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Key Clinical Message Pauci‐immune necrotizing glomerulonephritis (PING) is a small vessel renal vasculitis usually associated with the presence of antineutrophil cytoplasmic antibodies (ANCA) against myeloperoxidase or proteinase. A small proportion of PING patients do not have ANCA antibodies. Abstract A condition known as Pauci‐immune necrotizing glomerulonephritis, or PING for short, is a type of kidney inflammation that affects small blood vessels. This condition is typically linked with the existence of certain antibodies, specifically antineutrophil cytoplasmic antibodies or ANCA, which target myeloperoxidase or proteinase. However, it's worth noting that a minor percentage of individuals diagnosed with PING do not possess these ANCA antibodies. A 24‐year‐old woman with no previous medical history arrived at the ER due to various symptoms including joint pain, fever, difficulty swallowing, and shortness of breath. Despite multiple symptoms suggesting systemic lupus erythematosus (SLE), this diagnosis was ruled out based on the EULAR/ACR 2019 classification criteria and laboratory tests. Other potential diagnoses such as rheumatoid arthritis (RA) and eosinophilic garnulomatosis with polyaniitis (EGPA) were also excluded based on respective criteria. The patient was treated with a 3‐day course of methylprednisolone, followed by prednisolone, which improved her creatinine levels. Subsequent tests for P‐ANCA and C‐ANCA were negative. A kidney biopsy confirmed necrotizing glomerulonephritis, consistent with pauci‐immune vasculitis. A bronchoscopy revealed bleeding and hemorrhage in her lungs, but bacterial culture analysis was negative. The patient was given piperacillin, tazobactam, and vancomycin for septic coverage, as well as intravenous immunoglobulin (IVIg), which led to symptom improvement.

Key Clinical Message In the context of lymphoma, it is of paramount importance to perform subsequent Positron Emission Tomography‐Computed Tomography (PET‐CT) scans to ensure the comprehensive eradication of neoplasms. Abstract Primary renal diffuse tumors constitute less than 1% of all renal neoplasms. Among these, diffuse renal large B‐cell lymphoma is an exceedingly rare extranodal lymphoma. A 64‐year‐old male presented to the Department of Urology with complaints of persistent left flank discomfort for a duration of 2 weeks. Additionally, he reported generalized weakness, fatigue, and symptoms indicative of lower urinary tract obstruction, such as discomfort in the left testicle and dysuria. Ultrasound imaging revealed an echogenic structure with thickened, reactive walls and a turbid fluid core, located in the left flank, proximal to the lower pole of the kidney. This structure was subsequently identified as diffuse renal large B‐cell lymphoma. For the diagnosis of large B‐cell lymphomas, it is imperative that a proficient hematopathologist performs a comprehensive examination of the tumor tissue, preferably utilizing an excisional biopsy. The categorization of lymphoma requires specialized tests such as immunohistochemistry, flow cytometry, fluorescence in situ hybridization (FISH), and molecular testing. In instances where a renal mass is detected, healthcare professionals should consider performing a biopsy. In lymphoma cases, follow‐up Positron Emission Tomography‐Computed Tomography (PET‐CT) scans are crucial to confirm the complete eradication of the tumor.

Key Clinical Message The importance of urologists and pathologists being knowledgable about primary testicular hemangiomas and other benign adult testicular neoplasms, though rare, is crucial. Ensuring these professionals are well‐versed in these conditions is vital in medicine. Testicular sparing surgery, especially when tumor markers are negative, is a common approach for patients with small or uncertain testicular masses. Abstract The cause of the uncommon benign testicular tumor known as testicular capillary hemangioma is currently unclear. Children are shown to have a greater incidence than adults. Histopathological examination reveals a vascular tumor with a well‐formed capillary lumina. The lesions are bordered by flattened endothelium and have lobulated clusters of closely spaced capillaries with an abundance of vascular gaps. These capillaries have anaplastic characteristics and lack mitotic activity. The patient, who was 24‐year‐old, came to the urology department complaining of severe testicular pain. He had no significant medical history. Clinical examination found a mass at the upper pole of the testicle. An ultrasonography Doppler study found a left varicocele that measured 3.5 mm in diameter, as well as a mass at the upper part of the left testicle. Pathologic examination confirmed the presence of a benign hemangioma with. Although rare, it is important for urologists and pathologists to be aware of primary testicular hemangiomas and other benign adult testicular neoplasms. Testicular sparing surgery has always been considered in patients with small or indeterminate testicular masses with negative tumor markers.

Tuberous sclerosis complex (TSC) is a genetically inherited disorder distinguished by the development of numerous benign neoplasms across multiple organ systems.Renal angiomyolipoma represents 0.3% of all primary renal tumors and are classified as benign mixed mesenchymal neoplasms. In this report, we reported the clinical presentation of a 28-year-old individual who was received by the department of urology. The patient was admitted presenting with asymptomatic, macroscopic hematuria that had been ongoing for a period of 10 days. Subsequent diagnostic evaluations revealed an association between the presenting urinary condition and tuberous sclerosis complex with a concurrent renal angiomyolipom

Abstract Background The nucleoside transport capabilities of the human equilibrative nucleoside transporter-3 (hENT3) are disrupted by mutations in SLC29A3 (10q22.2), which are genes for the nucleoside transporter and are the cause of the unusual autosomal recessive disease known as H syndrome. As a result, histiocytic cells invade a number of organs. Case presentation A 17-year-old Syrian male was admitted to the internal medicine department with a one-month history of polyuria, polydipsia, general weakness, and pallor. He had a history of progressive bilateral sensorineural hearing loss and failure to gain weight for three years. Physical examination revealed various abnormalities, including scrotal mass, small penis and testicles, absence of pubic and axillary hair, joint abnormalities, short stature, hallux valgus, fibrous protrusion near the navel, and hyperpigmented non-itchy painful skin plaques. Clinical signs along with laboratory test results confirmed hyperglycemia, primary hypogonadism, osteopenia, and growth hormone deficiency. After a review of the relevant medical literature, this patient’s presentation of hyperglycemia with hypogonadism, hyperpigmentation, hallux valgus, hearing loss, hematological abnormalities, and short stature suggested the diagnosis of H syndrome. The patient received treatment with insulin and testosterone, leading to a significant improvement in his presenting symptoms. Conclusions H syndrome is a very rare condition, and the fact that the first case has only recently been reported in Syria serves to emphasize how rare it is. H Syndrome should be suspected if a patient has short stature with signs of hyperglycemia and other endocrine and cutaneous abnormalities. We are reporting this case to increase physicians’ awareness of this exceedingly rare and unique syndrome.

Abstract Celiac disease (CD) is an autoimmune disease characterized by a specific serological and histological profile. Hematological findings are one of the most common presentations and can sometimes be the only manifestation of the disease. In patients with unexplained isolated hematological abnormalities, a high index of suspicion for CD is necessary. A 33‐year‐old woman was admitted to the Department of Gastroenterology and Hepatology because of abdominal pain and fatigue. She was diagnosed with myelodysplastic syndrome. After many investigations, it is explained that she has CD. It is important to consider myelodysplastic syndrome as a hematological manifestation of CD. All patients with myelodysplasia should be investigated for CD and related conditions such as primary sclerosing cholangitis.

Key Clinical Message However, it is noteworthy that certain patients with minor functional limitations in their hand may have experienced undiagnosed thumb hypoplasia during their childhood years. These individuals may have successfully adapted to their condition without seeking medical intervention and may express a preference for nonintervention (as in this case). Abstract Thumb hypoplasia is a congenital underdevelopment of the thumb, accounting for 5%–15% of congenital hand disorders. It occurs equally among both genders and can affect both thumbs. The condition is categorized using Blauth's classification with Type I being the mildest form. We report a 23‐year‐old Syrian male presented with a bilateral restriction in opposition movement when using a pen or razor. Clinical examination and x‐ray imaging revealed a bilateral Type I hypoplastic thumb with bilateral minimal hypoplasia of the toes. Despite the surgical treatment options available, the patient opted not to undergo surgery due to his adaptation to his condition. Hypoplastic thumb Type I is a congenital condition characterized by underdevelopment of the thumb. Bilateral thumb hypoplasia with toes hypoplasia is extremely rare. A full systemic evaluation should be done due to its associations with other syndromic manifestations and treatment options are discussed concerning the best functional outcomes and patient preferences.

Key clinical Message This case highlights the significance of maintaining clinical suspicion for CPBs in adults presenting with SBO. Early surgical intervention, offering both diagnosis and treatment, is essential for managing this rare cause of SBO. Increased clinical awareness of CPBs will help ensure they are considered in the differential diagnosis of adult patients with bowel obstruction.

Key Clinical Message A novel radiologic sign in patients with renal failure and uremic encephalopathy (UE) with metabolic acidosis has recently been identified as the lentiform fork sign. On magnetic resonance imaging (MRI), the “lentiform fork sign” has been described as bilateral symmetrical hyperintensities in the basal ganglia encircled by a hyperintese rim delineating the lentiform nucleus. Changes in uremic solute retention, aberrant blood–brain barrier transport, disordered vascular reactivity, altered electrolyte and acid–base balance, and altered hormone metabolism are the most likely causes of the condition. A 56‐year‐old male with end‐stage renal disease was brought to the emergency room for a progressive change in mental status and involuntary arm movements over the previous 5 days, which were accompanied by mild dyspnea. A brain MRI was performed, and it revealed hyperintensity on T2/FLAIR in the white matter surrounding the basal ganglia. the patient was treated with dialysis and improved greatly. Intensified hemodialysis and glycemic control are the cornerstones of treating diabetic uremic syndrome (DUS) with likely reversible clinical symptoms and remission of imaging abnormalities.

Lower urinary tract symptoms (LUTS) are including an overactive bladder, voiding and storing urine. The causes of LUTS include infectious and inflammatory. In this paper we present a rare case of LUTS caused by scabies mites and could be the third case reported in the medical literature. A 12-year-old child came to hospital complaining of tenesmus, dysuria and hematuria several days ago. A diagnosis of LUTS was established and investigations showed the scabie mite is the possible cause for the disease. Scabies mites have the ability of entering into the urinary tract leading to LUTS in patients affected with scabies.