Fungal pericarditis is a rare disease but its incidence has risen in parallel with the global increase in invasive fungal infections. This systematic review analyzes data from previously reported cases of fungal pericarditis to provide an improved understanding of the etiology, clinical presentation, management, and outcomes of this rare disease. We reviewed Medline and Scopus databases from 1 January 1990 to 29 January 2024 for case reports that documented the isolation of a fungal pathogen from pericardial fluid or tissue. Of the 2330 articles screened, 101 cases met the inclusion criteria. Patients with fungal pericarditis and the involvement of at least one other organ—usually the lungs, brain, or kidney—had worse outcomes than patients with isolated pericardial disease. Immunosuppression was reported in 50% of cases and was associated with worse outcomes in adults. Patients who presented with chest pain, received adequate empiric antifungal therapy, and underwent pericardiocentesis and pericardiectomy had improved survival. The most common isolated pathogens were Candida spp., followed by Aspergillus spp. and Mucor spp., with the latter two linked to worse outcomes. Only 35% of patients received empiric antifungal medications before the causative pathogen was identified, and mortality was associated with a delay in appropriate therapy. Immunosuppression, disseminated disease, and presence of shock/multiorgan failure were additional risk factors associated with death. Fungal pericarditis carries a mortality rate of up to 50%, with nearly half of patients being immunocompromised. Clinicians frequently do not consider fungal pericarditis in the differential diagnoses, which leads to delays in treatment and poorer outcomes. Further prospective multicenter studies are urgently needed to better understand the epidemiology, improve diagnostic testing and management, and decrease unacceptably high mortality in patients with fungal pericarditis.

Objective. To compare clinical symptoms, treatment, and outcomes between typical and atypical forms of Kawasaki disease (KD) in patients treated at our institution. Methods. A retrospective observational study was conducted at the Pediatric Clinic, University Clinical Center Niš, reviewing medical records of 17 patients diagnosed with KD between September 2017 and February 2024. Clinical characteristics, laboratory results, treatment regimens, and outcomes were compared between typical (n=12) and atypical KD (n=5) groups. Statistical analysis was performed using the R statistical computing environment. Results. Patients presented with high fever (>38.5 °C) at admission. Diagnosis was delayed in atypical KD cases compared to typical cases (9.6 ± 2.3 days vs. 7.92 ± 2.81 days, respectively). Echocardiographic abnormalities were present in 35% of all cases, including mild left ventricular dysfunction (n=2) and pericardial effusion (n=4). Treatment with intravenous immunoglobulins (IVIg) and aspirin led to significant clinical improvement in most patients. However, corticosteroids were added in 12% (n=2) of cases due to prolonged fever despite initial therapy. One atypical KD patient, diagnosed late, was treated with aspirin alone. Laboratory markers showed notable improvements post-treatment, particularly CRP reduction in typical KD from 77.33 ± 55.92 mg/L to 9.43 ± 7.04 mg/L. Conclusion. Both typical and atypical KD patients showed good shortand medium-term prognoses, with no significant complications noted during follow-up. However, delays in diagnosis, particularly among atypical cases, highlight the need for improved communication across healthcare levels. A larger, multicenter study is recommended to enhance patient management and outcomes.

Cardiovascular toxicity is an important complication of treatment for hematologic malignancies, but it is often discussed mainly in terms of direct myocardial injury. Endothelial injury may provide a common link between several cardiovascular complications seen in these patients. Endothelial dysfunction may already be present because of the malignancy itself and can be further increased by anticancer treatment, immune activation and haematopoietic stem cell transplantation. Oxidative stress, reduced nitric oxide availability, inflammation, increased vascular permeability and activation of coagulation can shift the endothelium from a protective to a pro-inflammatory and prothrombotic state. These changes could contribute to hypertension, thrombosis, atherosclerotic disease, coronary microvascular dysfunction, arterial stiffness and myocardial dysfunction. The role of endothelial injury is particularly relevant with BCR-ABL inhibitors, proteasome inhibitors, CAR-T-cell therapy, bispecific antibodies and transplantation, although the mechanisms and strength of evidence differ between treatments. Several circulating biomarkers and tools, including angiopoietin-2, von Willebrand factor, soluble thrombomodulin, adhesion molecules and the Endothelial Activation and Stress Index, may help identify endothelial injury, but their clinical roles still remain unclear. This review examines endothelial injury across hematologic malignancies and their treatments and discusses its role in cardiovascular toxicity, current approaches to vascular protection and the main gaps that need to be addressed before endothelial assessment can become part of routine cardio-oncology care.

In 1885, French neuropsychiatrist Dr. Georges Gilles de la Tourette was the first to describe a disease of tics. His success was not unexpected, as he was a student of the renowned neurologist Dr. Jean-Martin Charcot. Georges Gilles de la Tourette was born on October 30, 1857, in Saint-Gervais-les-Trois-Clochers, France, as the eldest of four children. Immediately after graduating in 1881, he went to Paris for further training. His special interests included hysteria, psychotherapy, and hypnotism. By revising an article titled “Experiments with the ‘Jumpers of Maine’ ”, he concluded that a somewhat similar disorder exists in different cultures across the world. He soon described additional signs of the syndrome, including inarticulate sounds, echolalia, and coprolalia, and accentuated the hereditary nature of the disease. Insightful and dedicated yet short-tempered and arrogant, Georges Gilles de la Tourette was an inspiring physician and teacher. He left behind a significant legacy in the study of involuntary movements, particularly through his description of the syndrome that would come to be known as Tourette syndrome. This description of the syndrome is just a portion of his contributions to neurology and psychiatry. His work, often met with both admiration and criticism, reflects the complexities of his personality and the challenges he faced in his professional life.

Ilic D, et al. Pediatr Gastroenterol Hepatol Nutr. 2026 Sep;29(5):413-419. https://doi.org/10.5223/pghn.2026.29.5.413

Babesiosis is a tick-borne infection caused by intraerythrocytic Babesia parasites and may result in severe hemolytic anemia and systemic complications. Coinfection with other Ixodes-borne pathogens may further complicate diagnosis and management. We report a 45-year-old immunocompetent man working as a landscaper in Connecticut who presented with syncope following two weeks of fever, fatigue, diaphoresis, arthralgias, jaundice, and dark urine. Laboratory evaluation revealed profound hemolytic anemia with a hemoglobin of 6.8 g/dL, elevated lactate dehydrogenase (LDH), undetectable haptoglobin, reticulocytosis, and stage 1 acute kidney injury. Peripheral blood smear demonstrated characteristic Maltese cross formations, with approximately 0.6% parasitemia, and polymerase chain reaction (PCR) testing confirmed Babesia microti and Borrelia burgdorferi coinfection. Direct antiglobulin testing for immunoglobulin G (IgG) was negative. The patient required intensive care monitoring and transfusion and improved following treatment with atovaquone, azithromycin, and doxycycline. Subsequent outpatient evaluation identified asymptomatic Strongyloides stercoralis infection, which was treated with ivermectin. This finding was clinically significant because warm autoimmune hemolytic anemia is a recognized complication of babesiosis and may require corticosteroid therapy, which can precipitate potentially life-threatening Strongyloides hyperinfection in patients with occult infection. This case highlights that severe babesiosis may occur despite low-level parasitemia and emphasizes the importance of recognizing coinfections and obtaining a detailed occupational and environmental exposure history, particularly when future immunosuppressive therapy may be considered.