pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Current Issue
Vol 10 No 4 (2025): July-August
Case Report(s)
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We present a case of a primigravida woman at 30 weeks of gestation with monochorionic diamniotic (MCDA) twins, both affected by fetal growth restriction (FGR) and fetal anemia. One twin demonstrated absent end-diastolic flow on umbilical artery Doppler. Both twins had oligohydramnios. The placenta was enlarged (~110
mm in thickness) and showed gross clots at delivery, consistent with chronic placental abruption. Amniotic fluid was blood-stained during the cesarean section performed due to recurrent late decelerations. Placental pathology was normal except for mild vascular abnormalities. TORCH and antiphospholipid syndrome (APS) screenings were negative. This case highlights the diagnostic complexity of FGR and fetal anemia in both fetuses of MCDA twins and supports the chronic abruption-oligohydramnios sequence as the underlying cause. -
Mucormycosis is an invasive fungal infection caused by fungi of the order Mucorales. It can lead to significant mortality and morbidity in immunocompromised and diabetic patients. We herein present a patient with untreated type 2 diabetes who was admitted for acute progressive vision loss. Following diagnostic findings, she was diagnosed with mucormycosis that directly infiltrated the cerebral arteries, resulting in blindness in her left eye. This is an uncommon presentation of mucormycosis, as it led to arterial invasion without involving the orbit. This case underscores the significance of promptly diagnosing mucormycosis in susceptible individuals to avert catastrophic outcomes.
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Cerebral venous sinus thrombosis (CVST) is a rare but important cause of stroke in young adults. Although hemorrhagic venous infarction is well recognized, subarachnoid hemorrhage (SAH) as a presentation of CVST is uncommon and can easily mimic aneurysmal rupture. We describe a 33-year-old woman who presented with acute severe headache. Noncontrast CT revealed both subarachnoid and intracerebral hemorrhage. CT angiography was normal, with no evidence of aneurysm or arteriovenous malformation. CT venography demonstrated thrombosis in the distal part of the left internal cerebral vein, confirming CVST. During hospitalization, pulmonary CT angiography performed for new-onset dyspnea also revealed pulmonary thromboembolism (PTE). The patient was treated with anticoagulation and achieved clinical stability without progression of hemorrhage. SAH due to CVST is rare, accounting for fewer than 3% of cases. Convexity-localized SAH and parenchymal hemorrhage should raise suspicion for venous origin, particularly when angiography is normal. Literature review demonstrates that CVSTassociated SAH has often been misdiagnosed as aneurysmal hemorrhage. This case further highlights the potential for multisite venous thrombosis, as demonstrated by concomitant PTE. CVST should be considered in young patients with SAH and normal CTA findings. Venous imaging is essential for accurate diagnosis, and clinicians should remain vigilant for systemic thromboembolism.
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Pregnancy concurrent with severe underlying cardiac disease presents a substantial risk to maternal and fetal well-being. Despite routine antenatal screening, patients may occasionally deny or be unaware of critical cardiac histories, complicating perioperative management and leading to catastrophic decompensation. We report the case of a 22-year-old primigravida admitted for labor with intrauterine fetal demise (IUFD). The initial history was non-contributory, and the physical examination was unremarkable. Following an uncomplicated delivery and regional analgesia, the patient experienced sudden hemodynamic collapse, seizure, and pulmonary edema, necessitating emergent intubation and intensive care. Subsequent echocardiography revealed previously undiagnosed severe aortic stenosis (AS) with a mean pressure
gradient of approximately 100 mmHg. This case highlights how severe, compensated pathology can be masked by patient denial, underscoring the indispensable role of a meticulous history and physical examination as the primary diagnostic tool in obstetric anesthesia, regardless of self-reported symptoms. -
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by obsessions and compulsions that are time-consuming, distressing, and cause significant impairment in functioning. Obsessions are recurrent, intrusive, and unwanted thoughts, urges, or images, while compulsions are repetitive behaviors or mental acts performed to reduce the distress associated with these obsessions or to prevent perceived harm. OCD affects approximately 1–3% of the population and typically begins in adolescence or early adulthood. If left untreated, it usually follows a chronic or progressive course. A 29-year-old male with a two-year history of obesity presented to our clinic for weight management. His body mass index (BMI) was calculated as 36.1 kg/m². The patient had previously been treated with metformin for insulin resistance; however, therapy was discontinued after three months because of gastrointestinal intolerance, and tirzepatide
was then initiated. At the 11th dose of tirzepatide, the patient reported a three-week history of worsening intrusive thoughts and increased stress, for which he was referred to psychiatry. His family history revealed that his father had been diagnosed with OCD for 20 years. The patient was diagnosed with OCD by the psychiatry department and initiated on psychotherapy and a selective serotonin reuptake inhibitor (SSRI), with subsequent improvement of his obsessions and compulsions. -
Pancreatic injury following blunt abdominal trauma is an uncommon clinical scenario that often poses diagnostic and therapeutic challenges. Early recognition is critical to avoid serious complications.A 21-year-old healthy male presented to the emergency department following abdominal blunt trauma during assult.He reported epigastric pain and was initially hemodynamically stable. A contrast-enhanced CT scan revealed a pancreatic laceration without immediate signs of ductal disruption. The patient was managed conservatively but later developed peritonitis. Surgical exploration confirmed a Grade III pancreatic injury with ductal involvement, leading to distal pancreatectomy. The patient recovered uneventfully and showed complete recovery at follow-up.This case underscores the importance of maintaining a high index of suspicion for pancreatic injuries in blunt abdominal trauma. When pancreatic duct involvement is suspected, timely surgical intervention is essential to optimize patient outcomes.
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Peripheral neuropathy is rarely the initial presentation of lymphoma. Acute inflammatory demyelinating sensorimotor neuropathy, meeting the diagnostic criteria of Guillain-Barré syndrome, might be associated with Hodgkin’s lymphoma. A 33-yearold woman presented with dyspnea, generalized lymphadenopathy, acute-onset progressive ascending muscle weakness of the lower extremities, and acute bilateral uveitis. EMG-NCV confirmed acute inflammatory demyelinating polyneuropathy. Malignant lymphoma was suspected. A core needle biopsy of the left axillary lymph node was performed and revealed the classic type of Hodgkin’s lymphoma. The ABVD regimen was administered along with five consecutive sessions of plasmapheresis.
The neurological signs and symptoms improved gradually. In conclusion, acute inflammatory demyelinating polyneuropathy mimicking Guillain-Barré syndrome might be associated with HL and precede the diagnosis of lymphoma. Therefore, clinicians need to be aware of the neurological manifestations of lymphoma for
appropriate diagnosis and treatment. -
Fecal impaction is a frequent complication in elderly and neuropsychiatric populations, often due to multifactorial causes such as impaired motility, medication side effects, and behavioral abnormalities. In rare instances, ingestion of indigestible material, such as date pits, can lead to obstructive fecal loading. We report a 54-year-old woman with bipolar disorder and schizophrenia who presented with abdominal pain and
constipation lasting three days. Laboratory findings were unremarkable, except for an elevated ESR. Imaging studies, including plain abdominal radiographs and abdominal ultrasound, showed no clear signs of obstruction but revealed colonic fecal loading. A CT scan without contrast demonstrated marked colonic dilatation and multiple hyperdense intraluminal foreign bodies, consistent with date pits. Upon questioning,
the patient confirmed excessive ingestion of whole dates. Conservative management with enemas led to successful resolution, and the patient passed stool containing numerous intact date pits. Unusual causes of fecal impaction should be considered in at-risk populations, particularly psychiatric patients with erratic dietary behaviors. Recognizing the CT signature of ingested date pits is essential for accurate diagnosis and timely, conservative management. -
Esophageal duplication cysts (EDCs) are rare congenital foregut anomalies often presenting with nonspecific gastrointestinal (GI) symptoms in childhood. Diagnosis requires a high index of suspicion and comprehensive work-up. We report a 56-yearold male with type 2 diabetes mellitus and benign prostatic hyperplasia. He presented with a one-month history of intermittent, burning epigastric pain exacerbated by eating and accompanied by nausea. Physical examination revealed mild epigastric tenderness. Upper GI endoscopy showed a bulging lesion in the lower esophagus, a large cardia polyp, a small gastric body polyp, and antral erythema. Endoscopic ultrasound (EUS) identified a well-defined, homogeneous, round lesion (33 × 20 mm)
Esophageal duplication cysts (EDCs) are rare congenital foregut anomalies often presenting with nonspecific gastrointestinal (GI) symptoms in childhood. Diagnosis requires a high index of suspicion and comprehensive work-up. We report a 56-yearold male with type 2 diabetes mellitus and benign prostatic hyperplasia. He presented with a one-month history of intermittent, burning epigastric pain exacerbated by eating and accompanied by nausea. Physical examination revealed mild epigastric tenderness. Upper GI endoscopy showed a bulging lesion in the lower esophagus, a large cardia polyp, a small gastric body polyp, and antral erythema. Endoscopic ultrasound (EUS) identified a well-defined, homogeneous, round lesion (33 × 20 mm)
demonstrating acoustic enhancement in the lower esophagus. Contrast-enhanced abdominopelvic computed tomography (CT) revealed an intraluminal, non-enhancing lesion (25 × 26 mm) at the lower esophageal sphincter (LES), suggestive of a duplication cyst. Thoracic imaging showed no abnormalities. Due to persistent symptoms, the patient underwent successful video-assisted thoracoscopic surgery without complications; no recurrences occurred during follow-up. EDCs should be considered in the differential diagnosis of submucosal or intraluminal esophageal lesions, even in adults despite their rarity. EUS yields high accuracy in characterizing these lesions. Thoraco-abdominal CT scans delineate relationships to surrounding structures. For symptomatic lesions, video-assisted thoracoscopic surgery demonstrates a successful outcome with low complication rates. -
Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus. It usually presents with vesiculobullous lesions along a single dermatome. Disseminated herpes zoster (DHZ) is said to occur when there are more than 20 lesions outside the primarily affected dermatome. Cases of DHZ have been reported in elderly patients and those with states of immunosuppression such as HIV infections, cancer, post-COVID-19 infections, or patients on immunosuppressive drugs. However, here the authors are reporting a rare case of extensive cutaneous dissemination of herpes zoster in a young, healthy, immunocompetent male without any other comorbidities, treated successfully with intravenous acyclovir.
