Sclerodermatous Graft-Versus-Host Disease: A Rare Sequela of Hematopoietic Stem Cell Transplantation.

Although graft-versus-host disease (GVHD) is a common immunologic reaction after an allogeneic hematopoietic stem cell transplant (HSCT), progression into sclerodermatous GVHD is a rare sequela. It can present locally or generalized with various cutaneous and mucocutaneous manifestations, resulting in loss of skin elasticity and reduced functional capabilities. One of the most debilitating consequences of sclerodermatous GVHD is its effect on a range of motion due to fibrosis of the skin and subcutaneous fat. We present the case of a 54-year-old male with a medical history of acute myeloid leukemia and an allogeneic stem cell transplant who was diagnosed with sclerodermatous GVHD. We review the characteristic clinical and histopathological findings of sclerodermatous GVHD, as well as its treatment. Early recognition and intervention are crucial to prevent complications, such as joint contractures.

Diagnosis and Management of Cesarean Scar Ectopic Pregnancy: A Case Study.

A cesarean scar ectopic pregnancy (CSEP) designates an ectopic pregnancy within the myometrium of a past uterine incision. Early diagnosis through transvaginal ultrasonography is crucial as an untreated CSEP can lead to serious complications, including hemorrhage, loss of future fertility, and maternal death. We present a case of a 33-year-old female with five previous cesarean sections, who presented at seven weeks of gestation with concerns of a CSEP. Here, we highlight the importance of early diagnosis and maintaining high clinical suspicion in women with multiple previous cesarean sections who present with menstrual abnormalities. The CSEP is a serious condition and requires a high index of suspicion during diagnosis and follow-up. Ultrasound scanning and training should be readily available to quickly identify and treat this life-threatening condition.

A Case of Herpes Zoster Ophthalmicus in a Recently Transplanted Renal Patient.

Herpes Zoster Ophthalmicus (HZO) is a common manifestation of the reactivated Varicella Zoster virus, primarily affecting the eye and trigeminal nerve. This case study presents the clinical course of a 51-year-old male who underwent a renal transplant due to end-stage renal disease, further complicating the management of HZO. The patient's medical history also includes hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD), cerebrovascular accident (CVA), and retinal detachment. Upon examination, the diagnosis of HZO was confirmed based on the presence of a characteristic unilateral vesicular rash in the V1 cranial nerve dermatomal distribution, accompanied by ophthalmic symptoms such as eyelid swelling and visual impairment. Given the patient's immunosuppressive regimen post-transplant, intravenous acyclovir was initiated for antiviral therapy, while supportive care was provided for pain control. Notably, the patient experienced a subsequent decrease in pain intensity and improvement in the vesicular rash. This case highlights the challenges in managing HZO in patients with a history of renal transplant and multiple comorbidities, emphasizing the importance of tailored treatment strategies to optimize patient outcomes. Further research is warranted to better understand the impact of immunosuppression and comorbidities on the course and management of HZO in this population.

Radiocapitellar Arthroplasty: Systematic Review.

Introduction: Primary elbow osteoarthritis affects approximately 2% of the population, and has been treated with arthroplasty. However, total elbow arthroplasty (TEA) implants currently have severe weight limitations and issues with longevity. In patients with unicompartmental arthritis, unicompartmental arthroplasty may be used instead of TEA. We describe the use of Uni-Elbow Radio-Capitellum and Lateral Resurfacing Elbow for radiocapitellar arthroplasty (RCA) in this article. Methods: Reviewers independently searched databases for keywords, such as radiocapitellar arthroplasty, RCA, uni-elbow radiocapitellum, UNI-E, and lateral resurfacing elbow, LRE. The measured outcomes of interest were the change in motion arc and patient-reported outcome scores. Studies that were not of appropriate quality determined by the Cochrane risk of bias summary tool and review studies were excluded. Results: RCA resulted in a postoperative 38.3° ± 28.5° increase in elbow flexion-extension (P < .001), and 35.2° ± 28.6° increase in elbow pronation-supination (P < .001). Mayo Elbow Performance Score was significantly increased by 44.8 ± 12.6. DASH Score saw a significant reduction by 45.0 ± 14.6 points (P < .001), while the American Shoulder and Elbow Surgeons Score increased by 47.0 ± 10.6 points (P < .001). Of the 105 adult patients 16.2% experienced complications such as minor stiffness, ulnar neuropathy, component loosening, or radial head UNI-E stem failure. Reported complications were higher in the UNI-E group than in the LRE group. Conclusion: RCA has shown promise as an option to treat radiocapitellar arthritis, particularly when excising the radial head causes lateral column instability.