Frontiers in Medicine最新文献

{"title":"Case Report: Durable, well-tolerated complete response to epcoritamab plus pirtobrutinib in Richter transformation relapsing after CD19 CAR T-cell therapy.","authors":"Ahmed Salleh Barefah","doi":"10.3389/fmed.2026.1998014","DOIUrl":"10.3389/fmed.2026.1998014","url":null,"abstract":"<p><p>Richter transformation (RT) that relapses after CD19-directed chimeric antigen receptor (CAR) T-cell therapy has no established therapy and carries a dismal prognosis. We report an 84-year-old man with multiply relapsed, biopsy-proven diffuse large B-cell lymphoma-type RT and a high-risk MYC/BCL2 double-expressor phenotype who developed systemic relapse, with extensive osteolytic bone disease, after lisocabtagene maraleucel. Three cycles of atezolizumab produced no objective benefit. Treatment with epcoritamab, a CD3xCD20 bispecific antibody, plus pirtobrutinib, a non-covalent Bruton tyrosine kinase inhibitor, produced complete nodal metabolic resolution within 3 months that deepened to a complete metabolic response (Deauville score 2) by 10 treatment cycles, with resolution of two interim osteolytic lesions whose transient nature illustrates the interpretive challenges of PET/CT response assessment after cellular and T-cell-engaging therapies. The chemotherapy-free regimen was well tolerated at age 84, with no cytokine release syndrome, no neurotoxicity, and no cytopenias; the only toxicity was mild, reversible dexamethasone-related myopathy. The patient remains in ongoing clinical remission after approximately 10 months of therapy. This case extends the reported experience with epcoritamab plus pirtobrutinib specifically to the post-CAR T-cell relapse setting and suggests that this chemotherapy-free doublet may warrant consideration as a salvage strategy for older or frail patients with RT who are unfit for further cytotoxic therapy.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1998014"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib in refractory acquired reactive perforating collagenosis with atopic dermatitis and chronic kidney disease: a case report.","authors":"Qing Wang, Maolin Yao, Lvyao Wang, Xiao Qiu, Hao Lu, Xiangyu Hu, Yuanfang Wan, Juanjuan Liu","doi":"10.3389/fmed.2026.1924464","DOIUrl":"10.3389/fmed.2026.1924464","url":null,"abstract":"<p><strong>Background: </strong>Acquired reactive perforating collagenosis (ARPC) is a rare perforating dermatosis characterized by transepidermal elimination of degenerated collagen fibers. It frequently develops secondary to systemic comorbidities, including diabetes mellitus, chronic kidney disease (CKD), and atopic dermatitis (AD), which limit therapeutic options and contribute to unpredictable outcomes. Here, we report a case of ARPC with concurrent AD in a patient with type 2 diabetes mellitus and stage 4 CKD, who experienced acute paradoxical exacerbation within 24 h of dupilumab initiation and achieved sustained remission with upadacitinib.</p><p><strong>Case summary: </strong>A 72-year-old male presented with a 5-year history of recurrent generalized pruritus, erythema, papules, and nodules. Despite treatment with glucocorticoids and anti-allergic medications, the skin lesions remained poorly controlled. Histopathological examination revealed transepidermal elimination of collagen fibers through the ulcer bed into the underlying dermis. Verhoeff-van Gieson staining demonstrated collagen fibers traversing the ulceration. The patient was diagnosed with ARPC. He had poorly controlled comorbidities, including AD, type 2 diabetes mellitus, and stage 4 CKD. Dupilumab was administered as a single 600 mg dose but was discontinued due to paradoxical worsening within 24 h. Following two years of recurrent relapses despite systemic corticosteroids, antihistamines, and thalidomide, oral upadacitinib 15 mg once daily was initiated, with marked resolution of skin lesions and pruritus. After 9 months of treatment, upadacitinib was discontinued, and the patient remained in stable remission at 1-year follow-up. No adverse effects were observed, and renal function remained stable throughout treatment.</p><p><strong>Conclusion: </strong>This case suggests that upadacitinib is a promising salvage therapy for refractory ARPC, particularly after failure of Th2-targeted biologics. Its favorable safety profile at the standard dose without adjustment in stage 4 CKD supports its use in patients with complex comorbidities.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1924464"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Clinical characteristics and management strategies of intraspinal tophaceous gout: a case series and literature review.","authors":"Hongyan Zhang, Liping Lu, Jianguo Tian, Zhenzhen Ma","doi":"10.3389/fmed.2026.1961092","DOIUrl":"10.3389/fmed.2026.1961092","url":null,"abstract":"<p><strong>Background: </strong>Intraspinal tophaceous gout, defined as monosodium urate crystal deposition within the effective spinal canal causing neural compression, is a rare subtype of spinal gout with no unified diagnostic standard. Despite documented gout history, it is frequently misdiagnosed preoperatively.</p><p><strong>Methods: </strong>We retrospectively analyzed five male patients with pathologically confirmed intraspinal tophaceous gout (median age 25 years, range 21-48) admitted to two tertiary hospitals between January 2018 and May 2026, alongside a systematic literature review of strictly defined cases.</p><p><strong>Results: </strong>The preoperative misdiagnosis rate was 60%. Computed tomography values of 142-272 Hounsfield units provided diagnostic clues, yet no patient underwent preoperative dual-energy computed tomography. Three patients underwent open decompression with fusion, one endoscopic decompression, and one computed tomography-guided biopsy followed by conservative observation; pathology confirmed gouty tophus or granuloma in all. One patient developed a postoperative intraspinal hematoma on day 4, a previously unreported complication. Long-term follow-up revealed multiple vertebral compression fractures and thoracic spinal cord injury in one patient with poor compliance with urate-lowering therapy, a bone event that requires long-term vigilance. Pooled analysis of the 38 strictly defined cases (33 literature cases plus this series) confirmed that the preoperative misdiagnosis rate exceeds 50% and that most lesions are epidural.</p><p><strong>Conclusion: </strong>Intraspinal tophaceous gout should be considered in young male patients with back pain and neural deficits, even with known gout history. A stepwise imaging strategy, individualized surgical or biopsy-first management, vigilant postoperative monitoring, and long-term urate-lowering therapy are essential for optimal outcomes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1961092"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic fibrinogen decline rate outperforms static admission values in predicting hematoma expansion in APL-related intracranial hemorrhage: a retrospective cohort study.","authors":"Wentao Lai, Jing Hu","doi":"10.3389/fmed.2026.1956224","DOIUrl":"10.3389/fmed.2026.1956224","url":null,"abstract":"<p><strong>Background: </strong>Intracranial hemorrhage (ICH) is the leading cause of early death in acute promyelocytic leukemia (APL). Current risk assessment relies on static coagulation parameters at admission, but APL-associated coagulopathy evolves rapidly. Whether dynamic changes in coagulation markers predict hematoma expansion remains unknown.</p><p><strong>Objective: </strong>To determine whether the fibrinogen decline rate and D-dimer increase rate predict hematoma expansion in APL-related ICH, and to compare their predictive performance with static admission values.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 68 APL patients with spontaneous ICH. Hematoma expansion was defined as absolute growth >12.5 mL or relative growth >33% on follow-up CT. To ensure temporal precedence of the predictors relative to the outcome, the fibrinogen decline rate and D-dimer increase rate were calculated over a fixed 24-hour landmark window from the first CT-confirmed ICH (T0) to 24 h (T1). Multivariable models were adjusted for baseline fibrinogen and D-dimer levels. Logistic regression and receiver operating characteristic analyses were performed.</p><p><strong>Results: </strong>Hematoma expansion occurred in 22 patients (32.4%). The fibrinogen decline rate independently predicted expansion in multivariate analysis after adjustment for the baseline fibrinogen level (OR 1.92 per 0.1 g/L/day, 95% CI 1.35-2.74, <i>P</i> = 0.001), while the D-dimer increase rate did not (OR 1.07, 95% CI 0.95-1.21, <i>P</i> = 0.28). The AUC for the fibrinogen decline rate was 0.85, outperforming the static admission fibrinogen level (AUC 0.68) and the absolute fibrinogen nadir (AUC 0.70). The combined model achieved an AUC of 0.94 (bootstrap 95% CI 0.87-0.99). The optimal cut-off for the fibrinogen decline rate was 0.35 g/L/day (sensitivity 77.3%, specificity 80.4%).</p><p><strong>Conclusions: </strong>The dynamic fibrinogen decline rate independently predicts hematoma expansion in APL-related ICH and outperforms static admission values. Serial coagulation monitoring in the first 24 h may enable earlier identification of high-risk patients. The proposed cut-off of 0.35 g/L/day warrants prospective validation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1956224"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interaction between severe postoperative complications and adjuvant chemotherapy on overall survival after upfront resection of pancreatic ductal adenocarcinoma.","authors":"Shiwei Wu, Daobin Wang, Dongxing Zhang, Jiayue Zou, Xiaoyuan Hu, Jun He, Xiaofeng Xue, Lei Qin","doi":"10.3389/fmed.2026.1968161","DOIUrl":"10.3389/fmed.2026.1968161","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Severe postoperative complications (Clavien-Dindo grade ≥3) occur in 10%-30% of patients after curative resection of pancreatic ductal adenocarcinoma (PDAC). Whether adjuvant chemotherapy modifies their impact on long-term survival remains unclear. This study aimed to systematically evaluate the interaction between severe complications and adjuvant chemotherapy after PDAC resection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively analyzed 383 patients with pathologically confirmed PDAC who underwent upfront curative-intent resection at our center between January 2018 and January 2024. Our institutional database initially contained 398 surgical records; 15 records meeting the R2 margin-status or M1-metastasis exclusion criteria were excluded, leaving 383 patients for the primary analysis. Median overall survival (OS) was estimated using the Kaplan-Meier method, and group comparisons were performed with the log-rank test. Covariates adjusted for in the multivariable Cox regression model included age, sex, BMI, tumor differentiation, margin status, vascular invasion, perineural invasion, lymph node ratio, and tumor size. Stratified Cox regression and interaction-effect models were further constructed. Exploratory recurrence-free survival (RFS) analyses defined an event as recurrence or death from any cause. Sensitivity analyses excluded patients with OS &lt;60 days and, additionally, evaluated a 90-day threshold.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Severe complications occurred in 40 of 383 patients (10.4%). Adjuvant chemotherapy was received by 16 of 40 patients (40.0%) in the severe-complication group and 205 of 343 patients (59.8%) in the non-severe-complication group (&lt;i&gt;P&lt;/i&gt; = 0.026). Among patients who did not receive chemotherapy, median OS was significantly shorter in the severe-complication group than in the non-severe-complication group (7.9 vs. 14.6 months, &lt;i&gt;P&lt;/i&gt; &lt; 0.001); among those who received chemotherapy, the difference was not statistically significant (18.8 vs. 20.5 months, &lt;i&gt;P&lt;/i&gt; = 0.445). In the interaction model, severe complications were associated with increased mortality in the no-chemotherapy stratum (HR: 4.18, 95% CI: 2.49-7.01, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) but not in the chemotherapy stratum (HR: 1.24, 95% CI: 0.66-2.34, &lt;i&gt;P&lt;/i&gt; = 0.511). In separate stratified Cox models adjusted for the same covariates, adjuvant chemotherapy was associated with lower mortality in the severe-complication group (HR: 0.15, 95% CI: 0.04-0.57, &lt;i&gt;P&lt;/i&gt; = 0.005), whereas the association was not statistically significant in the non-severe-complication group (HR: 0.76, 95% CI: 0.56-1.03, &lt;i&gt;P&lt;/i&gt; = 0.075). Exploratory RFS analysis showed shorter RFS among patients with severe complications (median 6.4 vs. 11.1 months; adjusted HR: 1.58, 95% CI: 1.09-2.28, &lt;i&gt;P&lt;/i&gt; = 0.016).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this retrospective cohort, severe complications were associated with worse OS among patients who did not receiv","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1968161"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal microcirculatory and choroidal structural characteristics of retinal vein occlusion-related macular edema with serous retinal detachment.","authors":"Xianxian Kong, Fengjiao Li, Yalin Wang, Jing Wang, Weiyan Zhou","doi":"10.3389/fmed.2026.1941751","DOIUrl":"10.3389/fmed.2026.1941751","url":null,"abstract":"<p><strong>Objective: </strong>To characterize retinal microcirculation and choroidal structure in treatment-naive retinal vein occlusion-related macular edema (RVO-ME) eyes with/without serous retinal detachment (SRD) using ultra-widefield swept-source OCT angiography (UWF-SS-OCTA).</p><p><strong>Methods: </strong>This retrospective single-center study included 69 treatment-naive RVO-ME eyes (35 CRVO and 34 BRVO) classified by OCT-defined SRD. Between-group comparisons included CMT, FAZ metrics, sectoral VFD of the SCP, MCP, and DCP, SFCT, and three-dimensional choroidal metrics (CVV, CSV, CVI, and CSI). The location and extent of the occluded retinal region were also analyzed in BRVO eyes.</p><p><strong>Results: </strong>Thirty-five CRVO and 34 BRVO eyes were included. In both subtypes, SRD eyes had shorter disease duration, greater CMT (CRVO: 795.19 ± 240.83 vs. 397.84 ± 136.56 μm; BRVO: 633.53 ± 214.39 vs. 366.47 ± 86.20 μm), and lower FAZ circularity index (CRVO: 0.64 ± 0.23 vs. 0.84 ± 0.06; BRVO: 0.80 ± 0.07 vs. 0.86 ± 0.08) than non-SRD eyes (all <i>P</i> < 0.05). CRVO-SRD eyes had worse BCVA and a higher proportion of ischemic eyes (13/16 vs. 6/19) than non-SRD eyes (both <i>P</i> < 0.05). In BRVO, occlusion location was similar between groups (superotemporal branch most common), but SRD eyes had more extensive retinal involvement (<i>P</i> < 0.05). BRVO-SRD eyes showed reduced retinal vascular flow density in most macular sectors. In CRVO-SRD eyes, middle capillary plexus flow density was consistently reduced across all sectors. BRVO-SRD eyes showed greater SFCT, CSV, and CVV, whereas CRVO-SRD eyes showed higher foveal CSI and lower CVI in selected sectors.</p><p><strong>Conclusions: </strong>In treatment-naive RVO-ME eyes evaluated by UWF-SS-OCTA, SRD was associated with greater macular thickening, more irregular FAZ morphology, and more pronounced retinal microcirculatory impairment, with MCP-VFD reduction as the most consistent feature. Choroidal volume expansion in BRVO and compositional remodeling in CRVO suggest subtype-specific choroidal involvement; together, these findings support the potential value of layer-specific retinal perfusion metrics and three-dimensional choroidal parameters for imaging-based stratification.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1941751"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of 0.05% cyclosporine A eye drops for dry eye disease in patients with thyroid-associated ophthalmopathy: a prospective, parallel-group cohort study.","authors":"Yu Zhang, Juan Bao, Cuiyu Wang, Ruiyao Gao, Kai Zhang, Yingxin Chen","doi":"10.3389/fmed.2026.1951598","DOIUrl":"10.3389/fmed.2026.1951598","url":null,"abstract":"<p><strong>Background: </strong>Thyroid-associated ophthalmopathy (TAO) is frequently accompanied by dry eye disease (DED), which can lead to ocular surface damage and decreased visual quality. This study aimed to evaluate the effectiveness of 0.05% cyclosporine A (CsA) eye drops in the treatment of TAO-related DED.</p><p><strong>Methods: </strong>This prospective, parallel-group cohort study included 86 participants diagnosed with TAO-related DED. Participants were divided into either the CsA group (<i>n</i> = 43) or the control group (<i>n</i> = 43). The CsA group received 0.05% CsA eye drops (twice daily), and control group received polyethylene glycol eye drops (four times daily). Ocular parameters were assessed pre-treatment and at 1, 2, and 3 months post-treatment.</p><p><strong>Results: </strong>After 3 months of treatment, the CsA group demonstrated significantly better outcomes than the control group in ocular surface disease index (OSDI) scores, fluorescein tear breakup time (FBUT), and Schirmer I test (SIT) values (all <i>P</i> < 0.05), with between-group differences emerging as early as month 1. Corneal fluorescein staining (CFS) scores also showed significantly greater improvement in the CsA group (<i>P</i> < 0.05). Both groups exhibited comparable improvements in tear meniscus height (TMH) and ocular redness scores over time (<i>P</i> > 0.05). The incidence of adverse events was low in both groups, with all events being mild.</p><p><strong>Conclusion: </strong>0.05% CsA eye drops were associated with improvement in tear film stability, tear secretion, and corneal epithelial integrity in participants with TAO-related DED, and were well tolerated over the 3-month follow-up period.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1951598"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Distal ureteral obstruction decades after presumed intrauterine device removal in a woman with uterus didelphys.","authors":"Chengsheng Xiao, Cheng Li","doi":"10.3389/fmed.2026.1985408","DOIUrl":"10.3389/fmed.2026.1985408","url":null,"abstract":"<p><strong>Background: </strong>An ectopic intrauterine device (IUD) can rarely cause ureteral obstruction and hydroureteronephrosis. Diagnosis may be delayed when a prior removal procedure is believed to have been complete.</p><p><strong>Case presentation: </strong>A 48-year-old woman presented with a 1-year history of right flank pain and urinary frequency after repeated treatment for presumed urinary tract infection and possible genitourinary tuberculosis without sustained improvement. More than 20 years earlier, an IUD had been inserted before uterus didelphys was recognized. Two to three years later, an unintended pregnancy led to recognition of the duplicated uterine anatomy, induced abortion, and an IUD removal procedure. The original records were unavailable, so device location and intact retrieval at that time could not be verified. Multimodality imaging at the index admission showed severe right hydroureteronephrosis, focal distal ureteral narrowing, and an ectopic metallic IUD outside both uterine cavities; cystoscopy was unremarkable. Open ureteral exploration and reconstruction identified an intact IUD with an attached calculus externally compressing an approximately 1-cm fixed distal ureteral stricture without entering the ureteral lumen. The narrowing persisted after device removal, requiring segmental ureteral resection and anastomosis over a double-J stent. Histopathology of the resected ureter showed chronic inflammatory changes without tuberculous changes. The stent was removed 2 months postoperatively. At 6 months after surgery, computed tomography showed marked decompression of the right collecting system and no residual pelvic metallic device; serum creatinine remained normal.</p><p><strong>Conclusion: </strong>A history of IUD removal should not be treated as proof of device absence when intact retrieval is undocumented. In otherwise unexplained unilateral ureteral obstruction, a remote IUD history should prompt review of prior device localization and targeted pelvic imaging, particularly when historical records are unavailable or duplicated uterine anatomy complicates localization. A fixed stricture may require reconstruction even after the ectopic device is removed.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1985408"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report and literature review: complications of the association between rheumatoid arthritis and tuberculosis.","authors":"Alexandra-Maria Cristea, Dragos-Cosmin Zaharia, Oana Andreea Parliteanu, Ioan Berila, Alexandra Minca, Dragos Minca, Stefan Dumitrache-Rujinski, Ionela Alina Croitoru, Ana Maria Zaharie, Adelina Afetelor, Irina Ruxandra Strambu","doi":"10.3389/fmed.2026.1971306","DOIUrl":"10.3389/fmed.2026.1971306","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary tuberculosis is one of the major public health issues globally. According to the World Health Organization, it is among the top 10 causes of death caused by a single pathogen. In Romania, its reported incidence rate in 2024 was approximately 60 per 100,000 people, making it the country with the highest incidence in Europe. Rheumatoid arthritis (RA) is a systemic chronic autoimmune inflammatory disease characterized by the destruction of the small joints along with symmetrical distribution and multiorgan involvement. Pulmonary manifestations are more common in males with positive serology and can involve the lungs, airways, or pleura. Short-term corticotherapy may be initiated in patients with severe symptoms, and biological therapy (anti-TNF alpha drugs) may be used in those with inefficiency of disease-modifying antirheumatic drugs, with an increased risk for disseminated forms of tuberculosis in those with latent infection.</p><p><strong>Case description: </strong>We present the case of a 38-year-old male patient with a 5-year history of seropositive RA who was treated with methotrexate and methylprednisolone, without any prior investigations for latent tuberculosis infection or any chest radiography performed, and was admitted with severe respiratory failure. The results of thoracic computed tomography showed bilateral pneumothorax and pneumomediastinum, with pulmonary lesions suggestive of a diagnosis of tuberculosis, which was confirmed by bacteriological testing of samples.</p><p><strong>Conclusion: </strong>The coexistence of two severe diseases-one requiring immunosuppressive treatment and the other one favored by immunosuppression-in a country with a high prevalence of tuberculosis infection and in the absence of latent tuberculosis infection screening or periodic pulmonological assessment can lead to severe, life-threatening complications that require complex, multidisciplinary, long-term, and expensive management.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1971306"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Laparoscopic management of a primary omental pregnancy concealed beneath the bowel.","authors":"Jiaqi Shi, Xiaoteng Qiang, Cuihong Ji, Siyi Lian, Xuxing Zhang, Wei Liu","doi":"10.3389/fmed.2026.1938779","DOIUrl":"10.3389/fmed.2026.1938779","url":null,"abstract":"<p><p>Primary omental pregnancy is an extremely rare form of ectopic pregnancy. We report a case of successful laparoscopic management in a 19-year-old nulliparous woman with no traditional risk factors. Despite sonographic evaluation, including transvaginal, transabdominal, and multi-organ abdominal ultrasonography, the ectopic lesion was not identified preoperatively. Diagnostic laparoscopy was performed, but initial pelvic exploration was also negative. Only after lifting the bowel was a 2 cm omental pregnancy discovered, concealed beneath the bowel, and completely excised. Postoperatively, serum beta-human chorionic gonadotropin (β-hCG) declined by 70.3% on day 1 and 95.3% on day 4 without methotrexate use. This case underscores two points: first, systematic laparoscopic exploration beyond the pelvis is essential when initial inspection is negative; second, the absence of traditional risk factors does not exclude rare-site ectopic implantation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1938779"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}