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Febrile Lumbar Pain Revealing a Massive Collection: Complicated Psoas Abscess Managed Surgically

Published on: 5th March, 2026

Psoas abscess is a rare but potentially life-threatening condition with non-specific clinical manifestations. The condition may be primary or secondary, depending on whether it has an underlying cause. The condition may be diagnosed with the help of imaging studies, especially contrast-enhanced computed tomography (CT).A 55-year-old female patient with a history of treated hypertension presented with a 15-day history of fever and left-sided low back pain. Her laboratory parameters showed a high leukocyte count of 22,000 cells/mm³ and elevated levels of C-reactive protein (367 mg/L). Her renal functions were within normal limits, and the urine culture was negative. Contrast-enhanced CT revealed a large left-sided intra-abdominal fluid collection extending from the diaphragm to the left iliac fossa, measuring 66 x 305 mm with air bubbles. The collection also showed a left-sided intramuscular psoas collection of 66 x 50 x 131 mm. The patient received intravenous broad-spectrum antibiotics (third-generation cephalosporin, aminoglycoside, and metronidazole). The patient underwent mini-lumbotomy, and nearly 1 liter of pus was drained. The patient’s postoperative course was satisfactory with complete resolution of symptoms. The histopathological examination showed non-specific changes.Psoas abscess should be suspected in patients with febrile low back pain and inflammatory syndrome. Contrast-enhanced CT scans are essential for diagnosis and assessment of the extent of disease. In complicated cases with large abscess formation, early surgical drainage along with appropriate antibiotics will provide the best outcome.This case highlights the importance of early diagnosis and adapted management for successfully navigating the complexities associated with this condition.
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Bacteriolysis Destruction for Cu- and Zn-Ions Induced Peptidoglycan Cell Wall Based on the Halo-test Results in Cu(NO3)2 and ZnSO4 Solutions against Staphylococcus epidermidis

Published on: 24th March, 2026

Bacteriolysis of peptidoglycan (PGN) cell wall destruction on cleavage, hydrolysis, and decomposition by copper nitrate and zinc sulfide solutions has been investigated on the ground of the results obtained from halo antibacterial susceptibility tests in metal sulfate solutions against Staphylococcus epidermidis, in which from halo-antibacterial susceptibility tests of metallic ion concentration of 100 mM/L against Staphylococcus epidermidis, the order of bacterial effect for the metal nitrate solutions is as follows, Cu2+>Zn2+ >Ag+>Pb2+>Al3+, and the other, in the metal sulfate solutions, the antibacterial effect order is found to be Zn2+>Cu2+>Ag+>Al3+. Cu(Ⅱ)-, Zn(Ⅱ)-ions induced bacteriolytic destructions for PGN cell wall on cleavage, hydrolysis, and decomposition within Cu(NO3)2 and ZnSO4 solutions have been elucidated that Cu(Ⅱ) and Zn(Ⅱ) ions can inhibit PGN biosynthesis Transpeptidase (TP)/Trans-glycosylase (TG) and PGN elongation, PGN cleavage occurs by copper ions- and zinc ions-containing autolysins amidase; AmiE, Rv3717, AmiA, PGN cell wall is hydrolyzed by copper-, and zinc-containing enzymes; PGRPs, MurA, LytA, LytM=Endopeptidase, Hydrolase LytB, and PGN decomposition by copper-, zinc-containing PGN inhibitive elongation occurs. Thus, Cu(Ⅱ) and Zn(Ⅱ) within Cu(NO3)2 and ZnSO4 solutions inhibit PGN biosynthesis and activate bacterial PGN autolysins against Staphylococcus epidermidis.
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Bilateral Severe Encrustation of Long-Term Indwelling Double-J Stents in a Young Non-Lithiasic Patient

Published on: 16th March, 2026

Ureteral double-J stents are a commonly used device in urological practice to allow urinary drainage, avoid ureteral obstruction processes, and protect the upper urinary tract after surgical procedures. However, long indwelling time may give rise to numerous complications, such as infection, migration, and fragmentation of the stent, especially encrustation. Encrustation of stents is a well-known complication that has been closely related to the time active of the stent and can cause significant morbidity if not timely addressed. In severe cases, abundant mineral deposition can result in the development of large calculi encasing the stent and rarely progress to staghorn stones. These cases may pose challenges in terms of the extraction of the stent and may result in complex endourological intervention. The encrustation likelihood is substantially higher if stents are left forgotten or remain in place longer than the advised period. Most patients with heavily encrusted stents have symptoms including flank pain, urinary tract infection, hematuria, or obstructive uropathy, but can present without any symptoms, and this can delay the diagnosis.
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Not Every Bladder Mass Is Malignant: A Case of Inverted Urothelial Papilloma in a Young Adult

Published on: 30th March, 2026

Inverted Urothelial Papilloma (IUP) is an unusual variety of urothelial tumors that typically occurs in adults, with a predominance in males. The definitive diagnosis of IUP relies on histopathological examination, as the clinical presentation and endoscopic appearance are non-specific. The recommended treatment for IUP includes the complete transurethral resection, with some controversy regarding the need for cystoscopic follow-up. In this case, we present an atypical instance of IUP in a 21-year-old male patient, diagnosed with gross hematuria and irritative lower urinary tract symptoms. A clinical assessment revealed a 3.0 × 2.6 cm intravesical mass. The definitive diagnosis was confirmed histopathologically and further substantiated by immunohistochemistry, which demonstrated low expression of p53 and Ki-67, effectively ruling out malignancy. This case underscores the diagnostic challenges posed by bladder masses in young adults, emphasizing the necessity of integrating morphological and immunohistochemical findings to prevent overdiagnosis of urothelial carcinoma. The paper focuses on the diagnostic approach and management of this rare condition in the young male population.
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Late Extensive Regional Recurrence of Paratesticular Dedifferentiated Liposarcoma 10 Years after Orchiectomy: A Case Report

Published on: 1st April, 2026

Background: Paratesticular liposarcoma is a rare entity, with dedifferentiated liposarcoma (DDLPS) representing the most aggressive subtype. Late recurrences with unusual patterns of spread have been documented but remain poorly characterized.Case presentation: We report a case of a 68-year-old male with a 10-year recurrence of paratesticular DDLPS following right orchiectomy. The patient initially underwent resection of a 5×4×4.5 cm paratesticular mass in 2015, with histopathology confirming DDLPS and negative distal spermatic cord margins. After loss to follow-up, he presented in 2026 with extensive regional recurrence involving bilateral pubic soft tissues, abdominal wall musculature, and right external iliac lymphadenopathy. Biopsy confirmed recurrent DDLPS with Mouse double minute 2 homolog (MDM2) positivity. Given the multi-site infiltrative nature and muscle involvement, the multidisciplinary team recommended neoadjuvant chemotherapy with ifosfamide and doxorubicin before consideration of surgical resection.Conclusion: This case illustrates the propensity for late regional recurrence in paratesticular DDLPS and highlights the unusual pattern of spread along anatomic pathways, including the abdominal wall and inguinal region. The case underscores the importance of long-term surveillance, aggressive initial surgical margins, and multidisciplinary management in this rare malignancy.
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Adult Bladder Exstrophy with Premalignant Changes Following Failed Reconstruction: A Case Report

Published on: 1st April, 2026

Background: Bladder exstrophy is a rare congenital abnormality that is usually managed with multiple surgical interventions. Long-term consequences include recurrent urinary tract infections, bladder stones, fistulae, and metaplastic changes with malignant potential.Case Presentation: We present a case of a 21-year-old male with a history of failed childhood surgeries for bladder exstrophy who presented with a vesicocutaneous fistula and a 7 cm bladder stone. He underwent an open cystolithotomy with bladder augmentation and creation of a Benchekroun continent valve. However, the patient developed recurrent fistulae due to poor tissue quality. Histopathological examination confirmed early squamous metaplasia in the bladder mucosa. After discussion in a multidisciplinary meeting, the patient underwent a radical cystectomy with ileal conduit urinary diversion using the Bricker technique. He is doing well at 3 months with no evidence of any complication.Conclusion: This case illustrates the difficulties encountered in managing adult patients with bladder exstrophy and failed reconstructions. The presence of squamous metaplasia, poor bladder tissue, and recurrent complications all contributed to the decision for radical cystectomy. It is important to recognize these changes and address them appropriately in a timely manner to prevent further complications and possible malignant changes.
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