pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Current Issue
Vol 11 No 2 (2026): March-April
Case Report(s)
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We present the case of a 32-year-old female who presented with chronic pelvic pain. On imaging, she was found to have a left renal arteriovenous malformation (AVM) and congested pelvic veins. This case underscores the importance of considering renal AVMs in the differential diagnosis of pelvic congestion syndrome (PCS) and highlights the utility of ultrasound (USG) and computed tomography (CT) in diagnosing this condition.
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A 28-year-old woman with poorly controlled type 1 diabetes mellitus (T1DM) presented with a two-week history of fever, left lower back pain, and progressive difficulty walking. Imaging confirmed the concurrent presence of a left iliopsoas abscess and left hip septic arthritis—an exceedingly rare combination. The abscess was treated
with CT-guided percutaneous catheter drainage, and the hip joint infection was managed with open arthrotomy and irrigation. Culture of aspirated material identified methicillin-resistant Staphylococcus aureus (MRSA). Treatment was completed with a six-week course of targeted intravenous vancomycin and concurrent optimization of glycemic control. Complete clinical, laboratory, and radiological resolution was documented at six months. This case highlights that clinicians should maintain a high index of suspicion for concurrent deep-seated infections in diabetic patients presenting with musculoskeletal symptoms and fever. MRI is the imaging modality of choice for delineating both pathologies simultaneously, and successful management necessitates a multidisciplinary approach integrating surgical drainage, pathogendirected antimicrobial therapy, and metabolic optimization. -
Mitochondrial Enoyl CoA Reductase Protein-Associated Neurodegeneration (MEPAN) syndrome is an ultra-rare autosomal recessive disorder of mitochondrial fatty acid synthesis, characterized by childhood-onset progressive movement disorder, optic atrophy, and basal ganglia abnormalities. It results from a deficiency of mitochondrial trans-2-enoyl-CoA reductase, an enzyme essential for oxidative phosphorylation and for regulating oxidative stress. We report the first Iranian case of MEPAN syndrome in a 2-year-old boy presenting with developmental delay and several atypical features. Whole-exome sequencing (WES) identified a novel likely pathogenic MECR variant. This case underscores the importance of genetic evaluation in children with
unexplained developmental delays and expands the clinical spectrum associated with MECR mutations. -
Retention polyps, also known as juvenile polyps, are non-neoplastic hamartomatous lesions. Their occurrence in adults is rare, and finding a solitary retention polyp in a patient with underlying inflammatory bowel disease (IBD) is exceptionally uncommon. We report the case of a 42-year-old male with a 9-year history of ulcerative colitis, currently in clinical and endoscopic remission (Mayo Endoscopic Score 1) on mesalamine therapy. During a routine surveillance colonoscopy, a solitary, asymptomatic, 15 mm sessile polyp with a smooth, cystic appearance was discovered in the rectum. The lesion was removed via endoscopic mucosal resection (EMR). Histopathological evaluation revealed no evidence of dysplasia or malignancy, confirming the diagnosis
of a retention polyp. Although rare, retention polyps should be considered in the differential diagnosis
of solitary polyps in adult patients with UC. Complete endoscopic resection and precise histopathological examination are essential to rule out dysplasia and guide appropriate management. -
Placental chorioangioma is the most common benign non-trophoblastic vascular tumor of the placenta. Although most lesions are small and clinically insignificant, giant chorioangiomas (>4 cm) are rare and may be associated with significant maternal and fetal complications, including polyhydramnios, fetal anemia, hydrops fetalis, growth restriction, preterm delivery, and perinatal death. We report two cases of prenatally diagnosed giant placental chorioangioma with favorable perinatal outcomes. The first patient was a 32-year-old gravida 2 para 1 woman in whom a placental mass measuring 9 × 7 × 5.5 cm was identified at 19 weeks of gestation. Serial ultrasonographic and Doppler evaluations demonstrated a vascular placental tumor consistent with chorioangioma. Mild polyhydramnios developed during follow-up; however, fetal growth, cardiac function, and middle cerebral artery peak systolic velocity remained normal. The pregnancy was managed conservatively,
and a healthy neonate was delivered by cesarean section at 37 weeks of gestation. The second patient was a 23-year-old primigravida referred at 35 weeks of gestation with a 9 × 6 cm placental mass. Serial assessments showed no fetal compromise or maternal complications. She delivered a healthy 3200-g female infant vaginally at 38 weeks and 3 days. Histopathological examination confirmed the diagnosis of placental chorioangioma in both cases. Despite their large size, both tumors were associated with favorable maternal and neonatal outcomes. These cases highlight the variable clinical course of giant chorioangiomas and emphasize the importance of close antenatal surveillance using ultrasound and Doppler studies to detect potential complications. Giant placental chorioangiomas may remain clinically stable and result in successful pregnancy outcomes when carefully monitored. Prenatal ultrasonography with color Doppler plays a pivotal role in diagnosis and follow-up, while histopathological examination remains the definitive method of diagnosis. -
Electrical storm and refractory ventricular fibrillation (VF) are rare but catastrophic complications of acute myocardial infarction (AMI) and are associated with high mortality despite adherence to advanced cardiac life support protocols. We report a 48‑year‑old man with a history of ischemic heart disease, percutaneous coronary intervention, and hypertension who presented with severe exertion‑induced chest pain and was diagnosed with acute inferior ST‑elevation myocardial infarction. During monitoring, he developed recurrent malignant ventricular arrhythmias progressing to refractory VF despite repeated biphasic defibrillation and antiarrhythmic therapy. Sequential defibrillation with 200‑J shocks was performed with procedural sedation and analgesia before each attempt, with a cumulative delivered energy of approximately 4000 J. Intravenous amiodarone, lidocaine, and magnesium sulfate were administered, and thrombolytic therapy with reteplase was initiated. Persistent VF ultimately required dual sequential defibrillation, which successfully restored a stable sinus rhythm. The patient was transferred for urgent coronary angiography and was discharged three days later in stable clinical condition. This case highlights the potential role of dual sequential defibrillation as a rescue strategy in refractory ventricular fibrillation complicating acute myocardial infarction.
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Post-surgery ileus is a common complication after abdominal surgery. In cases of prolonged postoperative ileus lasting more than three days, underlying inflammatory bowel disease (IBD) should be considered. We present a 35-year-old woman who developed prolonged ileus after cesarean section, complicated by multiple ileal
perforations that led to the diagnosis of Crohn’s disease. This case illustrates smallbowel perforation as the first clinical presentation of Crohn’s disease in the postpartum period. -
Transient hypocalcemia after thyroidectomy happens despite watchful preservation of the parathyroid glands and their blood supplies during surgery. Thyroidectomy for Graves’ disease is accompanied by a higher risk of transient hypocalcemia than for benign thyroid disease, including goiter, and the reasons are still unclear. We report two patients with Graves’ disease and goiter with symptomatic hypocalcemia after total thyroidectomy.
We report a 64-year-old woman with multinodular goiter and a 41-year-old Iranian woman with a history of Graves’ disease who presented with transient symptomatic hypocalcemia after total thyroidectomy with intact parathyroid glands on surgery. They had a longer hospitalization time than usual surgeries due to hypocalcemia. However, they had normocalcemia at 1-year follow-up after discharge. Severe hypocalcemia after thyroidectomy can have some related complications and may be life-threatening. Calcium supplementation before surgery is a simple choice of treatment for the reduced probability of symptomatic hypocalcemia after Graves’ disease or benign thyroid disease in high-risk patients. -
Deep vein thrombosis (DVT) is a serious medical problem that usually occurs in people who are immobilized, and its formation is not expected in people who do physical activity such as walking. Arbaeen walking is an event that takes place every year in Iraq over long distances and usually in hot and dry weather. During walking, there is a high probability of dehydration, which can be a risk factor for blood clots in the deep vessels. Since oral contraceptives also increase the possibility of blood clots in the vessels, it seems that women who use oral contraceptives and go for this walk, due to the possibility of concurrent dehydration, are at high risk for DVT. Due to the importance of this issue, we are currently introducing a case of a 44-year-old woman who suffered a DVT while taking a contraceptive while walking on Arbaeen.
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Massive hemoptysis during pregnancy is a rare but potentially life-threatening emergency, and pulmonary carcinoid is an unusual underlying cause. We report a 31-year-old primigravida who presented at five weeks of gestation with sudden massive hemoptysis. Chest computed tomography and flexible bronchoscopy
revealed a hypervascular endobronchial lesion in the right bronchus intermedius causing partial airway obstruction and right middle lobe collapse. Histopathological and immunohistochemical examination confirmed a typical pulmonary carcinoid. Following multidisciplinary evaluation, definitive surgery was postponed until the
second trimester because the patient remained clinically stable without recurrent bleeding. At 12 weeks of gestation, she underwent right middle lobectomy with systematic mediastinal lymph node dissection, achieving complete (R0) resection with negative lymph nodes. The postoperative course was uneventful, and both maternal recovery and fetal development remained favorable during follow-up. This case highlights the importance of multidisciplinary management and appropriately timed surgical intervention in achieving favorable maternal, fetal, and oncologic outcomes.
