Aim: Acute viral myositis is an uncommon complication that typically occurs during the recovery phase of viral infections and is most frequently observed in children. It is rarely reported in adults and usually presents as myalgia of the proximal upper and lower limbs. This case report describes an atypical presentation of acute myositis in an immunocompetent adult occurring shortly after RSV infection. Methods: A 68-year-old male patient presented with sudden-onset bilateral lower limb myalgia and weakness following recent RSV infection. Laboratory evaluation revealed elevated C-reactive protein with normal creatine kinase levels. The extensive infectious and autoimmune workup was not revealing. MRI, muscle biopsy, and electrophysiological studies were conducted to further investigate the etiology of the symptoms. Results: MRI demonstrated diffuse bilateral muscle edema consistent with inflammatory myositis, while muscle biopsy and electrophysiological studies were unremarkable. The patient received supportive care, including hydration, analgesia, and rest, without corticosteroids or antivirals. Complete recovery occurred within two months. Conclusion: This case highlights an atypical presentation of RSV-associated myositis in an adult patient characterized by normal creatine kinase levels but elevated inflammatory markers. Increased awareness of this rare entity may facilitate prompt diagnosis, and prevent unnecessary diagnostic investigations as well as inappropriate immunosuppressive therapy.
Transverse myelitis is an unusual complication of neurosyphilis. As rare diseases reveal the extraordinary, we present here, a rare case of a young patient with lower limb paresis and difficulty urinating. Neurosyphilis was diagnosed and treatment with penicillin G, corticosteroids and intensive physiotherapy, resulted to significant improvement.
Nasopharyngeal carriage of Streptococcus pneumoniae is a key factor for transmission, invasive disease, and antimicrobial resistance. Data on pneumococcal carriage in children in Cypriot are limited. We conducted a cross sectional study from December 2023 to May 2024, during a period of high PCV10 and PCV13 vaccine coverage in Cyprus, including children aged six months to six years who attended outpatient clinics in Cyprus. Nasopharyngeal swabs were cultured, and Streptococcus pneumoniae isolates were identified using conventional methods and confirmed by polymerase chain reaction. Serotyping was performed using multiplex polymerase chain reaction, latex agglutination, and whole-genome sequencing when needed. Antimicrobial susceptibility was assessed according to European guidelines. Logistic regression was used to identify risk factors for carriage. A total of 809 children were included, 83.85
Nephrotic syndrome (NS) encompasses a heterogeneous group of glomerular diseases characterized by heavy proteinuria, hypoalbuminemia, edema, and multiple systemic complications. Despite substantial advances in diagnostic techniques and targeted therapies, the management of NS remains challenging in clinical practice. In addition to complex treatment decisions, clinicians must address diagnostic uncertainty, recognize secondary causes, and prevent potentially serious complications including thrombosis, infections, cardiovascular disease, and progressive kidney dysfunction. Adverse outcomes in NS frequently arise not only from inappropriate management but also from overlooked steps in diagnosis, monitoring, and long-term care. Here, we present 10 practical tips to improve clinical decision-making in the diagnosis and management of NS. Key positive strategies include appropriate use of kidney biopsy and modern immunopathologic techniques, integration of immunologic biomarkers such as anti-phospholipase A2 receptor antibodies in the evaluation of membranous nephropathy, systematic exclusion of secondary causes, and comprehensive supportive care including blood pressure control, antiproteinuric therapy, and thrombosis prophylaxis in high-risk patients. In addition, evidence-based use of immunosuppressive therapies (IST) tailored to specific disease entities is emphasized. Equally important are commonly overlooked pitfalls that may compromise outcomes, including delayed genetic testing in steroid-resistant disease, prolonged ineffective immunosuppression, inadequate post-transplant surveillance for recurrence, under-recognition of cardiovascular risk, and failure to prevent complications associated with IST. Highlighting these practical considerations may help increase awareness of common pitfalls and support more attentive clinical management of patients with NS.
Abstract Systemic lupus erythematosus (SLE) is associated with significant cardiovascular morbidity, with myocardial involvement representing one of the most clinically significant yet underrecognized cardiac manifestations, largely due to its frequently subclinical presentation and diagnostic complexity. Lupus nephritis (LN), a common and clinically significant manifestation of SLE, is further associated with increased cardiovascular risk, reflecting a dynamic cardiorenal interaction driven by persistent immune activation. Recent advances in cardiovascular imaging techniques have facilitated the early detection of myocardial injury in SLE, improving diagnostic accuracy and enabling timely intervention, but have also uncovered the increased possibility of subclinical, underdiagnosed cases. Herein, this review focuses on myocardial disease in SLE, outlining the diagnostic tools available for early detection of myocardial complications.
