Cureus最新文献

Introduction Adult exfoliative dermatitis (ED) is a severe inflammatory dermatosis with heterogeneous etiologies and substantial morbidity. Hospital-based prospective data remain limited in Thailand. We aimed to prospectively describe the clinical characteristics, etiologies, management, and outcomes of adults with ED at a tertiary-care hospital in Thailand, and to assess changes during follow-up. Methods We conducted a prospective hospital-based cohort study enrolling consecutive adults diagnosed with ED from November 2024 to March 2026. Baseline demographics, comorbidities, prior treatments, clinical manifestations, and disease severity were recorded. Etiology was determined by clinicopathologic correlation and treating-physician adjudication. Patients were followed longitudinally for up to 12 months after diagnosis, and changes in disease severity and clinical outcomes were assessed during follow-up. Analyses were primarily descriptive. Exploratory comparisons across follow-up visits were reported using nonparametric tests with corresponding p-values. Results Thirty-four patients were recruited; two were lost to follow-up, and one had incomplete baseline data, leaving 31 for analysis. The mean age was 58.0 ± 18.2 years, and 74.2% were male. Most were managed as outpatients (67.7%), while 32.3% required hospitalization. Pruritus, scaling, and erythema were present in all patients. Nail involvement was frequent (64.5%), whereas pustules and mucosal involvement were uncommon (6.5% each). Systemic features occurred in a subset, including arthritis (25.8%), fever (16.1%), edema (16.1%), and lymphadenopathy (6.5%). Conclusions In this prospective hospital-based cohort, adult ED demonstrated uniform core cutaneous features with variable systemic involvement and a substantial proportion requiring hospitalization. These findings provide pragmatic clinical profiles to support early recognition and structured evaluation of etiology and complications in routine practice.

Small intestinal fungal overgrowth (SIFO) is defined by an abnormal proliferation of fungal organisms, most commonly Candida species, within the small intestine. Fungal infections, particularly candidiasis, are recognized causes of gastrointestinal (GI) symptoms, especially in patients with underlying conditions, such as malignancy or diabetes mellitus (DM), and in those exposed to immunosuppressive therapies, corticosteroids, or prolonged antibiotic use. SIFO is an underrecognized cause of GI symptoms, including bloating, diarrhea, and malabsorption. In rare cases, excessive fungal colonization can lead to mechanical bowel obstruction. This case report describes a patient with advanced retroviral infection who developed small bowel obstruction secondary to SIFO, underscoring the diagnostic challenges, therapeutic approaches, and the critical importance of early recognition and management.

Treatment-resistant depression (TRD) presents a complex clinical challenge, particularly when comorbid with substance use disorders (SUDs) or other compulsive behaviors. With up to a third of major depressive disorder (MDD) patients failing to respond to standard antidepressant therapies, there is growing interest in interventions such as esketamine, a glutamatergic N-methyl-D-aspartate (NMDA) receptor antagonist approved for TRD in 2019, as an intranasal therapy. While esketamine has demonstrated efficacy in alleviating depressive symptoms of TRD, emerging data also point towards its potential in addressing compulsive and addictive behaviors, particularly in patients whose depression and SUDs are deeply intertwined. This review aims to evaluate and synthesize the current literature on the use of esketamine in treating not only TRD, but specifically its application in patients suffering from comorbid substance use and addiction-related behaviors. We aim to clarify the therapeutic mechanisms, examine both human and animal data, and identify whether esketamine offers a dual-modality treatment approach that concurrently reduces depressive symptoms and addictive tendencies. Across peer-reviewed studies, including randomized control trials, cohort analyses, systematic reviews, and preclinical investigations, findings suggest that esketamine may reduce drug-seeking behavior, attenuate cravings, and improve outcomes when combined with behavioral interventions (such as mindfulness-based therapy). In rodent models, esketamine significantly inhibited cocaine-seeking after various abstinence conditions, and clinical data point to its potential role in treating alcohol misuse. In conclusion, esketamine holds potential as a dual-action therapeutic in patients with TRD and comorbid addiction; however, further large-scale studies are needed to explore its therapeutic magnitude, duration of benefit, safety, and effects on substance use-related outcomes.

Acute pancreatitis is a common cause of hospital admission; however, cases secondary to medication use are rare. We report a case of drug-induced mild acute pancreatitis in a 33-year-old female with type 2 diabetes mellitus. The patient presented with a one-day history of vomiting and lower chest and epigastric pain after five months of starting sitagliptin therapy. She was also taking the combined oral contraceptive pill. Clinical examination revealed epigastric tenderness and signs of dehydration. Laboratory findings showed elevated white cell count, C-reactive protein, and triglyceride levels. Although the serum amylase level was not clinically significant, a contrast-enhanced computed tomography performed 24 hours after the onset of symptoms demonstrated pancreatic inflammation and peri-pancreatic fluid consistent with acute pancreatitis. Common etiologies, including gallstones and alcohol, were excluded through imaging and history. The patient was managed conservatively with intravenous fluids for hydration and intravenous insulin for the severe hypertriglyceridemia and ketoacidosis. Sitagliptin was discontinued and replaced with gliclazide as opposed to metformin, which she was intolerant to. The combined oral contraceptive pill was continued. She demonstrated gradual improvement with normalization of inflammatory markers and triglyceride levels, achieving full recovery by day five. This case highlights the importance of considering sitagliptin and other medications, such as the combined oral contraceptive pill, as potential causes of acute pancreatitis and emphasizes the need for early recognition and prompt discontinuation of the offending agent to ensure optimal outcomes in patients.

Nodular pulmonary amyloidosis is a rare entity characterized by extracellular deposits of amyloid protein in the pulmonary parenchyma, usually with a benign prognosis and often asymptomatic. We report a case of a 61-year-old man with a prior diagnosis of Sjögren's syndrome who, during routine follow-up, was found to have multiple asymptomatic pulmonary nodules in the right lung, with uptake on positron emission tomography-computed tomography (PET CT) (SUVmax 2.11). Surgical resection was performed, and histological analysis revealed nodular deposits of amyloid protein with kappa light chain predominance, without evidence of systemic involvement. This case highlights the importance of considering nodular pulmonary amyloidosis in the differential diagnosis of pulmonary nodules in patients with Sjögren's syndrome, emphasizing the need for histological evaluation to avoid misdiagnosis and inappropriate treatment.

Hepatic hemangiomas are uncommon vascular tumors in the neonatal period and are rarely reported in extremely preterm infants. Cystic variants are exceptionally rare and may exhibit atypical imaging features, making early diagnosis challenging. Spontaneous rupture with massive hemorrhage represents a life-threatening complication. We report the case of a male neonate born at 27 weeks of gestation with a birth weight of 900 g who was initially admitted to the neonatal intensive care unit for respiratory distress syndrome. During hospitalization, the infant developed recurrent severe anemia associated with progressive hepatomegaly and abdominal distension requiring multiple packed red blood cell transfusions. Clinical examination revealed marked abdominal enlargement. Abdominal radiography and contrast-enhanced computed tomography demonstrated a large multiloculated cystic hepatic mass. The clinical course rapidly deteriorated with acute hemorrhagic anemia and progressive abdominal enlargement, ultimately resulting in death. Histopathological examination of a postmortem liver biopsy confirmed a ruptured cystic hepatic hemangioma. In very preterm neonates, unexplained anemia associated with hepatomegaly should prompt consideration of rare hepatic vascular tumors. Although exceedingly rare, ruptured cystic hepatic hemangioma carries a poor prognosis in this vulnerable population.

Primary malignant tumors of the trachea are rare, with squamous cell carcinoma (SCC) being the most frequent subtype. Due to limited data, optimal systemic therapy for unresectable or recurrent cases remains undefined. We report a case of recurrent primary tracheal SCC achieving durable complete remission with immune checkpoint inhibitor (ICI)-based combination chemotherapy. A 73-year-old man with a history of resected lung cancer was incidentally diagnosed with tracheal SCC. Following bronchoscopic tumor debulking, he underwent concurrent chemoradiotherapy. Recurrence with pulmonary metastases occurred 4 months later. He was treated with four cycles of pembrolizumab plus nab-paclitaxel and carboplatin, followed by pembrolizumab maintenance. Complete radiologic remission was achieved and sustained for over two years. This case highlights the potential of ICI-based regimens, widely used in non-small cell lung cancer, as a promising option for recurrent tracheal SCC. Multidisciplinary approaches incorporating immunotherapy may offer meaningful benefit in this rare malignancy.

Acute mediastinitis is a rare but life-threatening condition, most commonly secondary to esophageal perforation. Foreign body ingestion in adults is an unusual etiology, with limited data from Morocco, where only a few cases have been reported. We report a case of mediastinitis complicating esophageal perforation following accidental foreign body ingestion in a Moroccan patient, highlighting diagnostic challenges and management in a resource-limited setting. We report the case of a 38-year-old patient admitted with septic shock, complicated by dysphagia and epigastric pain, five days after accidental foreign body ingestion. A cervicothoracic CT scan revealed esophageal perforation complicated by mediastinitis and inhalation pneumonia. Emergency surgical management consisted of a Kocher cervicotomy with mediastinal drainage, combined with early broad-spectrum antibiotic therapy, which led to a favorable postoperative outcome. This case from Morocco underscores the importance of early clinical suspicion, prompt CT imaging, and aggressive medico-surgical management in improving outcomes, even in delayed presentations. It contributes to the growing body of regional literature on foreign body-induced mediastinitis in North Africa.

Osteonecrosis of the femoral head is a well-recognized musculoskeletal complication of sickle cell disease (SCD) that frequently results in early joint destruction and functional disability in young patients. The coexistence of avascular necrosis and septic arthritis in SCD patients is uncommon and presents significant diagnostic and therapeutic challenges. We report the case of a 24-year-old male patient with sickle cell disease who developed septic arthritis of the hip following femoral head core decompression, ultimately requiring staged total hip arthroplasty.

Introduction Sacroiliitis is a well-recognized cause of axial low back pain and significantly contributes to chronic cases seen in orthopedic and pain clinics. While intra-articular corticosteroid injections provide established short-term symptom relief, their long-term effectiveness remains variable. Platelet-rich plasma (PRP) has emerged as a biological alternative with regenerative potential, and viscosupplementation using hyaluronic acid offers viscoelastic and anti-inflammatory effects that may enhance joint function. This study aimed to compare the therapeutic efficacy of intra-articular corticosteroid, PRP, and viscosupplement injections in treating sacroiliitis. Materials and methods This retrospective comparative study included 60 adults with clinically and magnetic resonance imaging (MRI)-confirmed sacroiliitis who were treated between January 2022 and December 2024. Patients received one of the following treatments: fluoroscopy-guided intra-articular injection of 40 mg methylprednisolone acetate combined with lidocaine (steroid group; n=20), 5 mL of autologous PRP prepared using a standardized double-spin centrifugation protocol (PRP group; n=20), or intra-articular hyaluronic acid viscosupplementation (viscosupplement group; n=20). Pain and functional status were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, one week, one month, three months, and six months. Statistical analysis was conducted using repeated measures and one-way analysis of variance (ANOVA). Results Baseline VAS scores were comparable among the steroid (7.9±0.8), PRP (7.8±0.9), and viscosupplement (7.8±0.7) groups (p>0.05). The steroid group demonstrated greater early pain reduction at one week (4.6±0.9) compared to the PRP (6.2±0.8) and viscosupplement (5.8±0.9) groups. At six months, the PRP group showed the greatest improvement, with a mean VAS of 3.8±1.0, followed by the viscosupplement group (4.3±1.1), while the steroid group had higher scores (5.1±1.2) (p<0.05). Similarly, the mean ODI at six months was lowest in the PRP group (31.9±6.8%), followed by the viscosupplement (35.6±7.2%) and steroid groups (40.3±7.5%) (p<0.05). All groups showed significant improvement from baseline (p<0.001). No major complications were observed. Conclusion Intra-articular injections of corticosteroids, PRP, and viscosupplements effectively reduce pain and disability in sacroiliitis. Corticosteroids provide rapid early symptom relief, while PRP demonstrates superior mid-term improvement. Viscosupplementation offers sustained clinical benefits and represents a safe and effective therapeutic alternative.