Introduction: Histoplasmosis is a rare opportunistic, inhalation-acquired systemic mycosis caused by Histoplasma capsulatum, endemic to Southeast Asia, including Malaysia. Although classically seen in immunocompromised hosts, it is increasingly reported in immunocompetent individuals. Infection is associated with environmental exposures such as bat or bird droppings and soil disruption. Histoplasmosis is a progressive granulomatous disease that can closely mimic tuberculosis and malignancy, making diagnosis challenging. Case: An 87-year-old Malay male with a history of treated pulmonary tuberculosis presented with a 6-month history of intermittent fever, anorexia, weight loss, and hypotension. Initial computed tomography imaging demonstrated bilateral heterogeneous adrenal masses (right: 2.2 × 3.7 × 5.0 cm; left: 2.0 × 3.7 × 5.2 cm) with indeterminate washout characteristics. Biochemical adrenal evaluation, including a short Synacthen test, confirmed primary adrenal insufficiency. Extensive microbiological and malignancy workup, including bronchoscopy, cultures, and tumor markers, was non-diagnostic. In view of clinical deterioration and epidemiological risk, empirical antituberculous therapy was initiated; however, no clinical improvement was observed after 2 months. PET-FDG revealed intensely hypermetabolic bilateral adrenal masses (SUVmax right 16.7, left 13.2) with no other abnormal foci. Non-invasive fungal investigations were negative. Definitive diagnosis was established via computed tomography-guided adrenal biopsy, which demonstrated necrotizing granulomatous inflammation with intracellular yeasts, subsequently identified as H. capsulatum. The patient was treated with oral itraconazole and corticosteroid replacement, resulting in significant clinical improvement and planned interval radiological reassessment. Conclusion Disseminated histoplasmosis is a diagnostic challenge, particularly in frail elderly patients, where invasive procedures may be delayed. It can mimic tuberculosis and malignancy and may lack an identifiable exposure history. Non-invasive tests may be inconclusive, making tissue biopsy essential. Adrenal involvement may result in primary adrenal insufficiency, further complicating the clinical picture. Early consideration and timely confirmation are crucial for appropriate management.
Adrenal incidentaloma ; Lung Neoplasms

Purpose: Cyclodialysis can occur after ocular trauma or intraocular surgery and can lead to persistent hypotony and vision loss if not treated appropriately. In eyes with prior trabeculectomy, conventional cyclopexy requires a conjunctival incision, which may compromise a functioning filtering bleb. We present a case in which a capsular tension ring (CTR) was inserted into the ciliary sulcus to repair cyclodialysis without conjunctival incision, preserving the filtering bleb.Case summary: A 65-year-old man developed hypotony, a shallow anterior chamber, and cataract progression after trabeculectomy. Swept-source anterior segment optical coherence tomography revealed approximately 200° of cyclodialysis involving the nasal and temporal quadrants. The patient had already lost vision in the left eye, and the right eye represented the only eye with preserved visual potential. As preservation of the filtering bleb in the right eye was essential, phacoemulsification with intraocular lens implantation was performed, and a CTR was inserted into the ciliary sulcus without conjunctival incision. One day after surgery, anterior segment optical coherence tomography confirmed complete reattachment of the ciliary body. At the 1-year follow-up, the ciliary body remained well attached with no recurrence of cyclodialysis. The filtering bleb appeared clinically diffuse and healthy, and both visual function and intraocular pressure remained stable throughout the follow-up period. Conclusions Insertion of a CTR into the ciliary sulcus without conjunctival incision enabled successful closure of the cyclodialysis cleft while preserving filtering bleb function, offering a practical treatment option for eyes with prior trabeculectomy.

Purpose: To compare the clinical outcomes of early pars plana vitrectomy versus intravitreal antibiotic injection in patients who developed infectious endophthalmitis after cataract surgery. Methods: The medical records of patients diagnosed with infectious endophthalmitis following cataract surgery between 2006 and 2023, whose initial best-corrected visual acuity (BCVA) values were 0.48 to 2.3 in LogMAR units, were retrospectively reviewed. Final BCVA and the degree of visual improvement were compared between early vitrectomy and intravitreal antibiotic injection-only groups. Additionally, patients who underwent delayed vitrectomy within 3 days after the initial intravitreal antibiotic injection (delayed vitrectomy group) were separately analyzed and compared. Results: At 6 months post-treatment, the mean BCVA values were significantly better in the early vitrectomy group (0.37 ± 0.27) than in the injection group (1.02 ± 0.81) (p = 0.004); the early vitrectomy group also had greater visual improvement at both 1 week and 6 months after treatment (p = 0.004, p < 0.001). Compared to the delayed vitrectomy group, the early group demonstrated significantly greater visual improvement at both time points (p = 0.010, p = 0.001). The retreatment rate was higher in the injection group than in the early vitrectomy group. Conclusions In patients who developed infectious endophthalmitis after cataract surgery and had an initial visual acuity between light perception or better and 20/60, early vitrectomy resulted in better visual outcomes compared to intravitreal antibiotic injection alone or delayed vitrectomy.

Objectives: In alignment with the World Health Organization’s goal of eliminating hepatitis C, this study assessed the current treatment status and reasons for non-treatment among patients with hepatitis C in Jeonbuk State, Republic of Korea, to inform strategies for improving care engagement. Methods: Among 311 individuals diagnosed with hepatitis C and reported through the NationalNotifiable Infectious Disease Surveillance system between January 2023 and June 2024, 208 patients were surveyed after excluding those who had died or could not be contacted.Statistical analyses included the chi-square test, the Cochran-Armitage test for trend, and logistic regression. Results: Overall, 116 participants (55.8%) reported having received antiviral therapy. Among the 92 untreated individuals, the most common reason for non-treatment was the absence of symptoms (n = 23; 25.0%), followed by the burden of drug costs (n = 21; 22.8%). Conclusion These findings highlight suboptimal treatment uptake and key barriers that may hinder progress toward hepatitis C elimination. Expanding screening and strengthening linkage-to-care strategies, while addressing financial barriers, will be essential to achievingnational elimination targets.

Purpose: This study was performed to compare clinical features and emergency department (ED) outcomes between children and adults with non‑typhoidal Salmonella (NTS) gastroenteritis in a single‑center cohort. Methods: We retrospectively reviewed electronic medical records of ED patients with stool multiplex polymerase chain reaction-confirmed NTS at CHA Bundang Medical Center from January 2016 through December 2021. Demographics, presentation, laboratory and imaging findings, microbiology, and treatments were abstracted. Primary outcomes were the high acuity (a Korean Triage and Acuity Scale level 1-2), ED length of stay, and disposition. Results: Of 189 patients, 134 were children and 55 adults. The children had fewer comorbidities (5.2% vs. 56.4%; P < 0.001) and high acuity (children, 0% vs. adults, 14.5%), shorter median ED length of stay (237.0 minutes [interquartile range, 188.0-336.0] vs. 360.0 minutes [335.0-569.0]; difference, 123.0 minutes [95% confidence interval, 85.0-328.0]; P < 0.001), and less frequent hospitalizations to the intensive care unit (children, 0% vs. adults, 14.5%; P < 0.001). Fever (94.8% vs. 63.6%) and hematochezia (37.3% vs. 0%) were more common in the children (Ps < 0.001), while adults had higher frequencies of abdominal pain (87.3% vs. 71.6%; P = 0.020) and enteritis/ileus on radiography (63.3% vs. 45.3%; P = 0.033), and higher median values of segmented white blood cells (79.0% vs. 69.4%; P = 0.010) and C‑reactive protein concentration (7.2 vs. 6.3mg/dL; P < 0.001). Ceftriaxone was more commonly used in the children (children, 72.7% vs. adults, 51.9%; P < 0.001). Conclusion Compared with the adults, the children with NTS gastroenteritis presented with lower clinical acuity, shorter ED stays, and no hospitalizations to the intensive care unit, despite more common fever and hematochezia. These findings may support a conservative ED approach in children with careful, indication‑based antibiotic use and highlight opportunities for antimicrobial stewardship.

Purpose: Children with tic disorders/Tourette syndrome (TD/TS) frequently present with co-occurring neuropsychiatric conditions, such as obsessive-compulsive disorder and a range of behavioral issues. However, these accompanying problems may be overlooked during diagnosis. This study aimed to investigate the neurocognitive and behavioral characteristics of children with TD/TS who visited a pediatric clinic. Methods: We retrospectively reviewed medical records of children diagnosed with TD/TS at a secondary referral center in Korea. A subset of these data was statistically compared with those from healthy controls. To minimize confounding factors, only children with cognitive development within the normal range were included. Results: Data from 36 children with TD/TS (27 males, nine females; ages 6 to 14 years, mean 9.5±2.1) were analyzed. The mean Full Scale Intelligence Quotient (FSIQ) on the Korean–Wechsler Intelligence Scales for Children (K-WISC) was 98.8±11.7 (n=24). Compared with healthy controls (n=38), the TD/TS group (n=13) scored significantly lower on the Perceptual Reasoning Index, despite no group difference in overall FSIQ (K-WISC-IV). On the Korean Child Behavior Checklist, the TD/TS group showed significantly higher rates of clinical-range scores in multiple domains, including anxiety, somatic complaints, attention problems, and obsessive-compulsive behaviors (P<0.05). The mean Korean-attention-deficit/hyperactivity disorder Rating Scale-IV (K-ARS-IV) score was 11.3±7.7, with 17.1% of participants exceeding the clinical threshold. Conclusion Children with TD/TS and normal cognitive development demonstrate specific neurocognitive weaknesses and elevated behavioral/emotional problems. Early behavioral and cognitive assessments should be incorporated into the initial evaluation.

Background: The accurate laboratory-based detection of respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is essential for effective patient management and infection control in the post–coronavirus disease 2019 era. In this study, the performance of the PowerChek Respiratory Virus Panels 1–4 assay (Kogene Biotech) in detecting non-SARS-CoV-2 respiratory viruses and SARS-CoV-2 was compared with those of two established commercial assays. Methods: Residual clinical respiratory specimens collected between December 2023 and February 2024 were retested using the PowerChek assay. Of the 129 specimens retested, 80 had tested positive for 14 non-SARS-CoV-2 respiratory virus targets in the Allplex Respiratory Panels 1–3 assay (Seegene) and 49 had been tested using the Alinity m SARS-CoV-2 assay (Abbott; 20 positive and 29 negative for SARS-CoV-2). Agreement, Cohen’s kappa, and discordant results were assessed. Results: For the 14 non-SARS-CoV-2 respiratory virus targets, the virus-specific overall percent agreement (OPA) ranged from 95.0% to 100%, the positive percent agreement (PPA) ranged from 66.7% to 100%, and the negative percent agreement (NPA) ranged from 96.0% to 100%, with kappa values of 0.64–1.00. Lower agreements were observed for human coronavirus OC43 and influenza A virus. For SARS-CoV-2 detection, the OPA was 98.0% (PPA, 95.0%; NPA, 100%; kappa, 0.96). Conclusion The detection performance of the PowerChek assay was comparable to those of the established assays for most respiratory virus targets, with lower agreement observed for some targets. These features support its practical utility for the routine multiplex molecular detection of respiratory viruses, including SARS-CoV-2.

Background: Alitretinoin, a pan-retinoid receptor agonist approved for chronic hand eczema, exhibits immunomodulatory effects that may benefit alopecia areata (AA). However, clinical evidence for its use in AA is limited. Objective: To evaluate alitretinoin's clinical efficacy and immunological mechanism in patients with AA. Methods: We reviewed retrospectively twenty-one patients with AA who were treated with alitretinoin, either as monotherapy (n=9) or add-on therapy (n=12). Treatment response was assessed using the Severity of Alopecia Tool (SALT) scores, and in vitro studies used human outer root sheath cells stimulated with interferon-γ and polyinosinic:polycytidylic acid to investigate the drug’s effects on inflammatory pathways. Results: Both groups showed significant reductions in SALT scores (p=0.04 and p=0.02, respectively). Patients with baseline SALT scores below 50 demonstrated superior improvement.Adverse events were mild, with headache (33.3%) and cheilitis (4.8%) being the most common. In vitro, alitretinoin suppressed interleukin-6 and tumor necrosis factor-α expression, decreased phosphorylation of signal transducer and activator of transcription (STAT) 1/STAT3, and downregulated major histocompatibility complex class I expression, suggesting restoration of hair follicle immune privilege. Conclusion Alitretinoin appears to be a safe and potentially effective treatment for patients with mild to moderate AA unresponsive to conventional therapies. Its role as a monotherapy or adjunctive option in selected cases warrants further investigation through larger controlled studies.