Ischemic alopecia as a complication from therapeutic embolization of the middle meningeal artery.

Selective endovascular embolization using microspheres is a widely used, relatively low-risk procedure to control intracranial bleeding. Side effects such as cranial nerve palsies and stroke have been reported in the literature. Skin necrosis and alopecia are exceedingly rare complications of endovascular embolization with a reported incidence of less than 1%. We report a case of a 55-year-old female who developed alopecia following a therapeutic embolization of the middle meningeal artery using microspheres. The clinical-histopathologic diagnosis and relevant literature are reviewed.

Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI.

Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.

Novel Presentation of Reticulate Acropigmentation of Kitamura With Bilateral Clinodactyly.

Reticulate acropigmentation of Kitamura (RAPK) is a rare genetic hyperpigmentation disorder that is a member of the dyschromatoses characterized by hyperpigmented macules or papules that may interrupt the dermatoglyphics with extra-dermatological manifestations. We present a case of a 29-year-old black male who presented with hyperpigmented atrophic macules both on the extremities and genitals, as well as bilateral clinodactyly of the 5th fingers and inferior gingival hyperplasia with teeth crowding, to draw attention to the novel extra dermatological manifestations of RAPK and the differential diagnosis of cutaneous hyperpigmented lesions.

Correction: Novel Presentation of Reticulate Acropigmentation of Kitamura With Bilateral Clinodactyly.

[This corrects the article DOI: 10.7759/cureus.26894.].

Psychogenic Polydipsia in a Patient With a Clinical Triad.

Psychogenic Polydipsia (PP) is a condition involving excessive fluid intake causing hyponatremia. While the mechanism is unknown, treating arginine vasopressin (AVP) dysregulation with the class of drugs, vaptans, during acute psychotic episodes has been an effective treatment. These patients may present with a triad of acute psychosis, polydipsia, and electrolyte imbalances suggesting a syndrome of inappropriate antidiuretic hormone. Our patient is a 57-year-old female with a past medical history of schizophrenia who presented with seizures due to severe hyponatremia in the context of excessive water consumption and mild delusions regarding her sister. Her episodes of neural dysfunction started after she stopped taking her antipsychotic medications, making a drug-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) less likely. However, she had a normal urine osmolality raising suspicion of antidiuretic hormone involvement. The mechanism of hyponatremia in the context of polydipsic schizophrenia is not well established. Some evidence suggests that brain changes may cause AVP dysregulation, which can be exacerbated by acute psychotic episodes. Our case report describes a clinical scenario with the clinical triad of acute psychosis, polydipsia, and electrolyte imbalances suggestive of this mechanism.

Bullous Pemphigoid: A Spontaneous Presentation in a Patient With Chronic Kidney Disease.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering pathology characterized by the development of pruritic, tense bullae and blisters on the lower extremities, axilla, and trunk. Its dermatopathology entails autoantibodies that target hemidesmosomes located in the basement membrane. The disease typically manifests in individuals over 50 years old with a higher prevalence in patients with concurrent neurological or dermatological autoimmune diseases. In this report, we discuss a case of a 67-year-old male who presented with a one-month history of itchy blisters occurring bilaterally in the lower extremities. The manifestation of BP, its pathophysiology, and treatment modalities are explored, We also engage in a review of the relevant literature.

Salvage of Chronic Therapy-Resistant Bilateral Charcot Foot Osteoarthropathy with Signs of Osteomyelitis.

Charcot arthropathy is an insidious condition affecting the lower limbs of diabetic patients. It is a complication of diabetic neuropathy resulting from subsequent Wallerian degeneration of the nerves. This complication may eventually lead to limb amputation and a poor patient prognosis if not diagnosed and treated successfully. Herein, we report the case of a 73-year-old female who presented with rapidly progressive bilateral Charcot foot over a 5-week period, necessitating an exostectomy on the mid foot, specifically on the cuboid bone and the navicular cuneiform joint. Her presentation with rapidly progressing foot ulcers on the plantar aspect prompted initial treatment based on osteomyelitis. The report will therefore serve as a useful guide on how to properly treat Charcot foot, which may present in an atypical manner.

Retraction: Triumvirate Presentation and Treatment of Psoriasis in the Setting of HIV and Treponema pallidum Infection.

[This retracts the article DOI: 10.7759/cureus.22129.].

Triumvirate Presentation and Treatment of Psoriasis in the Setting of HIV and Treponema pallidum Infection.

Psoriasis is an autoimmune condition in which the immune system attacks healthy skin cells, causing the accelerated formation of new skin characterized by scaly patches or plaques. These lesions are formed due to the formation of new skin underneath dead skin that has yet to be shed. Although the cause of psoriasis is not completely understood, it has been associated with infections that may trigger or exacerbate the condition. Syphilis, a highly infectious sexually transmitted disease, may trigger a psoriasis outbreak; because syphilis is known as "the great imitator", it can present as many other chronic dermatoses and therefore often makes it very difficult to diagnose. Here, we describe a case of a 17-year-old Vietnamese male from Dong Nai Province who was initially diagnosed with psoriasis and later diagnosed with syphilis and HIV infection upon further investigation and testing.

Clinical Presentation and Treatment of Thromboangiitis Obliterans With Superimposed Osteomyelitis.

Thromboangiitis obliterans (TAO) is an autoimmune vasculitis that typically presents in male smokers between the ages of 25 and 40. Although TAO primarily affects medium-sized blood vessels, it can also infiltrate small blood vessels as well as nerves and veins. The inflammation can cause segmental thrombosing and occlusion of the blood vessels leading to gangrene and eventual amputations. This case presents a unique sequela of TAO, in which a 28-year-old male with a chronic tobacco smoking history was diagnosed with TAO after presenting with pain and discoloration in his foot, in addition to superimposed osteomyelitis. This case serves to remind emergency clinicians, internal medicine physicians, general practitioners, and infectious disease specialists of the TAO differential in patients presenting with pain and discoloration in the feet, as well as the importance of working up the patient for any superimposed infections.

Novel Presentation of Cardiotoxicity and Other Complications in Tricyclic Antidepressant Poisoning.

Tricyclic antidepressant (TCA) is a known frequently used and highly potent antidepressant that serves as an unsuspecting source of acute human poisoning. We present a case of an Asian female in her mid-30s who suffered TCA toxidrome that manifested as severe cardiovascular toxicities including arrhythmia characterized by QT elongation that was managed emergently. Hemodynamics and ECG findings improved gradually following appropriate therapy in the intensive care unit. Following two days of treatment, the patient regained consciousness and after seven days the patient made a full clinical recovery and was discharged with no residual neurological effects. The relevant medical literature on TCA poisoning is reviewed.

Presentation and Treatment of cholinergic Crisis in the setting of Carbamate poisoning.

The case details the acute onset of muscarinic poisoning with associated symptoms and long-term complications, as a new readily available suicide tool that clinicians should be keen to, combined with the appropriate treatment so lifesaving therapy may be urgently administered along with future mental health therapy.

Presentation and Repair of Serial Misdiagnosed Congenital Patellar Dislocation.

Congenital patellar dislocation (CPD) is a rare deformity in children that involves a laterally displaced patella. While potentially identified in early childhood using diagnostic imaging techniques, it is often misdiagnosed at birth, creating pain and mobility issues as the child grows. Dislocation of the patella is permanent and manually irreducible, often manifesting with flexion contracture of the knee, genu valgum, external tibial torsion, and foot deformity. Surgical correction is the treatment of choice in order to prevent future sequelae. We herein present a case of CPD in a four-year-old Asian male who was initially misdiagnosed before undergoing successful surgical repair using the Roux-Goldthwait technique.