{"title":"Correction to: Washed microbiota transplantation in refractory intestinal Behçet's disease with trisomy 8/myelodysplastic features.","authors":"","doi":"10.1093/qjmed/hcaf170","DOIUrl":"https://doi.org/10.1093/qjmed/hcaf170","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Severe Mixed Hypersensitivity Reaction Induced by Antivenom: Diagn ostic Challenges and Precision Management.","authors":"Shuo-Feng Zhuang, Shi-Ming Zhan, Tian-Xing Li","doi":"10.1093/qjmed/hcaf197","DOIUrl":"https://doi.org/10.1093/qjmed/hcaf197","url":null,"abstract":"<p><strong>Objectives: </strong>To report a rare, life-threatening mixed hypersensitivity reaction (Types I and III) induced by snake antivenom and describe a precision management strategy.</p><p><strong>Clinical features and outcome: </strong>A 55-year-old woman with a history of plant allergy received antivenom treatment(6 vials total) for a Trimeresurus stejnegeri bite, with initial symptom resolution. On post-serum day 7, she developed syncope, fever, generalized pruritus, and urticaria, followed by recurrent rash, pruritus, nausea, vomiting, abdominal pain, myalgia, arthralgia, and hypotension on day 8. Laboratory findings included leukocytosis, neutrophilia, elevated D-dimer, IgE (155.0 IU/mL), and serum creatinine (123 μmol/L). Multidisciplinary consultation diagnosed a mixed hypersensitivity reaction (anaphylaxis + serum sickness). Management employed a \"Shock control-Inflammation suppression-Volume optimization\" strategy: epinephrine (intramuscular/intravenous) for shock, dexamethasone and antihistamines for inflammation, and aggressive crystalloid resuscitation. Hemodynamic stability and symptom resolution were achieved.</p><p><strong>Conclusions: </strong>This represents the first documented case of severe mixed hypersensitivity (co-occurring Type I anaphylaxis and Type III serum sickness) triggered by antivenom. It highlights the diagnostic challenge posed by overlapping biphasic features and multi-system involvement occurring within the typical serum sickness window. Precision management addressing both pathogenic pathways simultaneously, specifically via combined hemodynamic stabilization, anti-inflammatory therapy, and volume support, was critical for successful recovery. Enhanced vigilance for this synergistic reaction pattern is warranted.</p>","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manu Sharma, Deeksha Sharma, Yvk Chaitanya, Harshita Dokania, Deeksha Katoch
{"title":"Snail shell on Moon appearance: Cataracta Nigra over Coloboma.","authors":"Manu Sharma, Deeksha Sharma, Yvk Chaitanya, Harshita Dokania, Deeksha Katoch","doi":"10.1093/qjmed/hcaf196","DOIUrl":"https://doi.org/10.1093/qjmed/hcaf196","url":null,"abstract":"<p><p>We report a rare case of posteriorly dislocated cataracta nigra associated with fundal coloboma with vitreous hemorrhage in a 50-year-old Asian female presenting with a history of blunt ocular trauma 5 years prior. The patient's visual acuity was limited to light perception, and anterior segment examination revealed a typical iris coloboma. Posterior segment visualization was obscured by dense vitreous hemorrhage. During pars plana vitrectomy, removal of the hemorrhage revealed a densely pigmented, black cataractous lens (cataracta nigra) resting on the colobomatous area, resembling a \"snail shell on moon\" appearance. The lens was successfully emulsified and removed via phacofragmentation under perfluorocarbon liquid protection, and the vitrectomy was completed. Postoperatively, visual acuity improved to 6/60.</p>","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji Li, Ming Zhang, Jing Zhang, Sheng-Guang Li, Ruohan Yu, Lina Zhang, Yadan Zou, Ting Long, Yanfeng Zhang
{"title":"Granulomatous Mastitis with Erythema Nodosum and Erysipelas-like Lesions: Expanding the GMENA Syndrome.","authors":"Ji Li, Ming Zhang, Jing Zhang, Sheng-Guang Li, Ruohan Yu, Lina Zhang, Yadan Zou, Ting Long, Yanfeng Zhang","doi":"10.1093/qjmed/hcaf191","DOIUrl":"https://doi.org/10.1093/qjmed/hcaf191","url":null,"abstract":"<p><p>Granulomatous mastitis (GM) is a rare, benign inflammatory breast condition that occasionally presents with systemic features such as erythema nodosum (EN) and arthritis, collectively termed GMENA syndrome. We report a unique case of a 32-year-old woman with GM, EN, and an erysipelas-like skin lesion (ELL) in the absence of arthritis. Despite antibiotic therapy, her condition deteriorated with persistent fever and elevated inflammatory markers. Cultures remained sterile, while biopsies confirmed idiopathic GM and non-infectious perivascular dermal inflammation. Immune work-up revealed antiphospholipid antibodies, suggesting an underlying immune-mediated process. Initiation of systemic corticosteroids led to rapid resolution of symptoms and normalization of inflammatory markers. This case highlights a previously unreported triad-GM with EN and ELL-and suggests that GM may trigger immune-driven microvascular inflammation beyond classical GMENA. Clinicians should be alert to sterile, infection-mimicking skin manifestations in GM, particularly when antibiotic treatment fails. Early recognition and timely immunosuppression can be critical for favourable outcomes and may prevent unnecessary antibiotic use or invasive procedures. The co-existence of antiphospholipid antibodies raises questions regarding their role in the pathogenesis of systemic features in GM, warranting further investigation.</p>","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trapped cranial nerve and dense bones-Sclerosteosis due to LRP4 mutation.","authors":"Subbiah Sridhar, Muthu Aravind Kumar","doi":"10.1093/qjmed/hcaf190","DOIUrl":"https://doi.org/10.1093/qjmed/hcaf190","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multiple Myeloma Presenting with Multinucleated Plasma Cells, Vertebral Lesions, and M-Protein Spike.","authors":"Saeid Jokar","doi":"10.1093/qjmed/hcaf195","DOIUrl":"10.1093/qjmed/hcaf195","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tennis Ball Sign.","authors":"Sheng-Fu Chen, Pei-Ti Yao, Te-Chun Shen","doi":"10.1093/qjmed/hcaf192","DOIUrl":"10.1093/qjmed/hcaf192","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priscilla Detweiler, Patrick Wu, Perry Vacchio, Su Boon Yong
{"title":"UK Study Reveals Resident Doctors Spend Four Hours of Administrative Work for Each Hour of Seeing Patients.","authors":"Priscilla Detweiler, Patrick Wu, Perry Vacchio, Su Boon Yong","doi":"10.1093/qjmed/hcaf193","DOIUrl":"10.1093/qjmed/hcaf193","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Classic Pattern of Type 1 Brugada Syndrome on Electrocardiogram.","authors":"Samuel Chin Wei Tan, Zhao-Wei Yin, Yun-Tao Zhao","doi":"10.1093/qjmed/hcaf194","DOIUrl":"10.1093/qjmed/hcaf194","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Donut-in-Donut: Cardiac Abnormalities due to Mycobacterium Tuberculosis.","authors":"Wenyu Huang, Qiao Deng, Kaiyue Diao","doi":"10.1093/qjmed/hcaf189","DOIUrl":"https://doi.org/10.1093/qjmed/hcaf189","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}