A document by Sarah Baïli. Click on the document to view its contents.

Congenital Lobar Emphysema: A diagnostic dilemma with co-existent Congenital Heart Defects

Title: Recurrent Staphylococcal Scalded Skin Syndrome in a 20 month old – A case reportAuthors: Camille Basurto, M.S.1, Nada Baah-Owusu, M.D. 2, Kyla Berreth, D.O.2Institutional Affiliations: 1Liberty College of Osteopathic Medicine, 306 Liberty View Lane, Lynchburg, VA, 24502;2Sovah Pediatrics - Danville, 201 S. Main Street, Suite 2100, Danville, VA 24541Corresponding Author Present Address: 40 Glen Hill Road, Wilton, CT 06897Keywords: Staph scalded skin syndrome, exotoxins, Staphylococcus, toxic epidermal necrolysis, atopic dermatitisWord, Figure, reference count: 1406, 2, 13Conflict of Interest Statement: The authors have no disclosures to report.Consent statement: Patient’s guardians provided written consent for the use of patient photographs and related materials for publication.Abstract: We present a case of a 20 month old child with a history of atopic dermatitis that exhibited recurrent erythematous-bullous lesions consistent with Staphylococcal Scalded Skin syndrome (SSSS). SSSS is an exfoliative toxin mediated skin disorder most commonly found in children. In this paper, we discuss the importance of recognizing the clinical symptomatology and progressive nature of SSSS, particularly in patients with a history of atopic dermatitis, to assure prompt treatment and resolution of the syndrome.

Recurrent Pyogenic CholangitisA 59-year-old South Asian female presented with the complain of pain upper abdomen and recurrent fever for one year. There was no history of vomiting, jaundice, anorexia or weight loss. Family history was unsupportive of diagnosis. On laboratory examination, alkaline phosphatase was elevated by two times. Serum bilirubin was normal and her leukocytes count was 11200/mm3. Rest of the systemic examination was normal. Contrast enhanced computed tomography(CECT) revealed multiple hypodense/hyperdense lesion in segment 3 of liver. Magnetic resonance imaging(MRI) showed hypo-hyperdense focal lesions with conglomerate appearance on segment 3 of liver suggestive of hepatolithiasis (Figure 1). Left lateral segmental resection (Figure 2) and intrahepatic choledochoscopy from dilated left hepatic duct and stone clearances was done. On histopathological examination, definitive diagnosis of recurrent pyogenic cholangitis was established with no evidence of malignancy. At a 3-year follow-up, the patient is free of recurrence.The incidence of hepatolithiasis is variable. It is highly prevalent in parts of Asia, such as China, Japan, and South Korea, with a reported incidence between 3.1% and 21.2%.1 However, with an incidence of about 1%, hepatolithiasis is rare in Western countries.The mechanism of development of hepatolithiasis is yet to be fully elucidated. Cholestasis, cholangitis, an anatomical abnormality of the bile ducts, abnormal bile metabolism, malnutrition, and low socio-economic status are significant risk factors for hepatolithiasis. According to several studies, indications of hepatectomy for hepatolithiasis include the following instances: (i ) unilobar hepatolithiasis, and particularly that on the left; (ii ) atrophy or severe fibrosis of the affected liver segments or lobe; (iii ) presence of a liver abscess; (iv ) cholangiocarcinoma; and (v ) multiple intrahepatic stones causing marked biliary stricture or dilation.2 Globalization, apart from changing the socioeconomic status of regions, has additionally altered disease dynamics globally. Hepatolithiasis, as a result of recurrent pyogenic cholangitis, although still rare, is becoming progressively evident in the West because of immigration from the Asia-Pacific region, where the disease is endemic. Such rare but emerging disease has imposed significant challenges to the physicians and surgeons. Uenishi et al.3 presented outcomes for 86 patients who underwent a hepatectomy from 1998 to 2012. Seventy-six patients (88%) had immediate stone clearance whereas 82 patients (95%) had final stone clearance.3 A multi-disciplinary team approach involving radiologists, internists, pathologists, oncologists, and surgeons is deemed necessary for the timely diagnosis and safe, affordable treatment, thus ensuring good prognosis to the patients.Low socio-economic status of our patient could have been the attributing factor. Also, unilobar hepatolithiasis, and particularly that on the left was the main indication for left lateral segmental hepatectomy in our case. With this image, we would like to recommend that the differential diagnosis of hepatolithiasis should be thought in the back of mind if an elderly person from endemic region presents with the complain of pain upper abdomen and recurrent fever. Surgical intervention is deemed necessary with the aforementioned indications and it can provide good prognosis to the patient with an excellent stone clearances.Conflict of interests: NoneConsent: Written informed consent was obtained from the patient for the accompanying images.

Performing afib ablation combined with the placement of the Watchman device for LAA occlusion has been evaluated before, with results showing evidence of safety and ability to perform (6). This can save time and materials allowing patients to have two procedures simultaneously, preventing repeating exposure to possible risks that come with

AbstractOur patient was a 61-year-old man with dedifferentiated chondrosarcoma (DCS) and a benign thrombus or a tumor thrombus. We diagnosed the patient with a tumor thrombus by angioscopic observation of a smooth-surfaced, white, elevated lesion in the IVC that had invaded the vein wall. Although anticoagulant therapy was discontinued, his condition progressed without an elevation in D-dimer levels or the appearance of new thromboembolism. After one course of chemotherapy, the patient refused to continue the treatment and was treated with palliative care. He died of the underlying disease approximately half a year later. This is the first case of a DCS patient where benign and tumor thrombi was differentiated by angioscopy. Angioscopy is one of the useful tools for this differentiation which can evaluate the color tone and surface properties of an object.

INTRODUCTION:Tubercular meningitis is a severe form of meningitis caused by tuberculosis bacteria. 1It is a rare condition, but in India, it is a significant public health concern, as the country has a high incidence of tuberculosis. 2 This disease affects the protective layers surrounding the brain and spinal cord, leading to inflammation and the formation of blood clots in the veins of the brain. These clots can lead to a condition called cortical venous thrombosis, which can be life-threatening. In this case, an 18-year-old man in India has been experiencing symptoms of tubercular meningitis complicated by cortical venous thrombosis. He has been suffering from a severe headache, fever, and neck stiffness, which are typical symptoms of meningitis, and are signs of confusion and disorientation.We immediately started treatment for this patient’s condition, which included a combination of antibiotics to fight the tuberculosis bacteria and anticoagulant medication to prevent further blood clots from forming. We also monitored his intracranial pressure to prevent any further complications. These symptoms are concerning as they indicate a worsening of his condition, and we closely monitored him to prevent any further complications.In India, tuberculosis is a significant public health concern, and the country has implemented several programs to control the spread of the disease like the National Tuberculosis elimination program.3 These include early detection, treatment, and prevention strategies such as vaccination and contact tracing.

A document by Tejash Shahi. Click on the document to view its contents.

A Series of Unfortunate Events: Long-neglected Malpositioned Pacemaker and its ConsequencesAbdelrahman Osman, BS and Ali Ahmad, MD.

IntroductionPulmonary alveolar microlithiasis (PAM) is an uncommon, autosomal recessive lung disease with high penetrance (OMIM #265 100) and is considered to be a monogenic disorder. 1 The only known pathogenic gene is solute carrier family 34 member 2 (SLC34A2) (Entrez Gene ID 10568).2-4 SLC34A2 mutations lead to the accumulation of calcium phosphate in the alveoli, restrict alveolar dilatation, and then progress to a restrictive lung function complicated with reduced dynamic and static volumes.5, 6 Dyspnea is the most frequent symptom, followed by dry cough, chest pain, asthenia, pneumothorax, pulmonary fibrosis, and cor pulmonale.7-10While children are always in the onset at the early stage of PAM and usually remain asymptomatic when diagnosed; however, some can present with dry cough, exertional dyspnea, and chronic hypoxic signs, including clubbing.3 Recently, some complications with PAM have been reported, such as asthma, pneumomediastinum, subcutaneous emphysema, and so on.11-14PAM is difficult to be diagnosed because of nonspecific symptoms in children. The diagnosis of PAM is often based on radiographic studies at first, and an exact diagnosis requires at least one additional clinical feature including genetic testing demonstrating a mutation in SLC34A2, microlith analysis, or histopathology.15 Gradually, it has been a tendency that gene analysis would play an increasingly important role in the diagnostic procedure. Bendstrup et al. summarized 30 genetic variants of SLC34A2 in 2020.16In this case, we identified a PAM patient complicated with bronchitis obliterans by computerized tomography (CT), bronchoscopy and whole-exome-sequencing. Two novel compound heterozygous gene mutations, gain (EXON:2-6 duplication) and c.1218C>A (p. Phe406Leu) were identified to expand the spectrum of gene mutations.

First Reported Rhodotorula mucilaginosa Brain Abscess: Found As Coinfection in Woman with Common Variable Immune DeficiencyAuthors: Arjun Bhatt, B.A.1Melinda S. Dunlap, M.D.2Han Pham, M.D.3Kimmo J. Hatanpaa, M.D., Ph.D3Philip Boyer, M.D., Ph.D3Rita M. Gander, Ph.D3Anna G. Symmes, M.D.1Affiliations: Department of Internal Medicine1Brody School of MedicineGreenville, North CarolinaDepartments of Internal Medicine2 and Pathology3University of Texas Southwestern Medical CenterDallas, Texas

A document by Marhaba Iqbal. Click on the document to view its contents.

A document by Carlos F de Paule. Click on the document to view its contents.

A document by Yasmin Sheikhhassani. Click on the document to view its contents.

Pemigatinib treatment for intrahepatic cholangiocarcinoma with FGFR2 fusion detected by a liquid comprehensive genomic profiling testShun Ishido¹*, Nobuharu Tamaki¹*, Kento Inada¹, Jun Itakura¹, Yuka Takahashi¹, Naoki Uchihara¹, Keito Suzuki¹, Yuki Tanaka¹, Haruka Miyamoto¹, Michiko Yamada¹, Hiroaki Matsumoto¹, Tsubasa Nobusawa¹, Taisei Keitoku¹, Kenta Takaura¹, Shohei Tanaka¹, Chiaki Maeyashiki¹, Yutaka Yasui¹, Kaoru Tsuchiya¹, Hiroyuki Nakanishi¹, Masayuki Kurosaki¹#, Namiki Izumi¹*These authors equally contributed to this case report.#This author (Masayuki Kurosaki) is corresponding author.Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, JapanGuarantor of this article: Masayuki Kurosaki

Key clinical message:We described a type IIIb dens invaginatus, its root canal treatment and results on 3- and 12-months visits. Despite its significant challenges, proper endodontic therapy in such cases can cause positive prognoses and successful outcome.Keywords:Dens Invaginatus, Root Canal Therapy, Dens in Dente, Cone-beam Computed Tomographic Imaging1. IntroductionDens invaginatus (DI), also known as dens in dente, invaginated odontoma, dilated composite odontoma, dentoid in dente1, telescopic tooth and deluted compound odontoma2 is caused by an infolding of the enamel organ into the dental papilla prior to the calcification of the tooth.3 The invagination may be limited to the pulp chamber or be extended to the root and even the apex.1The prevalence of this developmental anomaly ranges 0.3-10%.4 DI can affect any primary or permanent tooth.5 Maxillary lateral incisors are the most affected teeth.2 The involvement of maxillary central incisors have been reported2 and it may rarely occur in canines and posterior teeth, though.4 DI may occur simultaneously with supernumerary teeth, but this is not a common phenomenon.4 Although environmental and genetic etiological factors have been reported, there is no consensus on its etiology.4 Oehlers described 3 types of DI based on its apically extension5 according to their radiographic features6 which is the most commonly used.3 The invaginatus in type I is limited to the crown;1 type II is defined as an invagination that goes beyond the cementoenamel junction making a blind sac through the root, communicating with the dental pulp or not;3 type III is referred to the enamel lined infolding that penetrates through the root, opening an independent lateral (also called type IIIa) or apical (also named type IIIb)6 foramen eventually and usually with no pulpal communication.3Increased risk of pulpal and periodontal diseases in associated with the progression of microorganism and their products through the coronal aspect of the invagination is the clinical significance of dens invaginatus.5 Although 2-dimensional images are used to diagnose DI,4 3-dimensional radiographies including cone-beam computed tomography (CBCT) is recommended for managing severe types of DI.7 Several approaches for clinical management of different types of DI including restorative management, non-surgical root canal therapy, surgical treatment, intentional replacement or extraction have been described.8In this case report, we described a non-surgical management of type IIIb DI occurred in maxillary central incisor with two root canals view in 2-dimensional radiography simultaneously with impacted supernumerary tooth.2. Case presentationAn 18-year-old Iranian male was referred with the chief complaint of correcting the shape of his anterior tooth.Medical history revealed that there was no history of systemic disease, medication and allergic reaction. The patient was categorized in ASA1 group with no evidence of hereditary dental anomalies and no history of dental trauma, sinus tract or swelling. No pain was reported in accordance with the mentioned tooth. The patient oral hygiene was fair.Objective findings revealed normal extra oral exam, normal facial appearance, conical shaped tooth #8 and periodontium probing within a normal limit.Clinical evaluation as reported in table 1, confirmed normal response of tooth no. #8 to percussion and palpation test with no response to cold, heat and electric pulp tests.Periapical radiographic findings revealed periapical radiolucency with impacted supernumerary tooth and fully developed (dens invagination) tooth no. #8 (figure 1). Cone beam computed tomography (CBCT) was prescribed for treatment planning (figure 2).According to the given medical and dental history, radiographic evaluation, objective findings and clinical evidences, diagnosis of type IIIb dens invagination with chronic apical periodontitis in pulpless and infected tooth no. #8 was made.Recommended treatment plan including nonsurgical root canal treatment and follow up and possible surgical intervention in the future and alternative treatment plan consist of orthodontic replacement supernumerary tooth or extraction and replacement with fixed prosthesis or implant were explained.According to consultation with the senior orthodontist, extraction of the supernumerary tooth was suggested in accordance with its shape and position.Treatment procedure for tooth no. #8 was done with 4 recall visits in 12 months.At first session, after local anesthesia with lidocaine2% and epinephrine 1/100000 (Persocaine-E; Darou Pakhsh; Iran) and access cavity preparation and the tooth isolation using rubber dam, access the mesial canal was done troughing the mesial part of the root by mueller bur (figure 3A). Working lengths was determined with an electronic apex locator and was confirmed radiographically. Root canals were prepared with hand K file (Mani; Japan) up to #40 and rotary file up to F3 (denco blue; China) simultaneously with passively ultrasonic irrigation using 5/25% sodium hypochlorite (NaOCl). Creamy Calcium hydroxide (Golchai; Iran) paste was placed to the canals with a lentulo spiral (Mani; Japan) for 10 days and access cavity was sealed with temporary restoration.At the second session, tooth no. #8 was asymptomatic and no pain was reported. After local anesthesia with lidocaine2% and epinephrine 1/100000 (Persocaine-E; Darou Pakhsh; Iran), removal of temporary filling and isolation using rubber dam, intracanal medicament was removed by copious irrigation with NaOCl combined with hand instrumentation and a final rinse with ethylenediaminetetraacetic acid (EDTA) (EDTA; Morvabon; Iran). Obturation was carried out using mineral trioxide aggregates (MTA) (MTA Angelus; Brazil), gutta-percha and sealer (AH-26; Dentsply Sirona; Germany). MTA was used as a plug at the apical of distal canal and the rest of distal and mesial canals were obturated using gutta-percha and sealer with warm vertical obturating technique. Access cavity was sealed with resin modified glass ionomer (RMGI) (GC Fuji II LC; Japan) (figure 3B).Recall visits were set to control the healing process. 3- and 12-month follow up evaluation revealed that the tooth no. #8 was asymptomatic and the periapical lesion was healed (figure 3C and 3D). It was permanently restored and supernumerary tooth was extracted.3. DiscussionDI is a developmental anomaly with the most prevalence of affected maxillary lateral incisors.8 Although, affected canines, premolars, molars and maxillary central incisors have also been reported.8 This malformation is classified into 3 groups6 and type III is more complicated compared to the others.9 A different treatment plan would be useful for each type of dens invagination.1 Despite uncommon communication with the pulp in type III,9pulpal disease or a periapical lesion has been reported in many cases.4 Thus, 3-dimensional radiography is essential to choose the best treatment plan.4In the present case, type IIIb dens invaginatus with necrotic pulp and periapical lesion was diagnosed in the right maxillary central incisor using CBCT.Non-surgical root canal therapy is the first line of clinical management in necrotic tooth affected with DI.2 According to the root canal morphology complexity and varieties including unreachable fines and intracanal communications, complex endodontic considerations, eradication of necrotic tissue using proper chemical and mechanical procedures for cleaning, shaping and obturation is mandatory in DI cases.1 Thus, the clinician should be well-informed regarding various techniques and materials.5 Although, the effect of mechanical and chemical root canal preparation on the reduction of the number of microbial organisms is significant, the use of a dressing between treatment sessions including calcium hydroxide as a popular and well-known intracanal medicament is mandatory to eliminate intracanal residual pathogens.10 Despite of its advantages, calcium hydroxide has negative effect on the sealing qualities during obturation.10 Thus, copious irrigation using NaOCl and EDTA prior to obturation is recommended to conquer the adverse effect of residual intracanal calcium hydroxide on the root canal filling.10 Moreover, for nonsurgical endodontic treatment of DI, the preferred approach is using MTA plug at the apical end and root canal obturation using lateral condensation or warm gutta-percha techniques.8 Various obturation materials including Biodentine, MTA and gutta-percha using different sealers have been suggested, though.2In the present case, scrolling the axial view of the tooth in CBCT revealed that the space between two roots had no connection to the canals. Thus, it had not been sealed with bioceramic material. MTA-Angelus was used for this purpose due to its short setting of 15 minutes.11A successful clinical and radiographic outcome was reported in the present case. Asymptomatic tooth with healed periapical lesion was reported in 3-month recall session.Despite its significant challenges, a proper endodontic therapy for DI cases may have positive long-term prognoses.1Conflict of interestsNoneDeclaration of patient consentThe patient has given his consent for his clinical information to be reported in the journal.AcknowledgmentNoneReferences1. Martins JNR, da Costa RP, Anderson C, Quaresma SA, Corte-Real LSM, Monroe AD. Endodontic management of dens invaginatus Type IIIb: Case series. Eur J Dent. 2016;10(4):561-5.2. Ghandi M, Ghorbani F, Jamshidi D. Nonsurgical management of a patient with multiple dens invaginatus affecting all maxillary incisors. Saudi Endodontic Journal. 2022;12(1):138-42.3. Alkadi M, Almohareb R, Mansour S, Mehanny M, Alsadhan R. Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography. Sci Rep. 2021;11(1):19727.4. Zhu J, Wang X, Fang Y, Von den Hoff JW, Meng L. An update on the diagnosis and treatment of dens invaginatus. Aust Dent J. 2017;62(3):261-75.5. Pradhan B, Gao Y, He L, Li J. Non-surgical Removal of Dens Invaginatus in Maxillary Lateral Incisor Using CBCT: Two-year Follow-up Case Report. Open Med (Wars). 2019;14:767-71.6. González-Mancilla S, Montero-Miralles P, Saúco-Márquez JJ, Areal-Quecuty V, Cabanillas-Balsera D, Segura-Egea JJ. Prevalence of Dens Invaginatus assessed by CBCT: Systematic Review and Meta-Analysis. J Clin Exp Dent. 2022;14(11):e959-e66.7. Cho WC, Kim MS, Lee HS, Choi SC, Nam OH. Pulp revascularization of a severely malformed immature maxillary canine. J Oral Sci. 2016;58(2):295-8.8. Yalcin TY, Bektaş Kayhan K, Yilmaz A, Göksel S, Ozcan İ, Helvacioglu Yigit D. Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography. PeerJ. 2022;10:e14450.9. Mary NSGP, Sangavi T, Venkatesh A, Prakash V. Dens Invaginatus clinical diagnosis and management: A Review. European Journal of Molecular & Clinical Medicine. 2020;7(5):2020.10. Raghu R, Pradeep G, Shetty A, Gautham PM, Puneetha PG, Reddy TVS. Retrievability of calcium hydroxide intracanal medicament with three calcium chelators, ethylenediaminetetraacetic acid, citric acid, and chitosan from root canals: An in vitro cone beam computed tomography volumetric analysis. J Conserv Dent. 2017;20(1):25-9.11. Hansen SW, Marshall JG, Sedgley CM. Comparison of intracanal EndoSequence Root Repair Material and ProRoot MTA to induce pH changes in simulated root resorption defects over 4 weeks in matched pairs of human teeth. J Endod. 2011;37(4):502-6.

Protracted Complete Response After Limited Checkpoint Inhibitor Dosing: A Case ReportAuthors:Dr. Quinne Sember, MD Scripps HealthDr. Darren Sigal, MD Scripps HealthAcknowledgements: NoneManuscript has not been presentedNo disclaimers and no conflicts of interest.Consent statement:Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policyCorresponding author:Quinne Sember, MD10710 North Torrey Pines Rd.La Jolla, CA 92037Phone: 716-574-6335Email: [email protected]: @SemberQuinne

Letter to the editor regarding the paper ”Rare tapeworm segments case report and review of literature”Michele CalatriUniversity of Cagliari – Faculty of Medicine [email protected] Editor,My initial enthusiasm was born from the premise of reading about an uncommon species of human parasite in the article “Rare tapeworm segments case report and review of literature” by Ahmed Ali Gaffer11Gaffer A. Rare tapeworm segments case report and review of literature. Clinical Case Reports . 2023;11(4). doi:https://doi.org/10.1002/ccr3.7167, which has given way first to confusion and then to a sincere disappointment, due to the many mistakes, inaccuracies, and misspellings which unfortunately result in a chaotic and inconclusive report.First, it should be noted that in most of his manuscript, the author makes incorrect use of the terms ”cestode” and ”trematode” as if they were interchangeable. As it is known, cestodes and trematodes belong to two different classes, Cestoda and Trematoda, within the phylum Platyhelminthes. These two groups of parasitic flatworms, while sharing some similarities (e.g. bilateral symmetry and the lack of a body cavity) by having a common ancestor, count many different morphological characteristics such that the two cannot be easily confused. In particular, the head or more properly ”scolex”, neck, and the ribbon-like segmented body (strobila) composed of segments called proglottids, in addition to the lack of a mouth and digestive tract, are all external peculiarities of adult cestodes, while adult trematodes typically have an anterior mouth, organs of attachment or ”suckers” and an unsegmented leaf-shaped body22Bogitsh BJ, Carter CE, Oeltmann TN. Human Parasitology . Academic Press, An Imprint Of Elsevier; 2019.. Having said that, it seems that the observed parasite would belong to Cestoda rather than Trematoda, assuming it is a parasite.The second major problem in the report is the total lack of the minimum morphological features that are usually required for the identification of a cestode. The image attached has a very poor resolution quality, the micrometer bar is absent and the author admits that eggs have not been detected in the observed specimen. The presumed scolex, an organ whose dimensions and morphologies often represent critical keys in classifying Cestoda genera and species33Khalil LF, Jones A, Rodney Alan Bray, C.A.B. International. Keys to the Cestode Parasites of Vertebrates . Cab International; 1994., lacks any useful detail. Inside each “triangular-shaped” segment it is honestly difficult to understand how it was possible to identify a uterus just from an amorphous central mass and consequently to count the individual ”uterine branches” of the hypothetical tapeworm. It should be remarked that this is an act that would usually require the injection of India ink through a lateral genital pore, another useful point of reference, not observed in the image provided44CDC. CDC - DPDx - Taeniasis. www.cdc.gov. Published January 22, 2019.https://www.cdc.gov/dpdx/taeniasis/index.html. Here the doubt is that the author has confused the uterine branches with the segments of the elements he observed, which - if it were a cestode - should instead be its proglottids (!).The scenario described so far becomes even more entangled in the final reflections when the author hypothesizes that we are dealing with an infective larval stage, expressing concern about the risk that the parasite “is ready to become adult worm”. In Cestoda, the larval forms, known as metacestodes, are quite different from the adult tapeworms, even because they lack of reproductive organs contained in the proglottids.To provide a minimum of clarity, perhaps it is necessary to briefly recall the biological cycle of a human cestode. In most cases, it involves two hosts: embryos develop into metacestodes in an intermediate host; metacestodes mature into adult worms in a definitive host. Humans can serve as both intermediate and definitive hosts.The intermediate host usually becomes infected after ingesting food or water contaminated with the parasite’s eggs. Once in the intestine, the eggs hatch releasing oncospheres that penetrate the intestinal walls, pass to the mesenteric capillaries, and from there to the bloodstream, through which they can reach various tissues (muscle, liver, lung, brain, bone), encyst and develop in metacestodes.The clinical spectrum of metacestode infections varies from asymptomatic to life-threatening conditions, essentially depending on the site of encystment. Given the parasitized sites, the approach to these infections is usually represented by imaging techniques, serology, and molecular diagnostics, the optical microscopy is useful only when the parasite is observed in biopsy specimens for histological examination55Lynne Shore Garcia. Diagnostic Medical Parasitology . Washington Asm Press; 2016..Examples of human metacestodiasis are cysticercosis, echinococcosis, and sparganosis, caused – respectively - by metacestodes of Taenia solium, Echinococcus spp., and Spirometra spp.The definitive host becomes infected if it consumes raw (or undercooked) meat containing the larval forms. Inside the intestine of the new host the metacestodes evert their scoleces through which they tenaciously attach themselves to the intestinal wall and, in a few months, they develop in adult worms, with the production of proglottids, a process known as strobilation.Those caused by adult cestodes are among the most common intestinal infections worldwide, afflicting millions of people, especially in developing countries. The symptoms are usually mild and non-specific and they can be diagnosed by the identification of eggs or proglottids in stool, a few months after the infection.Examples of human cestodiases are taeniasis, dibothriocephaliasis, and hymenolepiasis, caused by the adult tapeworm of Taenia spp., Dibotriocephalus spp., and Hymenolepis spp.However, this whole premise would seem to have been ignored by the author who, all along the manuscript, describes what he considers to be a parasite as it would be an adult tapeworm but - inexplicably - he comes to the conclusion that it is a larval form(!).For all the reasons described above, any comparative work with already described cestode species is also particularly difficult, if not impossible.Cases of rare or uncommon cestodiasis in humans have sometimes been described, such as in the case of infections by adults anoplocephalids of the genera Mathevotaenia66Lamom C, Greer GJ. Human Infection with an Anoplocephalid Tapeworm of the Genus Mathevotaenia. The American Journal of Tropical Medicine and Hygiene . 1986;35(4):824-826. doi:https://doi.org/10.4269/ajtmh.1986.35.824, Bertiella, Inermicapsifer, and Moniezia, by davaineids of the genus Raillitiella and Metacestoides77Sapp SGH, Bradbury RS. The forgotten exotic tapeworms: a review of uncommon zoonotic Cyclophyllidea. Parasitology. 2020;147(5):533-558. doi:https://doi.org/10.1017/S003118202000013X, but none of the above have similar features to those reported by the author. Not even among non-cyclophyllid cestodes, such as diphyllobothrids, can morphological similarities be found with the proposed case. Some of the infections with juvenile aberrant cestodes have been described in the literature, but no similarities can be found with these either88Garin F, Maria Teresa Galán-Puchades, Moulignier A, et al. Human brain abscess due to a tetra-acetabulate plerocercoid metacestode (Cyclophyllidea). American Journal of Tropical Medicine and Hygiene. Published online May 1, 2005. doi:https://doi.org/10.4269/ajtmh.2005.72.513.So, ultimately, are the elements in the picture cestodes and did they cause this patient’s clinical manifestations?As I have tried to stress, while it is certainly possible to rule out the grounds that we are dealing with a ”rare tapeworm”, without more data or better images, it is not possible to comment further on the true nature of the elements found by the author, although similarities with the material of plant or fungal origin are certainly evident (spines? Trichomes? Spores?). Given the eating habits of the young patient, it is also possible that there is another type of parasite, not observed by the author, behind the reported symptoms or that another type of pathogen is responsible, maybe a virus or a bacteria.To finish, although new technologies, such as the genetic tests called upon to help by the author, can certainly make an important contribution to today’s parasitological diagnostics, it should be remembered that their role must be to accompany and integrate the morphological identification of parasites by optical microscopy and not to replace it. The risk, is that basic skills in morphological identification under the light microscope are lost, which would paradoxically lead, among other things, to failure to detect precisely those species that are rare or entirely new in human pathology99Bradbury RS, Sapp SGH, Potters I, et al. Where Have All the Diagnostic Morphological Parasitologists Gone? Humphries RM, ed. Journal of Clinical Microbiology. 2022;60(11). doi:https://doi.org/10.1128/jcm.00986-22.