BACKGROUND:Appropriate tapering strategy for corticosteroids in ulcerative colitis (UC) is uncertain. AIM:To compare the efficacy and safety of two steroid tapering regimens in patients with active UC. METHODS:We randomised patients with active UC with initial steroid response after 2 weeks to short (total 6 weeks) or long taper (total 10 weeks). Randomization was stratified for acute severe UC. The primary outcome was steroid-free clinical remission at 6 months. Secondary outcomes included assessment of symptomatic remission, relapse rate, endoscopic and histological scores, and safety. RESULTS:Of 94 patients (48 in long, 46 in short taper) randomised, short taper was inferior to long taper in inducing clinical remission at 6 months (RR = 2.19; CI 1.08-4.46; p = 0.02). The relapse rates were similar in the long (37%) and short taper (46%) arms (HR: 0.34; CI: 0.10-1.11; p = 0.42). The median UCEIS scores (3 vs. 2; p = 0.23) and Nancy scores [2 (IQR 0-3) vs. 1.5 (0.75-3); p = 0.4] were not different between arms. Adverse events in the long and short taper arms, such as acne (14.58% vs. 2.16%), myopathy (8.33% vs. 6.52%), skin changes (2.08% vs. 2.17%), mood changes (0% vs. 4.34%), cytopenia (0% vs. 2.17%), and headache (6.25% vs. 6.52%) were similar. CONCLUSION:A shorter taper duration of 6 weeks was inferior to a longer taper of 10 weeks in achieving clinical remission of UC at 6 months. TRIAL REGISTRATION:CTRI Number: CTRI/2021/06/034129.

Angiomyolipoma (AML) is an uncommon mesenchymal neoplasm with myomelanocytic differentiation. Hepatic AML (HAML) is an uncommon tumor that often mimics a primary hepatic epithelial malignancy and is a challenging diagnosis for clinicians and pathologists. This article discusses the clinical, radiological, histopathological, and immunohistochemical details of two cases of HAML and their differential diagnoses. A 46-year-old woman and a 38-year-old man presented with pain, weakness, and weight loss. Radiology revealed large, well-defined, heterogeneous, enhancing masses in the non-cirrhotic liver. Histopathology showed a variable combination of epithelioid cells, spindle cells, adipocytes, and thick-walled blood vessels with smooth muscle actin (SMA) and HMB45 immunopositivity. The diagnosis of HAML depends on classical histopathology. However, a wide array of differential diagnoses should be considered depending on the proportionate representation of each component. A detailed histological evaluation, judicious use of immunohistochemistry to document myo-melanocytic differentiation, and awareness of the entity are useful for the correct diagnosis.

BACKGROUND Discriminating between gastrointestinal tuberculosis (GITB) and Crohn's disease is a perplexing challenge for clinicians. The clinical presentation, endoscopic appearances, radiographic features, and histological findings of these two granulomatous disorders are similar. AIM To study the diagnostic accuracy of Xpert MTB/RIF Ultra (Xpert Ultra) and TrueNat MTB plus assay (TrueNat Plus) in the diagnosis of GITB diagnosis. METHODS We prospectively included patients suspected to have GITB who underwent colonoscopy and had endoscopic findings consistent with tuberculosis, such as ulcers, ulcerated strictures, and ulcero-polypoidal lesions. Xpert Ultra and TrueNat Plus assays were performed using standard protocols from intestinal tissue to assess the comparative performance of the two assays (Xpert Ultra and TrueNAT Plus) in diagnosing GITB compared with a composite reference standard (CRS). The CRS included a combination of clinical symptoms, tissue acid-fast bacilli smear/culture, imaging findings, histopathology, and response to therapy to diagnose GITB. RESULTS Of the 38 patients with complete follow-up, 26 had GITB, and 12 served as controls (n = 10 Crohn's disease cases, n = 2 alternate diagnosis). GITB cases included three acid-fast bacilli culture-positive patients, four with granulomas, 17 with Xpert Ultra positivity and 15 with TrueNat plus positivity. Compared with the CRS, the overall sensitivity and specificity of Xpert Ultra for the diagnosis of GITB was 65.38% [95% confidence interval (CI): 44.33-82.79] and 83.33% (95%CI: 51.59-97.91), respectively. TrueNat plus had a sensitivity of 57.69% (95%CI: 36.92-76.65) and specificity of 50% (95%CI: 21.09-78.91). CONCLUSION TrueNat plus has a lower sensitivity and specificity compared with Xpert Ultra. However, the improved sensitivity of these tests compared with standard tests comes at the cost of reduced specificity.

Pigment cast nephropathy can cause an acute decline in renal function. The cause of pigment casts in renal allografts is poorly understood, although it has been observed in recipients of road traffic accident donors. We describe a case of pigment cast nephropathy in a renal allograft identified through several sequential biopsies performed for allograft dysfunction. A 27-year-old man underwent a deceased donor kidney transplant and developed delayed graft function with elevating creatinine levels. Early biopsies showed calcineurin inhibitor toxicity and pigment casts, and although tacrolimus was adjusted, kidney function continued to fluctuate. Over the following months, repeated biopsies consistently revealed pigment casts coexisting with pyelonephritis and antibody-mediated rejection. Despite treatment with antibiotics and intensified immunosuppression, the casts persisted. Further evaluation confirmed that the casts contained hemoglobin, and further investigations confirmed glucose-6-phosphate dehydrogenase (G6PD) deficiency as the underlying cause. After managing infections and rejection, his kidney function stabilized with creatinine at 1.55 mg/dl. Pigment cast nephropathy in the posttransplant setting can be triggered by a myriad of causes, which in the index case were deceased donor trauma–related myoglobinuria, infections, and finally G6PD deficiency–related hemoglobinuria. The trigger factors for G6PD deficiency include certain drugs and infections.

Background: Clostridioides difficile infection (CDI) is well-recognised as a cause of flare in inflammatory bowel disease (IBD). Objectives: To prospectively evaluate CDI as a cause of flare in moderate-to-severe ulcerative colitis (UC) and perform a region-specific systematic review to evaluate the role of CDI in IBD patients in South Asia. Design: A single-centre prospective observational study followed by a region-specific systematic review. Data sources and methods: The observational study was conducted between December 2024 and December 2025 and included patients with moderate-to-severe UC flares. Triple testing using Stool glutamate dehydrogenase (GDH), an enzyme immunoassay (EIA) for toxin A/B, and polymerase chain reaction (PCR) testing was performed. A literature search in PubMed, Embase, and Scopus was conducted on 5th December 2025 to identify relevant studies from South Asia. Information on the study population (IBD type, age, gender, disease activity), the testing method, and the outcomes of CDI testing were extracted. The pooled prevalence of CDI was estimated using a random-effects model. The risk of Bias was assessed using Joanna Briggs’ tool. Results: Of the 101 patients with active UC, 59 had acute severe UC. Six patients tested positive for GDH, whereas only one tested positive for EIA and PCR. A total of 13 studies reporting on 1267 patients were included in the systematic review. Pooled prevalence of CDI was 0.06 (0.03–0.11, I 2 = 80.8%). Subgroup analyses were performed by testing method, study type, and region. However, there was persistent statistical heterogeneity. Funnel plot and Egger’s test suggested the presence of publication bias. Conclusion: Our observational study shows a low prevalence of CDI as a cause of UC flares. The findings of the systematic review suggest high variability in the CDI positivity across South Asia. These differences were not fully explained by the method of testing, the type of study, or the geographic location of the study.

Collagenous colitis-like amyloid deposition in the gastrointestinal tract is an uncommon pattern of gastrointestinal amyloidosis. This pattern is usually associated with AA-amyloid. The recognition of this pattern is difficult for an unaware pathologist. We report collagenous colitis-like deposition of AA amyloid in a 45-year-old woman at the time of autopsy. The woman suffered from antisynthetase syndrome-systemic lupus erythematosus overlap syndrome-was on continued immunosuppression and presented with fever, watery diarrhea, and vomiting. The amyloid showed a band-like congophilic subepithelial deposition throughout the large intestine and terminal ileum. This pattern of amyloid deposition can be distinguished from collagenous colitis by its pale blue-green color on Masson trichrome stain, frayed/fuzzy edges, congophilia with apple-green birefringence, and SAA-positivity.

BACKGROUND:Anti-complement factor H antibody- (anti-CFH Ab) associated atypical hemolytic uremic syndrome (aHUS) is a known cause of pediatric complement-mediated thrombotic microangiopathy. In our center, plasma exchange (PEX) until remission paired with immunosuppression continues to be the mainstay of therapy, due to limited access to eculizumab. We wanted to study the long-term outcome of this cohort. METHODS:We conducted a retrospective cohort study of children (<12 years) with Anti-CFH Ab-associated aHUS admitted between January 2017 and December 2024 at our center. Clinical, laboratory, treatment, and outcome data were retrieved from medical records. The primary outcome was renal recovery, defined as eGFR >90 mL/min/1.73 m2 with normal blood pressure, no significant proteinuria, and absence of hematuria at last follow-up or at 5 years. RESULTS:Of 66 records screened, 40 children were eligible. Median age at presentation was 7 years (interquartile range [IQR] 5,8). Median anti-CFH Ab titer was 306 AU/mL (IQR 214-426). Low C3 was noted in 55% of subjects. All patients received PEX (median 11 cycles; IQR 7.25, 20) and immunosuppression. Median follow-up was 24 months (IQR 7-53). At last follow-up, 21 (52.5%) achieved complete renal recovery, while 19 (47.5%) had CKD stage 2-4. Relapse incidence was 7.1 per 100 person-years, usually within 6 months of onset. No baseline clinical, laboratory, or treatment variable except duration of dialysis independently predicted renal recovery. Persistent proteinuria was observed up to 6 months but subsequently improved. CONCLUSIONS:PEX paired with immunosuppression remains effective for anti-CFH Ab-associated aHUS, but further studies are needed to refine protocols and evaluate complement inhibitors for improved long-term outcomes.

This report documents a young female patient with microgranular variant acute promyelocytic leukaemia (APL) harbouring FLT3-ITD mutation who presented with fatigue, fever, gum bleeding and altered sensorium. Despite prompt initiation of all-trans retinoic acid and arsenic trioxide therapy, she developed worsening respiratory distress and neurological deterioration, succumbing within 70 hours of admission. Postmortem examination revealed extensive extramedullary leukaemic infiltration in the liver, heart, brain parenchyma and meninges, confirming widespread disease beyond the commonly recognised medullary involvement. This case highlights the diagnostic challenges in differentiating extramedullary APL from haemorrhagic complications and differentiation syndrome. Our literature review reveals that extramedullary involvement in APL at diagnosis is rare but clinically significant, with skeletal and central nervous system (CNS) being the most common sites. The optimal management strategies remain undefined, particularly for CNS-directed therapy. This case underscores the importance of considering extramedullary involvement in APL patients with atypical or rapidly progressive presentations.

Calciphylaxis is a rare and life-threatening condition caused by the buildup of calcium in the small blood vessels. It usually affects the deep layers of the skin and tissues in areas such as the abdomen and lower limbs, but can also affect internal organs like the intestines, causing symptoms like gastrointestinal bleeding and bowel tissue death. We encountered a case of calciphylaxis affecting the blood vessels in the intestines of a chronic kidney disease patient who had received a deceased donor kidney transplant. Unfortunately, the diagnosis was delayed, leading to a fatal outcome. This case underscores the importance of considering visceral calciphylaxis in high-risk patients, even when there are no outward signs on the skin.

Renal allograft mucomycosis is a rare but potentially fatal fungal infection that can occur in kidney transplant recipients. This case report describes the case of a 43-year-old male with diabetic nephropathy who underwent live-related renal allograft transplantation in March 2024. Three months posttransplant, he presented with fever, acute allograft dysfunction, and pancytopenia, initially suspected to be graft pyelonephritis. However, further investigation, including a fine-needle aspiration, revealed invasive mucormycosis in the graft kidney, confirmed on culture. Despite aggressive treatment with antifungals and supportive care, the patient developed complications including graft nephrectomy, surgical site infections, and pneumonia. Unfortunately, he succumbed to severe sepsis 2 weeks postnephrectomy. This case highlights the rare but fatal risk of mucormycosis in renal transplant recipients.

Background Kidney involvement has been reported frequently in people with Dengue virus infection (DVI). We evaluated the patterns of renal involvement in DVI and its effect on morbidity and mortality. Materials and Methods This study was conducted on 170 patients hospitalized with dengue fever in a tertiary care hospital between July 2022 and September 2023. Patients were tested for clinical and laboratory parameters, including urine routine and microscopy, spot urine protein/creatinine ratio, and ultrasonography. Patients with renal involvement were followed up for four and 12 weeks. Results Of 170 patients, 51 (30%) had renal involvement, and 36 (21.17%) had acute kidney injury (AKI). Ten patients developed Kidney Disease Improving Global Outcome Stage 3 AKI, of which seven required kidney replacement therapy, and 27.6% of patients developed urinary abnormalities. Patients with renal involvement had higher mortality (p-value <0.001). Among those who survived, renal abnormalities resolved in all except one who progressed to chronic kidney disease. Three patients showed cast nephropathy in their renal biopsies. Conclusion This study links renal involvement to higher mortality of patients with DVI, underscoring its importance in management and prognostication.

Mammography is traditionally regarded as a domain confined to the detection of breast malignancies; however, it can also serve as a mirror for diverse systemic, haematological, autoimmune, infectious, and metabolic diseases. Imaging manifestations may reveal distinctive pathognomonic features that directly suggest an underlying systemic disorder or provide subtle indirect clues that prompt timely multidisciplinary evaluation, thereby sparing patients from unnecessary procedures. In this comprehensive review, we present one of the most diverse compilations of extramammary and systemic disorders manifesting within the breast. Through multimodality imaging and clinico-pathological correlation, we illustrate entities ranging from tubercular mastitis, IgG4-related mastitis, breast lymphoma, breast metastases, to vasculitis, amyloidosis, diabetic mastopathy, and systemic failure states, including cardiac and renal disease. Mammography provides an underutilised opportunity to assess overall patient health, guide systemic illness workup, and aid in risk stratification for conditions such as cardiovascular disease or syndromic malignancy predisposition, in addition to cancer detection. By consolidating these entities into a single resource, this article aims to expand the interpretive lens of breast radiologists, improving diagnostic precision and enabling them to contribute decisively to multidisciplinary patient care.

Background Viral infections can increase the likelihood of an individual developing membranous nephropathy (MN). Limited information is available regarding the treatment approaches for such cases. We conducted a review focusing on hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV)-associated MN. Materials and Methods Our investigation encompassed patient records and cases documented in the literature, utilizing various search engines (PubMed, Scopus, Embase, and Web of Science). We aimed to identify all reported instances of MN associated with HBV, HCV, or HIV infections between 2010 and February 2023 in individuals aged 18 years and above, who underwent PLA2R testing in their serum or kidney biopsy. Results We analyzed 63 patients with MN associated with viral infections, comprising 7 patients from our center and 57 from the review, consisting of 43% with HIV, 28.5% with HBV, 17.5% with HCV, and 11% with mixed infections. The average age of these patients was 47 years. Their mean proteinuria, serum albumin, and creatinine levels were 7.5 g/day, 2.3 g/dl, and 1.4 mg/dl, respectively. Two-thirds of these cases were PLA2R-related. Notably, 24% of patients achieved remission solely through antiviral treatment, while nearly 40% attained remission with a combination of antiviral and immunosuppression therapies. Eight patients did not achieve remission despite receiving immunosuppressive therapy and antiviral agents. Conclusion The review suggests that using antiviral medications alone or combined with immunosuppressive therapy can lead to substantial remission in patients with viral-associated MN.

INTRODUCTION:The diagnosis and management of abdominal tuberculosis, i.e Gastrointestinal Tuberculosis (GITB) and tuberculous peritonitis (TBP) is challenging. Abdominal tuberculosis, presenting usually with abdominal pain, intestinal obstruction, and constitutional symptoms, is typically a paucibacillary condition. The diagnosis hinges on a correct interpretation of clinical, radiological, histological, biochemical, and microbiological findings as also appropriately assessing response to therapy. AREAS COVERED:The authors review potential missteps that could occur in managing GITB and TBP sourced from published literature and clinical experience. These include avoiding excess use of tests with limited accuracy, understanding limitations of ascitic adenosine deaminase (ADA) and granulomas, avoiding empirical antitubercular therapy (ATT) where possible but also understanding that microbiological tests may not always be positive, and finally not to bank solely on subjective clinical responses but to use objective markers in assessing response to therapy. In addition, diagnosis of predisposing immunosuppressed states, attention to nutrition, appropriate management of sequelae with endoscopic dilatation/surgery, and early surgery when indicated are some of the additional issues discussed. EXPERT OPINION:In future, a more secure diagnosis banking on the use of better microbiological tools, multiparameter-based models, artificial intelligence-based approaches, and use of advances in -omics-based approaches can improve diagnosis and avoid some missteps.

Ulcerative colitis is usually localised to the colon, leading to a uniform mucosal inflammation. Rarely, endoscopic findings or even an abdominal radiograph may reveal mucosal islands, which are defined as patches of residual normal mucosa within inflamed areas. They usually portend a poor prognosis. We report such a case where cytomegalovirus colitis, confirmed via immuno-histochemistry, was found. This case highlights the potential prognostic value of these findings, which, though subtle, can guide early, aggressive, but effective management.