Case Reports in Clinical Practice

Persistent Pseudologia Fantastica in a Patient with Bipolar Disorder and ADHD: A Case Report

2025-10-15T11:11:58+0330

Pseudologia fantastica is characterized by habitual, elaborate, and often fantastical fabrications that the patient recognizes as untrue. We report a case of a 24-year-old male with bipolar disorder and adult ADHD whose
treatment included mood stabilizers and atomoxetine, which improved psychiatric symptoms but had minimal effect on the pseudologia. This case highlights the persistent nature of pseudologia fantastica and its diagnostic
and therapeutic complexity, calling for further investigation into its management.

A Rare Coincidence of Non-keratinizing Nasopharyngeal Squamous Cell Carcinoma (SCC) and Pituitary Adenoma: A Case Report

2025-10-15T11:12:10+0330

This is the first reported case of the coexistence of nasopharyngeal carcinoma and pituitary adenoma in a 36-year-old female. The case is significant due to the rarity of these two tumors occurring simultaneously and the diagnostic challenges posed by overlapping symptoms. The patient presented with a history of chronic nocturnal headaches localized to the temporal region. Initial symptoms included six months of amenorrhea, massive bilateral galactorrhea, and classic clinical signs of acromegaly. The nasopharyngeal mass was initially missed during early evaluations, as the patient was primarily assessed for a secreting pituitary adenoma. The
nasopharyngeal mass was detected for the first time during rhinoplasty using an endoscope. Histopathological examination confirmed differentiated nonkeratinizing nasopharyngeal carcinoma alongside a pituitary adenoma. During radiotherapy for the nasopharyngeal carcinoma, the patient developed visual symptoms, including ptosis and outward deviation of the eye. The patient declined surgical excision of the pituitary adenoma; therefore, the radiotherapy field was expanded to include the adenoma. The radiotherapy dose was 70 Gy, delivered in 35 sessions. After three months of expanded radiotherapy, all symptoms, including
headaches and visual disturbances, were completely resolved. Follow-up after 14 months showed no evidence of recurrence or disease progression.

Spontaneous CSF Otorrhea Masquerading as Middle Ear Effusion: A Case Report

2025-10-15T11:12:11+0330

Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare but important differential diagnosis in cases of persistent middle ear effusion. We report a case of a 45-yearold female who presented with persistent aural fullness and hearing loss in the right ear immediately following an airplane flight. She was initially diagnosed with middle ear effusion and underwent myringotomy with grommet ventilation tube insertion. However, the patient continued to experience profuse watery otorrhea for two months postoperatively. Subsequent computed tomography of the temporal bone confirmed a CSF leak from a defect in the tegmen tympani near the anterior epitympanum. The patient underwent successful endoscopic CSF otorrhea repair under general anaesthesia. Three months postoperatively, the patient’s hearing improved, and her aural symptoms resolved. This case highlights the importance of considering spontaneous CSF leaks in cases of sudden-onset conductive hearing loss, even in the absence of trauma or prior surgical history.

Naegleria Amebic Keratitis (Corneal Abscess) in the Use of Color Cosmetic Soft Contact Lens Wear: A Case Report

2025-10-15T11:12:12+0330

Amebic keratitis is a rare but serious corneal infection that is occasionally seen in contact lens wearers. In the early stages, the disease may be mistaken for bacterial keratitis due to corneal inflammation and a reduced visual field, which can delay diagnosis and treatment. In this case report, we present a young female who exhibited symptoms of a corneal ulcer associated with contact lens use and was initially treated for bacterial keratitis. Upon further evaluation, the diagnosis of Naegleria amebic keratitis was confirmed.

Cerebral Venous Thrombosis as a Complication of Spontaneous Intracranial Hypotension: A Case Report

2025-10-15T11:12:12+0330

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid (CSF) leakage, which can lead to complications such as cerebral venous thrombosis (CVT), occurring in 1–2% of SIH patients. This case report describes the presentation, diagnosis, and management of SIH complicated by CVT. A 36-year-old woman with no comorbidities presented with a three-week history of severe, initially orthostatic headaches. Neurological examination revealed mild bilateral disc oedema, and imaging showed generalized brain oedema. MRI with MRV confirmed cerebral venous sinus thrombosis along with typical SIH features, including pachymeningeal enhancement and venous engorgement. She was treated with heparin infusion and
isotonic saline, responding well without seizures or hemorrhagic complications. This case highlights the risk of CVT in SIH and underscores the importance of early diagnosis through neuroimaging and lumbar puncture. The patient’s favorable response to anticoagulation demonstrates effective management, though further
studies are needed to establish definitive treatment guidelines for SIH-associated CVT.

Heterotopic Pregnancy Presenting as Maternal Acute Abdomen at 19 Weeks of Gestation: A Case Report

2025-10-15T11:12:12+0330

Heterotopic pregnancy is the simultaneous presence of intrauterine and ectopic gestations. It is typically diagnosed in the first trimester via sonography or when patients present with vaginal bleeding or abdominal pain. We report a case of a 26-year-old Asian primigravida woman who conceived through ovulation induction and presented at 19 weeks and 4 days of gestation—one week after a successful Macdonald cerclage, with severe abdominal pain and hemodynamic instability. Bedside ultrasound revealed significant hemoperitoneum and a viable intrauterine fetus. Emergency laparotomy identified an unruptured right fallopian tube containing a 5 × 6 cm mass. A right salpingectomy was performed due to suspected ectopic pregnancy, and no other bleeding source was found. Histopathology confirmed tubal ectopic pregnancy. The postoperative course was uneventful, and the intrauterine pregnancy successfully progressed to term. Heterotopic pregnancy should be considered in the differential diagnosis of hemoperitoneum, even in the second trimester.

Acute Ischemic Stroke Following Snakebite: A Case Report

2025-10-15T11:12:13+0330

Snakebite envenomation is associated with a wide spectrum of complications, ranging from local tissue damage to life-threatening systemic effects. This case report describes a rare presentation of acute ischemic stroke in a 77-year-old man following envenomation by a suspected Montivipera raddei albicornuta in northwestern Iran. The patient initially presented with right lower limb cellulitis, thrombocytopenia,
coagulopathy, and acute kidney injury. Within six hours, he developed left-sided hemineglect, hemiparesis, hemifacial weakness, dysarthria, and a decreased level of consciousness. Neuroimaging revealed a non-hemorrhagic infarct localized to the right parietal lobe within the distribution of the middle cerebral artery. This
case underscores the potential for thrombotic events, including ischemic stroke, in the context of venom-induced disseminated intravascular coagulation (DIC). It also highlights the need to reassess the efficacy and dosing strategies of available antivenoms and to establish protocols for early identification of thrombotic events following envenomation in high-risk snakebite patients.

A Rare Heteroplasmic MT-ND5 Mutation (m.13094T>C) in an Iranian Patient with Adult-Onset MELAS: Diagnostic Challenges and Therapeutic Implications

2025-10-15T11:12:13+0330

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes [MELAS] is a rare multisystem mitochondrial cytopathy that is highly heterogeneous in severity and clinical presentation, mostly caused by diverse mutations in the mitochondrial DNA. While m.3243A>G is the most common variant, rare mutations like m.13094T>C in MT-ND5 are increasingly recognized but poorly characterized. This report documents the case of a 37-year-old Iranian woman diagnosed with MELAS. Her clinical manifestations include recurrent episodes of stroke-like events, focal seizures, and elevated serum and CSF lactate. Mitochondrial DNA analysis [mtDNA] was positive for a very rare pathogenic point mutation [mtDNA; m.3243A>G] in the MT-ND5 gene, with a heteroplasmy level of 8.2%. This case highlights: 1. Adult-onset MELAS with MT-ND5 mutations is underdiagnosed. 2.Low heteroplasmy (8.2%) may still cause severe phenotypes, suggesting tissuespecific effects. 3.Ethnic diversity in mtDNA mutations warrants broader genetic screening in non-classical cases.

The Importance of Regular Dental Check-Ups in the Early Diagnosis of Neoplasms: A Case Report of Ameloblastoma

2025-10-15T11:12:01+0330

A 51-year-old female presented for her routine annual dental check-up. During the intraoral examination, she reported pain upon pressure applied to the apical portion of the mandibular left first premolar. She was referred for a panoramic radiograph, which revealed a suspected radiolucency in the interradicular region of the left mandibular canine and premolars (Figure 1). A periapical radiograph confirmed the finding (Figure
2), and cone beam computed tomography (CBCT) was performed.CBCT revealed a localized, unilocular radiolucent lesion with well-defined corticated borders, extending from the alveolar crest to the apex of the
first premolar, measuring 11 mm vertically, 10 mm buccolingually, and 4.2 mm anteroposteriorly. The lesion caused thinning of the lingual cortical plate, as well as thinning, expansion, and perforation of the buccal cortical plate. The lamina dura and periodontal ligament were not visible in the mesial portion of the first premolar and the distal aspect of the canine. The lesion resulted in severe root resorption of the first premolar and mild resorption of the adjacent canine (Figure 3). Differential diagnoses included radicular cyst, ameloblastoma, and central giant cell granuloma. Radicular cyst was ruled out through vitality tests. Biopsy and histopathological evaluation confirmed the diagnosis of ameloblastoma, and the patient was referred for surgical management. Although rare, ameloblastoma is the second most common odontogenic tumor [1]. It grows slowly and often remains asymptomatic in its early stages [2].Smaller lesions may be detected incidentally during routine dental check-ups. As the tumor enlarges, facial asymmetry and cortical bone perforation may occur due to failed periosteal bone formation [2]. If left untreated, it can reach significant dimensions [2]. This highlights the critical importance of regular dental check-ups for the early detection of such tumors. Regular dental examinations are essential for early detection, allowing timely intervention and
reducing the risk of complications, disfigurement, or functional impairment.