Case Reports in Clinical Practice <strong><em>Case Reports in Clinical Practice</em> publishes original, uncommon, educationally valuable and challenging case reports in whole aspects of clinical medicine. This journal published by Tehran University of Medical Sciences. </strong> Tehran University of Medical Sciences en-US Case Reports in Clinical Practice Are Herbal Supplements Safe? - Shahin Akhondzadeh ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 1 1 Primary Hypertrophic Osteoarthropathy: A Case Report <p><span>The primary hypertrophic osteoarthropathy (PHOA or pachydermoperiostosis) <span>is a rare (5% of total HOA) hereditary disease. One study described that the <span>prevalence of PHOA is 0.16%. PHOA characterized by skin thickening <span>(pachydermia), finger clubbing, and proliferation of periosteum (periostitis) <span>with subperiosteal new bone formation and enlarged extremities secondary to <span>periarticular and bone proliferation. Clinical manifestations are variable; the <span>term complete syndrome is used for the patient with pachydermia, coarsening <span>of the face skin and scalp, periostitis, and cutis verticis gyrata; the incomplete <span>form is used when there is no sparing of the scalp; and the frusted form is used <span>for pachydermia with minimal or absent periostitis. We describe a 29-year-old <span>white man with PHOA, and clinical and radiological characteristics of this <span>syndrome, as well as therapeutic approach of PHOA.</span></span></span></span></span></span></span></span></span></span></span><br /></span></p> Shima Asadi komeleh Abdolrahman Rostamian Fatemeh Shahbazi Shafieh Movassagi Parviz Soofivand ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 2 6 An Uncommon Manifestation of Mycosis Fungoides (MF) with Annular Lesions <span>Mycosis fungoides (MF) is the most common type of cutaneous T-cell <span>lymphoma, which often appears in the form of patches, plaques, and tumors as <span>originally described by Alibert and Bazin. The manifestation of MF as annular <span>lesions is uncommon, and herein we report one of those cases. A 54-year-old <span>woman complaining of itchy skin lesions from three years before, came to our <span>clinic with no response to topical steroids. In skin examination, there were <span>annular lesions with erythematous slightly raised borders, and some scattered <span>erythematous thin plaques in trunk and extremities with a predilection to lower <span>extremities. Epidermal and poikilodermic changes were not evident. There <span>were no lymphadenopathy and hepatosplenomegaly. Biopsies were obtained <span>from three different lesions and the diagnosis of all samples was consistent <span>with MF. A diagnosis of stage 1B of MF was made and the patient went under <span>oral psoralen and ultraviolet A (PUVA) therapy. MF has different clinical <span>manifestations that can be confused with other inflammatory dermatological <span>disorders. Until now, less than 10 cases of MF with annular lesions have been <span>reported in the English literatures, and most of them initially were under <span>treatment with other differential diagnosis of annular lesion than MF</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br /></span> maryam nasimi robabeh abedini azita nikou elham alipour ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 7 9 Quetiapine-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Challenging Case <span>Hyponatremia due to syndrome of inappropriate antidiuretic hormone <span>secretion (SIADH) occurs as a rare but clinically important phenomena in <span>various conditions including malignant neoplasms, infections, and central <span>nervous system disorders, and as an adverse effect of numerous drugs. To the <span>authors’ knowledge, there are a few reports on SIADH associated with <span>quetiapine in the literature. This case presents a 58-year-old woman receiving <span>quetiapine for the treatment of bipolar disorder. The patient was hospitalized <span>due to generalized tonic-colonic seizure. After checking her laboratory tests, <span>she was found to be hyponatremic, and the treatment began accordingly. The <span>situation was resolved after discontinuation of quetiapine therapy. Quetiapine <span>was thought to be <span>the cause for the patient’s symptoms, and she was <span>diagnosed with SIADH induced by this medication. Close monitoring of the <span>sodium level is recommended in patients taking quetiapine.</span></span></span></span></span></span></span></span></span></span></span></span><br /></span></span> Pantea Arya Sara Hashempour Akbar Shafiee Azita Kheiltash Padideh Ghaeli ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 10 13 Relapsing Polychondritis and Hematuria: A Case Report <p><span>Relapsing polychondritis (RP) is very rare inflammatory disorder <span>characterized by episodic, progressive, and destructive courses affecting <span>cartilages. Renal involvement also is very rare presenting sign in these <span>patients. It has seldom been described in children. We describe an 11-yearold girl with RP and complaint offrequent episodes of hematuria, and <span>dysuria with fever and periorbital edema that auricular cartilage <span>involvement appeared after renal involvement. Renal involvement in the <span>setting of RP is mainly important, and need close observation.</span></span></span></span></span></span><br /></span></p> Mojtaba Fazel Zeinab Kavyani Masoome Sadat Sadeghzadeh Maassoumeh Akhlaghi ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 14 17 Port Site Hernia with Presentation of Increasing in Creatinine <p><span>Incisional hernia is defined as dehiscence of fascia and bowel obstruction. <span>The clinical manifestation includes gross disruption of the wound with <span>drainage, presence of a bulging with exertion or Valsalva maneuver, <span>painful continuous bulge if bowel or omentum is incarcerated, and bowel <span>obstruction or infarction. We report a 63-year-old woman with the history <span>of three times cesarean section with a midline incision. She was operated <span>for ovarian tumor. Total laparoscopic hysterectomy and lymphadenectomy <span>was performed. She attended to hospital 5 days after surgery with the chief <span>complaint of abdominal pain, nausea, and vomiting. There was a bulge <span>tender around the umbilical port and patient’s creatinine was 4 mg/dl in <span>laboratory test. The ultrasound confirmed a port site hernia. A strangulated <span>hernia was diagnosed and treated with laparotomy.</span></span></span></span></span></span></span></span></span></span></span><br /></span></p><strong><br clear="all" /> </strong> Zahra Tavoli Fatemeh Tabatabaei ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 18 20 Esophageal Squamous Cell Carcinoma Presenting as Two Simultaneous Adjacent Masses Confirmed by Pathologic Findings: Report of a Rare Case <p><span>Esophageal squamous cell carcinoma (SCC) is a common neoplasm which <span>incidence shows an increasing trend in most populations. This article <span>presents a case of 79-year-old woman with diagnosis of differentiated <span>squamous cell carcinoma of the esophagus as two adjacent mas with <span>metastasis, which invaded the perigastric and distal esophagus lymph nodes. <span>The patient underwent esophagectomy and gastroesophagotomy. The <span>jejunostomy tube was also embedded. The presence of two simultaneous <span>esophageal tumoral lesions is extremely uncommon and requires further <span>assessments. The prognosis and survival of such patients not seems to be <span>worse than those of patients with isolated esophageal neoplasm.</span></span></span></span></span></span></span></span></span><br /></span></p> Hamidreza Khorshidi Mehrdad Taghipour Babak Yousefi Arash Dehghan ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 21 25 Anesthetic Considerations of Patient with Parry Romberg Syndrome <p><span>Parry Romberg syndrome is a rare progressive degenerative disease <span>characterized by unilateral atrophy affecting the skin, connective tissue, <span>muscle, and bone, typically occurs in children and young adults. The end <span>result is facial asymmetry associated with other skin, dental, visual, <span>cardiovascular, and neurological disorders that ceases without apparent <span>cause after a highly variable period. Inconsistency in the pattern of atrophy <span>and multisystem involvement make intraoperative anesthetic management <span>of these patients a challenge for anesthesiologists. We present a case of <span>Parry Romberg syndrome and her associated clinical findings with specific <span>attention to the anesthetic consideration of this disease.</span></span></span></span></span></span></span></span></span><br /></span></p> Sussan Soltani Mohammadi Farideh Toorany Abdolrahim Shahhosseini ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 26 29 An Unusual Presentation of Cerebral Vein Thrombosis: A 40-Year-Old Woman with Acute Intractable Cervical Pain and Lateral Neck Bending <p><span>Cerebral venous thrombosis (CVT) is an uncommon but fatal type of stroke <span>with a wide spectrum of signs and symptoms. We report a 40-year-old woman <span>who presented with acute intractable neck pain and lateral cervical bending. <span>Investigations with neuroimaging revealed evidence of thrombosis in her right <span>transverse and sigmoid sinuses. The precipitating factors for the thrombosis <span>were consumption of oral contraceptive pills during the month of Ramadan, <span>and dehydration due to fasting. The patient immediately was treated with the <span>therapeutic dose of anticoagulant. We concluded that in patients with severe <span>cervical pain, especially those who are predisposed to thrombotic <span>complications, CVT should be considered in the differential diagnosis.</span></span></span></span></span></span></span></span></span><br /></span></p> Seyed Sadeq Kalantar nasbeh amrzargar Sakineh Ranji Burachaloo ##submission.copyrightStatement## 2018-07-24 2018-07-24 3 1 30 34