Cutaneous Pili Migrans is a rare creeping eruption typically presenting as a linear black track on the feet. Involvement of the scrotum is extremely uncommon, and an annular morphology has not been reported. A 40-year-old man presented with an asymptomatic black ring-like lesion beneath the scrotal epidermis. Dermoscopy revealed a thick circular hair shaft embedded with minimal inflammation, confirming the diagnosis. Without intervention, the lesion spontaneously resolved within one month. This first report of annular scrotal Cutaneous Pili Migrans expands the clinical spectrum and highlights the role of dermoscopy in avoiding unnecessary procedures.

Imperforate hymen should be suspected in adolescent girls presenting with primary amenorrhea and cyclic abdominal or pelvic pain. Early genital examination is essential for timely diagnosis. Prompt hymenectomy prevents hematocolpos, urinary obstruction, infection, and future reproductive morbidity.

Exercise-induced left bundle branch block (EI-LBBB) is a rare phenomenon, particularly in patients without structural heart disease. Its pathophysiology remains poorly understood and there are no defined treatment protocols. We report a 77-year-old man with a history of syncope who developed EI-LBBB during a cardiac stress test, with transient electrocardiographic changes that resolved at rest. Coronary angiography revealed only a mild-moderate (approximately 25%-50%) proximal left anterior descending artery stenosis, and the rest of his cardiac evaluation was unremarkable. The patient was commenced on an aerobic exercise program, and reported symptomatic improvement on follow-up. Although EI-LBBB is often linked to underlying structural heart disease and coronary artery disease, it can occur in patients with normal cardiac structure. This report summarizes an approach to evaluation and follow-up of EI-LBBB and reviews management strategies described in the literature, including exercise training in selected patients.

Hepatic cystic lesions pose diagnostic challenges due to overlapping imaging features, as simple hepatic cysts may mimic biliary cystadenoma or hydatid cysts. We report a 43-year-old female with chronic right lower abdominal pain, initially diagnosed with hydatid cyst on ultrasonography and later suspected as biliary cystadenoma on CT and MRI. She underwent laparotomy with cyst excision and cholecystectomy, but histopathology confirmed a simple hepatic cyst. This case highlights the limitations of radiology in differentiating hepatic cystic lesions, the crucial role of histopathology-particularly the absence of ovarian-like stroma-in establishing diagnosis, and the importance of imaging-pathology correlation for accurate management and avoiding inappropriate treatment.

Myiasis is larval infestation of tissues, particularly common in tropical, and subtropical regions, especially in pre-existing wounds. Poor hygiene, inadequate wound care, and exposed wounds, can predispose to secondary bacterial infection. We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery.

The presence of the bilateral claustrum sign in new-onset refractory status epilepticus (NORSE) should prompt consideration of Hashimoto's encephalopathy, even without thyroid dysfunction. Early recognition and corticosteroid therapy can be lifesaving, emphasizing an autoimmune-inflammatory mechanism underlying this rare presentation.

Chronic lymphocytic leukemia is not uniformly low risk for tumor lysis syndrome. This case shows that first-cycle bendamustine-rituximab in patients with high disease burden can precipitate severe TLS with acute kidney injury and multiorgan failure. Individualized prophylaxis, patient education, and close monitoring during early therapy are essential.

Intravesical migration of intrauterine devices (IUDs) is an uncommon complication that may lead to recurrent urinary tract infections, lower urinary tract symptoms, and bladder stone formation. Diagnosis requires high clinical suspicion and confirmation through imaging and cystoscopy. We present the case of a 33-year-old hypertensive woman with a history of two cesarean deliveries for preeclampsia who underwent IUD placement in 2016. She subsequently developed recurrent urinary tract infections. In 2024, hysteroscopic removal was attempted unsuccessfully. Computed tomography revealed a calcified "T-shaped" image in the posterior right bladder wall. Open cystolithotomy was performed, achieving complete removal without complications, and the patient had a favorable postoperative course. Bladder migration of IUDs is rare and may occur years after insertion. Clinical presentation is often nonspecific, which can delay diagnosis. Imaging, including CT scan, and cystoscopy are essential for localization and surgical planning. Open cystolithotomy is a safe and effective approach in cases with large calculi. This case highlights the importance of considering intravesical IUD migration in women with persistent urinary tract symptoms and absence of the device in the uterine cavity. Early diagnosis and appropriate surgical management allow safe resolution and prevent major complications.

Tjalma syndrome, also known as pseudo-pseudo Meigs syndrome, is a rare complication of systemic lupus erythematosus (SLE) characterized by ascites, pleural effusion, and elevated CA-125 levels in the absence of malignancy. We report a case of a 22-year-old woman with SLE presenting with vulvar swelling, severe polyserositis, nephritis, and progressive respiratory failure. SLE was confirmed by strongly positive anti-dsDNA with low complement levels. Despite immunosuppressive and supportive therapy, the patient's condition rapidly worsened, and she died due to hyperkalemia-induced ventricular fibrillation. This case highlights the diagnostic challenges of Tjalma syndrome, the need for thorough exclusion of malignancy, and the importance of early immunosuppression in preventing fatal outcomes.

Schwannomas are benign peripheral nerve sheath tumors (PNSTs) arising from myelin sheaths, with schwannomatosis characterized by multiple lesions without neurofibromatosis type 1 (NF1) or type 2 (NF2) stigmata. Malignant transformation is rare but documented. We report a 44-year-old patient with multiple painful, slow-growing recurrent masses in the right axilla, bilateral inguinal regions, and right lumbar area; these masses were initially noted early in 2017. Surgery was done with subsequent recurrence 6 years after initial diagnosis and surgery. Contrast-enhanced CT scans done in 2023 revealed heterogeneously enhancing, well-defined ovoid masses, some with spinal connections, consistent with schwannomas. Multiple biopsies of different sites at different time periods were consistent with histology that confirmed the diagnosis of schwannomatosis, with no NF1 or NF2 features. Histopathology results are attached. The patient underwent palliative 1st line chemotherapy with noted regression of some of the masses, though surgical resection remains the standard treatment. The last contact with the patient prior to writing this case was at the time of chemotherapy. This case highlights schwannomatosis as a rare, painful condition distinct from NF1 and NF2. CT imaging is vital in low-resource settings for diagnosis, emphasizing the need for careful differentiation from other PNSTs due to distinct management and prognosis.