Keloid scarring is more prevalent in individuals with pigmented skin and can be particularly challenging to treat due to the risk of dyspigmentation and limited response to first-line therapies. This case describes a Fitzpatrick type IV patient whose keloid remodeling plateaued with intralesional corticosteroids but improved significantly following adjunctive fractional CO₂ laser therapy. The report highlights the safe use of lasers in darker skin types and reinforces the need to expand equitable access to such treatment modalities.

We report a case of a previously healthy 4-year-old girl who presented with two recurrent episodes of complicated pneumonia and Haemophilus influenzae bacteremia. Immunologic evaluation revealed hypogammaglobulinemia, as immunoglobulins (IgG, IgA, IgM, IgE) were below detectable levels and genetic testing identified a pathogenic TCF3 variant, confirming a diagnosis of TCF3 (transcription factor 3) deficiency. TCF3 is a key transcription factor in B- and T-cell development, and its deficiency results in impaired antibody production and increased susceptibility to infections. This case highlights the rarity of TCF3 mutations in pediatric patients, the importance of early recognition, and the critical role of immunoglobulin replacement therapy as the current mainstay of treatment.

A 56-year-old man with known pancreatic adenocarcinoma presented to the emergency department with facial twitching and a left-sided facial droop. Magnetic resonance imaging of the brain and subsequent biopsy revealed metastatic pancreatic adenocarcinoma with no other metastatic sites shown on computed tomography of the chest, abdomen, and pelvis. Following craniotomy and tumor resection, the patient has shown clinical improvement with no deleterious complications to date.

Heterotaxy syndrome, or situs ambiguus, is a rare congenital condition characterized by abnormal left-right positioning of thoracoabdominal organs. It often includes splenic anomalies such as polysplenia and vascular malformations like interruption of the inferior vena cava (IVC) with azygos continuation. These anatomical variants can impair venous return, increasing the risk of venous thromboembolism, particularly in young patients. We present the case of an 18-year-old woman with obesity and long-term estrogen-containing oral contraceptive use who presented with acute bilateral pulmonary emboli. Initial imaging noted polysplenia, but the diagnosis of heterotaxy syndrome with IVC interruption and azygos continuation was not made until 5 months later during evaluation for recurrent chest pain. Hypercoagulable workup was negative, and anticoagulation was continued due to ongoing thrombotic risk. This case highlights heterotaxy syndrome as an underrecognized contributor to venous thromboembolism in young individuals and underscores the importance of considering anatomical risk factors in cases of unprovoked thromboembolism.