The patient is a 33-year-old Chinese man.

He had sustainable foamy urine for more than one year.

He complained of intermittent hair loss.

One year prior, he was hospitalized at a local hospital for the same reason.

Routine urine tests indicated microscopic hematuria and proteinuria.

There was no further diagnosis or treatment.

One month prior, his blood pressure rose to 145/91 mmHg.

Microscopic hematuria and heavy proteinuria were again detected.

The patient's father had asymptomatic microscopic hematuria and proteinuria.

The father's findings were detected in a routine physical examination approximately 2 years prior.

The daughter had asymptomatic microscopic hematuria.

The son had microscopic hematuria and proteinuria.

The son had ever been diagnosed with chronic nephritis at a local hospital.

The patient's systolic blood pressure was 141 mmHg.

The patient's diastolic blood pressure was 90 mmHg.

No obvious abnormality was detected during physical examination.

No specific nervous system symptoms were recognized.

Microscopic hematuria and proteinuria were confirmed by urine tests.

No obvious abnormality was detected by abdominal ultrasound.

No obvious abnormality was detected by X-ray diagnosis.

No obvious abnormality was detected by electrocardiographic examination.

Heart echocardiography showed a small amount of pericardial effusion.

A histopathology study of renal biopsy was performed.

One glomerulus was enlarged and lobulated.

Para-aminosailcylic acid staining and Masson staining were positive.

Mild mesangial matrix proliferation was observed.

Three glomerular fibroblastic crescents were observed.

Pericystic fibrosis of glomeruli was observed.

Deposition of erythrotropin under the endothelium of the capillary loop was detected.

Electron microscopy revealed variable thickness of the glomerular basement membrane.

Electron microscopy revealed reticulation of the glomerular basement membrane.

Electron microscopy revealed irregular subepithelial protrusion of the lamina densa.

Fine particles and electron-dense bodies were detected in the stratified basement membrane.

Immunological staining for IgG, IgA, IgM, C3, C4, C1q, К, and λ was positive in four glomeruli.

The signals were deposited in the vascular lumen and mesangial area in a granular or linear form.

Three relatives had microscopic hematuria.

A diagnosis of ATS was highly suspected.

The patient and his children were recommended to undergo genetic testing.

Genomic DNA was extracted from blood samples.

The coverage of the target sequence was over 99.12%.

The mean sequencing depth was approximately 147.

A heterozygous substitution, NM_000091 c.2657-1G>A (p. V294fs), was found in intron 22 of the COL4A3 gene.

The mutation was confirmed by Sanger sequencing.

The mutation was excluded from the single nucleotide polymorphism database.

The mutation was included in the ClinVar database.

The mutation is located at an evolutionarily conserved splice site.

The splicing mutation is thought to lead to the skipping of exon 23.

The variant is classified as 'likely pathogenic' according to the American College of Medical Genetics and Genomics standards and guidelines.

A Chinese family with ATS was recruited for the current study.

Clinical characteristics of ATS patients were collected from medical records.

Potential causative genes were explored by whole-exome sequencing.

A heterozygous substitution in intron 22 of COL4A3 (NM_000091 c.2657-1G>A) was found in the patients.

The heterozygous substitution in intron 22 of COL4A3 was further confirmed by quantitative polymerase chain reaction.

The patient is a 33-year-old Chinese man.

He complained of intermittent hair loss.

There was no further diagnosis or treatment.

The daughter had asymptomatic microscopic hematuria.

The son had microscopic hematuria and proteinuria.

The patient's systolic blood pressure was 141 mmHg.

The patient's diastolic blood pressure was 90 mmHg.

No specific nervous system symptoms were recognized.

A histopathology study of renal biopsy was performed.

One glomerulus was enlarged and lobulated.

Mild mesangial matrix proliferation was observed.

Pericystic fibrosis of glomeruli was observed.

Three relatives had microscopic hematuria.

A diagnosis of ATS was highly suspected.

Genomic DNA was extracted from blood samples.

The coverage of the target sequence was over 99.12%.

The mean sequencing depth was approximately 147.

The mutation was confirmed by Sanger sequencing.

The mutation was included in the ClinVar database.


Your body needs to keep your blood clean and your organs working well. If your kidneys aren’t doing their job, it’s like having a leaky faucet — waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.

Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.

The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.

He complained of blurred vision in both eyes because of senile cataract in October 2015.

Visual acuities were 6/20 OD and 8/20 OS.

Slit-lamp examination revealed mild cortical cataract OU.

The initial ophthalmologist planned to perform cataract surgery for his right eye.

He had a medical history of prostate hypertrophy.

Viscoelastic materials with high-level cohesion were injected into the anterior chamber to dilate the pupil due to miosis following hydrodissection OD.

Severe thermal corneoscleral injury occurred soon after beginning the phacoemulsification.

The wound was tightly sutured by pedunculated conjunctiva.

Viscoelastic materials were injected again since the leakage was not suppressed.

He was referred to our hospital the next day.

There was marked corneal stromal opacity with intraocular fluid leakage.

The scleral wound was found to be opening following conjunctival incision.

Mobility of the sclera was markedly involved.

It was impossible to conduct direct suture of the injured sclera.

The patient underwent transplantation of a donor scleral graft using 10-0 nylon to the burn site.

After the transplantation and confirmation of the absence of intraocular fluid leakage, the lens nucleus was extracted from the newly formed wound on the temporal side of the scald.

Histologically, the injured sclera showed coagulation necrosis with eosinophilic materials.

Attachment of the transplanted sclera was favorable.

Intraocular pressure recovered to normal.

Three months after the surgery, macular edema occurred due to intraocular inflammation caused by the remaining lens cortex.

Anterior vitrectomy was conducted leading to the resolution of macular edema.

An intraocular lens was eventually fixed in the ciliary sulcus 7 months later.

The visual acuity improved to 2/20 OD with stable IOP and a reduced corneal opacity in October 2016.

Severe thermal corneoscleral injury occurred during phacoemulsification in the right eye of a 74-year-old male.

His medical history was prostate hypertrophy.

Visual acuity was hand motion and the intraocular pressure was 3 mm Hg OD.

There was heavy corneal stromal opacity with intraocular fluid leakage.

The patient underwent transplantation of a donor scleral graft to the burn site.

Histologically, the injured sclera showed coagulation necrosis without inflammatory cell infiltration.

**System Role:**

You are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.

**User Prompt:**

Please process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.
### Instructions for Each Level:

1. Level: Low Health Literacy (High Readability)

Target: Individuals needing the simplest terms for immediate action.

Linguistic Goal: Use "living room" language. Replace all medical jargon with functional descriptions (e.g., "renal" becomes "kidney").

Information Density: Focus strictly on the "need-to-know" info found in the Gold Summary.

Strategy: High paraphrasing using analogies. One idea per sentence.

Faithfulness: Must align perfectly with the Gold Summary.

2. Level: Intermediate Health Literacy (Medium Readability)

Target: The general public (news-reading level).

Linguistic Goal: Standard vocabulary. Common medical terms are okay, but technical "doctor-speak" must be simplified.

Information Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.

Strategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.

Faithfulness: Maintains the main narrative of the Gold Summary.

3. Level: Proficient Health Literacy (Low Readability)

Target: Researchers, clinicians, or highly informed patients.

Linguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.

Information Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.

Strategy: Minimal paraphrasing. Retain all original technical terminology.

Faithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.

I will provide the following information:

- Input Language: <<<SOURCE_LANGUAGE>>>
- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>
- Source Text (detailed content): <<<FULL_TEXT>>>

**Output Format (JSON only):**
    {
    "low_health_literacy": "...",
    "intermediate_health_literacy": "...",
    "proficient_health_literacy": "..."
    }


The patient was a 23-year-old critically-ill male.

He had graft-versus-host disease requiring high-dose corticosteroids.

He was admitted after 2 days of somnolence and confusion.

He had evolving respiratory distress requiring endotracheal intubation.

On admission, he would open eyes to painful stimuli.

On admission, he continued to follow commands.

Initial CT head showed a flame hemorrhage in the left gyrus rectus.

The flame hemorrhage was suspicious for vascular origin.

A hypodensity in the left thalamus was suspicious for an established infarction.

An angiogram demonstrated six fusiform aneurysms.

Three aneurysms were at the frontopolar branch of the left anterior cerebral artery.

One aneurysm was at the orbitofrontal branch of the left anterior cerebral artery.

One aneurysm was at the frontopolar branch of the right anterior cerebral artery.

One aneurysm was at the anterior temporal artery of the left middle cerebral artery.

Body imaging revealed cavitary lung lesions.

The patient was started on broad spectrum antibiotics.

The patient was started on antiviral medications.

The location of hemorrhage pointed to the left ACA branch aneurysms as the source.

Surgery was chosen to allow for inspection of all lesions under direct vision.

Surgery was chosen to obtain tissue for microbiological purposes.

A bicoronal craniotomy, parent vessel sacrifice, and excision of the three aneurysms arising from the left ACA were performed on postbleed day 2.

Intraoperatively, the aneurysms were friable, thin walled, and prone to bleeding.

The right ACA aneurysms were managed conservatively.

Microbiology confirmed angioinvasive S. apiospermum infection.

Vericonazole, amphotericin B, and caspofunging were started empirically.

Vericonazole, amphotericin B, and caspofunging were continued throughout the disease process.

A CT scan on postbleed day 4 revealed new left frontal intracerebral hemorrhage.

A CT scan on postbleed day 4 revealed intraventricular hemorrhage.

An emergency external ventricular drain was placed.

A follow-up angiogram revealed interval growth of the left orbitofrontal artery aneurysm.

Endovascular parent vessel occlusion was recommended.

Endovascular parent vessel occlusion was performed uneventfully.

An interval angiogram on postbleed day 7 demonstrated three new fusiform aneurysms of the right ACA.

An interval angiogram on postbleed day 7 demonstrated a new aneurysm of the left anterior choroidal artery.

An interval angiogram on postbleed day 7 demonstrated a new aneurysm of the left posterior communicating artery.

The interval angiogram on postbleed day 7 confirmed a stable appearing left anterior temporal artery aneurysm.

A3–A3 revascularization was attempted to avoid ACA sacrifice.

A3–A3 revascularization was unsuccessful.

Parent vessel sacrifice had to be performed.

An intraoperative angiogram demonstrated a new anterior communicating artery aneurysm.

The ACOMA aneurysm was left untreated at the time of surgery.

On further follow-up imaging, the ACOMA aneurysm continued to enlarge.

The ACOMA aneurysm was treated with endovascular A1 occlusions on postbleed day 9.

Surveillance imaging demonstrated interval growth of the previously identified left AChA aneurysm.

The left AChA aneurysm was ultimately treated with parent vessel sacrifice.

Surveillance imaging demonstrated interval growth of the previously identified left PCOMA aneurysm.

The left PCOMA aneurysm was ultimately treated with parent vessel sacrifice.

Despite multiple parent vessel sacrifices, the patient recovered neurologically.

The patient continued to follow commands with upper extremities.

The patient had severe paraparesis in the lower extremities.

Follow-up MRI confirmed a thalamic infarct.

The thalamic infarct was already seen on admission imaging.

Follow-up MRI showed new, incomplete ACA territory infarctions.

The infarctions were in keeping with previous surgeries and parent vessel sacrifice of the bilateral ACAs.

The patient remained intubated and ventilated.

The patient underwent a tracheostomy procedure.

The patient had septic shock from multidrug resistant pseudomonas superinfection.

The patient died 6 months after the hemorrhagic presentation.

The patient was a 23-year-old with Burkitt's lymphoma and graft-versus-host disease.

The patient was admitted with intracerebral hemorrhage.

The patient had 12 anterior circulation aneurysms from disseminated Scedosporium infection.

The patient died 6 months later from multiorgan failure.

The notable feature of this case is the rapid angioinvasiveness of the infection.

New aneurysms formed within days of clear angiographic imaging.

There was an apparent lack of skull base osteomyelitis.

The patient was a 23-year-old critically-ill male.

He was admitted after 2 days of somnolence and confusion.

On admission, he would open eyes to painful stimuli.

On admission, he continued to follow commands.

The flame hemorrhage was suspicious for vascular origin.

An angiogram demonstrated six fusiform aneurysms.

Body imaging revealed cavitary lung lesions.

The patient was started on broad spectrum antibiotics.

The patient was started on antiviral medications.

Surgery was chosen to obtain tissue for microbiological purposes.

The right ACA aneurysms were managed conservatively.

Microbiology confirmed angioinvasive S. apiospermum infection.

A CT scan on postbleed day 4 revealed intraventricular hemorrhage.

An emergency external ventricular drain was placed.

Endovascular parent vessel occlusion was recommended.

Endovascular parent vessel occlusion was performed uneventfully.

A3–A3 revascularization was attempted to avoid ACA sacrifice.

A3–A3 revascularization was unsuccessful.

Parent vessel sacrifice had to be performed.

The ACOMA aneurysm was left untreated at the time of surgery.

The patient continued to follow commands with upper extremities.

The patient had severe paraparesis in the lower extremities.

Follow-up MRI confirmed a thalamic infarct.

The thalamic infarct was already seen on admission imaging.

Follow-up MRI showed new, incomplete ACA territory infarctions.

The patient remained intubated and ventilated.

The patient underwent a tracheostomy procedure.

The patient died 6 months after the hemorrhagic presentation.


A 41-year-old Chinese man presented with palpable right breast lumps for 1 year.

On physical examination, a large retroareolar hard nontender mass approximately 4.5 cm in size was palpated over the right breast.

The mass was nonmobile and superficial but did not have any overlying skin findings.

A smaller adjacent mobile and nontender lesion, approximately 3 cm, was palpated just medial to the first mass.

Initial laboratory evaluation was normal for prolactin, estradiol, luteinizing and follicle-stimulating hormone levels.

He had never previously been treated with radiation, according to his past medical history.

Conventional mammography was performed on Flat III (Metaltronica Company, Rome, Italy).

Mammography showed a subcutaneous oval mass with a smooth and sharp margin on his right breast.

Another small oval mass with a less well-defined margin was seen adjacent to the main lesion.

MR imaging was performed on a 1.5 T Signa Infinity TwinSpeed MR scanner (GE Company, Milwaukee, WI, USA).

The examination comprised of routine T1- and T2-weighted fast spin echo (FSE) sequences in axial and sagittal planes.

T1- and T2-weighted imaging fat-suppressed in axial and sagittal planes, respectively.

On T1-weighted imaging, the lesions were predominantly hypointense to subcutaneous fat and mildly hyperintense to the pectoralis major muscle.

On T2-weighted imaging, the lesions were of a higher signal than the subcutaneous fat.

The larger lesion had a smooth contour and well defined borders on all sequences.

On T2-weighted images, the larger lesion had a lower signal central region.

Along the border of the larger lesion, there was a distinct rim of decrease in signal between the lesion and fat interface.

The small lesion had a less poorly defined border on conventional T2 weighted images.

On the fat-suppressed sequences, both lesions had better depiction for the margins and borders.

There was a mild mass effect of the dominant lesion on the underlying pectoralis major muscle.

The gross pathology of the specimens after surgery showed a yellowish tanned smooth surface mass measuring 4.5 cm × 3.0 cm × 2.0 cm.

A smaller lesion with similar features measuring 2.5 cm × 2.0 cm × 1.0 cm was also found.

Histologic specimens showed high cellularity monomorphic slender spindle cells arrayed in a storiform pattern.

The spindle cells were aligned at right angles to small vessels and collagen fibers intermixed with scattered adipose tissue.

The nuclei of the spindle cells were well differentiated with only rare mitotic figures.

The larger mass had a fibrous envelope and plentiful collagen fibers in the central region.

The smaller mass lacked the fibrous envelope.

There was positive immunohistologic staining for vimentin and cluster of differentiation (CD) 34.

There was negative immunohistologic staining for b-cell leukemia-lymphoma (Bcl-2), S-100 protein, smooth muscle actin (SMA), desmin and epithelial membrane antigen (EMA).

The patient is a 41-year-old Chinese man.

The patient initially presented with a palpable lump.

A mammogram showed two lesions in the right breast.

One lesion had a well circumscribed border.

The other lesion had an ill defined border.

Conventional magnetic resonance imaging was performed.

The well defined larger lesion showed mild central hypointensity.

The smaller lesion had an irregular border.

Both lesions were well characterized on the fat-suppressed sequences.


A 70-year-old male patient visited our clinic because of poor cognitive function and gait disturbance.

He was diagnosed with encephalitis following scrub typhus 23 years ago.

He was initially admitted to a local hospital with a high fever and headache 23 years ago.

He developed neurological symptoms as mental change, visual disturbance, and weakness, according to medical history.

The first MRI was conducted 7-d after onset.

The diagnosis of scrub typhus encephalitis was confirmed.

No special previous medical history was reported.

No special personal and family histories were found.

Physical examination revealed narrow visual fields.

His motor power on both extremities was intact without any pain.

Fine movements of the left hand were poor.

He could only manage to walk indoors because of sensory impairment.

Handgrip strength (right/left, kg) was 32.3/31.3.

Two-point discrimination test (right/left, mm) was 5/absence.

Monofilament test (right/left, mm) was 3.22/absence.

The patient had impaired cognition, with a mini-mental status examination score of 14.

The patient had impaired cognition, with a Montreal cognitive assessment score of 10[-].

We performed a computerized neuropsychological test.

DTI data were acquired with a 3.0 T scanner Intera (Philips, Ltd., Best, The Netherlands) with a six-channel head coil and single-shot echo-planar imaging.

For each of the 32 non-collinear diffusion-sensitizing gradients, we acquired 80 contiguous slices parallel to the anterior commissure-posterior commissure line.

The imaging parameters were as follows: acquisition matrix = 112 × 112, field of view = 224 mm × 224 mm, TR/TE = 8973/80 ms, parallel imaging reduction factor (SENSE factor) = 2, EPI factor = 49, b = 1000 s/mm2, NEX = 2, and slice thickness = 2.0 mm (acquired voxel size = 2 mm × 2 mm × 2 mm).

Analysis of the DTI data was performed using the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library (FSL: ) based on the probabilistic tractography method.

Head motion artifacts and image distortion due to eddy current were corrected by affine multiscale two-dimensional registration.

The 7-d MRI onset showed small lesions in the left frontal and parietal lobes, and large lesions in the right superior parietal lobule and both occipital lobes.

Compared with the 7-d MRI, the 23-year MRI findings indicated expanded lesions of encephalomalacia with marked dilation of both ventricles.

Probabilistic DTT of the Papez circuit revealed that the left thalamocortical tract and right mammillothalamic tract could not be reconstructed.

The anterior part of the fornix was found to be injured.

The patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago.

The Mini-Mental Status Examination score was 14.

Handgrip strength was 32.3 kg on the right and 31.3 kg on the left.

DTT revealed serious injuries of the left thalamocingulate tract.

DTT revealed serious injuries of the right mammillothalamic tract in the Papez circuit.

DTT showed a partial injury of the anterior part of the fornix.


The patient presented with an abnormal shadow on chest computed tomography (CT) at a medical checkup.

Chest CT showed a 17 mm × 8 mm ground-glass opacity with approximately 30% solid component in the right superior segment (S6).

The patient had undergone radical treatment of right breast cancer staged at pT2N0M0 IIA.

The patient had four cycles of postoperative adjuvant chemotherapy 11 years prior.

A thoracoscopic right S6 segmentectomy was planned.

We performed thoracoscopic surgery using two ports.

We made a 2-cm incision in the 7th intercostal space of the right midaxillary line as the observation hole.

We made a 4-cm incision in the 4th intercostal space of the right anterior axillary line as the operating hole.

Pleural adhesions were observed throughout the thoracic cavity perioperatively.

The horizontal and posterior oblique fissures were poorly developed.

The intersegmental plane could not be distinguished.

Digital palpation indicated that the nodule was located in a high position.

The posterior segmental and superior segmental arteries were located following the pulmonary trunk arteries.

The nodule was eventually found in the S2 of the right upper lobe.

The recurrent and ascending arteries were dissociated and resected.

The posterior segmental bronchus (B2) was exposed and transected.

The intersegmental plane was divided along the inflation-deflation line using the endostaplers.

Resection of the S2 of the right upper lobe was completed.

The tumor was 3 cm away from the incisal margin.

Intraoperative pathology analysis revealed minimally invasive adenocarcinoma (MIA).

Hilar lymph node sampling was performed.

On postoperative day 2, the right lung was completely redilated on CT.

Postoperative pathological examination revealed MIA with negative surrounding lymph nodes.

We reviewed lung CT images and performed three-dimensional (3D) reconstructions using Mimics Medical 21.0 software postoperatively.

The B2 originated from the bronchus intermedius.

The posterior segmental artery (A2) of the right upper lung lobe bifurcated into the A2a and A2b branching from the recurrent and ascending arteries, respectively.

The right superior pulmonary vein had no central vein but a posterior intrasegmental vein (V2t) that travelled below the S2.

We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung.

Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe.

Intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe.

The bronchi of the posterior segment of the right lung opened into the bronchus intermedius.

The procedure was completed uneventfully.

Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius.


A 19-year-old male was admitted to the Department of Plastic, hand and reconstructive surgery.

The patient had persistant dysaesthesia of the median nerve-supplied area.

The patient had a soft tissue laceration of the palmar wrist.

The injury occurred following a wakeboarding accident three days before admission.

The patient was wakeboarding on the largest German artificial wakeboarding circled nylon cable system.

The automatic nylon cable system stopped immediately due to an overlapping wire.

The male wakeboarder dived in the lake and got struck in the loose nylon cable system with his trunk and the hand.

The nylon cable system was activated by chance and he was pulled 1/4 of the radius of the lake with a speed of 40 km/h.

The patient suffered a strangulation of his wrist with immediate numbness of the median-nerve supplied area of the left hand.

The patient had a laceration of the palmar aspect of the wrist covering 0.5 × 5 cm tissue size.

At admission in a rural hospital, the two-point discrimination was > 15 mm for the entire interdigital nerves N1–N7 of the left hand.

The ulnar nerve was found without any pathology.

The patient could not perform a wrist flexion.

The capillary refill was 1s for all five fingertips.

No distinct pain in the snuff box area was evident on admission.

The left elbow joint had full range of motion.

Supination and pronation were limited due to persistent pain at the wrist level.

The patient was transferred three days after the initial injury with persistent clinical lesion of the median nerve.

Conventional x-ray of the hand and the wrist found regular articulation without an evident bony lesion.

No disruption of the scapular-lunar ligament was noted.

Computer tomography of the wrist and the hand proved regular bony structures.

In the operating room, dorsal compartment pressure of the forearm was 19 mmHg.

In the operating room, palmar compartment pressure of the flexor carpi ulnaris muscle was 16 mmHg.

The median nerve, 72 hours after the initial strangulation injury, appeared with hyperaemia and moderate swelling.

The median nerve had limited haematoma in the carpal tunnel.

The palmar branch of the median nerve was surrounded by a significant haematoma.

The haematoma surrounding the palmar branch of the median nerve was evacuated.

The ulnar nerve was inspected and found without any significant signs of injury or haematoma.

The laceration area was excised completely.

The skin could be closed primarily without compression.

On postoperative day 1, the patient regained the sensory function of the hand following 72 hours of acute carpal tunnel syndrome with median nerve contusion.

On postoperative day 1, the patient had remaining dysaesthesia of the thenar skin supplied by the palmar branch of the median nerve.

On postoperative day 5, the patient was discharged home after an uneventful postoperative course.

The patient complained of minor dysaesthesias in the thenar area.

The patient was advised to recover for a total of four weeks before returning to sport.

The palmar branch of the median nerve had strangulation damage.

The palmar branch of the median nerve is more superficially located in contrast to the median nerve.

The ulnar nerve was found without any pathology.

The patient could not perform a wrist flexion.

The capillary refill was 1s for all five fingertips.

The left elbow joint had full range of motion.

The laceration area was excised completely.


The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.

A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye.

The patient denied any previous history of ocular inflammation.

The patient denied any previous history of trauma.

The patient denied any previous history of surgery.

The patient denied any previous history of use of topical or systemic medications.

Snellen’s visual acuity in the right eye was 0.05.

Snellen’s visual acuity in the right eye was corrected to 0.5 with −3.00 to 2.00 × 15.

Snellen’s visual acuity in the left eye was 0.5.

Snellen’s visual acuity in the left eye was corrected to 0.8 with plano −0.75 × 170.

Intraocular pressure was 14 mm Hg in the right eye.

Intraocular pressure was 14 mm Hg in the left eye.

Slit-lamp examination of the right eye anterior segment showed clear cornea.

Slit-lamp examination of the right eye anterior segment showed deep and quiet anterior chamber.

Slit-lamp examination of the right eye anterior segment showed no iris transillumination defects.

Crystalline lens anterior capsular showed confluent pigment deposits stellate in shape over the pupillary axis.

Dilation of the right eye pupil showed no pigment deposits in the peripheral capsule.

Dilation of the right eye pupil showed no pigment deposits on the posterior lens capsule.

Dilation of the right eye pupil showed no pigment deposits on the anterior hyaloid face.

The examination of the left eye anterior segment was within normal limits before and after dilation.

Gonioscopy revealed open angle with mild pigmentation and prominent iris processes of the right eye.

Ophthalmic examination of the posterior segment was normal in both eyes.

The patient was reassured and prescribed glasses.

The patient was booked for regular follow-up.

Following discussion with the patient, she opted to have transepithelial photorefractive keratectomy for the right eye myopic astigmatism.

Transepithelial photorefractive keratectomy improved her unaided vision to 0.8.

Based on her previous ophthalmic history and slit-lamp examination of the right eye, a diagnosis of unilateral congenital lenticular pigmentation was made.

The patient presented with mild blurring of vision in the right eye.

The patient inquired about refractive surgery.

The patient denied any previous history of ocular trauma.

The patient denied any previous history of ocular surgery.

The patient denied any use of topical or systemic medications.

Slit-lamp examination of the right eye anterior segment was within normal limits except for the crystalline lens anterior capsular.

The right eye crystalline lens anterior capsular showed confluent pigment deposits stellate in shape over the pupillary axis.

Left eye examination was completely within normal limits.

A diagnosis of unilateral congenital lenticular pigmentation was made.


The patient is a 51-year-old Hispanic female.

She presented with acute onset chest pain for 1 day.

The chest pain was pressure-like, retrosternal, and radiated to her left arm and shoulder.

She reported the chest pain occurred suddenly while sitting at rest.

She had intermittent chest pain with exertion for the past 2 months.

The chest pain on presentation was similar in nature to the chest pain she had previously.

She sought medical care due to increased severity of pain.

Two months prior to presentation, she was diagnosed with hypothyroidism.

She was given levothyroxine 137 mcg daily.

The dose was reduced after labs indicated supranormal T3 and T4 levels.

She had most recently been on levothyroxine 100 mcg daily.

She did not use oral contraceptive pills.

She had a negative fasting lipid panel ~1 year prior.

She denied any other past medical or surgical history.

On presentation, her vitals were normal.

The physical exam was significant for a woman who appeared in her stated age in mild distress due to chest pain.

The electrocardiogram was consistent with normal sinus rhythm without any abnormalities.

Troponins were elevated and trended upward from 0.080 to 0.120 to 0.222 ng/mL each 8 hours apart.

TSH was nearly undetectable at <0.015 U/mL.

T3 and T4 were not measured on presentation.

Bedside 2D echocardiogram showed a normal left ventricle with EF of >60%.

There were no regional wall motion abnormalities.

Right ventricular systolic pressure was 32 mm Hg.

The patient was given atorvastatin 80 mg.

The patient was given clopidogrel 600 mg.

Sublingual nitroglycerin 0.4 mg was given.

The chest pain improved from 10/10 to 6/10.

Coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva.

A follow-up coronary computed tomography angiogram confirmed the anomalous RCA.

The anomalous RCA took an inter-arterial course.

The anomalous RCA originated from the coronary ostium.

There was at least 50% luminal stenosis.

The patient was referred to a cardiothoracic surgeon for definitive surgical correction.

The patient was discharged home with levothyroxine 50 mcg daily.

The patient was discharged home with metoprolol 25 mg BID.

The patient was advised against aggressive physical activity.

Informed consent was obtained from the patient for publication of this case report and any accompanying images.

The patient has a history of hypothyroidism.

The patient had acute onset chest pain for 1 day.

The patient's electrocardiogram was normal.

The patient was diagnosed with acute coronary syndrome.

The patient had a subnormal thyroid-stimulating hormone level.

The subnormal thyroid-stimulating hormone level suggested hyperthyroidism.

The coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva.

The coronary angiogram showed no evidence of atherosclerosis.

A coronary computed tomography angiogram was done.

The coronary computed tomography angiogram confirmed the anomalous RCA.

The coronary computed tomography angiogram showed a slit-like deformity of the coronary ostium.

The coronary computed tomography angiogram showed at least 50% luminal stenosis.

The patient was referred to a cardiothoracic surgeon.

The patient was referred for potential coronary artery bypass graft.

The patient is a 51-year-old Hispanic female.

She was given levothyroxine 137 mcg daily.

She did not use oral contraceptive pills.

On presentation, her vitals were normal.

TSH was nearly undetectable at <0.015 U/mL.

T3 and T4 were not measured on presentation.

The patient was given atorvastatin 80 mg.

The patient was given clopidogrel 600 mg.

Sublingual nitroglycerin 0.4 mg was given.

The chest pain improved from 10/10 to 6/10.

There was at least 50% luminal stenosis.


The patient is a 60-year-old white female.

She was referred to the nephrology clinic for an unexplained rise in creatinine to 1.4 mg/dL.

She was diagnosed with POEMS syndrome approximately 1 year prior.

Her serum protein electrophoresis around 2 years prior showed an m-spike of 1.0 g/dL.

Immunofixation electrophoresis demonstrated the presence of monoclonal IgG with kappa light chain restriction.

Complementary bone marrow biopsy indicated mildly increased plasma cells (5%-7%) with kappa light chain predominance.

She was diagnosed with hypertension approximately 3 years before her referral.

She was taking prednisone 20 mg daily, prescribed by her hematologist due to suspected vasculitis.

She reported intermittent consumption of nonsteroidal anti-inflammatory drugs (approximately 500 mg weekly) over the past couple of years.

At her first nephrology visit, her creatinine level was 1.4 mg/dL.

She was diagnosed with chronic kidney disease stage 3B at the nephrology visit.

Her estimated glomerular filtration rate was 43 mL/min/1.73 m2.

Her creatinine increased to 1.8 mg/dL 1 week after her first nephrology visit.

Urinalysis results showed nephritic range proteinuria, hematuria, and pyuria with moderate bacteriuria.

Autoimmune and infectious markers were negative.

The kidney biopsy showed diffuse and focal nodular mesangial expansion without hypercellularity.

DNAJB9 immunohistochemical staining and immunofluorescent studies were negative.

Electron microscopy showed mesangial matrix expansion with scattered embedded distinct curved fibrils ranging from 7 to 12 nm in diameter.

The patient was diagnosed with immunotactoid glomerulopathy in the context of hypertension and passive smoking.

Her blood pressure became uncontrolled after the kidney biopsy, reaching a peak of 183/93 mm Hg.

A duplex kidney ultrasound revealed left renal artery stenosis.

She was referred for appropriate management of renal artery stenosis.

Her most recent serum protein electrophoresis showed an M-spike of 0.8 g/dL.

Immunofixation electrophoresis confirmed the presence of monoclonal IgG with kappa light chain restriction.

At her most recent nephrology visit, 12 months later, her blood pressure was 144/78 mm Hg.

She was referred because of an elevated creatinine level.

She reported long-term exposure to cigarette smoke.

Further investigations revealed microscopic hematuria.

Further investigations revealed nephritic range proteinuria.

Kidney biopsy revealed diffuse and focal nodular mesangial expansion without hypercellularity.

Staining for fibrillary glomerulonephritis was negative.

Staining for immunoglobulins was negative.


The patient is a 4 years and 8-month-old Syrian Arabic girl.

She was born to healthy consanguineous parents.

She followed normal psychomotor development.

She had no remarkable illness until the age of 4 years and 2 months.

Her parents noticed rapid weight gain starting at 4 years and 2 months.

She gained about 1 kg every 10 to 15 days.

She required six to seven big meals per day.

She had diarrhea alternated with constipation.

Two months after the onset of obesity, she had urinary incontinence during night sleep.

She had prolonged periods of sleep (12 hours continuously).

She had difficulty staying awake during the day.

She was admitted to Damascus Children Hospital at the age of 4.5 years.

The family history was negative for similar presentations.

An older sister of the patient had died at the age of 12 years with a diagnosis of acute myeloid leukemia.

Her sister’s malignancy was not accompanied by any of the signs or symptoms the patient had.

On physical examination, general obesity was noticed.

Her body mass index (BMI) was equal to 20.1.

Her bone age was slightly advanced and fitted 5 to 5.5 years old.

A homogenous mild enlargement of the pituitary gland was observed.

Her endocrine function tests were normal.

She was discharged with risperidone 1 mg orally per day.

She was recommended to follow up at the out-patient psychiatric clinic after 3 months.

After 3 months, she developed dyspnea that worsened with exertion and during sleep.

She had two episodes of cyanosis and obstructive apnea.

She was intubated 24 hours after admission.

She was attached to a mechanical ventilator.

Her blood gases were pH 7.27, PaCO2 79 mmHg, PaO2 38 mmHg, and oxygen saturation 79%.

A chest CT scan demonstrated a 6 cm round mass filling most of her right lung.

A complete resection was performed of a 10×10 cm solid round mass.

ROHAAD syndrome was considered as a diagnosis.

A brain MRI revealed generalized cortical atrophy.

She died one week after the tracheostomy.

The patient had signs and symptoms of rapid-onset obesity with hypoventilation.

The patient had hypothalamic dysfunction.

The patient had autonomic dysregulation syndrome.

The patient had a mature ganglioneuroma in her chest.

The patient had homogenous mild enlargement of her pituitary gland.

The patient had generalized cortical brain atrophy.

Three months after her first marked symptoms were noted, she had a sudden progression of severe respiratory distress.

The patient's severe respiratory distress ended with her death.

She gained about 1 kg every 10 to 15 days.

Her endocrine function tests were normal.

She was intubated 24 hours after admission.

She died one week after the tracheostomy.


The patient is a 24-year-old right-hand dominant Hispanic female.

She initially presented to an urgent care office in October 2021.

She had a right small finger mass on the ulnar aspect of the proximal interphalangeal joint.

The mass had been present for several months prior to presentation.

She had no pertinent medical or surgical history.

Her family history was positive for renal cell carcinoma and diabetes on her maternal side.

The mass would grow and reduce in size, especially during her pregnancy.

The urgent care provider attempted aspiration of the mass, which was unsuccessful.

The mass was diagnosed as a likely ganglion cyst.

The patient saw another local hand surgeon sometime after her urgent care visit.

Plans to remove the mass were never executed.

In March 2022, she presented with complaints of increasing pain and an open wound with bleeding.

Plain radiographs demonstrated a soft tissue mass on the ulnar aspect of the small finger near the PIP joint.

The patient underwent a surgical excisional biopsy of the mass on 3/15/22.

The surgical pathology was reviewed by two independent pathologists.

The pathology was consistent with low-grade leiomyosarcoma of the finger.

A PET/CT scan in early April 2022 demonstrated a suspicious lymph node in the right axilla.

The treating oncologist thought the lymph node was benign and likely reactive.

The clinical and pathologic assessment was consistent with AJCC stage 1A disease.

The patient was discussed at the tumor board of the treating hospital in early May 2022.

It was agreed that she would likely get the most benefit from a ray amputation.

The patient presented with a new complaint of another mass on the small finger.

The exam and radiographs were consistent with another focus of leiomyosarcoma.

On 6/15/22, the patient underwent successful right-hand minor finger ray amputation.

The small finger ray was amputated to the level of the mid-metacarpal shaft.

The surgical margins assessed by a pathologist were clear for any tumor.

The biopsy results were again consistent with low-grade leiomyosarcoma.

The patient's right hand showed no evidence of recurrence or residual tumor clinically.

An MRI of the right hand obtained on 10/11/22 showed no local or systemic disease recurrence.

The patient continued progressing well postoperatively.

She initiated hand therapy approximately three weeks postoperatively.

Most recent occupational therapy clinic notes indicated full function of the right-hand digits 1–4.

She had comparable grip strength to the contralateral hand.

Postoperatively, she commented on a prominent and ropy scar.

She underwent aggressive therapy and massage.

Continued oncologic surveillance and repeat MRI showed no local or systemic disease recurrence at nine months postoperatively.

The patient was diagnosed with a primary leiomyosarcoma of the small finger.

She underwent extensive oncologic workup.

She underwent successful ray amputation.

She had no pertinent medical or surgical history.

The mass was diagnosed as a likely ganglion cyst.

Plans to remove the mass were never executed.

The patient continued progressing well postoperatively.

She underwent aggressive therapy and massage.


The patient was a 70-year-old Japanese man.

He had smoked 20 cigarettes a day for 47 years until 5 years ago.

He was under treatment and follow-up for essential hypertension, dyslipidemia and chronic kidney disease.

His blood pressure and lipid levels were well controlled with administration of 40 mg of olmesartan medoxomil and 5 mg of atorvastatin calcium hydrate.

He tested positive for SARS-CoV-2 by the polymerase chain reaction (PCR) test three days after coming in extended contact with a colleague who was also diagnosed with SARS-CoV-2.

He was urgently admitted to the hospital the day after symptom onset and confirmation of the diagnosis.

At admission, his body temperature was 36.4 °C.

At admission, his blood pressure was 185/72 mm Hg.

At admission, his peripheral oxygen saturation on pulse oximetry was 97.0%.

Laboratory findings showed lymphocyte depletion.

Laboratory findings showed coagulation abnormalities.

CT showed emphysematous changes in the lung field.

Ground glass opacities with neither a crazy-paving pattern nor consolidation was found below the dorsal pleura of the upper right lobe.

It was considered to be typical findings of early mild COVID-19 pneumonia.

Administration of favipiravir 3600 mg daily was started from the evening of the same day.

1 L/min oxygen administration via a nasal cannula was also started the following day.

Weakness and a decreased level of consciousness appeared from the early morning of Day 2.

Fav was discontinued on the evening of Day 2.

His symptoms improved by the morning of Day 3.

The frequency of administration of acetaminophen 500 mg was increased from 0 to 3 times a day.

His SpO2 decreased, requiring an increase in oxygen flow rate from 1 to 3 L/min by nasal cannula.

CT performed on Day 4 showed slight deterioration in the pneumonia.

The total CT score on Day 4 was 2/25 points.

200 mg of remdesivir was administered on Day 4.

100 mg of remdesivir was administered daily from Day 5 until Day 10.

On Day 7, blood gas data showed that the alveolar-arterial oxygen difference had increased to 122.1 mm Hg.

No pulmonary hypertension was observed on electrocardiogram or echocardiography.

A tendency of increasing D-D levels was also observed.

The combination of nafamostat mesylate 100 mg daily by continuous intravenous infusion and dexamethasone 6 mg daily was administered for four days from Day 7.

The treatment was remarkably effective, resulting in fever reduction.

The treatment resulted in a decrease in CRP and D-D levels.

On Day 10, oxygen administration could be discontinued.

On Day 10, his blood pressure control improved.

By Day 13, the alveolar-arterial oxygen difference had improved to 33.2 mm Hg without supplementary oxygen.

CT on Day 13 showed a tendency for improvement in pneumonia.

The total CT score on Day 13 was still 2/25 points.

For blood pressure control during the course of his hospitalization, continuous intravenous infusion of pernidipine was performed for two days when oral intake was difficult due to the decreased consciousness level.

From Day 4, olmesartan medoxomil 40 mg and nifedipine 20 mg were administered in combination.

With the treatment of COVID-19, his blood pressure gradually stabilized.

The dose of nifedipine was reduced from Day 14 to 10 mg.

Nifedipine was discontinued from Day 19.

The patient was a 70-year-old Japanese man.

The patient was hospitalized with the novel coronavirus disease.

The patient had hypoxemia that was disproportionate to the severity of pneumonia indicated by CT.

The patient had coagulation abnormalities.

We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy or hypoxic pulmonary vasoconstriction.

Early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone was successful.

The patient was a 70-year-old Japanese man.

At admission, his body temperature was 36.4 °C.

At admission, his blood pressure was 185/72 mm Hg.

Laboratory findings showed lymphocyte depletion.

CT showed emphysematous changes in the lung field.

Fav was discontinued on the evening of Day 2.

His symptoms improved by the morning of Day 3.

The total CT score on Day 4 was 2/25 points.

200 mg of remdesivir was administered on Day 4.

On Day 10, his blood pressure control improved.

Nifedipine was discontinued from Day 19.


A 21-year-old female patient with abdominal pain, irregular menstrual cycles, hyperestrogenemia, and recurrence of an ovarian mass was transferred to our hospital in July 2020.

Four months prior, the patient was referred to another hospital because of abdominal pain and irregular menstrual cycles.

Ultrasonography revealed a large multilocular cystic mass in the abdominal cavity.

The patient underwent single-port laparoscopic removal of the bilateral ovarian cysts.

During surgery, the bilateral ovaries were enlarged in a multilocular mass with yellow fluid inside.

Histopathology revealed multiple luteinized follicular cysts of the ovary.

After one month of clinical treatment, the patient experienced abdominal pain again.

Pelvic ultrasound indicated recurrence of enlarged ovaries with multiple large cysts.

The upper edge of the ovarian mass reached 20 mm above the umbilicus.

The thickness of the endometrium was 17.4 mm.

Biochemical evaluation demonstrated normal serum levels of LH, FSH, progesterone, cortisol, Free T4, thyroid-stimulating hormone, parathyroid hormone, calcium, phosphate, and growth hormone.

Biochemical evaluation demonstrated elevated levels of plasma CA125, estradiol, and prolactin.

Brain magnetic resonance imaging revealed the presence of a pituitary macroadenoma (17 mm × 27 mm × 19 mm).

Visual field examination after brain MRI revealed bitemporal hemianopsia.

Ultrasound showed a 48 mm × 30 mm × 23 mm mass in the right breast.

Histopathology revealed breast fibroadenoma.

Ultrasound imaging revealed no abnormalities in the thyroid, adrenal, or parathyroid glands.

The patient was treated with oral bromocriptine (2.5 mg) three times a day.

The patient had no significant history of illness, medical history, drug allergy, transfusion, injury, pregnancy, or other complications.

The patient had a smoking history for over four years.

The patient had menarche at age 12 years.

In the past year, the menstrual cycle of the patient had extended to 2–3 months.

The patient was 167 cm tall, weighed 68 kg, and had a body mass index of 24.38 kg/m2.

An ultrasonographic study of the pelvis revealed multicystic ovaries, similar to the typical signs of spontaneous ovarian hyperstimulation syndrome.

Computed tomography confirmed a large cystic mass in the abdominopelvic cavity, with a range of 19.4 cm × 7.9 cm × 15.9 cm.

A homogeneously enhancing 21 mm × 16 mm × 28 mm sellar mass was imaged by brain MRI.

Brain MRI revealed a pituitary macroadenoma.

Transsphenoidal surgery relieved her clinical symptoms.

Before transsphenoidal surgery, plasma CA125 levels were elevated.

Before transsphenoidal surgery, estradiol levels were elevated.

Before transsphenoidal surgery, prolactin levels were maintained at normal levels.

Before transsphenoidal surgery, luteinizing hormone levels were maintained at normal levels.

Before transsphenoidal surgery, follicle-stimulating hormone levels were maintained at normal levels.

Before transsphenoidal surgery, PROG levels were maintained at normal levels.

Before transsphenoidal surgery, cortisol levels were maintained at normal levels.

Before transsphenoidal surgery, FT4 levels were maintained at normal levels.

Before transsphenoidal surgery, thyroid-stimulating hormone levels were maintained at normal levels.

Before transsphenoidal surgery, parathyroid hormone levels were maintained at normal levels.

Before transsphenoidal surgery, GH levels were maintained at normal levels.

After transsphenoidal surgery, the patient was diagnosed with a functioning gonadotroph adenoma.

Pelvic ultrasound confirmed normal-sized ovaries.

The menstrual cycle returned to regular.

Hormones were maintained within a normal range.

There was no evidence of tumor recurrence after two years of follow-up.

The thickness of the endometrium was 17.4 mm.

Ultrasound showed a 48 mm × 30 mm × 23 mm mass in the right breast.

Histopathology revealed breast fibroadenoma.

The patient had a smoking history for over four years.

The patient had menarche at age 12 years.

Brain MRI revealed a pituitary macroadenoma.

Transsphenoidal surgery relieved her clinical symptoms.

Before transsphenoidal surgery, plasma CA125 levels were elevated.

Before transsphenoidal surgery, estradiol levels were elevated.

Pelvic ultrasound confirmed normal-sized ovaries.

The menstrual cycle returned to regular.

Hormones were maintained within a normal range.


She presented with palpitations and diarrhea that had started 1 day before admission.

She reported 5 episodes of watery stools.

The palpitations were of sudden onset and irregular.

Her initial heart rate was 150 beats/min with an irregular rhythm.

Subsequent examination showed her heart rate stabilized at 80 beats/min.

The initial electrocardiogram revealed atrial fibrillation with a heart rate of 150 beats/min and a right bundle branch block.

Spontaneous conversion to sinus rhythm was observed shortly after the initial electrocardiogram.

Pathological Q waves were noted in leads V1 and V2.

A bedside point-of-care ultrasound revealed a large, irregular, hyperechoic, spiculated mass within the left ventricle.

The chest radiograph revealed calcification within the cardiac silhouette.

Her medical history was significant for type 2 diabetes mellitus and hypertension.

She admitted to irregular adherence to her prescribed treatments.

She had 2 episodes of non–ST-segment elevation myocardial infarction in 2019 and 2022.

There was no evidence of infections, parasitic diseases, or sepsis in her medical history.

The differential diagnoses for a left ventricular intraventricular mass include thrombus, primary or metastatic tumors, vegetations, intracardiac calcifications, and parasitic infections.

A transthoracic echocardiogram demonstrated a preserved ejection fraction of 56%.

Regional wall motion abnormalities were present, including akinesia in the anterior, lateral, and inferior walls.

A hyperechoic, irregular mass measuring 3 × 5 cm was located in the apex and lateral wall of the left ventricle.

Laboratory evaluations revealed normal renal function, electrolytes, and calcium-phosphorus metabolism.

Coronary CT angiography showed a coronary calcium score of 0 Agatston units.

Extensive, thick, and irregular subendocardial calcifications measuring 66 mm in length were identified in the inferior, lateral, and apical walls of the left ventricle.

The characteristics of the mass were consistent with dystrophic myocardial calcification.

Antiarrhythmic therapy and anticoagulation were started.

The calcification was considered an incidental finding.

A plan for continued medical surveillance was established.

Spontaneous conversion to sinus rhythm occurred.

A left ventricular mass was identified on echocardiogram.

Computed tomography confirmed the mass as dystrophic calcification.

The calcification was linked to previous myocardial infarctions.

There was no significant systolic dysfunction.


The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.

The patient was a 53-year-old homeless man.

He was admitted to the hospital due to a right femoral neck fracture.

His medical history included noninsulin-dependent diabetes mellitus.

A physical examination performed at admission was unremarkable.

There were no other neurological defects.

Laboratory tests revealed white blood cells of 4330 cells/mL.

Laboratory tests revealed hemoglobin of 9.2 g/dL.

Laboratory tests revealed platelet count of 29,900 platelets/mL.

Only normochromic-normocytic anemia was present.

He successfully underwent surgery for the femoral neck fracture.

The surgery was performed by an orthopedic surgeon.

He had an episode of generalized seizures during the postoperative course.

After this episode of generalized seizures, he was referred to our department.

A computed tomography (CT) examination of the head without contrast showed a high-density and extraaxial mass in the right parietal convexity.

Peritumoral brain edema was clearly observed.

Enhanced magnetic resonance imaging (MRI) revealed an extraaxial, dural-based, and homogeneously enhanced mass with clear borders.

The mass was compatible with a meningioma en plaque.

The mass was iso- to hypointense on fluid-attenuated inversion recovery and T2 imaging sequences.

The mass was iso- to hyperintense on T1 imaging.

It was strongly suspected that the patient had a meningioma en plaque.

The mass was exposed with a right frontotemporal craniotomy.

The tumor appeared to be a meningioma en plaque.

The tumor was extraaxial, xanthochromic, firm, nonaspiratable, and had high vascularity.

The tumor was tightly adhered to the adjacent cerebral cortex.

The tumor was permeated by many pial arteries and veins of the brain surface.

It is very difficult to preserve these pial vessels during the total removal of a tumor.

A frozen section of the lesion showed inflammatory cell infiltration.

The inflammatory cell infiltration mainly consisted of lymphocytes and plasma cells.

The presence of these cells was initially interpreted as some kind of hematologic disorder or inflammatory pseudotumor.

Paraffin-embedded sections showed a hypercellular pattern with features of polymorphous and mixed inflammatory infiltrates.

The infiltrates were composed mainly of histiocytes in a background of collagen fibers.

Some histiocytes had foamy and eosinophilic cytoplasm.

Some histiocytes were seen to engulf viable lymphocytes.

This was thought to reflect emperipolesis (lymphophagocytosis).

The histiocytes were immunopositive for S-100 protein and CD68.

All of these findings were consistent with extranodal RDD.

The patient had incomplete left hemiparesis after surgery.

A brain CT examination conducted without contrast revealed postoperative hemorrhage.

A low-density lesion in the right frontal lobe was observed.

The low-density lesion seemed to be due to the sacrificed pial arteries from the brain-tumor interface.

A whole-body CT examination postoperatively was performed.

Findings of lymphadenopathy or other extranodal involvements were not found.

The patient has been free of seizures since the surgery.

He recovered from his hemiparesis 6 months after the surgery.

The patient had an episode of generalized seizures.

Imaging studies of the brain were compatible with a meningioma en plaque.

The mass was exposed by a right frontotemporal craniotomy.

The tumor was adhered tightly to the adjacent cerebral cortex.

The tumor was permeated by pial arteries of the brain surface.

The sacrificing of these arteries was inevitable in order to achieve the total removal of the tumor.

The patient had incomplete left hemiparesis after the surgery.

Brain computed tomography (CT) imaging revealed a postoperative hemorrhage.

Brain computed tomography (CT) imaging revealed a low-density lesion in the right frontal lobe.

The patient was postoperatively diagnosed with isolated central nervous system RDD.

The patient was a 53-year-old homeless man.

There were no other neurological defects.

Laboratory tests revealed hemoglobin of 9.2 g/dL.

Only normochromic-normocytic anemia was present.

The surgery was performed by an orthopedic surgeon.

Peritumoral brain edema was clearly observed.

The mass was compatible with a meningioma en plaque.

The mass was iso- to hyperintense on T1 imaging.

The mass was exposed with a right frontotemporal craniotomy.

The tumor appeared to be a meningioma en plaque.

Some histiocytes had foamy and eosinophilic cytoplasm.

Some histiocytes were seen to engulf viable lymphocytes.

All of these findings were consistent with extranodal RDD.

The patient had incomplete left hemiparesis after surgery.

A low-density lesion in the right frontal lobe was observed.

A whole-body CT examination postoperatively was performed.

The patient has been free of seizures since the surgery.


The patient is a 93-year-old Middle Eastern male.

The patient has no known food or drug allergies.

The patient was admitted to the hospital owing to fatigue and refractory hiccups lasting for 2 weeks.

The patient had had hiccups intermittently for more than 2 years.

The patient had tried several medications, including proton-pump inhibitors, chlorpromazine, and baclofen, with minimal relief of his symptoms.

The patient's home medications include levothyroxine, amlodipine, and rosuvastatin.

The patient denies dysphagia, odynophagia, food impaction, heartburn, vomiting, or weight loss.

Laboratory studies were only pertinent for an elevated eosinophil count of 18%.

Stool studies were negative for parasitic infection.

Imaging with computed tomography of the chest and abdomen was unremarkable.

An upper endoscopy was performed and was normal, without any endoscopic finding to suggest EoE.

Biopsies from the mid- and distal esophagus revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field.

The patient was prescribed a proton-pump inhibitor twice daily in combination with baclofen.

The symptoms of intractable hiccups recurred despite partial initial improvement.

The decision was made to switch therapy to topical budesonide 2 mg twice daily 30 minutes before meals.

The frequency of the hiccup episodes gradually decreased and resolved completely within a week.

Repeat blood test showed a decrease in eosinophilic count to 10%.

A repeat endoscopy was offered but declined by the patient.

The patient had longstanding treatment-refractory hiccups.

Computed tomography of the chest and abdomen was unremarkable.

There were no endoscopic findings to suggest eosinophilic esophagitis.

The patient had an elevated peripheral eosinophil count.

Biopsies were taken from the mid- and distal esophagus.

The biopsies revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field.

The diagnosis favored eosinophilic esophagitis.

The hiccups resolved following the initiation of eosinophilic esophagitis treatment.


He had leg tremor in standing position for the previous 8 months.

Seven months after development, the tremor subsided in the left leg.

The tremor persisted only in the right leg.

No tremor was evident when the patient was walking, reclining, or in a non-weight-bearing position.

The patient had no significant medical history.

The patient had no family history of tremor.

On examination, he showed incessant quivering in his right leg while standing.

The tremor disappeared when he was asked to walk, sit, lie down, or lean against the wall for support.

There was no resting or postural tremor of upper limbs.

Bilateral tendon reflexes were diminished.

Auscultation over the right popliteal fossa while the patient was standing revealed the 'helicopter sign'.

The 'helicopter sign' indicated orthostatic tremor.

All other components of neurological examination were normal.

Laboratory tests, including routine blood tests, blood biochemistry, vitamin B12, thyroid hormone, rheumatoid factor, antinuclear autoantibody, anti-cardiolipin antibody, and anti-neutrophil cytoplasmic antibody tests, were normal.

Tests of the blood and cerebrospinal fluid samples for anti-paraneoplastic antibodies, autoimmune antibodies, and anti-ganglioside antibodies were all normal.

Brain MRI revealed mild, asymmetrical, non-enhancing white matter lesions, mainly in the right frontal and posterior periventricular regions, on T2-weighted imaging.

No abnormal signal was found in the spinal cord on MRI.

Chest CT was normal except for a residual thymus gland.

FDG-PET was performed, and no abnormal metabolism was identified.

EMG recorded from the right gastrocnemius revealed a 6–8 Hz tremor.

The tremor was present when the patient was standing and disappeared when he was resting or walking.

No abnormalities were found in the left leg.

These features were consistent with slow orthostatic tremor.

Blood tests showed a phenylalanine/tyrosine ratio of 2.06.

Blood phenylalanine level was 140 μmol/L.

There was no phenylalanine in the urine.

Whole-exome sequencing with NGS technology confirmed the presence of a compound heterozygous mutation in c.158G > A and c.728G > A of the PAH gene.

Pedigree verification showed that the compound heterozygous variants were inherited from the parents.

The patient’s final diagnosis was orthostatic tremor secondary to mild hyperphenylalaninemia.

The patient had not received any relevant interventions prior to admission.

There was no clinical response to these treatments.

After discharge, the patient was treated with levodopa/benserazide tablets (250 mg, tid) and a low-phenylalanine diet.

One month later, the tremor was markedly alleviated.

Three months later, the tremor disappeared.

The patient was admitted for bilateral leg tremor while standing.

Symptom onset was eight months prior to admission.

One month before admission, the tremor disappeared in the left leg.

Electromyography recorded from the right gastrocnemius revealed a 6-8 Hz tremor.

The tremor appeared when the patient was standing.

The tremor disappeared when the patient was resting or walking.

Blood screening showed a phenylalanine/tyrosine ratio of 2.06.

Blood screening showed a phenylalanine level of 140 μmol/L.

Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G > A and c.728G > A, in the phenylalanine hydroxylase (PAH) gene.

After three months of levodopa/benserazide tablets (250 mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared.

The tremor persisted only in the right leg.

The patient had no family history of tremor.

Bilateral tendon reflexes were diminished.

No abnormalities were found in the left leg.

Blood phenylalanine level was 140 μmol/L.

There was no phenylalanine in the urine.

Three months later, the tremor disappeared.


She presented with complaints of COVID-19.

She developed symptoms after her husband returned from international travel.

She initially had symptoms of an upper respiratory tract infection.

She had shortness of breath on ambulation.

Ten days after her initial symptoms, she developed an urticarial rash on her abdomen, legs, and hands.

The rash reappeared twice before disappearing.

The rash only lasted hours on each occasion.

The patient has no past medical history.

She complained of tongue swelling on the tenth day after developing COVID-19.

The swelling went away after 1 hour on its own.

Her tongue had the appearance of tongue papillae that were inflamed.

Her tongue had a sensation of sensitivity in the areas interspersed between areas of regular mucosa.

She had some mild loss of sense of taste.

In the office, her blood pressure was 117/71 mmHg.

Her pulse oximetry was 100% on room air.

On further examination, she had a geographic appearance to the tongue.

Her abdomen and extremities showed no signs of rash at the time of the clinical examination.

Her neurological examination showed intact motor and sensory strength.

Her aspartate transaminase level was 18 U/L.

Her alanine transaminase level was 17 U/L.

She was diagnosed as having COVID tongue.

She was started on a mouthwash containing diphenhydramine-lidocaine-aluminum-magnesium-simethicone-nystatin.

She was to swish and swallow 5 mL every 6 hours.

She subsequently completed 30 days of the mouthwash.

She achieved 90% improvement in the appearance of the geographic tongue.

Over the next 6 months, she had multiple flares of tongue sensitivity.

She had visually active tongue lesions about every 3 weeks.

She was prescribed dexamethasone 0.5mg/5mL to be swished and spit four times daily for 10 days.

She did not achieve complete resolution of her tongue lesions.

Six months after developing COVID tongue, she underwent three treatments of photobiomodulation therapy (PBMT) to her tongue.

There was an interval of 24 hours between each session.

At a follow-up 2 months after the PBMT, she had no further flares.

The patient is a 30-year-old Caucasian woman.

She tested positive for COVID-19 after developing nasal congestion and cough.

Ten days after testing positive, she developed a systemic rash on her extremities and torso.

She developed swelling of the tongue lasting 1 hour.

She had oral lesions that resembled geographic tongue.

She had an irritable sensation on her tongue.

She had some mild loss of sense of taste.

We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours.

The patient used the mouth rinse therapy for 1 month.

She experienced a 90% improvement in her oral lesions and tongue sensitivity.

She had repeated flares every 3 weeks over a 6-month period.

The steroid mouthwash achieved incomplete resolution.

After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity.

After three sessions of photobiomodulation therapy, the lesions healed.

She presented with complaints of COVID-19.

She had shortness of breath on ambulation.

The patient has no past medical history.

She had some mild loss of sense of taste.

Her pulse oximetry was 100% on room air.

Her alanine transaminase level was 17 U/L.

She was diagnosed as having COVID tongue.


She was admitted due to repeated hematochezia for more than 3 months.

She experienced hematochezia at the age of 25 months.

The hematochezia was with small to moderate amounts of dark red or bright red paste-like stool.

She had abdominal pain mainly around the umbilical area.

The abdominal pain had no obvious relationship with eating.

The abdominal pain was not accompanied by vomiting.

The abdominal pain was not accompanied by diarrhea.

The abdominal pain was not accompanied by fever.

The abdominal pain was not accompanied by cough.

Routine stool analysis showed red and white blood cells.

The white blood cell count was 16.3 × 109/L.

The hemoglobin concentration was 123 g/L.

Abdominal ultrasound showed active intestinal peristalsis.

Abdominal ultrasound showed multiple hypoechoic nodules around the umbilical area.

Abdominal ultrasound showed enlarged mesenteric lymph nodes.

The patient was treated with anti-infection and hemostatic drugs.

The patient was fed with deeply hydrolyzed formula.

The deeply hydrolyzed formula yielded poor therapeutic effects.

The patient was transferred to our hospital.

The patient was born to a healthy and non-consanguineous Chinese couple.

The patient was generally in good condition after delivery.

The patient previously underwent a cervical lymph node abscess biopsy.

No abnormalities in growth and development were observed.

The white blood cell count was 11.70 × 109/L.

The immunoglobulin G (IgG) was 16.7 g/L.

The immunoglobulin M (IgM) was 1.66 g/L.

The immunoglobulin E (IgE) was 74 IU/ML.

The absolute count of B cells was 1688.52 cells/ul.

The absolute count of T cells was 4833.95 cells/ul.

The absolute count of NK cells was 877.12 cells/ul.

The antiprotease 3 antibody (ELISA) was 64.5.

The food allergen IgE for milk was 1.59 IU/ml.

C-reactive protein, procalcitonin, blood gas analysis, biochemical indexes, coagulation index, autoimmune antibody, rheumatoid factor, and T-SPOT.TB test yielded no abnormal findings.

No abnormality was found on chest and abdominal radiographs.

An initial diagnosis of cow milk protein allergy and congenital immunodeficiency disease was established.

A gastroscopy indicated erosive gastritis and erosive bulbar duodenitis.

The histopathological results showed mild chronic inflammation.

A colonoscopy indicated erosive colitis.

The mucosa presented mild chronic inflammation.

A large number of lymphocytes and eosinophils infiltrated in lamina propria.

The maximum number of lymphocytes and eosinophils per high power field was 85.

Crypt abscesses were found in the ascending and transverse colon.

The DHR assay of the patient’s granulocytes revealed almost absence of fluorescence upon granulocyte stimulation.

The DHR assay of granulocytes from the patient’s mother showed a SI of 277.05.

The DHR assay of granulocytes from the patient’s father showed a SI of 364.03.

A heterozygous de novo mutation c.388 C > T (p.R130X) in CYBB gene was identified.

The mutation was validated by Sanger sequencing.

A diagnosis of very early onset inflammatory bowel disease (VEO-IBD) with neutrophil dysfunction caused by CYBB gene mutation was established.

Hematopoietic stem cell transplantation (HSCT) was conducted using peripheral blood stem cells from the father.

Mycophenolate Mofetil combined with Tacrolimus Capsules were used to prevent graft-versus-host disease (GVHD).

Voriconazole was used against fungal infections.

Two months after HSCT, bone marrow and peripheral blood chimerism rates were 100% complete donor type.

The DHR assay of granulocytes from the patient at 8 weeks after HSCT showed abnormal histogram with the SI of 28.85.

The DHR assay of granulocytes from the patient at 16 weeks after HSCT showed normal histogram with the SI of 408.90.

Normal neutrophil function was restored.

A repeat colonoscopy six months after HSCT showed complete intestinal mucosal healing.

After 18 months of follow-up, there was no severe infection.

After 18 months of follow-up, there was no acute or chronic GVHD-related manifestations.

The patient had VEO-IBD associated with a monogenic mutation.

The patient presented with gastrointestinal symptoms.

The gastrointestinal symptoms included recurrent hematochezia.

The gastrointestinal symptoms included abdominal pain.

The symptoms had been present for more than 3 months.

A gastroscopy revealed erosive gastritis.

A gastroscopy revealed bulbar duodenitis.

A colonoscopy indicated erosive colitis.

Abnormal results were obtained from the dihydrohodamine (DHR) assay.

Abnormal results were obtained from immunoglobulin testing.

Whole-exome sequencing identified a heterozygous and de novo nonsense mutation (c.388 C > T; p.R130X) in the CYBB gene.

The mutation led to deficiency of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2).

NOX2 is a critical component of phagocytes.

The DHR assay showed that normal neutrophil function was restored.

Six months after HSCT, clinical remission was observed.

A repeat colonoscopy revealed intestinal mucosal healing was attained.

She experienced hematochezia at the age of 25 months.

She had abdominal pain mainly around the umbilical area.

The abdominal pain had no obvious relationship with eating.

The abdominal pain was not accompanied by vomiting.

The abdominal pain was not accompanied by diarrhea.

The abdominal pain was not accompanied by fever.

The abdominal pain was not accompanied by cough.

Routine stool analysis showed red and white blood cells.

The white blood cell count was 16.3 × 109/L.

The hemoglobin concentration was 123 g/L.

Abdominal ultrasound showed active intestinal peristalsis.

The patient was fed with deeply hydrolyzed formula.

The patient was transferred to our hospital.

The patient was generally in good condition after delivery.

No abnormalities in growth and development were observed.

The white blood cell count was 11.70 × 109/L.

The immunoglobulin G (IgG) was 16.7 g/L.

The immunoglobulin M (IgM) was 1.66 g/L.

The immunoglobulin E (IgE) was 74 IU/ML.

The absolute count of B cells was 1688.52 cells/ul.

The absolute count of T cells was 4833.95 cells/ul.

The absolute count of NK cells was 877.12 cells/ul.

The antiprotease 3 antibody (ELISA) was 64.5.

The food allergen IgE for milk was 1.59 IU/ml.

A colonoscopy indicated erosive colitis.

The mucosa presented mild chronic inflammation.

The mutation was validated by Sanger sequencing.

Voriconazole was used against fungal infections.

Normal neutrophil function was restored.

After 18 months of follow-up, there was no severe infection.


The patient has non-diabetic chronic kidney disease.

The patient was on regular hemodialysis for 3 years.

The patient's hemodialysis access was a right forearm arteriovenous fistula.

The patient was admitted due to involuntary movement for 5 days.

The patient had a resting tremor in the shoulder and neck 5 days prior to admission.

The patient did not have blurred vision.

The patient did not have mental disorder.

Myodynamic examination in both legs was normal.

Deep tendon reflexes in both legs were normal.

The Babinski reflexes were suspiciously positive.

The patient had significant fluctuation of blood creatinine levels.

The patient had altered hyperthyroidism.

The patient's intact parathyroid hormone (iPTH) levels were almost 3200 pg/mL.

The patient did not have a history of hypertension.

The patient did not have diabetes mellitus.

The patient did not have a respiratory tract infection.

The patient did not have toxic fume exposure.

Brain MRI showed symmetrical T2-weighted imaging hyperintense non-hemorrhagic lesions in bilateral basal ganglia.

Brain MRI showed T2/fluid-attenuated inversion recovery hyperintense lesions in bilateral basal ganglia.

Brain MRI showed corona radiata lesions with mild diffusion restriction.

Blood analysis showed urea nitrogen 25.80 mmol/L.

Blood analysis showed serum creatinine 1206 μmol/L.

Blood analysis showed uric acid 548 μmol/L.

Blood analysis showed phosphorus 1.88 mmol/L.

Blood analysis showed calcium 2.33 mmol/L.

Blood analysis showed anion gap 23.9 mmol/L.

The patient was diagnosed with UE as a symptom of bilateral basal ganglia lesions.

The patient did not suffer from diabetes mellitus.

The patient did not suffer from cerebrovascular events.

The patient did not suffer from intoxication.

The patient did not suffer from hyperlactacidemia.

UE was possibly due to a combined effect of uremic toxins and hyperthyroidism.

The patient was treated with high frequency and high flux dialysis.

The patient received 4 h hemodiafiltration with APS 15 uc dialyzer.

The patient received hemodiafiltration 4 times per week.

The patient received hyperbaric oxygen therapy.

The patient received 1 μg of calcitriol injection every 2 days.

The patient received 2 mg of haloperidol orally twice per day.

The patient received 2 mg of clonazepam orally twice per day.

The patient received 2 mg of benzhexol orally twice per day.

The amplitude of involuntary movement decreased.

Fourteen days after admission, brain MRI showed high signal in the bilateral basal ganglia on T2WI.

Fourteen days after admission, brain MRI showed high signal in the bilateral basal ganglia on T2FLAIR.

The signal in the bilateral basal ganglia on T2WI was significantly weaker compared to the initial MRI signal.

The signal in the bilateral basal ganglia on T2FLAIR was significantly weaker compared to the initial MRI signal.

About 1 month after admission, the patient achieved complete remission.

About 1 month after admission, the patient had restoration of normal body movement.

Upon discharge, blood test results showed urea nitrogen 10.48 mmol/L.

Upon discharge, blood test results showed serum creatinine 641.5 μmol/L.

Upon discharge, blood test results showed uric acid 435 μmol/L.

Upon discharge, blood test results showed phosphorus 1.43 mmol/L.

Upon discharge, blood test results showed calcium 2.30 mmol/L.

Upon discharge, blood test results showed anion gap 15.9 mmol/L.

Upon discharge, blood test results showed iPTH 1609 pg/mL.

Upon follow-up, brain MRI showed an almost complete resolution of the lesions.

Upon follow-up, brain MRI showed slightly hyperintense signal in the bilateral basal ganglia.

She has a history of non-diabetic hemodialysis for 3 years.

She suffered from severe involuntary movement.

Brain magnetic resonance imaging showed symmetrical T2-weighted imaging (T2WI) and T2/fluid-attenuated inversion recovery (T2FLAIR) hyperintense nonhemorrhagic lesions in the bilateral basal ganglia.

She was diagnosed with UE as syndrome of bilateral basal ganglia lesions.

The diagnosis was due to a combined effect of uremic toxins and hyperthyroidism.

She received treatment with high frequency and high flux dialysis.

The patient achieved complete remission with normal body movement.

The patient has non-diabetic chronic kidney disease.

The patient was on regular hemodialysis for 3 years.

The patient did not have blurred vision.

The patient did not have mental disorder.

Myodynamic examination in both legs was normal.

Deep tendon reflexes in both legs were normal.

The Babinski reflexes were suspiciously positive.

The patient had altered hyperthyroidism.

The patient did not have a history of hypertension.

The patient did not have diabetes mellitus.

The patient did not have a respiratory tract infection.

The patient did not have toxic fume exposure.

Blood analysis showed urea nitrogen 25.80 mmol/L.

Blood analysis showed serum creatinine 1206 μmol/L.

Blood analysis showed uric acid 548 μmol/L.

Blood analysis showed phosphorus 1.88 mmol/L.

Blood analysis showed calcium 2.33 mmol/L.

Blood analysis showed anion gap 23.9 mmol/L.

The patient did not suffer from diabetes mellitus.

The patient did not suffer from cerebrovascular events.

The patient did not suffer from intoxication.

The patient did not suffer from hyperlactacidemia.

The patient received hemodiafiltration 4 times per week.

The patient received hyperbaric oxygen therapy.

The patient received 2 mg of benzhexol orally twice per day.

The amplitude of involuntary movement decreased.

Upon discharge, blood test results showed iPTH 1609 pg/mL.


The patient was admitted to our hospital four days ago.

The patient had been diagnosed with xerostomia and xerophthalmia over 20 years.

Emission Computed Tomography (ECT) examination revealed decreased functions of bilateral parotid and submandibular glands.

A chest CT three years ago showed scattered, various-sized and roundish radiolucencies, striped or hazy opacities in both lungs and multiple small nodules in the right lung.

Another chest CT one year later revealed new patchy opacities in the right lung and lingual lobe.

The patient was admitted to our hospital one year and 4 months later due to recurrent cough, expectoration and low fever.

The chest CT revealed multiple cysts with multiple patchy and nodular opacities in both lungs.

Results of antinuclear antibody profiles and vasculitis series were: SSA (RO-52) positive (+), SSA antibody positive (+), ESR 87 mm/hr.

Immunoglobulins were: IgA 4.29 g/L, IgG 20.3 g/L and IgM 0.68 g/L.

Blood gas analysis: pH 7.39, pCO2 39.5 mmHg, pO2 68.4 mmHg and SaO2 93.1%.

Pathological report on (right lung biopsy): Chronic inflammation of lung tissue with diffuse distribution of lymphocytes in focal areas.

Diagnosis: lymphoma could not be excluded.

Preliminary clinical diagnosis: (1) Sjogren's syndrome, lymphocytic interstitial pneumonia first consideration; (2) malignant lymphoma to be excluded; (3) pulmonary infection.

The patient received anti-inflammatory treatment and was discharged after symptoms were improved.

After discharge, the patient continued to experience constant cough, expectoration and fever even after repeated anti-inflammatory treatments.

A left lung biopsy was performed 4 months later during her inpatient treatment in another hospital.

The pathological report indicated chronic suppurative inflammation with massive necrosis and cellulitis.

The patient’s chest enhancement CT after this admission displayed obviously more patchy and nodular foci in both lungs compared to previous CT images.

Some of the lesions were surrounded with ground glass shadows.

The diagnosis was: malignant tumor to be excluded.

Auxiliary routine blood examinations showed white blood cell count 21.8 × 109/L and absolute neutrophil count 21.14 × 109/L.

Pathological results from our hospital (right lung biopsy) and another hospital showed small areas of proliferating inflammatory fibrous tissue and small numbers of heterotypic cells within the necrotic tissue.

Immunohistochemistry showed: CD20 (+), Ki-67 (high-value-added activity), BCL-6 (+), CD21 (+).

Based on history and pathological results, the final diagnosis was Sjogren's syndrome, malignant transformation of LIP into diffuse large B-cell lymphoma.

Subsequently, chemotherapy with a reduced-dose regimen of rituximab and Chop (R-miniCHOP) was administered eight times.

Following treatment, PET/CT showed complete remission of lymphoma.

The patient was at high risk of recurrence and is under active follow-up.

Clinical and pathological data were obtained.

Literature related to the transformation was reviewed.

There were no specific clinical manifestations of LIP and its transformation into malignant lymphoma in the patient.

The chest CT mainly displayed multiple cystic foci.

The chest CT showed multiple nodules in both lungs.

The chest CT showed ground-glass shadows in both lungs.


He visited a clinic with a chief complaint of right inguinal pain.

Abdominal ultrasonography revealed a huge intra-abdominal mass.

He was referred to the hospital for further examination.

He had a history of autism spectrum disorder.

The abdomen was mildly distended and soft.

Laboratory examinations showed no abnormalities in blood count.

Laboratory examinations showed no elevation of tumor markers.

Abdominopelvic CT showed a huge mass with a maximum diameter of 34 cm.

MRI revealed an intra-abdominal tumor 34 × 15 × 8 cm.

The tumor appeared to be in contact with the gastric body.

A contrast-enhanced examination could not be performed due to the history of bronchial asthma.

Endoscopic ultrasonography showed a heterogeneous hypoechoic internal cavity.

EUS-FNA was not performed, given the risk of seeding.

No definitive diagnosis or organ of origin was confirmed preoperatively.

Surgery was performed under suspicion of gastrointestinal stromal tumor.

Surgery was performed under suspicion of desmoid tumor.

Surgery was performed under suspicion of mesenteric tumor.

Laparotomy was performed through upper and lower median incisions.

Intraoperative findings showed a giant tumor covered with a capsule.

The tumor extended from the pelvis to the diaphragm.

The tumor showed firm adhesions to the stomach.

The tumor showed firm adhesions to the transverse colon.

The tumor showed firm adhesions to the diaphragm.

The tumor was partially resected en bloc with portions of the stomach.

The tumor was partially resected en bloc with portions of the transverse colon.

The tumor was partially resected en bloc with portions of the diaphragm.

Primary anastomosis of the colon was performed.

The diaphragm was closed after tumor resection.

The tumor appeared to have been completely excised without rupture of the capsule.

The excised specimen measured 38 × 21 × 8 cm.

Pathological examination revealed atypical cells with spindle-shaped nuclei.

Immunostaining showed negative results for c-kit.

Immunostaining showed negative results for CD34.

Immunostaining showed negative results for desmin.

Immunostaining showed negative results for S-100.

Immunostaining showed positive results for β-catenin.

The diagnosis was confirmed as a desmoid tumor.

Pathological results for the surgical margins were negative.

Determining the primary site of tumor origin was difficult.

The patient was discharged 17 days after surgery.

A CT scan conducted 12 months after surgery showed a nodule 3.0 cm in diameter near the suture line of the gastric body.

The nodule's size remained unchanged on a subsequent CT scan taken 9 months later.

He was referred to the hospital for treatment.

Abdominal magnetic resonance imaging showed an intra-abdominal mass.

The mass showed partial signal hyperintensity on T2-weighted imaging.

The mass showed hypointensity on T1-weighted imaging.

The mass extended from the left abdominal cavity to the pelvic region.

No definitive diagnosis was obtained preoperatively.

Surgery was performed under suspicion of gastrointestinal stromal tumor or other significant disease.

A mass was identified firmly adherent to the transverse colon.

The mass was identified firmly adherent to the gastric wall.

The mass was identified firmly adherent to the diaphragm.

The transverse colon, gastric wall, and diaphragm were partially resected.

The excised specimen measured 38 × 21 × 8 cm.

Macroscopically, the tumor showed a smooth surface.

Macroscopically, the tumor showed a homogeneous interior.

Pathological examination revealed collagen fiber hyperplasia in the stroma.

Immunostaining was positive for β-catenin.

The diagnosis was confirmed as desmoid tumor.

Fifteen months after surgery, a local recurrence with a diameter of 3.0 cm was identified.

The patient remains under careful follow-up.

He was referred to the hospital for further examination.

He had a history of autism spectrum disorder.

The abdomen was mildly distended and soft.

MRI revealed an intra-abdominal tumor 34 × 15 × 8 cm.

EUS-FNA was not performed, given the risk of seeding.

Surgery was performed under suspicion of desmoid tumor.

The tumor extended from the pelvis to the diaphragm.

The tumor showed firm adhesions to the stomach.

The tumor showed firm adhesions to the transverse colon.

The tumor showed firm adhesions to the diaphragm.

Primary anastomosis of the colon was performed.

The diaphragm was closed after tumor resection.

The excised specimen measured 38 × 21 × 8 cm.

Immunostaining showed negative results for c-kit.

Immunostaining showed negative results for CD34.

Immunostaining showed negative results for desmin.

Immunostaining showed negative results for S-100.

Immunostaining showed positive results for β-catenin.

The diagnosis was confirmed as a desmoid tumor.

The patient was discharged 17 days after surgery.

He was referred to the hospital for treatment.

The mass showed hypointensity on T1-weighted imaging.

No definitive diagnosis was obtained preoperatively.

The mass was identified firmly adherent to the diaphragm.

The excised specimen measured 38 × 21 × 8 cm.

Macroscopically, the tumor showed a smooth surface.

Macroscopically, the tumor showed a homogeneous interior.

Immunostaining was positive for β-catenin.

The diagnosis was confirmed as desmoid tumor.

The patient remains under careful follow-up.