We report a rare case of a female patient with multiple rheumatological conditions. The patient initially presented with periodic, diffuse abdominal pain. This complaint was not fully investigated because polyarthritic symptoms became the predominant ones. This led to the diagnosis of rheumatoid arthritis. Afterward, the patient complained of xerostomia, xerophthalmia, and diffuse rash. After investigations, she was diagnosed with Sjögren’s syndrome. Suspecting a case of methotrexate-induced vasculitis, her initial prescription was changed to azathioprine and then to etanercept. Eventually, her persistent abdominal pain, combined with her Armenian origin, prompted her physician to order a genetic analysis of the MEFV gene, which revealed the V726A/P369S mutation, giving rise to the diagnosis of Familial Mediterranean Fever. In her routine follow-up, the patient was in a stable condition, adherent to the medications, and showed improvement in her symptoms. Therefore, this case shows the importance of early genetic testing in similar cases, which in turn will allow timely diagnosis and treatment.

Aim: This study aimed to investigate the susceptibility patterns of Pseudomonas aeruginosa strains, examine infection characteristics, and evaluate the appropriateness of empiric antibiotic therapy. Additionally, the study sought to identify factors influencing 30-day all-cause mortality in patients with Pseudomonas aeruginosa infections. Methods: This was a retrospective study conducted at Jordan University Hospital from January 2018 to March 2024. Adult patients (≥ 18 years) with confirmed Pseudomonas aeruginosa infections were included. Data were collected from medical records, focusing on demographics, infection characteristics, antibiotic treatment, and outcomes. The susceptibility patterns of Pseudomonas aeruginosa isolates were classified as multidrug-resistant (MDR) or non-MDR. Logistic regression was used to identify factors associated with 30-day mortality. Results: A total of 210 patients were included in the study, with 106 males (50.5%) and 104 females (49.5%). The majority of infections were community-acquired (n = 178, 84.8%), with the respiratory tract being the most common infection site (n = 81, 38.6%). Nearly half of the Pseudomonas aeruginosa isolates were MDR (n = 99, 47.1%). Empiric antibiotic therapy was administered to all patients, with imipenem-cilastatin (55.7%), vancomycin (35.7%), and piperacillin-tazobactam (26.7%) being the most commonly used antibiotics. Of the 210 patients, 32.4% (n = 68) received inappropriate empiric therapy. The 30-day all-cause mortality rate was 4.9% (n = 10). Multivariate analysis revealed that non-localized infections, such as bacteremia and sepsis, were strongly associated with increased mortality [adjusted odds ratio (AOR) = 17.455, P < 0.001]. Conclusions: This study highlights the high prevalence of MDR Pseudomonas aeruginosa infections, especially in community-acquired cases, and emphasizes the need for improved antimicrobial stewardship. The significant proportion of patients (32.4%) receiving inappropriate empiric therapy calls for better guidance in antibiotic prescribing practices. The key predictor of mortality was infection localization, indicating the importance of early intervention for systemic infections to reduce mortality rates.

Aim: The pathogenetic mechanisms and predictors of the development of polyposis and hypertrophy of the sinonasal mucosa (SM) in patients with chronic allergic airway inflammation have not been clearly established. The concentration of inflammatory biomarkers in nasal secretions was determined in children and adolescents with a combined course of bronchial asthma (BA) and allergic rhinitis (AR) in the absence or presence of polyposis and hypertrophy of the SM. Methods: A single-centre observational cross-sectional pilot study was conducted. 93 patients with BA aged 8 to 17 years were studied. Total Nasal Symptom Score (TNSS), sinonasal symptoms (SNOT-22), and peak nasal inspiratory flow (PNIF) were assessed. Concentrations of eosinophil cationic protein (ECP), interleukin 4 (IL-4), IL-1, total immunoglobulin E (IgE), and vascular endothelial growth factor (VEGF) in nasal secretions were determined. Results: The levels of ECP, IL-4, and IL-1 in nasal secretions were statistically significantly higher in patients with the presence of polyposis and hypertrophic SM than in those without, amounting to 83.1 [31.4; 166.8] ng/mL for ECP vs. 29.5 [5.3; 49.9] ng/mL, P < 0.001, for IL-4 174.6 [68.6; 325.5] pg/mL vs. 79.5 [42.8; 146.01] pg/mL, P = 0.004, for IL-1 98.7 [33.7; 267.5] pg/mL and 48.8 [9.01; 108.2] pg/mL, P = 0.025. There were no statistically significant differences in IgE and VEGF levels in nasal secretions, all P > 0.05. Parameters such as ECP, IL-4, and IL-1 were found to be significant predictors of polyposis and hypertrophy in the formation of SM. Conclusions: In patients with a combined course of BA and AR, the presence of polyposis and hypertrophy of SM is associated with higher levels of ECP, IL-4, and IL-1 in nasal secretion. This may indicate that pathological remodelling of SM is associated with both the intensity of allergic inflammation and its relationship with local activation of innate immunity.