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Forward2025 Clinician Corner - Respiratory failure in a patient with exhaled nitric oxide > 300 ppb and subsequent response to dupilmab
Multiple biologic agents are approved for the treatment of severe persistent asthma not controlled by inhaled corticosteroid/beta-agonist therapy. Appropriate phenotyping can aid in picking the right biologic for the right patient. Here is a unique case of a patient with severe asthma and respiratory arrest, with fraction of exhaled nitric oxide >300 ppb whose asthma became completely controlled with dupilumab.
2025 Clinician Corner - Unusual radiographic progression of tumoral calcinosis along the anterior cruciate ligament in an adolescent male
A 13-year-old boy was referred to orthopedic surgery for chronic intermittent pain and swelling of the left knee. Initial imaging was consistent with osteochondritis dissecans of the femoral condyle. Follow-up imaging demonstrated unexpected progression, with a mass extending into the notch, replacing the anterior cruciate ligament, and eroding the femoral and tibial condyles. Subsequent surgical biopsy and resection revealed tumoral calcinosis, with an ultimate diagnosis of autosomal recessive familial tumoral calcinosis. This case report highlights the radiographic appearance and progression of a rare disease in this unusual location and the differential diagnosis.
2025 Clinician Corner - Esophageal perforation following anterior cervical discectomy and fusion
Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal surgeries performed in the US but is associated with various morbidities. Esophageal perforation is one of the rarest complications of ACDF, but it is potentially fatal, therefore requiring timely detection and treatment. We present three cases of esophageal perforation after ACDF.
2025 Managing Medical and Surgical Error: an emotional guide
Medical errors are common and often lead to feelings of self-doubt, helplessness, and guilt. Society thinks of physicians as
healers, and physicians who see their role as offering a cure will always feel as if they haven’t done enough. This article discusses five steps in the management of medical and surgical error: (1) care for the patient and family, (2) report to appropriate
sources, (3) review the incident, (4) manage legal issues, and (5) engage in self-care. There is a focus on managing grief, with
tips for coping.
2025 Clinician Corner - Urrets-Zavalia syndrome and secondary acute angle-closure glaucoma induced by implantable collamer lens
Implantable collamer lenses (ICL) have revolutionized the management of high refractive errors, yet they present unique challenges. We present a case of a fixed and dilated atonic pupil following acute-angle closure glaucoma from pupillary block after ICL implantation, known as Urrets-Zavalia syndrome. A 39-year-old woman developed acute ocular pain and headaches after surgery, leading to elevated intraocular pressure and subsequent complications necessitating ICL removal. This case highlights the need for prompt identification and management of elevated intraocular pressure to prevent irreversible complications such as Urrets-Zavalia syndrome following ICL implantation.
2025 Clinician Corner - Histologic changes of basal cell carcinomas during vismodegib treatment
We report a case of a 63-year-old man with a history of numerous basal cell carcinomas (BCCs) on vismodegib who developed a pink subcutaneous nodule that was thought to be either a BCC or an epidermal inclusion cyst. Sections displayed a dome-shaped lesion composed of large dermal nodules of epithelioid cells with variable cytology. Some of the dermal nodules demonstrated squamatization of the epithelioid cells while others had a predominantly basaloid phenotype. Central necrosis was present in the majority of the large dermal nodules, but the lesion did not stain with CK7 or CK20, helping to rule out internal metastases. The epithelial nodules stained strongly with pancytokeratin (AE1/AE3), p40, and stained lightly with BCL-2, supporting the diagnosis of BCC. However, Ber-EP4 being negative and the presence of significant squamatization suggest vismodegib can alter both the histological and immunophenotype of BCCs. This phenomenon has rarely been reported in literature.
2025 Clinician Corner - Solitary erythematous round nodule with a hemorrhagic crust on the posterior shoulder
Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoproliferative disorder (PCMS-TCL) is a rare skin condition. We present a 67-year-old patient with a growing lesion on the shoulder that was diagnosed as PCMS-TCL. The patient was otherwise healthy without systemic involvement. The lesion was surgically excised, and no recurrence occurred. PCMS-TCL has an excellent prognosis, unlike other cutaneous lymphomas. This case highlights the importance of crafting a comprehensive differential diagnosis that incorporates any possibilities of rare disorders like PCMS-TCL to avoid unnecessary treatment.
2025 Clinician Corner - Choreoathetosis as a rare complication of paraneoplastic syndrome: a case report in small cell lung cancer with positive anti-Hu antibodies
Choreoathetosis is a rare complication of paraneoplastic syndrome, particularly associated with small cell lung cancer. We report a case of an elderly woman with small cell lung cancer who was diagnosed with choreoathetosis due to autoimmune-mediated paraneoplastic syndrome. The differential diagnoses for focal neurological deficits such as stroke, immunotherapy-related toxicity, radiation-induced toxicity, and brain metastasis were considered but the presence of onconeural antibodies made paraneoplastic syndrome a more likely diagnosis. Management of choreoathetosis in paraneoplastic syndrome can be challenging, with limited treatment options available.