Background: Understanding immune responses after HBV vaccination is important to prevent HBV infection in PLWH and to achieve successful treatment. Methods: Thirty-two PLWHs with CD4⁺ cell count > 350 cells/µL and HIV RNA < 200 copies/mL were vaccinated with 20 µg of HBV vaccine at weeks 0, 4, and 24 in this prospective study. We measured total HIV DNA levels, HBsAb titers and HBsAg-specific T-cell responses during follow-up time. Results: All patients achieved protective HBsAb titer after immunization. The magnitude of the IFN-r and TNF-a response to HBsAg was 22.0 (IQR: 6.5–65.0) and 106.50 (IQR: 58.5–203.0) spot-forming cells (SFC)/10⁵ PBMC, respectively at week 0. The level of IFN-r secreted at weeks 12 and weeks 36 to 48 was comparable with that at week 0. However, IFN-r response was higher at weeks 12 than that at weeks 36 to 48 (p = 0.02). The level of TNF-a secreted at weeks 12 was higher than that at week 0 (p < 0.001). Total HIV DNA levels were 2.76 (IQR: 2.47–3.07), 2.77 (IQR: 2.50–3.09), 2.77 (IQR: 2.41–2.89) log₁₀ copies/10⁶ PBMCs at weeks 0, 12, 36 to 48, respectively. No correlation was observed between IFN-r and TNF-a levels and HBsAb titer as well as total HIV DNA levels after immunization. Conclusion: Humoral immunity was satisfactory, but cellular immunity and decline in HIV reservoir were not optimal after HBV vaccine immunization in these patients.

Background: Paragangliomas (PGLs) are rare neuroendocrine tumors originating from the extra-adrenal autonomic paraganglia with a strong genetic background. SDHB pathogenic variants are associated with the highest rate of malignancy in PGLs. Most head and neck paragangliomas (HNPGs) are asymptomatic and benign, and multiple metastases are rare.Case presentation: A 37-year-old man presented at our hospital with a fever of unknown origin (FUO) without any other complaints except for mild consumption lasting over 6 months. Laboratory examinations showed elevated inflammatory markers (CRP, ESR, IL-6, and Ferritin) but no abnormalities in infection, immune, or tumor markers. Imaging examination found an oval-shaped space-occupying lesion in the right parapharyngeal space, with rare and unique vertebral imaging findings. Octreotide imaging and 68Ga-FAPI PET/CT scans indicated a potential for neuroendocrine tumors with lymph nodes, bone, and lung metastases. Pathology demonstrated metastatic paraganglioma. Whole-genome sequencing identified an SDHB pathogenic variant and a KIF1B variant of uncertain significance. Following multidisciplinary consultation, the patient opted for the cyclophosphamide-vincristine-dacarbazine (CVD) chemotherapy regimen and was subsequently transferred to a regional hospital for coordinated follow-up.Conclusions: This case reported rare co-occurring variants in SDHB and KIF1B and unusual imaging findings of metastasis in paraganglioma. A multimodal imaging evaluation and whole-genome sequencing were instrumental in assessing paraganglioma patients. This case suggested that atypical imaging features should raise suspicion of malignant diseases and underscored the importance of interdisciplinary collaboration in guiding the diagnosis and treatment of complex and rare clinical cases.

Purpose: To evaluate the clinical outcomes and safety of tigecycline (TGC) plus cefoperazone/sulbactam (CPS) or TGC monotherapy in patients with hospital-acquired pneumonia (HAP) caused by Carbapenem-Resistant Acinetobacter baumannii (CRAB). Methods: This was a retrospective analysis of multicenter data from 62 Chinese hospitals with CRAB HAP. Risk factors for receiving TGC with CPS therapy and predictors of mortality were assessed using multivariate logistic and Cox regression analyses, respectively. Propensity score matching (PSM) evaluated the efficacy and safety of antimicrobial regimens. Results: A total of the 180 patients were included, with 95 receiving TGC monotherapy and 85 receiving combination therapy. Multivariate logistic regression analysis revealed that older age (P = 0.011), and intensive care unit (ICU) admission (P = 0.007) were significant risk factors for combination therapy. Multivariate Cox regression demonstrated that combination therapy was associated with a significantly higher risk of 90-day mortality (P = 0.031). Patients in the standard-dose TGC (SDT) plus CPS subgroup had significantly higher rates of SOFA scores ≥ 7 (P = 0.009) and MV used (P = 0.028), as well as higher 30-/90-day mortality compared to high-dose TGC (HDT) plus CPS group. TGC plus CPS significantly reduced CRP levels (P = 0.009), while the variations in ALT, TBIL, Cr, Hb, and PLT levels did not differ between different antimicrobial regimens after PSM. Conclusion: HDT and CPS combination therapy was more effective in patients with advanced age and more severe condition. Safety profiles of different antimicrobial regimens were similar with liver, kidneys, and coagulation functions.

Background: Fever of unknown origin (FUO) remains a major diagnostic challenge due to its heterogeneous etiologies and nonspecific clinical manifestations. Although metagenomic next-generation sequencing (mNGS) represents a promising diagnostic tool, its clinical utility in adult patients with FUO remains incompletely characterized. Methods: In this study, we retrospectively analyzed adult FUO patients who underwent mNGS testing at Peking Union Medical College Hospital between March 2022 and April 2024. Clinically meaningful diagnostic contribution was determined according to the final clinical diagnosis following multidisciplinary adjudication. Diagnostic performance, pathogen spectrum, therapeutic impact, specimen type, and predictors of clinically meaningful mNGS results were evaluated. Results: A total of 127 FUO patients were included in the study. Infectious diseases accounted for 53.5% of final diagnoses, followed by noninfectious inflammatory diseases (11.0%), malignancies (10.2%), and undiagnosed conditions (19.7%). mNGS made a clinically meaningful diagnostic contribution in 31.5% (40/127) of patients, despite an overall positivity rate of 56.7% (72/127), and showed a higher sensitivity than conventional culture for infectious etiologies (69.1% vs. 16.9%), though with a lower specificity (57.6% vs. 96.0%). Diagnostic contribution varied significantly by specimen type, with drainage fluid/abscess samples showing the highest diagnostic yield (90.9%). Lower white blood cell count was independently associated with clinically meaningful mNGS results (OR 0.87, 95% CI 0.77–0.98). Conclusions: mNGS provides clinically meaningful diagnostic value in adult patients with FUO, particularly for identifying occult infectious etiologies. Lesion-directed sampling, whenever feasible, and careful interpretation of sequencing results in the clinical context are essential to maximize the diagnostic utility of this approach. A lower white blood cell count was independently associated with clinically meaningful mNGS results, although this finding requires validation in larger prospective studies.

The etiology of fever of unknown origin (FUO) is complex and diverse, with benign neoplasms remaining a rarely reported cause. This case report describes a young female patient who presented with FUO and persistently elevated inflammatory markers. A comprehensive diagnostic workup revealed no clear evidence of infectious, autoimmune, or malignant disease. However, during hospitalization, a previously stable, painless mass on her left foot, which presented for two years, exhibited increased local skin temperature. Imaging studies identified a metabolically active subcutaneous lesion at the site. The patient’s condition improved rapidly following excision of the mass, and histopathological examination confirmed the diagnosis of soft tissue myoepithelioma. Soft tissue myoepithelioma, a rare neoplasm of uncertain differentiation, was identified as the underlying etiology of the patient’s clinical presentation. Typically characterized by an indolent and subtle clinical course, this neoplasm most commonly manifests as a painless mass in the extremities or trunk. The disease exhibits a roughly equal sex distribution, with a peak incidence occurring between the ages of 30 and 40 years. Histologically, soft tissue myoepithelioma demonstrates a heterogeneous composition of myoepithelial cell types, predominantly epithelioid cells, and exhibits immunohistochemical expression of both epithelial and myogenic lineage markers. It is noteworthy that fever associated with myoepithelioma is extremely rare, with very few cases reported in the literature to date. This case highlights the rare presentation of soft tissue myoepithelioma as a hyperinflammatory fever, thereby expanding the recognized clinical spectrum of this tumor and deepening the understanding of this distinct entity.