Stereotactic radiotherapy (SRT), including stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hfSRT), plays a key role in the management of brain metastases (BM). As advances in systemic therapies prolong survival, local recurrence of BM has become more frequent, prompting interest in salvage reirradiation strategies. This systematic review aimed to evaluate the efficacy and safety of a second course of stereotactic radiotherapy (SRT2) for in-field recurrent brain metastases. Data on local control, overall survival, and radionecrosis were extracted and pooled using random-effects models. Eleven retrospective studies published between 2020 and 2025 were included, comprising 914 patients and 2,352 brain metastases, with 389 lesions treated with salvage SRS2/SRT2. Patients who had received prior whole-brain radiotherapy were excluded. The pooled 1-year local failure rate was 24
Cornelia de Lange syndrome (CdLS) is a rare genetic disorder characterized by a wide spectrum of clinical severity, ranging from mild to severe forms, and is typically associated with distinctive facial features, growth retardation, and multiple congenital anomalies. We report the case of a 10-day-old male newborn, born at term to non-consanguineous parents, who was admitted for respiratory distress, feeding refusal, and hypotonia. On examination, the patient presented with shock, cyanosis, severe respiratory distress, and marked hypotonia. Dysmorphic facial features were noted, along with bilateral ectrodactyly of the hands, micropenis, and bilateral cryptorchidism. Biological and radiological investigations did not identify any infectious or structural etiology. The diagnosis of CdLS was established based on clinical findings. Despite intensive care management, the patient's condition rapidly worsened, culminating in cardiac arrest with unsuccessful resuscitation. This case highlights a severe neonatal presentation of CdLS with a fatal outcome and underscores the importance of early recognition, multidisciplinary management, and genetic counseling, given the poor prognosis associated with severe forms.
Necrotizing otitis externa (NOE) is a severe and potentially life-threatening infection of the external auditory canal, particularly affecting elderly diabetic or immunocompromised patients. Pseudomonas aeruginosa is the most frequently isolated pathogen. Among fungi, Aspergillus and Candida spp. are the most commonly implicated. Nevertheless, Scedosporium sp. has also emerged as a notable pathogen in NOE. We report the case of a 67-year-old woman with poorly controlled diabetes who presented with persistent right-sided otorrhea and otalgia, complicated by facial paralysis. Imaging revealed bone erosion consistent with NOE. Mycological analysis of ear swabs identified Scedosporium sp. This case highlights the importance of considering fungal pathogens in refractory cases of otitis externa, particularly in high-risk patients. It underscores the need for early mycological investigations to ensure appropriate antifungal therapy.
Hydatid disease is a parasitic infection primarily caused by Echinococcus granulosus. Osseous hydatid disease is an uncommon manifestation and may present significant diagnostic and therapeutic challenges because of its insidious progression and tumor-like appearance. Femoral involvement is particularly rare. We report the case of a 44-year-old hypertensive woman who presented with chronic mechanical pain of the right hip evolving since 2019 and initially treated as lumbosciatica without improvement. MRI revealed an extensive intramedullary osteolytic lesion involving the right femoral diaphysis over 25 cm, initially suggestive of a bone tumor. Histopathological examination following femoral biopsy confirmed intraosseous hydatid disease. The patient underwent intramedullary curettage, reaming, and scolicidal irrigation associated with prolonged albendazole therapy. Despite initial treatment, MRI follow-up demonstrated local recurrence requiring revision surgery with repeated intramedullary debridement and irrigation using hydrogen peroxide and hypertonic saline. At more than six months of follow-up after revision surgery, the patient remained pain-free with preserved limb function and no pathological fracture. This case highlights the diagnostic difficulties, high recurrence potential, and therapeutic challenges of femoral osseous hydatidosis. In endemic regions, hydatid disease should be considered in the differential diagnosis of chronic osteolytic lesions of long bones.
Wiskott-Aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency characterized by the association of thrombocytopenia with microplatelets, eczema, and immune dysfunction, with a highly variable clinical presentation that may include severe hemorrhagic and infectious manifestations in early childhood. We report the case of an infant referred for evaluation of a hemorrhagic syndrome associated with eczema, in whom laboratory investigations revealed severe thrombocytopenia. The clinical course was complicated by a cerebral hemorrhage. The patient was managed with supportive measures, including intravenous immunoglobulin therapy and antibiotic prophylaxis. Despite treatment, thrombocytopenia persisted and required repeated platelet transfusions. Immunosuppressive therapy with corticosteroids and ciclosporin was introduced. This case highlights the importance of early recognition of WAS in infants presenting with thrombocytopenia and eczema, and emphasizes that management remains mainly supportive, while early evaluation for hematopoietic stem cell transplantation is essential to improve prognosis.
