Medicine最新文献

{"title":"Identification of COL5A1 and TGFBI as key basement membrane genes and their molecular mechanisms in gestational diabetes mellitus.","authors":"Xiaofang Weng, Xingdi Guo, Chunmei Pan","doi":"10.1097/MD.0000000000048610","DOIUrl":"10.1097/MD.0000000000048610","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) is a common complication during pregnancy, but the role of the basement membrane (BM) in GDM is not well understood. This study aims to investigate BM-related genes in GDM to provide new insights for diagnosis and treatment. Differentially expressed genes were identified from the GSE203346 dataset in the Gene Expression Omnibus and intersected with BM-related genes to identify BM-related differential genes. Machine learning and gene expression validation were used to identify key genes, which were further validated using an artificial neural network. Additional analyses included gene set enrichment analysis, immunoprecipitation, drug prediction, gene localization, and the construction of lncRNA-miRNA-mRNA and transcription factor-mRNA regulatory networks to explore underlying mechanisms. Among 801 differentially expressed genes, 24 BM-related differential genes were identified. COL5A1, TGFBI, AGRN, TNC, and ITGB6 were identified as candidate genes, with COL5A1 and TGFBI showing consistent low expression across datasets and being designated as key genes. The artificial neural network demonstrated that these key genes effectively distinguished GDM from control samples. Gene set enrichment analysis revealed the involvement of these genes in pathways such as systemic lupus erythematosus and cytokine-cytokine receptor interaction. TGFBI showed a significant positive correlation with CD4+ memory T cells, common lymphoid progenitors, hematopoietic stem cells, and smooth muscle, while COL5A1 was positively correlated with common lymphoid progenitors and smooth muscle. Six drugs were identified as interacting with both key genes. Our study suggests that COL5A1 and TGFBI offer the possibility of personalized treatment strategies for GDM in the future.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48610"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-specific association between AST/ALT ratio and 365-day mortality in patients with severe acute pancreatitis: A retrospective cohort study based on the MIMIC-IV database.","authors":"Zhimin Dong, Dasheng Dang","doi":"10.1097/MD.0000000000048324","DOIUrl":"10.1097/MD.0000000000048324","url":null,"abstract":"<p><p>Patients with acute pancreatitis (AP) in the intensive care unit experience high complication and mortality rates, making early prognosis prediction crucial. While the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio is correlates with prognosis in various diseases, its association with mortality in severe AP remains uncertain. AP patients were identified using the Medical Information Mart for Intensive Care-IV database. Cox proportional hazard regression models examined the link between the AST/ALT ratio and 365-day mortality. Kaplan-Meier survival curve analysis was conducted to assess patient survival across AST/ALT ratio quartiles. restricted cubic splines analysis determined the relationship curve between 365-day mortality and the AST/ALT ratio level. We also conducted subgroup analyses to assess the robustness of the findings. A total of 817 patients were included in this retrospective cohort study. After adjusting for all covariates, the Cox regression model showed that the AST/ALT ratio was positively associated with 365-day mortality in patients with AP (hazard ratio: 1.33, 95% confidence interval: 1.16-1.52). When the AST/ALT ratio was divided into 4 groups based on quartiles, participants in the Q4 group had a significantly higher mortality compared with Q1 (hazard ratio:2.11, 95% confidence interval: 1.30-3.40). The Kaplan-Meier curves showed that patients in the Q1 group had the lowest mortality (log-rank P < .001). The restricted cubic splines curve indicated a linear relationship between the AST/ALT ratio and mortality in AP patients (P for nonlinear > .05). Subgroup analyses further demonstrated that this association was more pronounced in men. Finally, the AST/ALT ratio improved the predictive performance of sequential organ failure assessment score for mortality in patients with AP. In critically ill AP patients, a higher AST/ALT ratio on admission was associated with greater 365-day mortality, especially in males. It is suggested that the AST/ALT ratio can be used as a simple and effective prognostic marker for patients with severe AP.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48324"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphocyte count and systemic immune-inflammation index (SII) as novel biomarkers for cognitive impairment: A cross-sectional study analysis.","authors":"Huirong Zhang, Kun Zhang, Wenting Li, Xiaoyu Ji, Wanyu Wang, Ruisong Li, Jing Zhou, Tao Liu","doi":"10.1097/MD.0000000000048545","DOIUrl":"10.1097/MD.0000000000048545","url":null,"abstract":"<p><p>Early detection of cognitive dysfunction through reliable biomarkers remains a critical challenge in geriatric medicine. While conventional peripheral blood parameters offer convenient and cost-effective biomarker potential, previous studies have been limited by their focus on isolated cell populations. This study investigates both individual blood cell parameters and their derived ratios to comprehensively evaluate their relationship with cognitive function. In this cross-sectional conducted from 2022 to 2024, we enrolled 109 participants (51 with cognitive impairment and 58 controls) from the Haikou City Community Health Service Center. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). We analyzed 26 blood parameters, including traditional metrics and calculated indices such as lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index (SII). The relationship between these parameters and cognitive domains was evaluated using comprehensive statistical analyses. Fifteen parameters showed significant differences between groups. Binary logistic regression identified SII as a risk factor (OR: 1.008, 95% CI: 1.003-1.012, P = .002). The receiver operating characteristic curve analysis indicated that the diagnostic accuracy of SII (AUC = 0.911, 95% CI: 0.856-0.966) was significantly superior to that of the sole parameter, the number of lymphocyte count (AUC = 0.702, 95% CI: 0.604-0.801). Our findings suggest that lower lymphocyte counts and elevated SII levels are associated with increased risk of cognitive impairment. These results provide new insights into the relationship between systemic inflammation and cognitive decline, with potential implications for clinical practice.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48545"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of risk factors of Mycoplasma pneumoniae infection in children.","authors":"Kun Zhang, Xiaodan Zhai, Ying Zhang, Xiaolin Xu, Xuejing Wang","doi":"10.1097/MD.0000000000048381","DOIUrl":"10.1097/MD.0000000000048381","url":null,"abstract":"<p><p>To explore the risk factors and predictive value of Mycoplasma pneumoniae (MP) infection in children. A total of 2042 children with suspected Mycoplasma pneumoniae infection who were treated for the first time at Civil Aviation General Hospital from October 2023 to December 2023 were selected as the study subjects. Among them, 1637 cases were confirmed as Mycoplasma pneumonia-infected and were included in the pneumonia group, while the remaining 405 cases were non-Mycoplasma pneumonia-infected and were included in the non-Mycoplasma pneumonia group. The clinical data of the 2 groups of children (including gender, age, initial symptoms, laboratory indicators, etc) and the risk factors of MP infection in children were compared, and the receiver operating characteristic curve was analyzed. This study showed that the percentage of neutrophils in the non-MP infection group was significantly lower than that in the MP infection group, and the difference was statistically significant (P < .001). When comparing the percentages of lymphocyte percentage (LY) and hemoglobin in the 2 groups of children, the Mycoplasma pneumonia-infected group was lower than the non-Mycoplasma pneumonia-infected group, and the differences were both statistically significant (P < .05). Logistic regression analysis revealed that white blood cell and neutrophil-to-lymphocyte ratio (NLR) might be valuable markers for predicting MP infection. The Spearman correlation indicated that LY was collinear with the occurrence of MP infection, and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis demonstrated that both LY and NLR might be valuable markers for predicting MP infection (P < .05). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR for diagnosing MP infection was 0.624, with a cutoff value of 1.36 (sensitivity of 0.798 and specificity of 0.558). In the diagnosis of MP infection, the consistency between the RNA method and the immunogold colloidal method was poor (Kappa = 0.108, P < .05). The consistency between the RNA method and the immunogold colloidal method in the diagnosis of MP infection is poor. Both the white blood cell and NLR are valuable markers for MP infection.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48381"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive management of lower midline diastema: A case report and literature review.","authors":"Ghadah Khaled Bahamdan, Norah Mohammed Alshehri, Faisal Hasan Alshehri","doi":"10.1097/MD.0000000000048618","DOIUrl":"10.1097/MD.0000000000048618","url":null,"abstract":"<p><strong>Rationale: </strong>Midline diastema is an unpleasant condition that affects a patient's smile and causes significant aesthetic concerns. Treating diastema and achieving the desired aesthetics, function, and harmony can be challenging without invasive treatment. This case report demonstrates a minimally invasive approach to closing a lower midline diastema.</p><p><strong>Patient concerns: </strong>A 38-year-old female patient presented to the dental clinic at King Khalid University with the primary complaint of a \"large space in the lower front tooth region.\" Her medical history indicated no significant health concerns.</p><p><strong>Diagnoses: </strong>The patient was diagnosed with localized periodontitis, stage III, grade B. She presented with a Miller class III gingival recession at the lower central incisors, an aberrant frenum, a decreased width of keratinized gingiva, and a midline diastema of 6 mm.</p><p><strong>Interventions: </strong>A free gingival graft is used to increase the width of the keratinized gingiva, followed by the placement of a zirconia resin-bonded bridge to close the space.</p><p><strong>Outcomes: </strong>The treatment yielded a satisfactory outcome, as evidenced by an increase in the width of keratinized gingiva from 1 mm at baseline to 5 mm at 4 months and a gain of 1 to 2 mm in clinical attachment level. Two months following surgery, complete closure of a 6-mm lower midline diastema was successfully achieved using a zirconia resin-bonded bridge.</p><p><strong>Lessons: </strong>The use of a free gingival graft effectively increases the width of the keratinized gingiva. A resin-bonded bridge offers satisfactory aesthetics and functionality, providing a conservative treatment that makes it a favorable option for closing lower midline diastema compared with more invasive and time-consuming procedures, such as bone grafting or orthodontic treatment.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48618"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal relationships between salt intake and gastric cancer: A two-sample Mendelian randomization study.","authors":"Keshuai Li, Jiaqi Wu, Shenglan Lai, Lili Yu, Hua Zhou, Jun Qian, Qibiao Wu","doi":"10.1097/MD.0000000000048510","DOIUrl":"10.1097/MD.0000000000048510","url":null,"abstract":"<p><p>The link between salt intake and the risk of gastric cancer remains uncertain, and a causal relationship has not been established. Therefore, clarifying the causal effect of salt intake on the risk of gastric cancer using reliable causal inference methods is necessary. The aim of this study was to assess the causal association between salt intake and cancer by integrating summary-level genome-wide association study (GWAS) data. Two-sample Mendelian randomization (MR) analyses were performed using summary statistics from a GWAS. Inverse-variance weighted (IVW) regression, Mendelian randomization-Egger (MR-Egger) regression, and weighted median analyses were used to evaluate the causal relationship between salt intake and gastric cancer. Moreover, Mendelian Randomization Pleiotropy RESidual Sum of Squares and Outliers and MR-Egger analyses were used to evaluate the level of multipotency, and \"leave-one-out\" sensitivity analysis was assessed. The IVW method estimate indicated that salt intake was not correlated with gastric cancer incidence. The IVW (β = 0.1008, standard error [SE] = 0.1510, odds ratio [OR] = 1.1061, 95% confidence interval [CI], 0.82-1.48, P = .5042), MR-Egger regression (β = 0.059, SE = 0.5318, OR = 1.0612, 95% CI, 0.37-3.01, P = .9111), and weighted median (β = 0.2639, SE = 0.2298, OR = 1.3020, 95% CI, 0.82-2.04, P = .2508) analyses revealed no causal relationship between salt intake and gastric cancer risk (P > .05). In addition, the funnel plot and MR-Egger analysis (P = .6694 > .05) did not indicate horizontal pleiotropy or heterogeneity. GWAS data from public databases were used in this study, and the causal relationship between salt intake and gastric cancer risk was analyzed via a two-sample MR method. The results revealed no genetic causal relationship between salt intake and gastric cancer.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48510"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonlinear association between the erythrocyte distribution width-to-albumin ratio and mortality in older adults: A retrospective cohort study using NHANES 1999 to 2018 data.","authors":"Jing-Jing Xu, Yong-Hai Chen, Jia-Xiao Sun, Guo-Pan Zhang","doi":"10.1097/MD.0000000000048451","DOIUrl":"10.1097/MD.0000000000048451","url":null,"abstract":"<p><p>Older adults face high risks of all-cause and cardiovascular disease (CVD) mortality; however, simple, inexpensive biomarkers for early risk identification are limited. The red cell distribution width-to-albumin ratio (RAR) is a low-cost, routinely measured marker, but its prognostic value in older adults is unclear. We examined whether RAR is independently associated with all-cause and CVD mortality in older adults. We conducted a retrospective cohort study using data from the United States National Health and Nutrition Examination Survey (1999-2018). The study included 16,558 adults aged ≥60 years, with median follow-up of 9.4 years. Multivariable Cox proportional hazards models estimated associations between RAR and mortality. Nonlinearity was evaluated using generalized additive models with penalized splines and two-piecewise Cox models combined with a recursive algorithm. Among 16,558 participants (mean age 70.7 ± 7.3 years; 49.8% men), RAR quartiles were Q1 (2.32-2.95), Q2 (2.95-3.16), Q3 (3.16-3.45), and Q4 (>3.45). Over a median 9.4-year follow-up, 6119 deaths occurred, including 2048 CVD deaths. In fully adjusted models, RAR was associated with greater risks of all-cause mortality (hazard ratio = 2.15, 95% confidence interval = 1.89-2.45) and CVD mortality (hazard ratio = 2.05, 95% confidence interval = 1.74-2.41). Associations were nonlinear, with a threshold at RAR = 4.05; below this level, higher RAR was linked to increased all-cause and CVD mortality, whereas above it, the association weakened and CVD mortality risk plateaued. RAR was independently and nonlinearly associated with all-cause and CVD mortality in older adults. These findings support RAR as a simple biomarker for mortality risk identification in older adults.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48451"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined central and peripheral nervous system involvement in acute disseminated encephalomyelitis in a young male: A case report.","authors":"Aasim Ali, Muhammad Shamoon, Muhammad Asad Shabbir, Fiza Nisar, Danish Yousuf, Gohar Mushtaq, Muhammad Abdullah Ali, Anousha Tanveer, Hammad Azam, Mukesh Kumar Sharma","doi":"10.1097/MD.0000000000048656","DOIUrl":"10.1097/MD.0000000000048656","url":null,"abstract":"<p><strong>Rationale: </strong>Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disorder of the central nervous system, typically presenting after infection or vaccination. Rarely, ADEM may involve the peripheral nervous system, presenting with pure motor axonal neuropathy, which poses a diagnostic and therapeutic challenge.</p><p><strong>Patient concerns: </strong>We report a 22-year-old Asian male with no prior medical history who initially experienced a mild upper respiratory infection followed by headache and a single generalized tonic-clonic seizure. He subsequently developed altered consciousness and flaccid paraplegia.</p><p><strong>Diagnoses: </strong>Brain magnetic resonance imaging demonstrated asymmetric, poorly marginated supratentorial white-matter hyperintensities on T2-weighted and fluid-attenuated inversion recovery sequences. Cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis and elevated protein, while autoimmune encephalitis panels and infectious studies were negative. Nerve conduction studies revealed predominantly motor axonal neuropathy affecting the lower limbs, with sensory sparing.</p><p><strong>Interventions: </strong>The patient received high-dose intravenous methylprednisolone followed by therapeutic plasma exchange due to incomplete motor recovery.</p><p><strong>Outcomes: </strong>After 2 weeks, he regained the ability to stand and ambulate with support, and repeat magnetic resonance imaging at 3 months demonstrated complete resolution of the lesions.</p><p><strong>Lessons: </strong>This case highlights a rare presentation of ADEM with peripheral nervous system involvement in a young adult, distinguished by predominant motor axonal neuropathy and a favorable response to plasma exchange. Recognition of peripheral involvement in ADEM is essential, particularly in younger patients with persistent weakness despite corticosteroid therapy, as timely diagnosis and intervention can significantly improve functional outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48656"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of biomarkers related to amino acid metabolism in nonobstructive azoospermia by bioinformatics.","authors":"Qing Hua Guo, Zhong Jun Ding, Dong Mei Liu, Xiao Shan Ren, XiaoYong Chen","doi":"10.1097/MD.0000000000048183","DOIUrl":"10.1097/MD.0000000000048183","url":null,"abstract":"<p><p>Nonobstructive azoospermia (NOA) is one of the most severe types of male infertility. Amino acid metabolism (AAM) is strongly associated with various diseases. This study intended to identify biomarkers related to AAM in NOA. Biomarkers were screened from GSE9210, GSE108886, and AAM-related genes through a series of bioinformatics analyses. Then, the diagnostic efficacy of the biomarkers was evaluated. Furthermore, the mechanisms of action of these biomarkers were investigated through enrichment analysis, immune infiltration analysis, construction of regulatory networks, prediction of potential drugs, and prediction of related diseases. Finally, reverse transcription-quantitative polymerase chain reaction was performed for verification. Three biomarkers (AKT1, ASNS, and SHC1) were derived, which demonstrated good diagnostic efficacy for NOA. Meanwhile, AKT1, ASNS, and SHC1 might play significant roles in the development of male germ cells through pathways such as male gamete generation, sexual reproduction, and gamete generation. Immune infiltration analysis revealed these 3 biomarkers were closely associated with T follicular helper cells, resting natural killer cells, and regulatory T cells. And AKT1, ASNS, and SHC1 were regulated by 24 transcription factors and 15 microRNAs. Remarkably, sodium selenite, aflodac, and genistein were commonly predicted by the biomarkers. In addition, lung neoplasms were associated with AKT1, lipoidosis was associated with ASNS, and drug-induced acute liver injury was associated with SHC1. Ultimately, AKT1 and SHC1 were significantly upregulated in NOA. This study identified 3 biomarkers as being associated with NOA, providing valuable clues to help treat and predict NOA.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48183"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANCA-associated vasculitis with thoracic spinal canal dural involvement and hypertrophic cranial pachymeningitis: A case report.","authors":"Xin Yin, Wei Zhou","doi":"10.1097/MD.0000000000048479","DOIUrl":"10.1097/MD.0000000000048479","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of small-vessel necrotizing vasculitides with minimal immune complex deposition. Hypertrophic cranial pachymeningitis, a rare complication of AAV, is characterized by focal/diffuse dural thickening and fibrosis, causing neurological dysfunction such as headache and optic nerve injury. While AAV-associated hypertrophic cranial pachymeningitis is well documented, reports of concurrent spinal dural involvement remain scarce. This case highlights the rare co-occurrence of cranial and spinal dural involvement in AAV, providing new clinical evidence to expand the understanding of AAV-related dural manifestations and improve diagnostic awareness among clinicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient concerns: &lt;/strong&gt;A 57-year-old male presented with fever, headache, otalgia, and hearing loss, and was diagnosed with granulomatosis with polyangiitis based on positive anti-proteinase 3 antibodies (664.3), cytoplasmic anti-neutrophil cytoplasmic antibody (1:10). Symptoms resolved with glucocorticoids, disease-modifying antirheumatic drugs, and anti-infective therapy. He later developed recurrent headache and lumbodorsal pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Diagnoses: &lt;/strong&gt;Thoracic magnetic resonance imaging (MRI) revealed a T10 to 12 epidural lesion, which was surgically resected. Pathology confirmed epidural vasculitis with necrotic/fibrous tissue, granulation, and inflammatory cell infiltration. Methylprednisolone and cyclophosphamide relieved back pain, but headaches persisted. Cranial MRI showed dural thickening in the cerebellar, posterior fossa, and foramen magnum regions, consistent with pachymeningitis. Cerebrospinal fluid analysis showed elevated mononuclear cells (35.00 × 106/L), nucleated cells (40.00 × 106/L), and protein (1.49 g/L), with negative cultures. The final diagnosis was granulomatosis with polyangiitis complicated by concurrent cranial and spinal dural involvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Initial management included glucocorticoids, disease-modifying antirheumatic drugs, and anti-infective therapy, which resolved the patient's fever, otalgia, and hearing loss. Surgical resection was performed for the T10 to 12 epidural lesion, followed by immunosuppressive therapy with methylprednisolone and cyclophosphamide. After adjustment of the treatment regimen, the patient's headache improved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Initial therapy resolved the patient's fever, otalgia, and hearing loss. Surgical resection combined with immunosuppressive therapy relieved lumbodorsal pain but failed to resolve headaches initially; cranial MRI confirmed pachymeningitis, and cerebrospinal fluid analysis indicated inflammatory changes. After adjustment of the treatment regimen, the patient's headache improved, and he has remained clinically stable during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Lessons: &lt;/strong&gt;This case demonstrates that AAV can involve both cranial and spina","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 18","pages":"e48479"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}