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Physical examination was notable for abdominal distention and mild tenderness to palpation on the left side of the abdomen. Computed tomography of the abdomen and pelvis is shown. What is the most likely diagnosis? nej.md/IC10092025 2/2
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A 23-year-old man with autism spectrum disorder and chronic constipation presented to the emergency department with a 1-week history of abdominal pain on his left side, nausea, and vomiting. 1/2

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To learn more about this term, read the editorial “Defanging the Neutrophil to Treat Bronchiectasis”: nej.md/4cANv89

Explore more terms: nej.md/glossary
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𝐑𝐞𝐚𝐜𝐭𝐢𝐯𝐞 𝐨𝐱𝐲𝐠𝐞𝐧 𝐬𝐩𝐞𝐜𝐢𝐞𝐬 are hydroxyl radicals, produced by the metabolism of oxygen, that are extremely reactive and immediately remove electrons from any molecule with which they interact. Full definition of this NEJM Illustrated Glossary term: nej.md/48UCLRX

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A visual representation of “reactive oxygen species”
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As more patients with sickle cell disease or β-thalassemia are treated with the gene-edited cellular drug exa-cel, there are more opportunities to test for potential off-target editing. Yen and colleagues provide an update. Read now: nej.md/4ocjWy9

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A diagram of the assessment of off-target editing in clinical trial participants.
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As aedes-borne diseases surge in the Americas, new control approaches are needed against the primary mosquito vector, 𝘈𝘦𝘥𝘦𝘴 𝘢𝘦𝘨𝘺𝘱𝘵𝘪. Research findings on the efficacy of targeted indoor residual spraying are summarized in a new Quick Take video. nej.md/47e9S1V

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Visual representation of a study that examines the effectiveness of targeted indoor residual spraying of an insecticide to reduce the incidence of aedes-borne diseases in children.
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Case Record of the MGH: A 36-year-old man was admitted because of fever, hypoxemia, and bacteremia. Imaging revealed pulmonary opacities, thickening of the duodenal wall, and a thrombus in the right renal vein. A diagnosis was made. Full case details: nej.md/3KYBaAE

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Initial imaging studies.
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Targeted Indoor Spraying to Prevent Aedes-Borne Diseases nej.md/46J4e7O

Permethrin-Treated Wraps for Prevention of Malaria nej.md/4msFwwX

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New in the October 9, 2025, issue of NEJM:

Baxdrostat Efficacy and Safety in Uncontrolled Hypertension (BaxHTN phase 3 trial) nej.md/4my7xUZ

Nexiguran Ziclumeran in ATTR with Polyneuropathy nej.md/46Qhur7

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Images and descriptions of what's new on NEJM.org this week  
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Idiopathic intracranial hypertension — high cerebrospinal fluid pressure most common in women of reproductive age with obesity — threatens vision. Treatment includes weight loss, medication, and surgery. Learn more in a new review: nej.md/3KJlVvk

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Panel A: Funduscopic images showing severe papilledema in the right and left eyes with hemorrhages and exudates.  
Panel B: The right and left fundi 3 months later, with resolving papilledema after reduction in intracranial pressure (ICP) by venous sinus stenting followed by shunt repair.
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𝘈𝘦𝘥𝘦𝘴 𝘢𝘦𝘨𝘺𝘱𝘵𝘪 mosquitoes spread chikungunya, dengue, and Zika. In a trial in Mexico, targeted indoor residual spraying led to lower mosquito levels but not lower disease risk. Full trial results: nej.md/46J4e7O

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A map of the trial area
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In a national cohort of veterans, the 2024–2025 Covid-19 vaccine was linked to reduced risks of emergency department visits, hospitalizations, and deaths from Covid-19 across the overall cohort and in various subgroups. Full study results: nej.md/47anKdz

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A graph showing the Covid-19–associated composite outcome over 180 days in the 2024–2025 vaccination season
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GASTROSAM trial: Many children with severe acute malnutrition have complications such as gastroenteritis, often with severe dehydration. Whether intravenous rehydration is safe in such children has been unclear. Research findings are summarized in a new Quick Take video. nej.md/4pTKHJy
A visual representation of the GASTROSAM trial, which  assessed intravenous rehydration therapy for children with severe acute malnutrition with gastroenteritis and severe dehydration.
nejm.org
Management of Monoclonal Gammopathy of Undetermined Significance.

In low-risk patients who are younger than 50 years of age, bone marrow biopsy and imaging may be considered a baseline evaluation, given the anticipated life expectancy. Learn more: nej.md/473uOsj

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A diagram showing the management of monoclonal gammopathy of undetermined significance.
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In rural South Africa, home-based hypertension care — delivered by community health workers and supported by remote nurses — led to a lower mean systolic blood pressure than clinic-based care. Full IMPACT-BP trial results and Research Summary: nej.md/4lHJ4ek

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The New England Journal of Medicine                   
Home-Based Care for Hypertension in Rural South Africa 
A Research Summary based on Siedner MJ et al. | 10.1056/NEJMoa2509958 | Published on September 1, 2025 

Visual representations of the patients in the trial and the treatments they were assigned.                       

Read the full Research Summary at NEJM.org.
nejm.org
Plague is a high-consequence infectious disease with epidemic potential.

The latest video in our partnership with @glaucomflecken.bsky.social summarizes new research evaluating ciprofloxacin versus aminoglycoside–ciprofloxacin for bubonic plague in Madagascar. 👉 nej.md/DrG27
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A 29-year-old woman presented with a 2-day history of painful swallowing. One week earlier, she had had a fever and sore throat. Upper endoscopy revealed multiple “volcano-like” ulcers in the middle esophagus. Read the full case details: nej.md/4nUkSqY

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Panel A: Upper endoscopy revealing multiple discrete, shallow, “volcano-like” ulcers with raised edges in the middle esophagus. 
Panel B: Widespread whitish exudates and friable mucosa seen in the distal esophagus. 
Panel C: Histopathological testing of a biopsy specimen from an ulcer showing viral cytopathic effects in the squamous epithelial cells of the esophageal lining.
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Clesrovimab is a long-acting monoclonal antibody against respiratory syncytial virus fusion protein. In the CLEVER phase 2b–3 trial involving 3614 healthy infants, clesrovimab reduced RSV disease and associated hospitalization. Full trial results and Research Summary: nej.md/48jpBO4

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The New England Journal of Medicine                   
Clesrovimab for Prevention of RSV Disease in Healthy Infants 
A Research Summary based on Zar HJ et al. | 10.1056/NEJMoa2502984 | Published on September 17, 2025 

Visual representations of the patients in the trial and the treatments they were assigned.                       

Read the full Research Summary at NEJM.org.
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IMPACT-BP trial: Poorly controlled hypertension is common, particularly in areas with structural barriers to health care. Research findings on home-based hypertension care in one such area — rural South Africa — are summarized in a new Quick Take video. nej.md/42V3hH2

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A visual representation of the IMPACT-BP trial, which assessed whether home-based hypertension care would improve blood pressure in populations with numerous barriers to care in South Africa.
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Monoclonal gammopathy of undetermined significance (MGUS) is important not only because it is the precursor to plasma-cell cancers, but also because it is causally related to numerous serious nonmalignant disorders. Learn more in a new review: nej.md/473uOsj

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Key points from the Review Article "Monoclonal Gammopathy of Undetermined Significance"
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Among patients with moderate hypertriglyceridemia and high cardiovascular risk, monthly olezarsen injections resulted in significantly greater reduction in triglyceride levels at 6 months than placebo. Full Essence–TIMI 73b phase 3 trial results and Research Summary: nej.md/4mws7Vt

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The New England Journal of Medicine                   
Targeting APOC3 with Olezarsen in Moderate Hypertriglyceridemia 
A Research Summary based on Bergmark BA et al. | 10.1056/NEJMoa2507227 | Published on August 30, 2025 

Visual representations of the patients in the trial and the treatments they were assigned.                       

Read the full Research Summary at NEJM.org.
nejm.org
CLEVER phase 2b–3 trial: The burden of severe RSV disease is highest in the first 6 months of life, when prevention is needed. Research findings on clesrovimab ― a long-acting investigational monoclonal antibody against RSV fusion protein ― are summarized in a new Quick Take video. nej.md/42FOKzd
An illustration of a healthy infant receiving a single dose of clesrovimab before or during the first RSV season.
nejm.org
A 52-year-old woman with hypertension presented with fatigue, vomiting, and confusion. Examination was notable for powdery, crystalline deposits on the arms, legs, trunk, and scalp. Read the full case details: nej.md/4pKf6tL

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Images in Clinical Medicine 
Uremic Frost 

Photos of the patient's right arm and left leg
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The GASTROSAM trial involving children with severe acute malnutrition and gastroenteritis showed no evidence of a difference in mortality at 96 hours between oral and intravenous rehydration strategies. Full trial results and Research Summary: nej.md/3TjfSP7

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