pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Current Issue
Vol 11 No 3 (2026): May-June
Case Report(s)
-
Ogilvie Syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare condition characterized by the acute dilation of the colon without any obvious mechanical obstruction. It is most commonly seen in critically ill patients with severe underlying conditions. Its occurrence in burn patients is rare, yet significant, given the clinical challenges it presents. We present two cases of Ogilvie Syndrome in burn patients. The first patient was a 63-year-old male who sustained third-degree burns over 40% of his totalbody surface area (TBSA). On day 12 post-burn, he developed significant abdominal distension, and imaging confirmed severe cecal dilation (15 cm in diameter). The diagnosis of Ogilvie Syndrome was made, and initial treatment included nasogastric tube insertion, electrolyte correction, and discontinuation of opioids and other motility-inhibiting medications. After a partial response to intravenous neostigmine, a therapeutic colonoscopy was performed, which successfully relieved the gas buildup and led to a marked improvement in the patient’s condition within two days. The second patient, a 45-year-old female, presented with second or third-degree burns covering 30%
TBSA. On day 10 post-burn, she developed mild abdominal distension and vague abdominal pain. Imaging confirmed cecal dilation of 16 cm. Treatment was initiated with nasogastric decompression, oral laxatives, intravenous neostigmine, and electrolyte correction. Within three days, her condition significantly improved, and no invasive procedures were required. Both cases highlight the effectiveness of supportive care, electrolyte management, and pharmacological treatments such as neostigmine in facilitating recovery. The main takeaway is the necessity for vigilant monitoring of burn patients, particularly those at high risk for Ogilvie Syndrome, and the importance of early, appropriate interventions to ensure better patient outcomes. -
Enfortumab vedotin (EV), an antibody–drug conjugate targeting Nectin-4, has become an important therapeutic option for patients with advanced urothelial carcinoma. Although cutaneous adverse events are frequently observed with EV, severe cutaneous toxicity is rare and may be associated with mortality.
We describe a 77-year-old woman with metastatic urothelial carcinoma who developed a severe cutaneous adverse reaction after initiation of EV in combination with pembrolizumab for platinum-refractory disease. Within the first treatment cycle, following the initial doses of EV, she developed progressive dermatologic symptoms beginning with pruritus and erythema and rapidly evolving into widespread painful erosive and desquamative skin lesions with epidermal detachment and oral mucosal involvement. The cutaneous involvement affected approximately 70% of the total body surface area (TBSA), predominantly involving the trunk and extremities. No evidence of ocular involvement or genital mucosal lesions was identified. EV was discontinued, and the patient received systemic corticosteroids. Her clinical course was complicated
by secondary infection and sepsis, and she died due to sepsis-related complications. This case highlights the diagnostic and therapeutic challenges of severe EV-associated cutaneous toxicity, particularly given its clinical overlap with other severe cutaneous adverse reactions and the frequent limitations encountered in critically ill oncology patients. Early recognition of evolving skin toxicity and prompt interruption of treatment are essential to reduce the risk of severe complications. -
Moyamoya syndrome (MMS) is a rare, progressive occlusive vasculopathy characterized by stenosis of the distal internal carotid arteries and the formation of collateral vessels resembling a “puff of smoke” on angiography. Patients with Down syndrome (DS) have a significantly higher risk of MMS; however, diagnosis is often delayed due to underlying intellectual disability. We report the case of a 21-year-old male with Down syndrome who presented with recurrent ischemic strokes. Initial magnetic resonance imaging (MRI) revealed
scattered infarcts in both hemispheres. Magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) demonstrated bilateral terminal internal carotid artery stenosis with compensatory anastomoses from the external carotid arteries, confirming the diagnosis of moyamoya syndrome. Due to adequate collateral circulation, the patient was managed conservatively with dual antiplatelet therapy rather than surgical revascularization. Unfortunately, the clinical course was complicated by Stevens–Johnson syndrome following antiseizure medication and subsequently severe pneumonia with bilateral pleural effusion, which ultimately led to the patient’s death. While confirming previous findings on the diagnostic challenges of MMS in DS, this report emphasizes that systemic complications pose a serious threat to these patients. -
Influenza-associated encephalitis (IAE) is a rare but serious complication of influenza infection, predominantly affecting children. While most reported cases present with moderate to severe neurological symptoms, mild and self-limiting forms remain underrecognized. We report the case of a previously healthy 9-yearold boy who presented with fever, lethargy, behavioral changes, and two episodes of nocturnal complex behavior concerning for seizures during the course of an influenza-like illness. Laboratory evaluations were notable for leukopenia and elevated D-dimer levels. Neuroimaging revealed a medial right temporal arachnoid cyst, and cerebrospinal fluid (CSF) analysis showed mild pleocytosis with positive influenza A PCR. Electroencephalography was normal. The patient was managed with intravenous antibiotics, antiviral therapy, and supportive care. His symptoms resolved rapidly without neurological sequelae, and he made a complete recovery. This case highlights that influenza-associated encephalitis can present with mild, transient
neuropsychiatric symptoms. It demonstrates that a positive respiratory influenza test does not preclude central nervous system involvement, underscoring the importance of cerebrospinal fluid analysis for diagnosis and to avoid unnecessary interventions. -
Eccrine poroma (EP) is a benign skin adnexal tumor that originates from eccrine sweat glands. It usually appears as a solitary mass on an extremity, commonly on the hand or foot. However, clinical presentation can be varied, posing diagnostic challenges. This study describes a rare case of ulcerative EP on the palm. It covers the clinical and histological features, the diagnostic and treatment approaches, and the potential for local recurrence or malignant transformation.
-
Serial Endoscopic Decompression in Recurrent Sigmoid Volvulus: Temporary Success, Definitive Failure
Recurrent Sigmoid Volvulus (RSV) is characterized by repeated torsion of the sigmoid colon around its mesenteric axis following previous intervention, most commonly after successful endoscopic detorsion. Recurrence rates are significantly higher after non-operative management compared with definitive surgical resection. Predisposing factors include advanced age, male sex, chronic constipation, high-fiber dietary
intake, and anatomical abnormalities such as a redundant sigmoid colon with an elongated mesentery. RSV is associated with substantial morbidity and carries the risk of bowel ischemia, perforation, sepsis, and death if treatment is delayed. Consequently, definitive surgical management, typically sigmoid colectomy with
primary anastomosis, should be considered to minimize recurrence and prevent lifethreatening complications. We report the case of a 73-year-old man with multiple recurrent episodes of sigmoid volvulus who underwent emergency sigmoid resection with primary end-to-end anastomosis after four previous hospital admissions
treated with endoscopic decompression. This case illustrates the limitations of repeated endoscopic decompression as a temporizing strategy and demonstrates the potential consequences of delaying definitive management. It further emphasizes the importance of early risk stratification and timely surgical intervention in suitable patients with recurrent sigmoid volvulus. -
Nicolau syndrome, also known as emboli cutis medicamentosa, is a rare but potentially severe complication of parenteral drug administration that may lead to acute pain, livedoid discoloration, and cutaneous or subcutaneous necrosis. We report the case of a 4-year-old boy who developed Nicolau syndrome shortly after intramuscular administration of benzathine penicillin for streptococcal pharyngitis. He presented with sudden severe pain, pallor, mottling, and livedoid changes involving the injected limb and adjacent regions. Prompt recognition and multidisciplinary conservative management, including anticoagulation, topical vasodilator therapy, corticosteroids, limb elevation, and intensive monitoring, were associated with progressive clinical
improvement and preservation of limb function. This case highlights the importance of early diagnosis and timely supportive intervention in preventing severe ischemic complications of Nicolau syndrome. -
Disseminated peritoneal leiomyomatosis (DPL) is a rare benign condition characterized by multiple smooth muscle nodules throughout the peritoneum. We report a 36-year-old woman presenting with vaginal bleeding and a large pelvic mass. Preoperative MRI raised concern for malignancy, including leiomyosarcoma. Surgical
and histopathological evaluation, however, revealed a benign uterine leiomyoma, an ovarian fibroma, and multiple omental smooth muscle nodules consistent with DPL. Notably, the patient had no history of prior uterine morcellation. This case underscores the importance of histopathological and immunohistochemical confirmation to differentiate DPL from malignant processes, preventing overtreatment and guiding
appropriate management. -
Hypothyroidism in children is a prevalent endocrine disorder characterized by insufficient production of thyroid hormones, significantly impacting physical growth, neurodevelopment, and metabolism. This case report presents a child exhibiting atypical manifestations. A 30-month-old (approximately 2.5 years)
girl presented with a chief complaint of brown-red particles in her urine. Initial investigations, including repeated urinalyses and abdominal-pelvic ultrasonography, yielded normal results. Importantly, repeated microscopic examinations of the urine samples revealed no crystals or abnormal cellular elements, confirming that the visible particles were purely macroscopic. Despite treatment for a suspected mild urinary tract infection, the symptom persisted. Growth parameters were within normal limits. Following consultation, thyroid function tests revealed elevated thyroid-stimulating hormone (TSH: 9.09 µIU/mL) and low total thyroxine (T4: 6.4 µg/dL), with normal anti-thyroid peroxidase antibodies, confirming a diagnosis of overt hypothyroidism. Upon diagnosis, levothyroxine therapy was initiated, leading to rapid symptom improvement and complete resolution of the urinary particles within days. This case underscores the importance of considering overt hypothyroidism in children with nonspecific urinary symptoms and highlights the
value of meticulous clinical follow-up.
