The Arab Medical Centre

Langerhans Cell Histiocytosis (LCH) is a rare clonal disorder of immature CD1a-positive dendritic cells, most commonly affecting children, with peak incidence between ages 1 and 3. This report presents a unique case of multifocal cutaneous LCH with cervical lymphadenopathy in a 7-month-old infant. The patient exhibited an unusual pattern of treatment resistance, failing to respond adequately to corticosteroids and vinblastine-prednisone, before achieving remission with methotrexate. This highlights the therapeutic challenges in managing refractory pediatric LCH and the need for alternative treatment approaches in such cases. This case emphasizes the importance of early diagnosis, tailored treatment regimens, and the potential utility of methotrexate in refractory cases. Comprehensive evaluation and multidisciplinary care are critical for managing this rare disease and minimizing its impact on quality of life.

Endometriosis, adenomyosis, and uterine adenomyomas prevail most frequently in reproductive-age women. However, about 2%–4% of postmenopausal women may suffer from endometriosis symptoms, while adenomyosis does not occur frequently after menopause in the absence of exogenous hormones. While cystic adenomyosis is an uncommon variant of adenomyosis, it is even rarer to be pedunculated. Usually, degeneration is a feature of uterine leiomyoma, 4% of which might be cystic, while ruptured adenomyoma with cystic degeneration is only reported few times in the literature. We present a case of a 50-year-old menopausal woman, with a ruptured pedunculated adenomyoma with endometriotic cystic degeneration, with a literature review.

Stricture formation is a well-known Crohn's disease consequence that usually results from recurrent cycles of inflammation and healing and primarily affects the small intestine.

In this report, we describe the case of a 35-year-old male with an 18-year history of Crohn's disease complicated by long-kinked ileal stricture who presented with a 3-month history of subacute small intestinal obstruction diagnosed with MR enterography and underwent failed medical treatment.

The patient, a male showing signs of wasting due to a prolonged subacute small intestinal obstruction, underwent an MR enterography which revealed a 6-cm kinked ileal stricture. Intraoperative observations included a significantly dilated small intestine proximal to the stricture and a collapsed distal small bowel. Following resection, the patient experienced a smooth recovery with marked improvement.

When there are clear indications for the surgical resection of a stenosed bowel segment caused by Crohn's disease, it is advisable to proceed with the surgery promptly, with a preference for side-to-side stapled anastomosis.