Nicolau syndrome is a rare adverse reaction at the site of an intramuscular injection, and is characterized by severe pain immediately after the injection and rapid development of distinct skin lesions. As this syndrome is rare, it may be overlooked at the early clinical phase and subsequently, clinical outcomes may be worse due to delay in treatment. We report on a female who developed Nicolau syndrome following intramuscular diclofenac injection, which required surgical reconstruction. Understanding the characteristics of Nicolau syndrome and careful surveillance for relevant clinical features may help physicians to more quickly diagnose and treat this condition.
Diclofenac ; Emergencies ; Female ; Humans ; Injections, Intramuscular ; Skin ; Soft Tissue Injuries

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology affecting the oral mucosa. As it is difficult to cure, long-term management aims to improve the patient’s quality of life by reducing inflammation and alleviating pain. While systemic and topical corticosteroids are commonly used treatments, their efficacy is often limited by side effects or poor compliance. This study investigates the effectiveness of intralesional steroid injections (ILIs) in patients resistant to conventional therapies. Two patients with refractory OLP were treated with intralesional triamcinolone acetonide injections administered directly into affected mucosal sites at minimal intervals. Clinical outcomes were assessed over an extended follow-up period using the Numerical Rating Scale (NRS) for pain and evaluations of lesion severity. Both patients exhibited significant and sustained improvements in pain and lesion severity following ILIs treatment. In one case, the NRS score decreased from 8 to 2 over multiple visits, with no additional injections needed in the last 6 months. In the other case, the NRS score improved from 6 to 1, requiring minimal injections for maintenance. The localized treatment was well-tolerated without significant side effects. ILIs are an effective and safe treatment for refractory OLP, offering durable symptom relief while minimizing systemic exposure and associated side effects.This approach provides a practical option for long-term management of OLP, enhancing patient quality of life when conventional therapies are inadequate. Future research should explore the potential of combining ILI with other immunomodulatory agents to further improve therapeutic outcomes.

Situs inversus is an extremely rare autosomal recessive disease with left-right inversion of internal organs. It carries technical difficulties in diagnostic or therapeutic procedures. There have been a few case reports on stone extraction by ERCP in situs inversus patients. ERCP techniques in situs inversus can be classified into conventional method and mirror image method. In mirror image method, the procedure is performed with the patient in the right lateral decubitus position and the endoscopist on the patient's left side. Until now, there is no consensus about which method is better. Herein, we report an unusual case of choledocholithiasis in a patient with situs inversus who underwent ERCP for stone extraction by both conventional method and mirror image method.
Aged ; Balloon Occlusion ; Cholangiopancreatography, Endoscopic Retrograde ; Gallstones/complications/*diagnosis/therapy ; Humans ; Male ; Situs Inversus/complications/*diagnosis ; Stents ; Tomography, X-Ray Computed

Trigeminal neuralgia (TN), primarily affecting the maxillary nerve and mandibular nerve, manifests as sudden and severe facial pain without autonomic symptoms such as tearing and ptosis. However, rare cases present with such symptoms, which necessitate differentiation from short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), as these disorders share similar pain episodes within the trigeminal sensory territory, often including autonomic manifestations. This study aims to clarify distinguishing features and facilitate accurate diagnosis. We report a 63-year-old female presenting with left upper premolar area pain upon infraorbital, zygoma, and upper lip contact. Her pain history followed re-endodontic and prosthodontic treatment of the left upper second premolar, and examination showed electric-like sensations without spontaneous pain. Treatments included anti-inflammatory medications and occlusal adjustments, which proved ineffective. A tentative diagnosis of TN led to treatment with carbamazepine, oxcarbazepine, and baclofen, noting episodic conjunctival injection and asymmetric tongue sensations during severe attacks. This case, marked by touch-evoked, short-duration pain in the maxillary branch and late-emerging mild autonomic symptoms, responded well to carbamazepine, favoring a TN diagnosis over SUNCT/SUNA. The presence of autonomic symptoms in suspected TN cases necessitates careful reevaluation to distinguish from SUNCT/SUNA, particularly when carbamazepine response is suboptimal. Accurate differentiation is crucial for targeted therapy, as medication efficacy varies significantly between these conditions.

Enterovirus 71 (EV71) is the predominant cause of hand, foot and mouth disease (HFMD). The antiviral activity of hederasaponin B from Hedera helix against EV71 subgenotypes C3 and C4a was evaluated in vero cells. In the current study, the antiviral activity of hederasaponin B against EV71 C3 and C4a was determined by cytopathic effect (CPE) reduction method and western blot assay. Our results demonstrated that hederasaponin B and 30% ethanol extract of Hedera helix containing hederasaponin B showed significant antiviral activity against EV71 subgenotypes C3 and C4a by reducing the formation of a visible CPE. Hederasaponin B also inhibited the viral VP2 protein expression, suggesting the inhibition of viral capsid protein synthesis.These results suggest that hederasaponin B and Hedera helix extract containing hederasaponin B can be novel drug candidates with broad-spectrum antiviral activity against various subgenotypes of EV71.
Blotting, Western ; Capsid Proteins ; Enterovirus* ; Ethanol ; Hand, Foot and Mouth Disease ; Hedera* ; Vero Cells

Enterovirus 71 (EV71) is the predominant cause of hand, foot and mouth disease (HFMD). The antiviral activity of hederasaponin B from Hedera helix against EV71 subgenotypes C3 and C4a was evaluated in vero cells. In the current study, the antiviral activity of hederasaponin B against EV71 C3 and C4a was determined by cytopathic effect (CPE) reduction method and western blot assay. Our results demonstrated that hederasaponin B and 30% ethanol extract of Hedera helix containing hederasaponin B showed significant antiviral activity against EV71 subgenotypes C3 and C4a by reducing the formation of a visible CPE. Hederasaponin B also inhibited the viral VP2 protein expression, suggesting the inhibition of viral capsid protein synthesis.These results suggest that hederasaponin B and Hedera helix extract containing hederasaponin B can be novel drug candidates with broad-spectrum antiviral activity against various subgenotypes of EV71.
Blotting, Western ; Capsid Proteins ; Enterovirus* ; Ethanol ; Hand, Foot and Mouth Disease ; Hedera* ; Vero Cells

Background: There is difference in the incidence of multi-system inflammatory syndrome in children (MIS-C) in patients with different variants of severe acute respiratory syndrome coronavirus 2, however, little is known about the epidemiology in Asian countries. We investigated and compared the epidemiology of the MIS-C during omicron-dominant period with that of previous periods in South Korea. Methods: We obtained clinical, epidemiological and laboratory data on MIS-C cases from national MIS-C surveillance in South Korea. We defined pre-delta period as January 2020–May 2021; delta period as June 2021–December 2021; and omicron period as January 2022–April 2022. We describe the clinical characteristics and outcomes of MIS-C patients by period. Results: A total of 91 cases were assessed to be MIS-C cases. Number of MIS-C cases have increased from six cases during pre-delta period to 66 cases during omicron period, while the incidence rate (the number of MIS-C cases per 100,000 cases of reported coronavirus disease 2019) has decreased from 38.5 cases per 100,000 (95% confidence interval [CI], 14.1–83.9) during pre-delta period to 1.6 cases per 100,000 (95% CI, 1.2–2.0) during omicron periods. During pre-delta period, 66.7% and 100% had hypotension and gastrointestinal involvement, respectively; while during omicron period, 12.1% and 6.1% had such clinical manifestations. Fifty percent of pre-delta MIS-C patients were taken intensive care unit (ICU) cares, while 10.6% of patients during omicron periods were in ICUs. Conclusion Omicron period were associated with less severe clinical manifestation compared to pre-delta and delta periods. Although incidence rate of MIS-C was lower for the omicron period than pre-delta and delta periods, number of patients reported with MIS-C may pose a substantial clinical burden.