystic fibrosis-related diabetes (CFRD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are now being investigated in people with cystic fibrosis (pwCF) and CFRD. To date, their therapeutic potential has been almost exclusively studied in case reports or case series. These agents improved glycated haemoglobin (HbA1c) and continuous glucose monitoring (CGM) parameters. Benefits were also observed in weight reduction, particularly for subjects on cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy elexacaftor/tezacaftor/ivacaftor (ETI). However, discordant results have also been reported. Moreover, GLP-1RAs have improved pulmonary function, even following lung transplantation. Importantly, the dual glucagon-like peptide1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide has also yielded favourable outcomes. Finally, preliminary evidence suggests potential inhibition of bone resorption, pointing to a therapeutic perspective in cystic fibrosis-related bone disease (CFBD). However, potential adverse events should not be ignored. These include risk of acute pancreatitis, nausea/vomiting, nutritional depletion, bowel dysmotility and distal intestinal obstruction syndrome, as well as others. Adverse events should be addressed with caution, and dose adjustments may be useful. Large prospective multicentre studies are now required to validate these outcomes and to suggest implications for clinical practice.