Background Amoxicillin, a commonly used broad-spectrum antibiotic, can crystallize in renal tubules when administered at high doses, causing acute amoxicillin-induced crystal nephropathy (AICN). This condition typically presents with acute kidney injury (AKI) and macroscopic hematuria. Risk factors include high dosage, rapid infusion, dehydration, and low urinary pH. Although urine microscopy can confirm amoxicillin crystals, it is underutilized, contributing to underrecognition of AICN.   Case Report We present the case of a 75-year-old woman with fever and cellulitis, diagnosed with native aortic valve endocarditis due to Streptococcus dysgalactiae. She was treated with high-dose intravenous amoxicillin (6 × 2 g/day). On day two, she developed macroscopic hematuria and progressive AKI, eventually requiring temporary hemodialysis. Urine microscopy revealed elongated amoxicillin crystals, confirming the diagnosis of AICN. Amoxicillin was discontinued and replaced with continuous penicillin G infusion. Renal function recovered markedly within one week, allowing discontinuation of dialysis.   Discussion This case highlights the... Continue Reading

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Recurrent Hypocalcemic Tetany in children is an important clinical feature of pseudohypoparathyroidism encompassing a spectrum of rare endocrine disorders characterised by end-organ resistance to parathyroid hormone (PTH). We report a case of a 10-year-old girl with genetically confirmed PHP Type 1a and 1c, presenting with classical features including recurrent hypocalcemic tetany, short stature, and mild intellectual delay. Notably, the child exhibited additional findings of primary hypothyroidism, celiac disease, positive autoimmune markers (ANA, SSA/Ro, Ro-52), congenital heart disease (ventricular septal defect), and Müllerian duct anomalies — features rarely reported in conjunction with pseudohypoparathyroidism. The whole spectrum of these findings cant be explained by GNAS mutation hence underscoring the importance of a multidisciplinary approach and highlights the possibility of blended or complex syndromes when atypical features co-occur in rare monogenic conditions. Continue Reading

Background: Croup is a common pediatric respiratory illness characterized by a barking cough, inspiratory stridor, and hoarseness resulting from upper airway narrowing. While most cases are of viral etiology, spasmodic croup can be triggered by non-infectious factors such as allergy, gastroesophageal reflux disease, or psychological stress.Case Presentation: We describe a previously healthy with no significant past medical history 10-year-old girl, with multiple presentations to the emergency department with persistent hiccups accompanied by inspiratory stridor with the classic “steeple sign”. Her clinical course suggested overlapping mechanisms, including reflux-related and stress-related functional triggers, as her symptoms improved with proton-pump inhibition and corticosteroids. Conclusion: This case illustrates an unusual presentation of recurrent spasmodic croup with persistent hiccups, likely multifactorial in origin. Awareness of atypical features may help in early identification and improve patient outcomes. Continue Reading

Antecedentes: La enfermedad de Kikuchi-Fujimoto (EKF) se ha reportado con mayor frecuencia en países asiáticos. Su curso clínico suele ser transitorio, con resolución espontánea en 1 a 4 meses; sin embargo, algunos pacientes pueden experimentar recurrencias. Presentación del caso: Un varón de 18 años con antecedentes de convulsiones febriles en la infancia presentó un mes de fiebre persistente, malestar general, exantema y linfadenopatía dolorosa generalizada. Al ingreso, estaba taquicárdico, febril y exhibía pancitopenia significativa. Los estudios infecciosos y el panel de sepsis fueron negativos, mientras que los reactantes de fase aguda estaban elevados. La TC reveló linfadenopatía sistémica y hepatoesplenomegalia. Dada la sospecha de linfoma o linfadenitis tuberculosa, se realizó una biopsia de ganglio linfático, que demostró linfadenitis necrosante compatible con la enfermedad de Kikuchi-Fujimoto. Debido a la asociación conocida con lupus eritematoso sistémico, se ampliaron las pruebas inmunológicas, revelando anticuerpos anti-ADN bicatenario elevados y criterios EULAR/ACR positivos, confirmando KFD... Continue Reading

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis frequently associated with systemic inflammatory diseases. We aimed to describe systemic disease associations, management strategies and outcomes of PG managed in internal medicine. We retrospectively reviewed all patients treated for PG in our department between January 2021 and December 2025 and extracted demographic, clinical, histologic, treatment and outcome data from medical records. Ten patients (5 women; mean age 38.2 years) were included. Ulcerative PG predominated (6/10) and 4 patients had pustular PG; lesions mainly involved the lower limbs and pathergy was observed in 5 patients. An associated systemic disease was identified in 8 patients, including Behçet disease, inflammatory bowel disease, systemic sclerosis, ANCA-associated vasculitis, systemic lupus erythematosus and Takayasu arteritis. All patients received systemic corticosteroids; additional immunosuppressants or anti-TNFα therapy were used as steroid-sparing treatments and/or to control the underlying systemic disease. Six patients achieved complete healing without relapse, whereas four experienced... Continue Reading

Objective: Reconstruction of large-segment tibial bone defects caused by osteomyelitis or fracture nonunion remains a major clinical challenge in orthopedic surgery, with the core demand of balancing mechanical stability and biological osseointegration. 3D-printed porous tantalum prostheses have emerged as a novel biomaterial for bone defect repair due to their bionic mechanical properties and excellent biocompatibility, and their combination with the Masquelet induced membrane technique (IMT) is expected to improve the therapeutic effect of large bone defects. However, clinical evidence of this combined strategy for tibial defect reconstruction is still insufficient. Methods: A series of six patients with large tibial bone defects treated in our hospital from December 2021 to December 2023 were retrospectively analyzed, including 1 case of osteomyelitis-induced defect and 5 cases of nonunion-induced defect. All patients received two-stage surgical treatment based on CARE guidelines: Stage I was debridement + vancomycin-loaded PMMA spacer implantation to induce membrane formation; Stage... Continue Reading