This paper reports a case of Bacteroides fragilis induced spondylitis. Diagnosis was confirmed through blood culture and metagenomic sequencing of pus for pathogen detection. Due to persistent lumbar pain, surgical intervention became imperative, resulting in favorable postoperative outcomes. A detailed patient history revealed a severe episode of oral ulceration two weeks before symptom onset, although a direct link to the infection remained elusive. Leveraging insights from this case, we conducted a comprehensive literature review on B. fragilis spondylitis, elucidating clinical manifestations, diagnostic methodologies, and therapeutic strategies.

Bronchial asthma and chronic polypous rhinosinusitis are diseases associated with a T2-inflammatory immune response. These nosologies can be combined, creating the preconditions for a more severe course of multimorbidity, requiring the use of genetic engineering biological therapy. Dupilumab is a monoclonal antibody that can specifically bind to the alpha subunit of the interleukin-4 receptor and block the action of interleukins 4 and 13, which play a key role in the development of T2 inflammation. Numerous studies have demonstrated the high effectiveness of this medicament. The use of dupilumab in some cases may be accompanied by an increase in eosinophils in the blood. This article presents scientific base and our own experience in treating patients with dupilumab-associated eosinophilia, in addition we describe an algorithm for examining this group of patients for the purpose of timely diagnosis of diseases such as eosinophilic granulomatosis with polyangiitis, eosinophilic pneumonia, etc. It should be noted that in the most cases eosinophilia during targeted therapy with dupilumab is temporary and does not cause clinical manifestations.
Бронхиальная астма и хронический полипозный риносинусит являются заболеваниями, ассоциированными с Т2-воспалительным иммунным ответом. Данные нозологии могут носить сочетанный характер, создавая предпосылки для более тяжелого течения мультиморбидности, требующей применения генно-инженерной биологической терапии. Дупилумаб представляет собой моноклональное антитело, которое способно специфически связываться с a-субъединицей рецептора интерлейкина(ИЛ)-4 и блокировать действие ИЛ-4 и ИЛ-13, играющих ключевую роль в развитии Т2-воспаления. Многочисленные исследования продемонстрировали высокую эффективность данного лекарственного препарата. Иногда применение дупилумаба может сопровождаться повышением эозинофилов в крови. В статье представлены научный обзор и собственный опыт ведения пациентов с дупилумаб-ассоциированной эозинофилией, а также алгоритм обследования данной группы больных с целью своевременной диагностики таких заболеваний, как эозинофильный гранулематоз с полиангиитом, эозинофильная пневмония и др. Необходимо отметить, что чаще всего эозинофилия во время таргетной терапии дупилумабом носит временный характер и не вызывает клинических проявлений.

BACKGROUND: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon.
METHODS: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented.
RESULTS: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities.
CONCLUSIONS: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.
UNASSIGNED: ante una herida crónica a nivel digital se plantea el diagnóstico diferencial entre osteomielitis o tumor primario. No es infrecuente la coexistencia entre osteomielitis y quiste óseo epidermoide.
UNASSIGNED: en este artículo describimos dos casos de quistes epidermoides en falange distal de la mano asociados a osteomielitis y se presenta una revisión de la literatura.
RESULTS: tanto la osteomielitis como el quiste óseo epidermoide se han relacionado con la presencia de un traumatismo previo en el sitio de la lesión, alteraciones ungueales y signos flogóticos crónicos, por lo que es importante llegar a un diagnóstico certero mediante un estudio anatomopatológico y realizar un buen desbridamiento quirúrgico que asegure la curación de ambas entidades.
CONCLUSIONS: el desbridamiento quirúrgico asociado a curetaje y relleno del defecto óseo con sustituto óseo por medio de antibiótico es una buena opción terapéutica en el tratamiento de estas lesiones.

IgG4-related retroperitoneal fibrosis is a rare cause of renal dysfunction that usually manifests as obstructive nephropathy (sometimes with extrarenal manifestations). Due to the non-specific symptoms at the onset of the disease and often latent course, special laboratory and instrumental examination methods are usually needed to establish a diagnosis. The article describes a clinical case of a relapse of IgG4-related retroperitoneal fibrosis in a 53-year-old patient, who developed bilateral ureterohydronephrosis with postrenal acute kidney injury after the withdrawal of glucocorticoid therapy. The patient underwent bilateral percutaneous nephrostomy and resumed glucocorticoids at a dose of 30 mg/day. Postobstructive diuresis was 22 L. Treatment resulted in a complete normalization of the creatinine level and transient hypokalemia, which was eliminated with potassium medications. At the final stage of the treatment, bilateral stenting of both ureters was performed with a tapering of glucocorticoids to 5 mg per day with CT control of the retroperitoneal space after 5 months. A clinical case demonstrates that an interruption of glucocorticoid treatment in patients with IgG4-related retroperitoneal fibrosis can lead to ureterohydronephrosis with the development of acute kidney injury. In such cases, stenting of the ureters could be considered an optimal therapeutic option.

Gastrointestinal cancers are highly prevalent around the world. In the metastatic setting, the most usual sites for metastases are the liver, lymph nodes, peritoneum, and lung. Urologic metastases are very rare. We report a case series of three patients with gastrointestinal tumours in different topographies (stomach, colon, and rectum) with urological metastases. In all cases, the patients were initially treated with curative intent. Two of the patients presented with bladder metastases, and the third had penile metastases in addition to pulmonary metastases. Haematuria was the most common symptom at presentation. One of the patients had a good overall survival and is still undergoing palliative intent chemotherapy. In the literature, there are few reported cases of urological metastases from gastrointestinal cancers, and that is the aim of this publication.

OBJECTIVE: To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature.
METHODS: We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic.
RESULTS: In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain.
CONCLUSIONS: The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it\'s association with a disease like the priapism forced us to explain to our patients this rare adverse effect.

Juvenile gangrenous vasculitis of the scrotum was described by the Girona dermatologist Joaquín Piñol Aguadéin 1973. The objectives of this article are to review the world publications and provide a clinical case of this disease between urological and/or dermatological.
A review of juvenile gangrenous vasculitis of the scrotum between 1973 and 2019 is carried out and a new clinical case is contributed. The identification of articles in Medline was carried outwith MeSH terms \"juvenile gangrenous vasculitis scrotum\" and in Google with \"juvenile gangrenous vasculitisscrotum\". Ten clinical-epidemiological variables were studied in the articles: year, source, authors, number of cases, age, previous pharyngo-tonsillitis, biopsy of the lesion, treatment, days to healing, city and country. The results of the variables were analyzed with descriptive statistics. A new clinical case is described.
We found 26 world references, 18 of them Spanish, corresponding to 24 publications and 2 conference papers with a total of 29 patients. The meanage of the patients was 23.6 years. The treatments used were exeresis of the lesion (23%), cephalosporins and/or corticoids i.v. (15.3%), tetracyclines, ciprofloxacin or oral amoxicillin-clavulanate (15.3%), local cure and oral corticoids (11.5%) and mupirocin or topical tetracyclines (7.6%). Healing took place in an average of 21 days. The cities with the most cases reported were Barcelona with 11 (37.9%) and Pontevedra with 2 (6.8%). By country, Spain contributed 22 cases (75.8%) and Chile, Argentina, Portugal, Italy, Tunisia, Turkey and Great Britainthe remaining 7 cases (24.1%).
Juvenile gangrenous vasculitis of the scrotum is a benign entity with a self-limiting course. The process is preceded by pharyngo-tonsillitis in about half of the patients. The results of the study confirm the endemic nature of the disease in Mediterranean countries, including Spain.
INTRODUCCIÓN Y OBJETIVOS: La vasculitis gangrenosa juvenil del escroto fue descrita por el dermatólogo gerundense Joaquín Piñol Aguadé en1973. Los objetivos de este artículo son realizar una revisión de las publicaciones mundiales y aportar un caso clínico de esta enfermedad a caballo entre urológica y/o dermatológica.MATERIAL Y MÉTODOS: Se realiza una revisión sobre la vasculitis gangrenosa juvenil del escroto entre 1973 y 2019 y se aporta un nuevo caso clínico. La identificación de artículos en Medline se llevó a cabo con términos MeSH en inglés “juvenile gangrenous vasculitis scrotum” y en Google con “vasculitis gangrenosa juvenil del escroto”. En los artículos se ha estudiado 10 variables clínico-epidemiológicas: año, fuente, autores, nº decasos, edad, faringoamigdalitis previa, biopsia de la lesión, tratamiento, días hasta curación, ciudad y país. Los resultados de las variables se analizaron con estadísticas descriptivas. Se describe un nuevo caso clínico.RESULTADOS: Hemos encontrado 26 referencias mundiales que correspondían a 24 publicaciones y 2 comunicaciones a congresos con un total de 29 pacientes. La edad media de los pacientes fue 23,6 años. Los tratamientos empleados fueron exéresis de la lesión (23%), cefalosporinas y/o corticoides i.v (15,3%), tetraciclinas, ciprofloxacino o amoxicilina-clavulánico orales (15,3%), cura local y corticoides orales (11,5%) y mupirocinao tetraciclinas tópicas (7,6%). La curación se produjo en una media de 21 días. Las ciudades con más casos aportados fueron Barcelona con 11 (37,9%) y Pontevedra con 2 (6,8%). Por países España aporta 22 casos (75,8%) y Chile, Argentina, Portugal, Italia, Túnez, Turquía, Gran Bretaña los 7 casos restantes (24,1%).CONCLUSIONES: La vasculitis gangrenosa juvenil del escroto es una entidad benigna de curso autolimitado. El proceso viene precedido de faringoamigdalitis en cerca de la mitad de los pacientes. Los resultados del trabajo confirman el carácter endémico de la enfermedad en los países mediterráneos entre los que destaca España.

Pure red cell aplasia (PRCA) is a rare paraneoplastic syndrome observed in 2-5 % of thymomas. Literature reports great variability in its management. Based on an illustrative clinical case, we present a systematic literature review whose main objective is to evaluate the therapeutic management of PRCA. The literature search was performed based on the PICO method in the Medline and Scopus databases. The reference clinical case concerns a 51-year-old woman with stage IVa thymoma. After initial response to chemotherapy, a locoregional progression occurred with PRCA development that responded favorably under second line chemotherapy. The patient finally died in a context of bicytopenia with febrile neutropenia. The systematic review covers 135 articles published between 1950 and 2019. Thymectomy alone or in combination with other therapies showed a 31 % complete remission (CR) rate for PRCA of, whereas none was reported with anti-tumor treatments without thymectomy. Among immunomodulatory therapies, cyclosporin gave the highest percentage of CR (74 %). Finally, the combination of thymectomy and immunomodulatory treatments showed a CR rate of 45 %. Thymectomy appeared to be the most effective anti-tumor treatment for PRCA. Immunomodulatory therapies, particularly cyclosporine, are shown effective, but the risk of infectious complications must be considered. The optimal place of anti-tumor and immunomodulatory therapies against PRCA has yet to be determined.

The \"non-recurrent\" course of the inferior laryngeal nerve (ILN) is an anatomical variant which must be borne in mind during thyroid surgery. The \"non-recurrent\" course of the ILN on the right side is associated with the aberrant right subclavian artery (arteria lusoria), and, on the left, is described in situs viscerum inversus. We present a case in which the \"arteria lusoria\" was not associated with the non-recurrent right ILN. The aims of this paper are to report this \"anomaly of the anomaly\" to surgeons who may be unaware of it on the one hand and on the other to emphasize that this is the only case so far reported in the literature. Moreover we proposed to explain embryologically these unexpected findings.

Acute cerebral infarction (ACI) caused by cervical arterial dissection (CAD) is a rare clinical disease. Therapeutic approaches include anticoagulant therapy, antiplatelet aggregation, and thrombolytic therapy. Currently, anticoagulant therapy or antiplatelet aggregation is the primary choice, whereas the thrombolytic therapy is still controversial. In this article, we report a patient with ACI caused by right CAD, which led to a compensatory increase in blood supply to the right middle cerebral artery through the anterior communicating artery. After treatment with intravenous thrombolysis, the clinical symptoms of the patient improved, and the National Institutes of Health Stroke Scale (NIHSS) score declined to 2 points from the initial 14 points. In addition, cranial computed tomography scans showed that there were no signs of intracranial or extracranial hemorrhage, but that the vessel occlusion was still uncured. After 17 days of antiplatelet aggregation treatment, a cranial magnetic resonance angiography scan showed complete recanalization of the right internal carotid artery. Furthermore, the NIHSS score was reduced to 1 point when the patient discharged, and for 3 months of follow-up.