Al Assad University Hospital

BackgroundKaposi sarcoma is a vascular neoplasm linked to human herpes virus 8 and presents in four main variants. The development of Kaposi sarcoma, particularly the iatrogenic form, in younger women with autoimmune conditions such as multiple sclerosis is exceedingly rare and presents unique diagnostic and therapeutic challenges.Case presentationWe report the case of a 48-year-old Arab woman with an 18-year history of multiple sclerosis managed with corticosteroids, who developed cutaneous iatrogenic Kaposi sarcoma on her lower extremities. The diagnosis was delayed for 2 years as the lesions were initially misattributed to her underlying multiple sclerosis. A skin biopsy eventually confirmed Kaposi sarcoma, and staging revealed localized cutaneous disease with no visceral involvement. The patient was treated with weekly paclitaxel, showing a favorable response. Due to conflict-related logistical issues, treatment was temporarily switched to vincristine and vinorelbine, which resulted in disease progression and adverse effects. Paclitaxel was successfully reintroduced, leading to sustained clinical improvement, and 2 years after completing therapy, the patient remains in good health with no evidence of Kaposi sarcoma recurrence or multiple sclerosis exacerbation.ConclusionThis case expands the known clinical and demographic spectrum of Kaposi sarcoma, underscoring the importance of maintaining a high index of suspicion in atypical patient populations to prevent diagnostic delays. The co-occurrence of multiple sclerosis and Kaposi sarcoma underscores the importance of recognizing iatrogenic Kaposi sarcoma in patients receiving immunosuppressive therapy and calls for further research into the complex intersection of autoimmune disorders and iatrogenic treatment-related immune dysregulation in oncogenesis. This report underscores the importance of individualized, persistent therapeutic strategies in managing Kaposi sarcoma.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13256-025-05683-4.

BackgroundSimple bone cysts are benign, fluid-filled lesions commonly affecting the metaphyseal regions of long bones in children and adolescents. While often asymptomatic, they may present clinically when complicated by pathological fractures. Diagnosis is primarily radiographic, and management ranges from observation to surgery. This report highlights a rare femoral neck simple bone cyst with fracture, focusing on the technical nuances of definitive surgical treatment in a weight-bearing location.Case presentationA 14-year-old Arab female with no prior medical history presented with acute left hip pain after a minor fall. Radiographs revealed a displaced sub-capital femoral neck fracture overlying a well-defined cystic lesion. Surgical management included dynamic hip screw-guided cortical windowing, meticulous curettage, alcohol irrigation, tightly packed cancellous grafting from the iliac crest, and structural fibular strut grafts placed above and below the screw path. Internal fixation was achieved with a femoral head screw and dynamic hip screw plate. Histopathology confirmed a simple bone cyst.ConclusionThis case underscores the value of a tailored, multi-component surgical technique in managing simple bone cyst-associated pathological fractures in pediatric weight-bearing bones. The approach resulted in excellent structural stability and functional recovery, with the patient regaining independent, unrestricted ambulation by 10 weeks postoperatively and no complications observed.

Ureteral endometriosis is an uncommon but potentially serious manifestation of deep endometriosis that may remain undetected until significant renal damage has occurred. We report the case of a 35-year-old woman with a 4-year history of right flank pain and macroscopic hematuria. She experienced recurrent bilateral hydronephrosis, managed previously with right-sided double J stents, while the left kidney was severely affected, asymptomatic, and diagnosed as non-functional for four years. Following removal of the right ureteral stent, she developed acute kidney injury necessitating urgent nephrostomy. Surgical exploration revealed distal ureteral fibrosis, and histopathological examination confirmed ureteral endometriosis. Ureteral reimplantation was successfully performed, leading to preservation of right renal function. This case underscores the diagnostic challenges of ureteral endometriosis and highlights the importance of early suspicion, multidisciplinary evaluation, and timely surgical management to prevent irreversible renal loss.

BackgroundType 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia, represents a growing global health burden. Natural menopause in women is defined as continuous cessation of menstruation for more than twelve consecutive months, and it is an important determinant of their future health. The average age at natural menopause is around 51 years. Early menopause is defined as the onset of menopause between the ages of 40 and 45 years, while genetic and environmental factors influence menopause timing, evidence suggests T2DM may accelerate ovarian aging. The aim of this study is to explore the existence of a relationship between T2DM and the natural age of menopause in Syrian women—a population with unique genetic and lifestyle factors underrepresented in existing literature.MethodsA cross-sectional study was conducted at Al-Mouwasat and National University Hospitals in Damascus, from 2022 to 2024. 175 naturally postmenopausal women aged over 45 years were included in the study, with participants stratified by T2DM status, which was confirmed either by an HbA1c level of ≥ 6.5% or a physician’s diagnosis. The age at menopause was ascertained based on self-reported cessation of menses for at least 12 months, exclusion of surgical or iatrogenic menopause cases, and validation against medical records. Data were analyzed using SPSS 25.0 with multivariable linear regression (α = 0.05).ResultsThe mean age at natural menopause did not differ significantly between women with and without T2DM (p = 0.099); key differences emerged in subgroup analyses. Women with T2DM demonstrated a 2.3-fold higher prevalence of early menopause (< 45 years) compared to non-diabetic counterparts (20.2% vs. 10.5%; p = 0.023). Notably, those with long-standing diabetes (> 10 years duration) experienced menopause ~ 2 years earlier than controls (p = 0.040). Furthermore, women with T2DM microvascular complications– specifically retinopathy (p = 0.044) and nephropathy (p = 0.000) – showed significantly earlier menopause compared to diabetes-free women.ConclusionsT2DM itself was not associated with a significantly earlier average age at natural menopause in Syrian women, but specific aspects of T2DM were significantly linked to earlier menopause, which are longer disease duration (> 10 years), and presence of microvascular complications (retinopathy or nephropathy). Critically, women with T2DM had a significantly higher prevalence of early menopause, indicating a doubled risk compared to non-diabetic women.

Introduction and importance:Whipple disease is a rare systemic infection caused by the bacterium Tropheryma whippelii, commonly affecting the gastrointestinal system, but it can also involve the central nervous system (CNS). Diagnosis typically relies on tissue biopsy and polymerase chain reaction (PCR) for bacterial DNA. This case emphasizes the challenges in diagnosing and treating neurologic manifestations of Whipple disease and highlights the importance of a multidisciplinary approach in managing complex neuroinfectious cases.Case presentation:We report a case of a 35-year-old Syrian female with neurological Whipple disease presenting with recurrent tonic-clonic seizures, cognitive disturbances, and communicating hydrocephalus, requiring a ventriculoperitoneal shunt. Her complex clinical course included pyomeningitis associated with shunt infection. Diagnostic imaging and cerebrospinal fluid (CSF) analyses confirmed CNS involvement. Management included antibiotic therapy targeting CNS infection and antiepileptics.Clinical discussion:There were multiple differential diagnoses for this patient, as well as the interplay of multiple conditions as a result of Whipple disease or medical intervention, which shows the importance of keeping every possibility in mind. Moreover, giving proper instructions to the patient can help reduce complicationsConclusion:The successful treatment and ongoing follow-up demonstrate the importance of a multidisciplinary approach in addressing the diverse manifestations of neurological conditions.

Proboscis lateralis (PL) is an exceedingly rare congenital craniofacial malformation characterized by a trunk-like appendage near the medial canthus. This report presents the first documented case of PL in Syria and, to our best knowledge, the broader Middle East region. The case is particularly notable for occurring in the absence of parental consanguinity, adding to its uniqueness. A 25-day-old female neonate presented with a 2.5 cm tubular structure at the right medial canthus, accompanied by right nasal cavity hypoplasia and nasal septum deviation. These findings were confirmed by CT imaging. Surgical intervention was suspended. PL arises from the disrupted fusion of the frontonasal and maxillary processes and is typically diagnosed clinically, though prenatal identification remains rare. Associated anomalies, including intracranial defects, necessitate imaging modalities such as CT or MRI for comprehensive evaluation. Surgical strategies vary depending on anatomical complexity, emphasizing the need for individualized approaches.

BackgroundHyperlipidemia is a common condition as nearly over 50% of adult Americans have high low-density lipoprotein (LDL) levels. Hyperlipidemia increases the risk of strokes, myocardial infarction, and other vascular events. PCSK9 monoclonal antibodies are one of the available options for the treatment of hyperlipidemia. Our study is a systematic review and meta-analysis that assesses the efficacy and safety of a new PCSK9 antibody, tafolecimab, in hyperlipidemia. MethodsSearching PubMed, EMBASE, Scopus, Web of Science (WOS), and Cochrane, we performed a PRISMA-based systematic review and meta-analysis to study effects of tafolecimab compared with placebo on different lipid indices that included LDL percent change, number of patients achieving ≥ 50% low-density lipoprotein cholesterol (LDL-C) reduction, LDL change from baseline, LDL change from baseline (CFB), apolipoprotein B CFB, and non-high-density lipoprotein cholesterol (non-HDL-C) CFB.ResultsFour randomized controlled trials (RCTs) with 1093 patients were included in our study; 709 (64.87%) of them were males. Tafolecimab reduced LDL percent change [mean difference (MD) = − 62.28, 95% confidence interval (CI) (− 65.21, -59.35), P < 0.00001], the number of patients achieving ≥ 50% LDL-C reduction [MD = 46.92, 95% CI (21.91, 103.9), P < 0.0001], LDL CFB [MD = − 73.58, 95% CI (− 83.13, -64.03), P < 0.001], non-HDL-C CFB [MD = − 82.21, 95% CI (− 86.65, − 77.77), P < 0.001], apolipoprotein B CFB [MD = − 52.01, 95% CI (− 54.86, − 49.17, P < 0.001]. No difference was detected in overall adverse events (AEs) [risk ratio (RR) = 0.94, 95% CI (0.88, 1.01), P = 0.1128], serous AEs [RR = 0.93, 95% CI (0.57, 1.52), P = 0.7799], and AEs leading to treatment discontinuation [RR = 2.58, 95% CI (0.76, 8.77), but yielded more injection site reactions [RR = 2.53, 95% CI (1.14, 5.63), P = 0.0222].ConclusionTafolecimab is a valuable treatment option for hyperlipidemia, which showed improvement in several lipid indices (LDL, LDL-C, LDL CFB, non-HDL-C CFB, and apolipoprotein B CFB). However, it increased the rates of injection site reactions.

Hydatid disease, primarily caused by the parasite Echinococcus granulosus, commonly affects the liver and lungs. However, it can also involve other organs, including the pancreas. Pancreatic hydatid cysts are rare, constituting less than 2% of all hydatid cases. Their infrequent occurrence and atypical presentation often pose diagnostic and therapeutic challenges, especially in non-endemic regions. A 42-year-old man with a cystic lesion in his pancreatic tail who had no notable medical history was seen. The diagnosis of a pancreatic hydatid cyst was validated by serological testing and diagnostic imaging techniques. Due to their uncommon nature, the differential diagnosis of pancreatic hydatid cysts can be challenging. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are important for identifying characteristic features. Serological testing further aids in confirming the diagnosis. Treatment typically involves a combination of medical and surgical approaches. Antiparasitic drugs, such as albendazole or mebendazole, are administered to kill the parasite. Surgical intervention is necessary to remove the cyst and reduce the chance of recurrence and complications. This instance highlights the significance it is to take hydatid disease into consideration when making a differential diagnosis for pancreatic cystic lesions, particularly in people from endemic regions. For the optimal possible patient outcomes and avoiding of complications, early diagnosis and effective treatment are important.