Metastasis of fallopian tube carcinoma to the thyroid gland: A case report

A 4-year-old boy presented with fever and unilateral neck swelling, initially treated as bacterial lymphadenitis with intravenous antibiotics. Over the following days, he developed bilateral non-purulent conjunctival injection, palmar erythema, mucosal changes, raised liver transaminases and rising inflammatory markers. The evolving picture led to a diagnosis of Kawasaki disease in the second week of illness.Cervical lymphadenitis is a common paediatric presentation, with infective aetiology being the most common. However, inflammatory conditions such as Kawasaki disease and haematological malignancy can present similarly. Among these, 'Node-first' Kawasaki disease, in which cervical lymphadenopathy precedes other features, while a recognised phenotype, is a rarer presentation and therefore a diagnostic pitfall. The similarity to infective lymphadenitis, together with overlapping laboratory and imaging findings, may delay definitive treatment and increase the risk of complications. An acute presentation of cervical lymphadenitis in a febrile child with inadequate or no response despite antibiotics and persistent high inflammatory markers should raise suspicion of possible alternative diagnoses like Kawasaki disease.

Thyroid metastasis (TM) from oropharyngeal squamous cell carcinoma (OPSCC) is exceedingly rare, with limited cases reported. Despite the vascular nature of the thyroid gland, its microenvironment does not favour metastatic spread.This case describes a male in his late 70s with p16-positive tonsillar SCC who presented with diffuse TM. The patient initially presented with dysphonia and weight loss, leading to a diagnosis of advanced SCC centred in the right tonsil with bilateral cervical lymphadenopathy. Further work-up revealed extensive thyroid involvement, confirmed by fine needle aspiration showing p16-positive SCC.This report highlights the need to consider uncommon sites of metastasis in patients with advanced OPSCC, especially those with human papillomavirus as a risk factor and underscores the importance of comprehensive diagnostic workups. Treatment options are tailored to individual cases given the rarity and this report highlights the importance of careful diagnosis and management of uncommon metastatic patterns.

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) is a common childhood autoinflammatory disease. This study investigated the influence of early-life factors on attack frequency and treatment resistance in children with PFAPA. Eighty-one children with PFAPA (diagnosed April 2021-2024) were retrospectively evaluated and divided into persistent and non-persistent (self-limiting) groups. Persistent PFAPA was defined as a < 50% reduction in attack frequency since diagnosis, having undergone tonsillectomy for PFAPA, or experiencing ongoing attacks beyond 7 years of age. The study included 81 PFAPA patients (female-to-male ratio 0.9; median age 76 months). The patients were divided into two groups: 28 persistent (34.6%) and 53 non-persistent (65.4%). Persistent patients had more frequent attacks (median 6 vs. 1 per year, p < 0.001) of shorter duration (median 3 vs. 4 days, p = 0.003), with less cervical lymphadenopathy (10.7% vs. 30.2%, p = 0.049) and abdominal pain (32.1% vs. 56.6%, p = 0.036). Preterm birth and pacifier use were less common in persistent patients (7.1% vs. 26.4%, p = 0.038; 25% vs. 52.8%, p = 0.016). In multivariate analysis, abdominal pain, preterm birth, and pacifier use independently predicted non-persistence, whereas colchicine use was non-significant. Early-life factors, including preterm birth and pacifier use, are associated with a self-limiting PFAPA phenotype. This study reveals that specific early-life factors-namely preterm birth and pacifier use-are independently associated with a milder, non-persistent PFAPA course. By identifying these perinatal and environmental influences, the research shifts the focus from purely clinical symptoms to the role of early immune maturation in disease trajectory. These findings provide clinicians with new tools to predict disease persistence, enabling more personalized management and better-informed parental counseling. The association between early-life exposures and PFAPA persistence offers a novel perspective on the pathogenesis of autoinflammatory conditions in children.

A 27-year-old woman was diagnosed with systemic lupus erythematosus and successfully achieved remission. She remained in long-term remission without relapse while receiving prednisolone, tacrolimus, and hydroxychloroquine. At the age of 42, after receiving an influenza vaccination, she developed multiple, progressively enlarging, painless cervical lymph nodes and was referred to our hospital. She presented with fever and cervical lymphadenopathy. Laboratory examination revealed an elevated sIL-2 receptor of 3300 U/mL. Computed tomography demonstrated lymphadenopathy in the left posterior cervical and left submandibular regions, as well as paraaortic lymphadenopathy. 18F-fluorodeoxyglucose positron emission tomography showed abnormal uptake with a maximum standardized uptake value of 14.5. A biopsy of the left posterior cervical lymph node was performed. Histopathological examination showed findings compatible with malignant lymphoma; however, definitive classification was difficult because immunohistochemistry showed loss of CD20 expression in the atypical cells and plasmacytic differentiation. In situ hybridization for Epstein-Barr virus-encoded RNA was negative. Based on the biopsy findings, we diagnosed the patient with Epstein-Barr virus-negative polymorphic lymphoproliferative disorder. We discontinued tacrolimus at the initial visit, after which the lymphadenopathy gradually regressed with almost complete resolution six months later. Iatrogenic immunodeficiency-associated polymorphic lymphoproliferative disorder resulting in complete remission after tacrolimus withdrawal in a patient with systemic lupus erythematosus has not been previously reported. Clinicians should be aware that iatrogenic immunodeficiency-associated polymorphic lymphoproliferative disorder may occur during tacrolimus use and that discontinuation of the drug may lead to improvement of lymphadenopathy.

A retropharyngeal abscess (RPA) is an infection that develops in the deep spaces of the neck, more common in children under five due to their prominent lymph nodes. However, it can also occur in adults. To our knowledge, Case reports of RPA revealing Granulomatosis with polyangiitis (GPA) (Wegener's) have yet not been reported. We present a case of a 62-year-old woman, originally from West Africa, with symptoms of sore throat, shortness of breath and otalgia. Imaging was compatible with RPA. Surgical drainage involved endoscopic and oral procedures with biopsies. Culture showed Streptococcus gallolyticus, blood tests revealed positive anti-nuclear antibodies (ANA) and anti-neutrophil cytoplasmic antibodies (C-ANCA) and pathological exam indicated vasculitis lesions. Treatment included broad-spectrum antibiotics, steroids and immunosuppressants. RPA occurs in the space between the buccopharyngeal and alar fascia from the skull base to the posterior mediastinum. Patients with RPA present symptoms including: fever, neck pain, swelling nuchal rigidity, sore throat, cervical lymphadenopathy, respiratory distress or stridor. In some cases, RPA can reveal an underlying disease like GPA, which is a necrotizing vasculitis often revealed by ENT symptoms. Nevertheless, ENT involvement in GPA is associated with better prognosis but more relapses.

Background Cervical lymphadenopathy has a wide differential diagnosis ranging from benign inflammatory conditions to malignant diseases. When clinical evaluation and cytological methods are inconclusive, surgical lymph node biopsy remains the gold standard for definitive diagnosis. Aims/Objectives This study aimed to evaluate the clinicopathological distribution of diagnostic cervical lymph node biopsies performed in patients with cervical lymphadenopathy at a tertiary referral center. Material and Methods This retrospective study included 400 patients who underwent excisional or incisional cervical lymph node biopsy for diagnostic purposes between January 2021 and December 2025. Results The mean age was 37.2 ± 22.4 years; 51.2% of patients were male and 25.3% were younger than 18 years. 57.2% of the biopsies were malignant, 39.2% benign, and 3.5% non-diagnostic. Malignancy was associated with male sex, older age, and larger lymph node size; the malignancy rate reached 92.9% when the lymph node size was ≥5 cm. The most frequent malignant category was leukemia/lymphoma (41.5%), followed by metastatic malignancy (14.5%). Conclusions and Significance Surgical biopsy for cervical lymphadenopathy provides a high diagnostic yield in a tertiary care setting, with a substantial malignancy burden. Early tissue diagnosis may reduce diagnostic delay, particularly for large (≥5 cm) and lower-neck/supraclavicular lymph nodes.

Rosai-Dorfman disease (RDD) is a rare type of histiocytosis usually presenting with painless bilateral cervical lymphadenopathy and leukocytosis. Cytopenias, particularly isolated lymphopenia, are particularly uncommon and poorly characterized. Hereby, we report a case of a 3-year-old boy presenting with progressive bilateral cervical lymphadenopathy and profound T- and B-cell lymphopenia. Immunophenotyping demonstrated markedly reduced CD3+, CD4+, CD8+, and CD19+ cells, low borderline level of NK-cells, and expansion of TCRγδ+ double-negative (CD3+/CD4-/CD8-) T cells. B-cell subset analysis revealed reduced switched memory and marginal zone compartments with increased transitional B cells, suggesting immune dysregulation. Imaging confirmed extensive cervical and mediastinal lymphadenopathy. Lymph node excision biopsy showed characteristic sinus histiocytosis with emperipolesis, confirming the diagnosis of nodal RDD. No autoantibodies were detected, and bone marrow examination and genetic testing were unremarkable. Given the clinical stability and absence of organ dysfunction, the patient was conservatively managed with prophylactic antimicrobials and close surveillance, remaining stable at follow-up. A review of the literature was also conducted, identifying eight well-characterized RDD cases associated with cytopenia, involving only two cases reporting isolated lymphopenia, emphasizing the rarity of this presentation. Most cases required systemic immunosuppression due to autoimmune features or progressive disease. Detailed lymphocyte subset characterization was rarely reported. In conclusion, this case expands the immunologic spectrum of RDD and highlights isolated severe lymphopenia as a uniquely rare presentation. Comprehensive immunophenotyping is essential to distinguish RDD from primary immunodeficiency and lymphoproliferative disorders, as immune-dysregulated RDD may represent a biologically distinct subgroup with implications for precision management.

Background: Rosai-Dorfman disease (RDD) is a rare, benign histiocytic disorder that typically presents with cervical lymphadenopathy but may involve extranodal sites in up to 40% of cases. Isolated spinal RDD without systemic manifestations is exceedingly rare and often mimics more common neoplastic or inflammatory spinal pathologies. When associated with hypertrophic pachymeningitis (HP), the condition may demonstrate an aggressive and relapsing course, posing significant diagnostic and therapeutic challenges. Case Description: We report the case of a 41-year-old male who presented in 2005 with progressive paraparesis and voiding difficulty. Magnetic resonance imaging revealed an intradural extramedullary lesion compressing the cervical spinal cord from C5 to T1. Surgical resection was performed with a presumptive diagnosis of meningioma. Histopathology confirmed RDD with secondary HP. One month after surgery, the patient experienced early recurrence, which was managed with corticosteroids and azathioprine. Six years later, a de novo lesion developed at the thoracic level and responded to a short course of corticosteroid therapy. No further immunosuppressive treatment was required after 2015, and the lesion has remained stable without neurological symptoms. Serial imaging over 20 years demonstrated both regression and stability of the disease, illustrating its chronic, relapsing nature. Conclusion: This case represents one of the longest documented follow-ups of isolated spinal RDD with secondary HP. It highlights the potential for both early recurrence and delayed de novo lesion formation, even after apparent disease control. Surgical decompression remains essential for diagnosis and initial treatment, but long-term management may require tailored immunosuppressive strategies and sustained clinical and radiologic surveillance.

Intravenous immunoglobulin (IVIg) is the standard of care for the treatment of Kawasaki disease (KD) and should be administered within 10 days of the onset of fever. Management guidelines for children with KD who defervesce spontaneously are not clear. In this study, we analysed patients with KD diagnosed between 1994 and 2024 at our centre who had defervesced spontaneously, had normal acute-phase reactants, and underwent echocardiographic examination, and in whom IVIg had not been administered. We reviewed the records of patients with KD from January 1994 - December 2024. The diagnosis of KD was based on standard guidelines. Patients with KD were said to be in spontaneous defervescence when they remained afebrile for ≥ 48 h, had normal acute-phase reactants [C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR)] and no coronary artery abnormalities (CAAs) on echocardiography at presentation, and when IVIg was not administered. Patients with spontaneous defervescence were subdivided into (i) early defervescence (Ed-KD), if the interval between onset of symptoms and defervescence was < 10 days, and (ii) late defervescence (Ld-KD), if the duration between onset of symptoms and defervescence was ≥ 10 days, respectively. Details of the clinical profile, laboratory investigations, and echocardiography findings were obtained from the records. Of the 1499 patients with KD enrolled during the study period, 115 patients (7.7%; 86 boys) defervesced spontaneously. The median age at disease onset was 6 years (mean, 5.6 years; range, 0.8-15 years). The median duration of fever, defined as the total duration of the febrile episode before spontaneous defervescence, was 5 days (range, 1-21 days). The median interval between illness onset (defined as fever onset) and diagnosis of KD was 15 days (range, 4-40 days), indicating that diagnosis was often made after fever had already subsided. The most common clinical feature was periungual desquamation, followed by rash, oral-mucosal changes, cervical lymphadenopathy, and conjunctival injection. Incomplete presentation was noted in 73.9% (n = 85/115) of patients. No patient has developed CAAs or other cardiac sequelae over a median follow-up of 9 months (range 2 months-156 months). The cumulative follow-up for the cohort was 235 patient-years. The 'low-risk' subgroup of patients with KD who defervesce spontaneously, and have normal acute phase reactants with no CAAs at presentation, have good clinical and coronary outcomes.

Syphilis is an infectious disease with a wide range of clinical manifestations. Diagnosis is often challenging as the symptoms of syphilis can mimic malignant or autoimmune diseases. Here, we report on a patient with tertiary syphilis mimicking a metastatic testicular tumour. Syphilis was diagnosed by serological testing and immunohistochemistry of tissue biopsies using specific antibodies. Additionally, a comprehensive literature review was conducted using a PubMed database search to identify previously reported cases and relevant studies. A 57-year-old male patient developed fever, night sweats and weight loss for three months after he had been treated with glucocorticoids for lumbar disc herniation. At first presentation, physical examination was unremarkable except for cervical lymphadenopathy. FDG-PET revealed hepatic and testicular lesions suspicious for malignancy. Biopsy of the hepatic lesion was inconclusive and showed features of pseudotumourous inflammation. The orchiectomy specimen demonstrated a large inflammatory pseudotumour composed of mixed lymphoplasmacytic and granulocytic infiltrates, with no evidence of neoplasia. Serological testing yielded elevated titers of Treponema pallidum antibodies and immunohistochemistry detected high numbers of spirochaetes in the biopsies. Antibiotic treatment with ceftriaxone and benzylpenicillin led to relief of symptoms and a decline of antibody titers. Literature review identified several cases of syphilis masquerading as malignant disease, whereas a potential reactivation of syphilis under immunosuppressive therapy remains rare. This case highlights tertiary syphilis as a rare but important differential diagnosis of pseudotumorous lesions mimicking metastatic malignancy, particularly in the presence of atypical histopathology. Immunosuppression may have contributed to clinical manifestation.

Accurate preoperative differentiation of cervical lymphadenopathy (LAP) is essential for optimal surgical planning. This study aimed to evaluate the contribution of preoperative pan-immune-inflammation value (PIV), platelet-to-lymphocyte ratio (PLR), demographic characteristics, and ultrasonographic findings in predicting malignant histopathology in patients undergoing excisional biopsy for cervical LAP, and to develop a practical clinical risk score. This retrospective cohort study was conducted at a tertiary referral center between January 2014 and December 2025. Patients who underwent excisional cervical lymph node biopsy with available preoperative ultrasonography and complete blood count data were included. The primary outcome was malignant versus non-malignant (reactive or granulomatous) histopathology. Candidate predictors included age, sex, neck level, ultrasonographic features (hilum loss, conglomeration, roundness index, and longest diameter), and inflammatory indices (PIV and PLR). Independent predictors were identified using multivariable logistic regression analysis, while discriminatory performance and optimal cut-off values were assessed using receiver operating characteristic (ROC) analyses. Of the 481 patients included, 184 (38.2%) had reactive, 91 (18.9%) granulomatous, and 206 (42.8%) malignant histopathology. Patients with malignancy were older (median age, 51.5 years) and more frequently male (65.5%) (both p < 0.001). Multivariable analysis demonstrated that conglomeration (OR, 6.18), male sex (OR, 3.51), Level V localization (OR, 7.77), increased roundness index (OR, 2.33), age (OR per year, 1.04), and PIV (OR per unit, 1.001) were independently associated with malignancy. Although PIV showed moderate discriminatory ability (AUC, 0.624), it achieved high specificity (83.3%) at a cut-off value > 567.1. A six-variable, points-based clinical scoring system (range, 0-11) effectively stratified malignancy risk (7.4% in the low-risk group and 83.1% in the high-risk group). Malignancy risk in cervical lymphadenopathy can be reliably predicted through the combined assessment of demographic characteristics, ultrasonographic patterns, and the Pan-Immune-Inflammation Value. Conglomeration, Level V localization, advanced age, and elevated PIV emerged as the strongest independent predictors of malignancy. However, multicenter external validation is required before the proposed risk score can be implemented in routine clinical practice.

A Child with Internal Jugular Vein Phlebectasia Masquerade as Cervical Lymphadenopathy

Glymphatics in the brain have recently been shown to drain cervical lymph nodes in animal models. Diagnosis of acute central nervous system (CNS) infections is limited by pauci-microbial nature of the cerebrospinal fluid (CSF). Evaluation of cervical lymphadenopathy in acute CNS infections may aid in diagnosis and provide evidence of glymphatics. To study the prevalence of cervical lymphadenopathy in acute CNS infections and to assess diagnostic yield by using cervical lymphadenopathy biopsy/FNAC. A cross-sectional study was conducted in a tertiary care hospital in India where adults (≥18 years) with acute CNS infections were recruited. They were clinically and radiologically (ultrasound) screened for cervical lymphadenopathy. Biopsy (surgical/FNAC) was carried in feasible cases and samples were sent for histopathology and culture. One hundred and five patients with acute CNS infections were enrolled for the study with tuberculous meningitis (TBM) being the most common (33%). 28.6% (30/105) of cases had cervical lymphadenopathy, of which only six patients met the criteria for biopsy. FNAC/biopsy of cervical nodes resulted in increase in definite microbiological/histopathological evidence of CNS infections by 25%. Prevalence of cervical lymphadenopathy in patients with acute CNS infections was 28.6% suggesting the presence of glymphatics. USG neck increased detection of abnormal cervical nodes that were not clinically palpable. Tissue diagnosis of cervical lymphadenopathy improved real-time diagnostic yield of acute CNS infections especially TBM.

Diagnostic utility of Xpert MTB/RIF ultra in clinically suspected tuberculous lymphadenitis in low-burden settings: a single center experience from Saudi Arabia.

Abstract Glossopharyngeal neuralgia-asystole syndrome (GN-AS) is a rare neurocardiogenic disorder in which paroxysms of sharp pain within the glossopharyngeal nerve territory trigger excessive vagal activation, resulting in bradycardia, hypotension, syncope, or even transient cardiac arrest. These events occur when afferent impulses from cranial nerve IX reflexively stimulate vagal efferent pathways in the medulla. Although GN-AS can occur idiopathically, it more often arises from secondary causes that irritate or compress the lower cranial nerves. Head-and-neck tumors, particularly tonsillar carcinoma, may provoke both neuralgic pain and cardioinhibitory syncope through local invasion of the glossopharyngeal and vagus nerves. A 55-year-old man with right-sided heart failure and recently diagnosed left tonsillar squamous cell carcinoma presented after his first radiation session with dizziness, nausea, and hypotension. While in the emergency department, his heart rate abruptly dropped to the 20s, followed by unresponsiveness and loss of pulse. A code blue was initiated; atropine and brief chest compressions restored circulation. ECG showed sinus rhythm with first-degree AV block and right bundle-branch block, unchanged from baseline. Laboratory results and troponin were unremarkable. During ICU monitoring, he experienced recurrent sharp left-sided jaw and throat pain followed within seconds by diaphoresis, bradycardia, and hypotension, each resolving after atropine. He subsequently had another brief cardiac arrest characterized by unresponsiveness and loss of pulses, with restoration of circulation following atropine administration. Neck CT demonstrated a soft-tissue mass at levels II-III consistent with known malignancy, and prior PET imaging had shown bulky level II-III cervical lymphadenopathy encasing the left carotid bifurcation and proximal internal carotid artery. The presentation was concerning for glossopharyngeal neuralgia-asystole syndrome. AV-nodal-blocking agents were discontinued, and carbamazepine plus corticosteroids were initiated for neuralgic pain and peritumoral edema. No further bradyarrhythmic episodes occurred thereafter. GN-AS is estimated to occur in 0.2-0.7 per 100,000 person-years. Reflex asystole results from intense vagal efferent discharge triggered by glossopharyngeal pain, often precipitated by swallowing, chewing, or talking. Differentiation from carotid-sinus hypersensitivity is essential, as the latter is painless and induced by neck movement or pressure. Recognition of the pain-preceding bradyarrhythmia pattern enables prompt neuralgic control and prevention of recurrent asystole. Glossopharyngeal neuralgia-asystole syndrome should be considered in patients with head-and-neck malignancy who develop pain-triggered bradycardia or syncope, as timely recognition and treatment can be lifesaving. This abstract is funded by: None

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, and self-limited inflammatory lymphadenitis. It predominantly affects young adults and typically presents with tender cervical lymphadenopathy, low-grade fever, and constitutional symptoms such as malaise, night sweats, and weight loss. Though initially recognized in Asian populations, cases are now reported worldwide. The etiology remains uncertain, but KFD has recognized overlap with autoimmune diseases. Systemic lupus erythematosus (SLE) and Sjögren's disease (SjD) account for most coexisting disorders. We present the case of a woman in her early forties with recurrent cyclical fevers and cervical lymphadenopathy. She had biopsy-proven KFD but showed relapse after a nine-year asymptomatic period after her first manifestation. A case-based review about KFD recurrence was conducted using PubMed/MEDLINE databases following CaBArET guidelines and identified a total of 21 reports for review of the clinical manifestations and treatment approaches of recurrent KFD. Our findings suggest that although KFD is typically self-limited, recurrence may be associated with autoimmune features in selected cases, emphasizing the need for renewed diagnostic vigilance even years after apparent resolution.Although treatment responses in recurrent Kikuchi-Fujimoto disease are heterogeneous, literature evidence and our case suggest that corticosteroids remain first-line, while agents such as hydroxychloroquine or anakinra may offer benefit in steroid-dependent or relapsing cases. However, these remain individualized interventions rather than standardized protocols, and controlled evidence is lacking. Key Points •Kikuchi-Fujimoto disease, although typically self-limited, can relapse after unusually long latency, highlighting the need for continued clinical awareness. •Recurrent presentations may mimic infectious or malignant conditions, often leading to extensive diagnostic work-ups. •Reactive histologic findings at recurrence do not exclude KFD and should be interpreted in the context of prior confirmed disease and clinical evolution.

We report a case of a patient in her 50s who first presented with cervical lymphadenopathy and later developed a slowly progressing facial lesion. After an initial lymph node biopsy, a diagnosis of cutaneous sarcoidosis was made and she was treated with immunosuppressive therapy. As the facial lesion continued to progress, a skin biopsy was performed which identified Mycobacterium gordonae In retrospect, this organism had been grown on liquid culture from the first lymph node biopsy but was dismissed as a contaminant. 15 years after the first onset of symptoms, she was commenced on multidrug antibiotic therapy, resulting in a marked improvement. This case underscores the need to interpret isolation of non-tuberculous mycobacteria in the context of clinical findings and to reconsider established diagnoses when the condition of the patient worsens.

Abstract Background Osteoarticular tuberculosis (TB) is a rare but serious manifestation of extrapulmonary TB. Despite improvements in imaging and microbiological diagnostics, bone TB remains challenging to identify because its clinical presentation is often nonspecific. While the spine and knee are the most frequently affected sites, involvement of less typical skeletal locations can occur, further complicating timely diagnosis. Methods We retrospectively reviewed all cases of bone TB diagnosed at the ‘Malattie Infettive e Ortopedia Settica’ Department—ATS Liguria, Savona area, from 2022 to 2025. Diagnostic confirmation relied on imaging, histopathology, culture, and polymerase chain reaction (PCR) testing for Mycobacterium tuberculosis. Results Eight patients (6 males, 2 females; mean age 50 years) were identified. Three were Italian, and five were foreign-born. Two patients had vertebral TB: an 80-year-old Ukrainian woman and a 25-year-old Gambian man. Both developed paraparesis requiring surgical stabilization; intraoperative cultures confirmed the diagnosis. Two patients (aged 19 and 23) presented with chronic knee arthritis. Initial arthrocentesis cultures and PCR were negative. Diagnosis was achieved through surgical biopsy; in one case, culture remained negative, but histopathology revealed necrotizing granulomas with Langhans giant cells, and PCR on the histological piece identified M. tuberculosis. A 75-year-old Italian woman with diabetes developed a tuberculous prosthetic joint infection, confirmed by synovial fluid culture. An 86-year-old Italian man with squamous cell carcinoma had mandibular TB diagnosed by bone biopsy, along with concurrent pulmonary TB. A 74-year-old Italian man presented with wrist pain and a draining fistula; bone culture was positive for M. tuberculosis. A 14-year-old boy had ankle inflammation and cervical lymphadenopathy; bone biopsy confirmed TB. All patients tested positive on the QuantiFERON-TB Gold assay. Only one had pulmonary involvement, and one had lymph node disease. All isolates were susceptible to first-line drugs. Treatment typically lasted 12 months, although one patient discontinued therapy after eight months due to hepatotoxicity. Conclusions Bone TB should be considered in cases of chronic osteoarticular infection, even in non-endemic settings and when atypical anatomical sites are involved. Diagnostic accuracy improves when culture, histopathology, and molecular testing are combined. Early recognition and multidisciplinary management are essential to optimize outcomes.

We describe a rare and aggressive case of multiple myeloma (MM) characterized by extensive lymph node involvement, loss of CD138 expression, and adipophilin (ADP)-positive cytoplasmic vacuolization, highlighting the role of lipid metabolism in disease aggressiveness. An 83-year-old woman presented with painless cervical lymphadenopathy and widespread osteolytic lesions. Bone marrow examination confirmed MM, while lymph node biopsy showed diffuse infiltration of atypical lymphoid cells with numerous tingible body macrophages, initially mimicking a high-grade lymphoma. Immunophenotyping showed CD3/CD5/CD20/CD23 negativity, focal CD138/CD79a positivity, diffuse MUM1 and κ-light chain positivity, and a high Ki-67 index. Compared with bone marrow plasma cells, lymph node MM cells exhibited prominent cytoplasmic vacuoles and nuclear enlargement. Immunohistochemistry demonstrated ADP positivity in lymph node lesions but not in bone marrow MM cells, suggesting metabolic reprogramming toward lipid utilization. Despite anti-myeloma therapy, the disease rapidly progressed, and the patient died within two months. This case underscores the clinical significance of CD138 down-regulation as a marker of dedifferentiation and poor prognosis, and suggests that altered lipid metabolism may contribute to the aggressiveness of metastatic MM. To the best of our knowledge, this is the first MM case with lymph node involvement showing CD138 down-regulation and ADP positivity.