Caffey’s disease, first described by Caffey and Silverman in 1945 is also known as infantile cortical hyperostosis (ICH), is a condition that affects infants and is mostly self-limiting. Presenting with painful soft tissue swellings, fever and irritability, it is characterized by cortical thickening of the underlying bones. Its clinical presentation can mimic infectious osteomyelitis, leading to diagnostic challenges. We report a case of a 2-month-old male infant with multifocal bony involvement and genetic findings suggestive of chronic recurrent multifocal osteomyelitis (CRMO), but with clinical features strongly favouring Caffey disease. This case highlights the overlap between autoinflammatory bone disorders in infancy and emphasizes the importance of integrating clinical, radiological, and genetic findings to arrive at an accurate diagnosis. This case is reported to get the awareness of the paediatricians about the disease, its existence in our population, presentation, and important differential diagnoses and management.

Cervical Chondrocutaneous Branchial Remnants (CCBRs) are rare congenital choristomas characterized by cartilaginous tissue within the cervical skin. We report a case of a 4-year-old girl presenting with bilateral soft tissue swellings in the lower neck, present since birth. Clinical examination and imaging suggested a congenital branchial remnant. Complete surgical excision was performed and histopathology confirmed hyaline cartilage surrounded by normal adnexal structures. Postoperative recovery was uneventful and no recurrence was noted. Bilateral CCBRs are exceedingly uncommon. Awareness of this entity is essential to differentiate it from other congenital neck masses and to evaluate for associated systemic anomalies.

Objectives: Magnetic resonance imaging (MRI) can complement clinical evaluation of ankle ligament injuries. This study aims to elucidate the relationship between lateral ligament injury and soft-tissue swelling in patients presenting with ankle injuries devoid of fractures, utilizing MRI. Materials and Methods: A retrospective analysis was conducted over a 1-year period, including 100 consecutive patients diagnosed with ankle injuries unaccompanied by fractures. All patients underwent MRI within 1 week of injury. Soft-tissue thickness surrounding the medial and lateral malleoli was measured on coronal proton density fat-suppressed MRI images. MRIs were further categorized based on the condition of ankle ligaments: normal ankle; isolated anterior talofibular ligament (ATFL) injury; isolated calcaneo-fibular ligament (CFL) injury; isolated anterior-inferior tibio-fibular ligament (AITFL) injury; combined ATFL and AITFL injury; and combined ATFL and CFL injury. Results: Analysis of the medial/lateral malleolar swelling ratio revealed an area under the curve of 0.636 (95% confidence interval [CI]: 0.500–0.773), indicating moderate discriminatory ability. Isolated lateral swelling exhibited a higher area under the curve of 0.842 (95% CI: 0.756–0.927). A lateral swelling measurement exceeding 2.5 mm demonstrated 91% specificity and 51% sensitivity. Statistical analysis revealed a highly significant association between lateral ligamentous injury and both lateral swelling ( P < 0.0001) and the swelling ratio ( P = 0.0001). Conclusions: Lateral malleolar soft-tissue swelling serves as a valuable predictor of ligamentous injury in ankle trauma cases. MRI provides complementary evidence to correlate the association between the size of lateral soft-tissue swelling and associated ligamentous injury.

Hepatoid Adenocarcinoma of the Lung (HAL) is a rare type of Non-Small Cell Lung Cancer (NSCLC), histologically similar to Hepatocellular Carcinoma (HCC). Hepatoid adenocarcinoma presenting as soft-tissue swelling is extremely rare. Less than 40 well-documented cases in the literature have been added to date. Diagnostic work-up included clinical history, Alpha-Fetoprotein (AFP) serum marker level, imaging, histological uniqueness, immunohistochemical expression, and molecular testing. Hepatoid adenocarcinoma of the lung has high malignancy and poor prognosis and needs a better treatment plan. Hence, we report a case of a 73-year-old male presenting with a history of swelling on the right arm for three months. On Magnetic Resonance Imaging (MRI), the soft-tissue swelling radiological features were suggestive of sarcoma. An excisional biopsy was done. Histomorphological and immunohistochemical expression revealing features of metastatic deposits from hepatoid adenocarcinoma of the lung. Patient expired during follow-up. Hepatoid adenocarcinoma of the lung is a special type of NSCLC. The surgical treatment of HAL in the limited stage can achieve long-term survival, but most of them are in the advanced stage when they are found, and the prognosis is poor, which requires multidisciplinary comprehensive treatment.

Mycetoma is a chronic, granulomatous infection typically affecting the lower limbs. We report a rare case of eumycetoma involving the upper back in a young man with a 10-year history of painless swelling that became symptomatic only recently. After initially diagnosed as an abscess, intraoperative discovery of black granules prompted further investigation. Histopathology confirmed Madurella mycetomatis infection. Imaging revealed a large heterogeneous mass without bone involvement. The patient underwent complete surgical excision followed by oral itraconazole therapy. At 1 month follow-up, postoperative recovery was uneventful, without recurrence. This case highlights the importance of involving mycetoma in the differential diagnosis of chronic soft tissue swellings, even in rare anatomical sites. Early suspicion, tissue biopsy and MRI are the determinants of accurate diagnosis. Public and clinician awareness is vital, particularly in endemic areas, to prevent misdiagnosis and reduce morbidity. To our knowledge, this is among the few documented cases of extrapedal eumycetoma.

Disclosure: F.R. Shaya: None. E.M. Alhussain: None. W. Taha: None.Increasing reports of patients with acromegaly have noted incidental discoveries of papillary thyroid carcinoma, which is the case for this report, emphasizing the potential need for routine thyroid screening in acromegaly management guidelines.A 42-year-old male presented with clinical features concerning for acromegaly , including facial changes, enlarged hands and feet, and soft tissue swelling. Laboratory evaluation confirmed elevated insulin-like growth factor 1 (IGF-1) levels, and magnetic resonance imaging (MRI) revealed an anterior pituitary macroadenoma. The patient underwent transsphenoidal pituitary resection.Histopathological analysis of the tumor showed a biphasic population of medium-sized epithelial cells, with some areas of necrosis. Immunohistochemical staining demonstrated strong reactivity for chromogranin, GH, thyroid-stimulating hormone (TSH), and follicle-stimulating hormone (FSH), consistent with a neuroendocrine origin. The Ki-67 proliferation index was low at 2%.During routine postoperative evaluation, an incidental thyroid nodule was detected. Fine-needle aspiration (FNA) confirmed the presence of papillary thyroid carcinoma. The patient had no known family history of thyroid cancer and was asymptomatic. He subsequently underwent total thyroidectomy without complications.The coexistence of acromegaly and papillary thyroid carcinoma in this patient raises important clinical considerations. Acromegaly is associated with elevated levels of GH and IGF-1, which have been implicated in promoting cellular proliferation and tumorigenesis. Several case reports have suggested an increased prevalence of papillary thyroid cancer in acromegalic patients, yet routine thyroid screening is not universally recommended in current guidelines.While definitive causative links between acromegaly and thyroid cancer remain under investigation, the role of IGF-1 in thyroid tumorigenesis warrants further exploration.This case presents the potential relationship between acromegaly and thyroid cancer, highlighting the importance of early thyroid evaluation in patients diagnosed with acromegaly. Incorporating routine thyroid ultrasound into standard evaluation protocols could facilitate the early detection and management of thyroid malignancies. Further prospective studies are necessary to refine surveillance strategies and determine whether thyroid ultrasound should be a formal recommendation in acromegaly management guidelines.Presentation: Sunday, July 13, 2025

Nasolabial cysts (NCs) are rare, non-odontogenic developmental cysts of the soft tissue, accounting for approximately 0.7% of all non-odontogenic cysts. These lesions predominantly affect women between the fourth and fifth decades of life, with a predilection for individuals of African descent. We report a case of a 50-year-old woman presenting with swelling adjacent to the right nostril, associated numbness, and aesthetic concerns. Radiographic examination revealed a peripheral soft tissue lesion anterior to the right maxilla that had destroyed the lateral nasal wall and anterior maxillary border, with extension into and partial obstruction of the right nasal cavity. Histopathological examination of the excised specimen revealed a cyst measuring 10×20mm with a 3mm wall thickness. The cyst was lined by squamous epithelium with areas of stratified cuboidal epithelium, surrounded by fibrous connective tissue containing mild chronic inflammatory infiltrate, blood vessels, and fat cells. The lesion was successfully treated by surgical enucleation through an intraoral approach. This case highlights the importance of considering nasolabial cysts in the differential diagnosis of soft tissue swellings in the nasolabial region, despite their rarity. Accurate diagnosis requires careful clinical examination, appropriate imaging, and histopathological confirmation to distinguish these lesions from odontogenic and other non-odontogenic entities.

Abstract A 2‐year‐old domestic cat presented following vehicular trauma. Orthopaedic evaluation revealed non‐weight‐bearing lameness of the right thoracic limb, soft tissue swelling, and crepitus upon palpation of the humerus and elbow. A severely comminuted closed Y‐T fracture of the right distal humerus was diagnosed on radiographs. Surgical stabilisation was achieved by placement of an intramedullary pin combined with a type 1a external skeletal fixator. Follow‐up revealed limb weight‐bearing at 3 days postoperatively and complete resolution of lameness at 6 weeks postoperatively. No complications associated with the external skeletal fixator were reported, and at the very long‐term follow‐up (482 days), the cat showed no lameness, pain, or decreased range of motion of the elbow. This case report describes the use of a type 1a external fixator combined with an intramedullary pin to stabilise a Y‐T humeral fracture with significant humeral supracondylar comminution.

Objective: To evaluate the clinical and radiographic effectiveness of Metapex as an intracanal medicament in the nonsurgical management of large periapical lesions. Methods: Three female patients (ages 44-55) presented to the Dental Department of Sanjeevan Hospital, Delhi, with extensive periapical radiolucencies associated with teeth 15, 26 and 46. Each case underwent thorough chemo mechanical debridement followed by placement of Metapex, a silicone-oil-based paste containing calcium hydroxide, 38% iodoform, and barium sulfate into the prepared canals. Systemic antibiotics were prescribed initially. Metapex dressings were refreshed at regular intervals over a period of four to five months. Patients were assessed for pain, swelling, and inter-appointment discomfort, and radiographic healing was monitored at 3-week, 2.5-month, and 5-month follow-ups. Results: All three patients reported complete resolution of pain and soft-tissue swelling without any inter- appointment discomfort. Serial periapical radiographs demonstrated progressive reduction in lesion size, with full trabecular bone regeneration observed by 2.5 months in the first case and by five months in the remaining cases. No adverse reactions or procedural complications were noted. Conclusion: Metapex, used as an intracanal dressing following conventional root canal therapy, facilitated predictable healing of large periapical lesions in this case series. Its combined antimicrobial action, biocompatibility, and radiopacity support its role as a first-line adjunct in conservative endodontic protocols for extensive periapical pathology. Keywords: Metapex, Intracanal medicament, Periapical lesion, Non-surgical endodontic treatment, Calcium hydroxide.

Intravascular papillary endothelial hyperplasia, also known as Masson tumour, is a rare proliferative vascular lesion that can affect the hand. We report a patient who was operated on for a progressively enlarging soft tissue lump at the base of his thumb. Initially, it was thought to be a post-traumatic false aneurysm arising from a branch of the radial artery following blunt trauma. Subsequent histology revealed it to be a Masson tumour. We aim to highlight this rare pathology that can affect the hand and the diagnostic confusion we faced during the evaluation and management of this patient. Level of Evidence: Level V (Therapeutic).

ObjectiveThis study endeavors to systematically investigate factors influencing knee joint stability following anterior cruciate ligament reconstruction (ACLR) using magnetic resonance imaging (MRI), with the goal of providing quantitative imaging evidence for determining clinical rehabilitation timelines and objectively evaluating treatment efficacy.MethodA total of 31 patients undergoing ACLR were retrospectively evaluated with MRI scans at 1, 4, and 12 months postoperatively. Parameters included graft length, tibial anteroposterior displacement, tunnel position, and angulation metrics JGS, JGC, angle α, angle β, angle θ)).Clinical outcomes were assessed using the Lysholm score. Longitudinal differences in stability parameters were analyzed by repeated-measures ANOVA (p < 0.05), with ROC curves evaluating diagnostic sensitivity.ResultAmong 31 patients, 28 achieved satisfactory graft healing, while three required revision reconstruction. At 4 months postoperatively, significant reductions in joint effusion volume and soft tissue swelling were observed. Knee joint stability at 12 months was significantly superior to values at both 1- and 4-month intervals (p < 0.05). Tibial range of motion and β-angle were significantly associated with joint stability, with AUC values of 0.64 and 0.62, respectively.ConclusionMultiparametric MRI objectively evaluates post-ACLR intra-articular healing and joint stability, delivering critical imaging evidence to guide evidence-based rehabilitation planning.Clinical trial numberNot applicable.

Objective: To describe a case of a craniomaxillofacial penetrating injury focusing on the importance of a multidisciplinary approach with insights into the surgical planning for successful removal of the foreign body during the pandemic. Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One Results: A 15-year-old boy presented with a work-related puncture wound in the right nasomaxillary area with accompanying soft-tissue swelling. Physical examination of his face showed no external foreign body. Craniofacial computed tomography scans revealed a rodshaped opaque foreign body about 12 cm in length and 9 mm in diameter lodged in the right maxillary sinus extending to the right temporal lobe. The otolaryngology-head and neck surgeonand neurosurgeon planned the crucial extraction of the foreign body, but the requirement for a negative RT-PCR, blood products, and additional imaging delayed this emergent operation. The foreign body was eventually removed via combined trans-antral approach and right frontotemporal craniotomy, zygotomy, and craniectomy around the foreign body in the temporal floor with duraplasty and cranioplasty. Conclusion: Successful treatment of penetrating craniomaxillofacial injuries involves diligent clinical assessment, radiologic diagnosis and a well-planned multidisciplinary surgical approach. Delays in treatment may be beneficial if they allow precise location of the foreign body and thorough evaluation of involved structures. Safeguarding the healthcare workers during the pandemic was as important as ensuring a successful and safe surgery for the patient.

Background/Objectives: The nasal bone is critical to both the functional integrity and esthetic contour of the facial skeleton. Nasal bone fractures constitute the most prevalent facial fracture presentation in emergency departments. The identification of these fractures and the determination of immediate intervention requirements pose significant challenges for inexperienced residents, potentially leading to oversight. Methods: A retrospective analysis was conducted on facial trauma patients undergoing cranial radiography (Waters’ view) during initial emergency department assessment between March 2008 and July 2022. This study incorporated 2099 radiographic images. Surgical indications comprised the displacement angle, interosseous gap size, soft tissue swelling thickness, and subcutaneous emphysema. A deep learning-based artificial intelligence (AI) algorithm was designed, trained, and validated for fracture detection on radiographic images. Model performance was quantified through accuracy, precision, recall, and F1 score. Hyperparameters included the batch size (20), epochs (70), 50-layer network architecture, Adam optimizer, and initial learning rate (0.001). Results: The deep learning AI model employing segmentation labeling demonstrated 97.68% accuracy, 82.2% precision, 88.9% recall, and an 85.4% F1 score in nasal bone fracture identification. These outcomes informed the development of a predictive algorithm for guiding conservative versus surgical management decisions. Conclusions: The proposed AI-driven algorithm and criteria exhibit high diagnostic accuracy and operational efficiency in both detecting nasal bone fractures and predicting surgical indications, establishing its utility as a clinical decision-support tool in emergency settings.

BackgroundThe incidence of spinal infections is increasing; However, pathogen identification remains challenging. Although Q fever spinal infection is reported infrequently, its accrual incidence is likely underestimated. The causative agent, Coxiella burnetii, cannot be routinely cultured. Consequently, physicians often misdiagnose Q fever spinal infection as spinal tuberculosis, leading to severe patient harm. Thus, improving clinicians’ awareness of the clinical characteristics of Q fever spinal infection is urgently needed.MethodsWe present a case of Q fever spinal infection and conducted literature searches in PubMed and the Chinese core journals of the Wanfang Database using keywords including “Q fever,” “Coxiella burnetii,” “spinal infection,” “osteomyelitis,” “spondylodiscitis,” and “psoas abscess.” Additional reports were identified through cross-referencing, with a cutoff date of 6 November 2024. Cases were included if patient age, sex, and baseline medical history were documented. Clinical data were retrospectively analyzed, and clinical features were compared between the aneurysm-associated group and the isolated spinal infection group. Fisher's exact probability test was used to evaluate the incidence difference.ResultsA total of 39 adult patients were enrolled (mean age: 67.82 ± 10.51 years, male: 34,87.2%), Eleven cases reported potential pathogen exposure. Thirty-three cases presented with early-onset of lower back pain, and 13 developed fever during the disease course. Thirty-four cases involved the lumbar spine, exhibiting continuous lesions of 1–3 vertebral bodies, with imaging features of vertebral osteomyelitis, discitis, paravertebral soft-tissue swelling, and/or adjacent aneurysmal changes. Among 21 cases with routine blood tests, 2 showed elevated leukocyte counts, 5 had mild anemia, and the remainder were normal. Serological testing was performed in 34 cases, with 29 testing positive on the first time; PCR testing was conducted in 25 cases, with 23 cases detecting positive specimens; and rapid diagnosis confirmed in all 3 cases via metagenomic next-generation sequencing (mNGS). Inflammatory reactions were identified in all 21 biopsied cases, with inflammatory granulomas reported in 7 and explicitly excluded in 4. There were 24 cases complicated with aneurysm and 15 cases with isolated spinal infection. A significant difference in CRP elevation rate was observed between the two groups (14/15, 93.33% vs 4/8, 50.00%, P = .033). Early local lesion debridement combined with doxycycline-based multidrug therapy showed favorable outcomes. Serological monitoring demonstrated low sensitivity for assessing therapeutic efficacy.ConclusionsThis study systematically summarizes the clinical characteristics of Q fever spinal infection and, for the first time, reports features associated with its distinct clinical subtypes. Q fever should be considered in case of chronic spinal infections—especially those complicated with vascular lesions. Based on clinical history evaluation, rapid diagnosis may be achieved through mNGS of specimens from local lesions. Combined with early initiation of doxycycline-based regimens, timely debridement of necrotic tissues and purulent material may improve treatment outcomes. Further investigations are needed to identify reliable biomarkers for monitoring therapeutic efficacy and to establish optimal treatment strategies for subtypes of Q fever spinal infection.

We report an extremely rare case in which delayed diagnosis and treatment of Mycobacterium tuberculosis infection primarily involving the subcutaneous tissues of an extremity led to hematogenous dissemination of the infection and subsequent deterioration of the patient. An 82-year-old man presented to our hospital with a painful mass on the right ankle for over a year, as well as persistent fever and shortness of breath for >14 days. He received piperacillin/tazobactam followed by meropenem, which failed to decrease his peak temperature. After performing chest computed tomography, acid-fast staining of the abscess specimen, GeneXpert M tuberculosis/rifampin assay, and cerebrospinal fluid tests, the patient was diagnosed with miliary pulmonary tuberculosis and tuberculous meningitis hematogenously transmitted from a primary subcutaneous tuberculous abscess. Isoniazid, rifampin, levofloxacin, linezolid, and ethambutol were administered through a nasogastric tube to treat the tuberculosis, and 5 mg of dexamethasone was administered to reduce the inflammatory response. The treatment was halted because of poor compliance, and the patient died of respiratory failure within 1 month of returning home. We suggest tuberculosis screening or biopsy recommendations for chronic soft tissue swellings in high tuberculosis-burden areas, to avoid missed or delayed diagnosis.

The aim of the study is differential diagnosis of primary chronic osteomyelitis (PCO) and fibrous dysplasia (FD) of the mandible. A retrospective comparative study of the case histories of 36 patients with PCO (average age 8.9 years) and 12 patients with FD (average age 8.5 years) who were treated at the Department of Maxillofacial surgery of the RCCH in the period from 2015 to 2023 was conducted. The features of clinical manifestations were evaluated: pain, swelling of soft tissues, trismus of the masticatory muscles, bone deformity, numbness of the lips, increased skin temperature in the area of lesions. The condition of the bone structures was assessed according to both panoramic radiographs and computed tomography (CT) scans. The bone structure, involvement of the condyle of the mandible, tooth displacement, displacement and width of the mandibular canal were evaluated. Both study groups were dominated by girls (PCO 1:2.6; FD 1:1) and unilateral jaw lesion (PCO 1:1.31; PD 1:1.4). Patients with PCO mainly complained of pain (94.4%), soft tissue edema (100.0%) and masticatory muscle trismus (100%), while patients with FD had no pain and an increase in volume of bone (83.3%) without trismus. Computed tomography of patients with PCO showed the formation of the subcortical bone, lysis of the cortical layer, dilation of the mandibular canal on the affected side, whereas in patients with FD, moderate or pronounced bone swelling, a well-defined cortical layer, displacement of teeth and the mandibular canal from the node of FD were mainly observed. The data obtained emphasize the importance of clinical and radiological signs in various diseases. Pain, edema, formation of the subcostal bone, unilateral expansion of the mandibular canal, the clarity of the boundary of the cortical and medulla and the continuity of the cortical bone are the key points allowing for the differential diagnosis of these conditions.

Exploring the antiarthritic potential of Caralluma fimbriata: Phytochemical screening and preliminary observations in a rat model.

Berotralstat effectiveness and safety in patients with hereditary angioedema with normal C1 inhibitor

To explore the clinical features of patients with necrotizing soft tissue infection (NSTI) and the related factors for sepsis, so as to provide a basis for early intervention and improvement of patients' prognosis. A retrospective case series study was conducted to analyze the clinical data of NSTI patients admitted to the department of burns and wound repair surgery of Guangdong Provincial People's Hospital from October 2021 to December 2024. Demographic information, underlying diseases, infection characteristics, laboratory test results and etiological findings at admission, treatment status, occurrence of complications (including sepsis) and prognosis were collected. Univariate and multivariate Logistic regression analyses were used to identify the associated factors for sepsis in NSTI patients. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of individual and combined factors for sepsis. A total of 159 NSTI patients were enrolled, mainly middle-aged and elderly males. Most patients had comorbidities, including diabetes mellitus (110 cases, 69.2%) and hypertension (67 cases, 42.1%). The main infection site was the lower extremities (104 cases, 65.4%). Common symptoms included redness (96 cases, 60.4%), swelling (129 cases, 81.1%), local heat (60 cases, 37.7%), pain (100 cases, 62.9%), and skin ulceration or necrosis (9 cases, 5.7%). Imaging findings included soft tissue swelling (66 cases, 57.9%), gas accumulation (41 cases, 36.0%), and abnormal signal/density shadows (50 cases, 43.9%). Staphylococcus aureus was the main pathogenic bacterium [12.0% (31/259)], and drug-resistant Escherichia coli had the highest detection rate among drug-resistant bacteria [35.1% (13/37)]. Regarding debridement and repair, most patients (80 cases, 50.3%) underwent debridement ≥ 72 hours after admission, while only 10.1% (16 cases) received debridement within 6 hours. Most patients underwent multiple debridements, with 2 times of debridements being the most common (68 cases, 42.8%), and the maximum times of debridements reached 6. The largest number of patients received secondary suture (44 cases, 27.7%). In terms of complications, sepsis was the most common (66 cases, 41.51%), followed by acute kidney injury, respiratory failure requiring mechanical ventilation, and multiple organ dysfunction syndrome (MODS), while disseminated intravascular coagulation (DIC) was the least common. During the follow-up period, 9 patients (5.66%) were readmitted within 90 days, and 11 patients died, with a mortality rate of 6.92%. Univariate analysis showed that diabetes, coronary heart disease, gout, body temperature, heart rate, C-reactive protein, platelet count, total bilirubin, albumin, creatinine, out-of-hospital treatment, and out-of-hospital use of antimicrobial agents were significantly associated with sepsis in NSTI patients (all P < 0.05). Multivariate Logistic regression analysis showed that coronary heart disease [odds ratio (OR) = 30.085, 95% confidence interval (95%CI) was 2.105-956.935], C-reactive protein (OR = 1.026, 95%CI was 1.009-1.054), and total bilirubin (OR = 1.436, 95%CI was 1.188-1.948) were independent associated factors for sepsis in NSTI patients (all P < 0.05). ROC curve analysis revealed that the combination of the three predictors yielded the highest AUC for predicting sepsis in NSTI patients compared to any individual predictor [area under the curve (AUC) = 0.799 (95%CI was 0.721-0.878)]. The clinical features of NSTI patients show certain regularity. Coronary heart disease, C-reactive protein, and total bilirubin are independent associated factors for sepsis in NSTI patients.

Graves' orbitopathy (GO) is a prevalent manifestation of Graves' disease (GD), characterized by proptosis, eyelid retraction, soft tissue swelling, diplopia, and potential visual acuity impairment. Furthermore, even mild GO can significantly impact mental health and overall quality of life for patients with GD. Despite its severity, available medical treatments for mild GO are limited. Recent basic studies on orbital fibroblasts suggest hydroxychloroquine (HCQ) as a promising therapeutic agent for GO patients. This randomized controlled trial (RCT) was designed to assess the efficacy of HCQ in treating mild GO. METHODS: This multi-center open-label RCT will be conducted in Taiwan with a total of 108 participants randomized into HCQ and control groups at 2:1 allocation ratio. The primary endpoint of this study is a composite outcome of ophthalmic parameters including eyelid aperture, soft tissue involvement, and exophthalmos. Secondary endpoints comprise changes in quality of life (GO-QoL), orbital volumetry via computed tomography (CT), diplopia scores, clinical activity scores (CAS), visual acuity, and thyroid autoantibodies. This RCT will elucidate the clinical benefits of oral HCQ in patients with mild GO, assessing ophthalmic outcomes, quality of life, disease activity, and thyroid autoantibodies. In addition, data obtained from orbital CT measurements will provide valuable insights into subtle changes in orbital fat and extra-ocular muscle volumes, potentially offering an objective tool for monitoring GO progression. TRIAL REGISTRATION{2A, 2B}: ClinicalTrials.gov NCT05126147.Registered on November 2021. https://clinicaltrials.gov/study/NCT05126147 . All items from the World Health Organization (WHO) Trial Registration Data Set are addressed within the relevant sections of this protocol.