Rajagiri Hospital

Scrub typhus is a mite-borne rickettsial infection endemic in many parts of India and typically causes small-vessel vasculitis; large-vessel involvement is rare. We report a 52-year-old immunosuppressed man on long-term tofacitinib who presented with prolonged fever, weight loss, and systemic inflammation, and was found to have multiple pseudoaneurysms involving the abdominal aorta, carotid, and popliteal arteries, along with pulmonary nodules and necrotic lymphadenopathy. Extensive evaluation for tuberculosis, fungal infections, and bacterial endocarditis was negative, with no response to broad-spectrum antimicrobials or antitubercular therapy. Serology for scrub typhus was positive following identification of travel to an endemic area, and doxycycline led to rapid clinical and biochemical improvement. Selected pseudoaneurysms were managed surgically and endovascularly with good outcomes. This case highlights scrub typhus as a rare cause of large-vessel pseudoaneurysms in immunosuppressed patients in endemic regions.

Extrahepatic portal vein obstruction (EHPVO) is a major cause of noncirrhotic portal hypertension, particularly in children and young adults. Traditionally, definitive management relied on surgical shunts such as proximal splenorenal shunt and meso-Rex bypass; however, extensive porto-mesenteric thrombosis, unfavorable anatomy, perioperative morbidity, and limited surgical expertise may restrict surgical feasibility in many patients. Over the last decade, advances in interventional radiology have substantially expanded therapeutic options beyond surgery. Portal vein recanalization (PVR) is increasingly considered a physiological endovascular treatment strategy in anatomically suitable patients because it restores hepatopetal portal flow while preserving native hepatic perfusion. In patients with diffuse intrahepatic involvement, persistent portal hypertension, or inadequate portal inflow, adjunctive transjugular intrahepatic portosystemic shunt (TIPS) may improve decompression and long-term patency. Transjugular extrahepatic portosystemic shunt (TEPS) serves as an advanced salvage option in complex anatomy unsuitable for conventional TIPS, while partial splenic embolization and variceal embolization complement management of hypersplenism and refractory variceal bleeding. This review provides an overview of endovascular interventions in EHPVO, highlighting the underlying rationale, patient selection, techniques, outcomes, and complications.

Orthobiologics, a subset of regenerative medicine, involves autologous or allogeneic cells and bioactive molecules to promote musculoskeletal tissue repair and regeneration. This review examines the evolution, clinical applications, limitations, and future directions of orthobiologic therapies. Modalities such as mesenchymal stromal cells, platelet-rich plasma, extracellular vesicles, and growth factors have shown promise in managing tendinopathy, partial tears of ligaments and tendons, osteoarthritis, avascular necrosis, and other soft tissue injuries. These therapies can modulate inflammation, enhance healing, and potentially delay disease progression.However, clinical translation is hindered by donor variability, lack of preparation and procedural standardization, safety concerns with stem cell use, inconsistent evidence, and the absence of consensus guidelines. The unregulated market has also led to widespread use of unproven biologics. Future integration into core clinical practice requires standardized protocols, regulatory oversight, and robust clinical trials. Advances in gene therapy and endogenous stem cell mobilization may further enhance therapeutic outcomes and position orthobiologics as a key component of joint preservation and regenerative musculoskeletal care.