Prurigo pigmentosa is an inflammatory dermatosis that rarely occurs in Europe and mostly affects young women. Here, we describe the typical clinical and dermoscopic criteria so that therapy can be initiated as early as possible. The 17-year-old patient presented here shows that this disease can also be observed in Western Europe and in men, and that doxycycline is a very effective treatment option.
UNASSIGNED: Die Prurigo pigmentosa ist eine in Europa wenig verbreitete entzündliche Dermatose, an der meist junge Frauen leiden. Wir beschreiben hier die typischen klinischen und dermatoskopischen Kriterien, damit frühestmöglich eine Therapie eingeleitet werden kann. Der hier vorgestellte 17-jährige Patient zeigt, dass diese Erkrankung auch in Westeuropa und bei Männern beobachtet werden kann und Doxycyclin eine sehr wirksame Therapieoption darstellt.

BACKGROUND: Scrub typhus is a naturally occurring acute febrile disease caused by Orientia tsutsugamushi. Although it can cause multiple organ dysfunction, central nervous system infections are uncommon.
METHODS: A 17-year-old male presented with a 5-day history of fever and headaches. The MRI of the head revealed thickness and enhancement of the left temporal lobe and tentorium cerebelli, indicating potential inflammation.
METHODS: The patient was diagnosed with a central nervous system infection.
METHODS: Ceftriaxone and acyclovir were administered intravenously to treat the infection, reduce fever, restore acid-base balance, and manage electrolyte disorders.
RESULTS: Despite receiving ceftriaxone and acyclovir as infection therapy, there was no improvement. Additional multipathogen metagenomic testing indicated the presence of O tsutsugamushi infection, and an eschar was identified in the left axilla. The diagnosis was changed to scrub typhus with meningitis and the therapy was modified to intravenous doxycycline. Following a 2-day therapy, the body temperature normalized, and the fever subsided.
CONCLUSIONS: The patient was diagnosed with scrub typhus accompanied by meningitis, and doxycycline treatment was effective.
UNASSIGNED: Rarely reported cases of scrub typhus with meningitis and the lack of identifiable symptoms increase the chance of misdiagnosis or oversight. Patients with central nervous system infections presenting with fever and headache unresponsive to conventional antibacterial and antiviral treatment should be considered for scrub typhus with meningitis. Prompt multipathogen metagenomic testing is recommended to confirm the diagnosis and modify the treatment accordingly.

BACKGROUND: Q fever, caused by the zoonotic pathogen Coxiella burnetii, exhibits a worldwide prevalence. In China, Q fever is not recognized as a notifiable disease, and the disease is overlooked and underestimated in clinical practice, leading to diagnostic challenges.
METHODS: We present a case series of three patients diagnosed with persistent Q fever between 2022 and 2023. The average age of our three cases was 63.33 years old, consisting of two males and one female. The medical history of the individuals included previous valve replacement, aneurysm followed by aortic stent-graft placement and prosthetic hip joint replacement. At the onset of the disease, only one case exhibited acute fever, while the remaining two cases were devoid of any acute symptoms. The etiology was initially overlooked until metagenomic next-generation sequencing test identified Coxiella burnetii from the blood or biopsy samples. Delayed diagnosis was noted, with a duration ranging from three months to one year between the onset of the disease and its confirmation. The epidemiological history uncovered that none of the three cases had direct exposure to domestic animals or consumption of unpasteurized dairy products. Case 1 and 2 resided in urban areas, while Case 3 was a rural resident engaged in farming. All patients received combination therapy of doxycycline and hydroxychloroquine, and no recurrence of the disease was observed during the follow-up period.
CONCLUSIONS: Q fever is rarely diagnosed and reported in clinical practice in our country. We should be aware of persistent Q fever in high-risk population, even with unremarkable exposure history. Metagenomic next-generation sequencing holds great potential as a diagnostic tool for identifying rare and fastidious pathogens such as Coxiella burnetii.

Ascites can manifest as a result of many conditions, with cirrhosis being the most common cause in the United States. Here, we present a case of lymphocytic ascites, a less common variant that occurred due to infection with Chlamydia trachomatis. This was a 37-year-old female with a history of substance and sexual abuse who presented with the chief complaints of abdominal pain, abdominal distension, and weight gain. She was febrile on admission with a distended, tender abdomen. The more common cardiac, renal, and hepatic causes were ruled out with extensive workup. Diagnosis and therapeutic paracentesis were done with fluid analysis significant for lymphocyte predominance and absence of malignant cells. Multi-modal imaging had ruled out suspicious malignant masses but CT abdomen/pelvis did show complex large volume ascites. Urine chlamydia and gonorrhea polymerase chain reaction (PCR) had resulted positive for chlamydia, leading us to start Doxycycline. Other infectious workups were negative, but ascitic fluid chlamydia NAAT was positive. Though initially worsening, the patient started showing significant clinical improvement after starting doxycycline, with the resolution of ascites and associated symptoms. This case report intends to bring to attention the importance of testing for chlamydia infection in cases of lymphocytic ascites, especially in sexually active females.

UNASSIGNED: The study aims to obtain the real-world safety profile of tetracyclines in children younger than 8 years old and provide reference for clinical drug applications.
UNASSIGNED: We made a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database through OpenVigil 2 and conducted a review of case reports regarding adverse drug reactions (ADRs) of tetracyclines in children younger than 8-year-old.
UNASSIGNED: FAERS analysis identified 32 ADRs of tetracyclines in children younger than 8-year-old. Respiratory, thoracic, and mediastinal disorders contained the most frequent ADRs among all system organ classes (SOCs). The top three positive signals with the highest proportional reporting ratio (PRR) were laryngeal injury, Horner\'s syndrome and methaemoglobinaemia. Sixteen published tetracyclines-associated cases in children younger than 8-year-old were identified in the literature, concentrating in three SOCs. Gastrointestinal disorders were the most commonly reported cases (n = 12).
UNASSIGNED: Several ADRs were newly reported only in children younger than 8-year-old in our research, including Horner\'s syndrome and methemoglobinemia. We recommended that the clinical practitioners should pay attention to the ADRs both in instruction and beyond the label. Take close care of children and timely intervene when the treatment is inevitable.

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This study addresses the risks of medication-induced esophageal injury through a case presentation of a 30-year-old patient treated with doxycycline. The case highlights the importance of proper medication administration and the role of endoscopic evaluation in diagnosis and management. The broader discussion emphasizes the prevalence of such injuries, especially with antibiotics, and factors influencing their occurrence. A clinical study illustrates the corrosive effect of tetracycline, highlighting the role of pH and hyperosmolar properties. The study concludes with a reminder of the critical role of healthcare professionals in recognizing and managing medication-induced esophagitis, with endoscopy as a key diagnostic tool.

We report the case of a traveler who returned from Zambia and was diagnosed with Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii conorii. The patient presented to Sapporo City General Hospital with symptoms of fever, malaise, headache, and rash. The pathogen was identified by Polymerase Chain Reaction assays and subsequent analyses. The patient improved with 10-day treatment of oral doxycycline. Although some cases of MSF have been reported in sub-Saharan Africa, none have been reported in Zambia. Rhipicephalus sanguineus sensu lato, the vector of the Rickettsia conorii conorii, has been found in various areas of Zambia. Our case report highlights the potential threat of Mediterranean spotted fever in urban areas of Zambia.

Doxycycline is one of the medications that cause drug-induced esophagitis. This condition occurs due to prolonged contact of the medications with the esophageal mucosa, leading to erosion, ulcers, and, in some cases, stricture of the esophagus. Chest pain, dysphagia, and odynophagia are the most common symptoms. Endoscopy is the gold standard for confirming the diagnosis. The treatment consists of stopping the offending medication and starting proton pump inhibitors (PPIs) and sucralfate. Herein, we describe a middle-aged man who presented with severe chest pain, odynophagia, and dysphagia that started two hours after ingesting the first doxycycline pill. An endoscopy showed multiple longitudinal ulcers in the distal esophagus. Symptoms significantly improved after starting a PPI and sucralfate, and feeding was resumed two days later. A follow-up with endoscopy after two months reported completely healed esophageal ulcers. In conclusion, doxycycline-induced esophageal injury is often an underdiagnosed and underreported condition. Physicians and patients should be more aware of doxycycline\'s detrimental effect on the esophagus, as it can induce esophageal ulceration even after a single dose if not administered properly. Therefore, all patients prescribed oral doxycycline should receive appropriate instructions to minimize this side effect.

Treatment of peri-implant diseases focuses on reducing the bacterial load and consequent infection control. The use of local antimicrobials as an adjunct to mechanical therapy may result in a better outcome. Among antimicrobials, doxycycline stands out because of its local modulation of cytokines, microbial reduction, and clinical parameters in the treatment of periodontal diseases. The objective of this case report was to describe the combined application of mechanical debridement and bioresorbable doxycycline-loaded nanospheres for the treatment of peri-implantitis in a 71-year-old man. At the 3-year evaluation, the peri-implant tissues had improved, showing decreased probing depths, an absence of bleeding on probing, and no suppuration. This case report highlights the importance of supportive therapy, which is essential for the long-term success of peri-implantitis treatment.