Zeinab El Mawla

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg‐Strauss vasculitis, is a rare systemic autoimmune disease. Neurological involvement is a significant complication. This report details a case of EGPA with severe, progressive polyneuropathy and atypical serological findings, highlighting diagnostic challenges and the importance of early intervention. A 55‐year‐old male with asthma and uncontrolled diabetes presented with progressive neuropathic pain and paraplegia. He had a history of significant eosinophilia. Clinical examination revealed a rash, neurological deficits, and signs of multisystem involvement. Laboratory tests showed marked eosinophilia, elevated inflammatory markers, renal impairment, and positive ANCA. Imaging revealed cerebral ischemic changes and small vessel vasculitis. A skin biopsy confirmed leukocytoclastic vasculitis, and echocardiography showed cardiac dysfunction. The constellation of symptoms led to a diagnosis of EGPA with multisystem involvement. This case illustrates the classic triad of EGPA symptoms: asthma, hypereosinophilia, and multisystem involvement, particularly neurological. The patient's progressive neurological symptoms and positive ANCA supported the diagnosis of CNS vasculitis. The rapid onset of neurological involvement, despite the patient's age and delayed diagnosis, underscores the aggressive nature of EGPA. The multisystem involvement, including cardiac and renal systems, highlights the need for a comprehensive diagnostic and therapeutic approach. Early diagnosis and aggressive immunosuppressive therapy are crucial for preventing irreversible damage. The atypical finding of c‐ANCA positivity, rather than the more common p‐ANCA, presents a diagnostic challenge and warrants further investigation into specific ANCA subtypes (MPO vs. PR3). This case emphasizes the need for a high index of suspicion for EGPA in patients with unexplained neurological symptoms, especially those with asthma or hypereosinophilia, even in the presence of unusual serological markers. EGPA is a complex disease with diverse neurological and systemic manifestations. This case emphasizes the importance of early recognition and prompt treatment with corticosteroids and immunosuppressive agents to improve patient outcomes and prevent long‐term sequelae. Clinicians should consider EGPA in patients with unexplained neurological symptoms, especially those with a history of asthma or hypereosinophilia.

Background: The coexistence of tuberculosis (TB) and diabetes mellitus (DM) represents a threatening health challenge, creating a dangerous double burden, particularly in low- and middle-income countries. DM not only increases susceptibility to TB but also worsens clinical outcomes. Objective: To assess the prevalence and clinical impact of dysglycemia among hospitalized patients with TB and to identify associated factors. Methods: We conducted a retrospective study of 202 adults hospitalized with either active or latent TB at a tertiary hospital between 2013 and 2023. Dysglycemia was defined as fasting plasma glucose (FPG) or admission random glucose test (HGT) ≥ 100 mg/dL, including patient with pre-existing DM; all other patients were classified as euglycemic. Because fasting status and HbA1c were unavailable in most cases, American Diabetes Association (ADA) diagnostic thresholds for DM and prediabetes (Pre-DM) could not be applied. TB Treatment outcomes were categorized according to World Health Organization (WHO) definitions. Descriptive statistics, t-tests, chi-square tests, and multivariable logistic regression were used to compare dysglycemic and euglycemic patients and to assess adjusted associations with adverse outcomes. Results: Dysglycemia was present in 77/202 patients (38.1%) including 7.4% with a prior diagnosis of DM. Patients with dysglycemia were older (45.19 vs. 35.58 years, p < 0.001) and had a higher prevalence of hypertension (23.4% vs. 2.4%, p < 0.001). Dysglycemia was independently associated with the need for intubation (adjusted odds ratio [aOR] 2.50; 95% CI 1.01–6.20), and these patients more frequently required invasive oxygen support (15.6% vs. 6.4%, p = 0.05). No significant differences were found in imaging or overall treatment outcomes between the two groups. Pulmonary TB predominated (94.1%), and 92.1% had active disease. Although mortality reached 13.4%, this might be underestimated, as 66.3% of patients were either discharged or followed up with their private physician. The adjusted association between dysglycemia and mortality was not statistically significant (aOR 1.15; 95% CI 0.55–2.40). Conclusion: A substantial proportion of TB patients had coexisting dysglycemia, associated with higher age, comorbid hypertension, and increased oxygen requirements. These findings highlight the need for integrated screening, early detection, and improved follow-up strategies for TB patients with dysglycemia in Lebanon.

COVID‐19 pneumonia is a strong radiological mimicker of pulmonary alveolar proteinosis (PAP), making their differentiation difficult. PAP is a rare diffuse lung disease caused by the accumulation of surfactant lipoproteins within the alveoli, resulting in impaired gas exchange and respiratory failure, with an estimated prevalence of 3.7–6.2 cases per million. This report presents a rare case of PAP complicated by COVID‐19 pneumonia in a 42‐year‐old man who presented with chills, fatigue, dyspnea and fever. Clinical, laboratory and radiological features were thoroughly assessed. High‐resolution CT revealed a crazy‐paving pattern with patchy consolidations, diffuse ground‐glass opacities and septal thickening. Early recognition of lung diseases with overlapping imaging features is essential to guide management and prevent adverse outcomes. The coexistence of PAP and COVID‐19 was associated with rapid clinical deterioration and poor prognosis. Further studies are needed to clarify underlying mechanisms and optimise treatment strategies.

Hydrocephalus, intraventricular hemorrhage (IVH), and ventriculitis are rare but devastating complications following spinal surgery. Their coexistence significantly worsens prognosis, especially when multidrug-resistant pathogens are involved. A 59-year-old man with a C7 fracture and complete paraplegia underwent anterior and posterior cervical spine surgeries complicated by cerebrospinal fluid (CSF) leakage. He later developed hydrocephalus and IVH, requiring external ventricular drainage. Shortly thereafter, fever and altered consciousness occurred, and pus was observed in the drain. CSF analysis confirmed carbapenem-resistant Enterobacteriaceae (CRE) ventriculitis, specifically caused by Escherichia coli. Treatment with intravenous meropenem, vancomycin, and escalation to intrathecal colistin and tigecycline achieved microbiological clearance. Despite this, neurological recovery was poor, and the patient succumbed 27 days after readmission. This report emphasizes the interplay of mechanical and infectious complications after spinal surgery, highlighting the need for early recognition, aggressive combined therapy, and preventive strategies to improve outcomes.

Introduction: Post-cardiac arrest syndrome (PCAS) is a major cause of mortality and neurological disability. Early prognostication is essential for clinical decision-making, but variability in interpretation of Non-Contrast CT (NCCT)) Gray to White Matter Ratio (GWR) measurement techniques limits its clinical standardisation. This study evaluated the association between the Gray-to-White Matter Ratio (GWR) on early non-contrast CT (NCCT) and 6 -month neurological outcomes, and compared manual versus automated GWR measurements. Methodology: A retrospective cohort of 120 patients who are comatose with PCAS patients with return of spontaneous circulation (ROSC) was analysed. NCCT scans (6–24 hours post-ROSC) were used to calculate GWR across basal ganglia, supratentorial cortex, and cerebellum using both manual and automated methods. Outcomes were classified using the Cerebral Performance Category (CPC). Prognostic performance was evaluated using receiver operating characteristic (ROC) analysis, and multivariable modelling was performed using Firth logistic regression. Results: Higher GWR values were significantly associated with favourable neurological outcomes across all regions and measurement methods (p<0.001). Automated global GWR demonstrated the highest prognostic accuracy (AUCarea under the curve=0.869; sensitivity 84.2%, specificity 84.1%) and was an independent predictor of poor outcome. Manual measurements showed moderate-to-good inter-rater reliability. Conclusion: GWR is a robust prognostic biomarker for neuroprognostication after cardiac arrest. Automated GWR measurement improves reproducibility and supports the standardisation of imaging-based prognostic assessment, with potential implications for clinical decision-making in post-cardiac arrest care.

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease primarily affecting the neuromuscular system. Gastrointestinal manifestations are typically functional in nature, while mechanical obstructions are rarely reported. Meckel's diverticulum (MD), a congenital gastrointestinal anomaly, is often asymptomatic but can cause obstruction in rare adult cases. Case report: We present the case of a 30-year-old male with early-onset ALS who presented with signs of intestinal obstruction, including severe abdominal pain, vomiting, and obstipation. Imaging revealed a closed-loop small bowel obstruction. Emergency laparotomy identified a torsed Meckel's diverticulum as the underlying cause. Surgical resection was performed, and the postoperative course was managed with tracheostomy and PEG placement due to progressive ALS-related respiratory and swallowing impairment. The patient was successfully stabilized and discharged with ongoing multidisciplinary support . The patient was discharged three weeks later in a stable condition and remains alive under multidisciplinary follow-up. Discussion: This case highlights the diagnostic challenge of distinguishing mechanical from functional gastrointestinal symptoms in patients with advanced ALS. While neurodegenerative progression often explains GI complaints in ALS, this case emphasizes the need to consider alternative etiologies, including surgical emergencies like MD-related obstruction. Conclusion: Mechanical small bowel obstruction due to Meckel's diverticulum in ALS is exceedingly rare. Timely diagnosis and intervention, supported by multidisciplinary perioperative care, are critical for favorable outcomes in this high-risk population. Despite significant ALS-related comorbidities, the patient's outcome was favorable with stable discharge and ongoing respiratory and nutritional support. Highlights:

Endobronchial lipomas are rare, benign tumours that arise from the submucosal fat of the bronchial wall and account for less than 0.5% of all lung tumours. These tumours can present with non‐specific respiratory symptoms, often mimicking common pulmonary conditions such as asthma, COPD, or infections, making diagnosis challenging. We present the case of a 54‐year‐old female smoker who experienced a three‐month history of chronic productive cough, dyspnea and recurrent respiratory infections. During this period, she was evaluated by three healthcare providers, each of whom prescribed multiple courses of antibiotics and inhaled bronchodilators based on presumed diagnoses of bronchitis or COPD exacerbation. Notably, no chest imaging was performed at the initial stages. Chest imaging revealed left lung collapse, and bronchoscopy revealed a polypoidal mass obstructing the left main bronchus. Histopathological analysis confirmed the diagnosis of an endobronchial lipoma. This case highlights the importance of considering benign bronchial tumours in the differential diagnosis of chronic respiratory complaints, especially in patients with a smoking history. Complete excision, either bronchoscopic or surgical, is the treatment of choice, resulting in excellent prognosis and symptom resolution.

Subclavian vein catheterization is a common procedure for central venous access in critically ill patients.

Isolated Pauci‐immune pulmonary capillaritis (IPIPC) is a rare form of small vessel vasculitis that affects only the lungs, causing inflammation of pulmonary capillaries and potentially leading to severe outcomes like alveolar haemorrhage. A 23‐year‐old woman with a prior diagnosis of rheumatoid arthritis presented with hemoptysis and respiratory distress, ultimately diagnosed with IPIPC. Despite treatment with high‐dose steroids and intravenous immunoglobulin, her condition deteriorated, resulting in respiratory failure and death. IPIPC often lacks systemic symptoms and ANCA positivity, complicating diagnosis and treatment. Imaging, bronchoscopy, and histopathology are key for diagnosis, while management typically involves corticosteroids and possibly immunosuppressives. The case underscores the challenges in identifying and treating IPIPC, highlighting the importance of early intervention to improve prognosis, even though complications can still lead to significant respiratory issues and mortality.