Case Reports in Clinical Practice

Nonsurgical Endodontic Retreatment of a Cystic Apical Lesion Associated with Root Resorption: A Promising Approach

Saeed Asgary — 2024-11-06

This case report highlights the successful management of a cystic apical lesion associated with root resorption through nonsurgical endodontic retreatment, utilizing calcium-enriched mixture (CEM) cement as an obturating biomaterial. A 35-year-old woman presented with mild discomfort in the mandibular right first molar (#46), with radiographic evidence of a well-defined radiolucent lesion at the apex of the mesial root. The tooth had a history of previous failed endodontic treatment with poor root canal obturation, indicating internal root resorption. Nonsurgical endodontic retreatment was performed, and the canals were filled/sealed with CEM cement. Follow-up radiographs showed a gradual reduction in the size of the cystic lesion. At 54 months, complete bone healing of the cystic apical lesion was evident. This case report provides clinical evidence supporting the potential efficacy of nonsurgical endodontic retreatment using CEM cement in managing certain cystic apical lesions, offering a promising alternative to traditional surgical enucleation, even in cases with inflammatory root resorption. Further research is needed to validate the long-term efficacy of this approach in larger patient populations.

Gross Hematuria Following Fetal Head Engagement in a Pregnant Woman with Glanzman Syndrome

Azam Zafarbakhsh — 2024-11-06

Glanzmann’s thrombasthenia (GT) is a rare genetic platelet disorder that leads to bleeding problems in affected individuals. We present a 28-year-old woman with GT who experienced a rare symptom of painless gross hematuria in the last month of pregnancy. To provide the best care, an interdisciplinary approach was followed by a team of obstetricians and gynecologists, hematologists, neonatologists, and anesthesiologists. The IUGR fetus was delivered by cesarean section and had mild acidosis and thrombocytopenia at birth. Both the baby and the mother were carefully cared for and treated. Hematuria also improved spontaneously within two weeks after delivery. Gross hematuria during pregnancy rarely occurs due to the pressure of the presenting part of the fetus on the mother’s bladder (due to engagement). Aggravation of any clinical symptoms in pregnant women with GT should alert maternal and fetal health care providers to make individualized decisions.

Triple Trouble: Acute Appendicitis with Right Testicular Torsion and Concurrent Right Inguinoscrotal Hernia-A Case Report

Mohd Shafiq Rahman — 2024-11-06

Acute appendicitis commonly presents with right iliac fossa pain. However, it may present with right scrotal pain and swelling, which may be confused with other scrotal pathologies such as orchitis, scrotal abscess, and testicular torsion. Acute appendicitis in children and adolescents may present with scrotal pain due to inflammatory intraperitoneal fluid tracking down into the scrotal sac via a patent processus vaginalis. In rare cases, acute appendicitis may present concurrently with testicular torsion, making the diagnosis much more challenging. Herein, we present an even rarer case of acute appendicitis with right testicular torsion and concurrent right inguinoscrotal hernia.

Two-year Local and Distant Control of Malignant Peripheral Nerve Sheath Tumor (MPNST) in NF1 Patients After Multiple Recurrences: A Case Report

Mostafa Farzin — 2024-11-06

Malignant peripheral nerve sheath tumors (MPNSTs) are rare, biologically high-grade sarcomas that tend to recur and metastasize. The known risk factors for MPNSTs include neurofibromatosis type 1, highly aggressive MPNSTs, and dismal survival outcomes. Multimodality therapies, including surgical resection, radiotherapy, chemotherapy, targeted therapy, and combination therapy, are available. This case report describes a young woman with NF1 who was referred to us with a history of three local recurrences of MPNSTs in the proximal part of her left thigh after several surgical attempts. Successful local and distant control was achieved via preoperative radiotherapy and chemotherapy prior to the latest surgery. With preoperative RT and chemotherapy, more long-term and successful local and distant control was achieved, particularly in high-risk NF1- associated MPNST patients with a history of recurrence. Trials with larger sample sizes may show improvements in local control (LC), disease-free survival (DFS), and overall survival (OS) with neoadjuvant interventions in such patients.

The First Case of Bernard-Soulier Syndrome Presenting with Isolated Hemoptysis and Probable Diffuse Alveolar Hemorrhage: A Case Report and Literature Review

Amirali Karimi — 2024-11-06

Bernard-Soulier syndrome (BSS) is a rare platelet function disorder due to an impaired GPIb-V-IX complex, with an estimated incidence of one per million. Usual presentations include gingival bleeding, epistaxis, easy bruising, and post-traumatic excessive bleeding, among others, but not hemoptysis. The patient was a 46-year-old male who presented with three cups of hemoptysis two days before the presentation. He also had moderate burning chest pain for the past two weeks, which was getting better. He was diagnosed with BSS 45 years ago and had approximately 100 prior presentations for bleeding from various locations, including three prior episodes of hemoptysis. The mainstay of treatment was platelet transfusions, and the patient was carefully observed. Only one case of hemoptysis in a patient with BSS was found, but the patient had hemoptysis due to underlying pulmonary tuberculosis. Therefore, hemoptysis or DAH were never reported in the literature due to BSS. This patient was the first case of massive hemoptysis and possible DAH related to BSS, emphasizing the need for proper attention due to its possible detrimental outcomes.

Fanconi Syndrome Due to Tenofovir Disoproxil Fumarate in a Patient with Chronic Hepatitis B Induced Cirrhosis: A Case Report

Milad Khodabakhshi — 2024-11-06

We present a 63-year-old woman with chronic hepatitis B. The patient has a history of cirrhosis due to chronic hepatitis B and is under treatment with Tenofovir disoproxil fumarate. The patient presented to our center with nausea, vomiting, and severe metabolic acidosis. After initial evaluation, along with the typical course of events
and the exclusion of differential diagnoses of normal anion gap metabolic acidosis, we determined that the cause of illness was related to Tenofovir disoproxil fumarate. All our practical and laboratory data supported a diagnosis of proximal tubular acidosis. After discontinuing the drug for two weeks and providing supportive management, metabolic acidosis and electrolyte imbalance improved. The other isoform of Tenofovir
(Tenofovir alafenamide) was initiated for the patient, and after two months of followup, there were no signs of acidosis or electrolyte imbalance.

The Rare Instance of Uterine Adenocarcinoma Metastasizing to the Skull Base, Manifesting as Blindness and Ptosis

Zahra Sanayepasand — 2024-11-06

Metastasis to the skull base is a rare but serious complication of various malignancies. This case report discusses a 50-year-old woman with a history of advanced endometrialadenocarcinoma who presented with progressive headache, left-eye blindness, and ptosis. Imaging revealed a mass along the left optic nerve, raising suspicions of mucormycosis, but biopsy confirmed metastatic endometrial adenocarcinoma. Despite
undergoing skull base radiotherapy, the patient’s vision did not improve. This case underscores the importance of considering metastatic endometrial adenocarcinoma in differential diagnoses for skull base lesions, particularly when other conditions are ruled out. Accurate diagnosis requires careful integration of clinical, radiological, and histopathological data.

Herbal Fertility Remedies Leading to Massive Pulmonary Embolism: A Case Report

Iman Bhia — 2024-11-06

The rising use of herbal medicines raises concerns about their safety and effectiveness. This case report involves a 55-year-old male who developed shortness of breath and chest discomfort after using herbal substances and sildenafil for erectile dysfunction and infertility. He was diagnosed with a massive acute pulmonary embolism (PE) via CT angiography and treated with alteplase, followed by oral apixaban after discharge. The herbal substances included carob, ginger, red ginseng, and others. This case highlights the need to investigate how herbal remedies may affect hormone balance and contribute to cardiovascular risks, particularly PE.

A Case Report of Dorsal Pancreatic Agenesis and Uterus Didelphys in a Young Woman: A Seldomreported Association

Ali Goudarzi — 2024-11-06

Agenesis of the dorsal pancreas is a rare congenital anomaly that often remains asymptomatic and is requently discovered incidentally during imaging for other conditions. Its association with Müllerian anomalies, such as uterus didelphys, suggests that both conditions may stem from similar embryological disruptions during early fetal development. This report aims to raise awareness of Agenesis of the Dorsal Pancreas (ADP) and its potential associations with Müllerian anomalies. By presenting a detailed case study, we seek to address the diagnostic challenges faced by healthcare professionals and the implications for patient management, emphasizing the importance of early detection and appropriate intervention. We present a case involving a 24-year-old Iranian female who presented with a 10-day history of abdominal pain and vomiting. Initial ultrasound imaging revealed moderate hydroureteronephrosis in the right kidney, prompting further investigation. A contrast-enhanced CT scan was performed, which not only confirmed ureteropelvic junction obstruction but also unexpectedly revealed dorsal pancreatic agenesis. In addition to these findings, the patient was diagnosed with uterus didelphys, highlighting a significant developmental anomaly. This case underscores the necessity for increased awareness of ADP and its associations with Müllerian anomalies among healthcare providers. Early and accurate diagnosis through advanced imaging modalities significantly improves patient outcomes and facilitates better management strategies for associated complications.

A Horseshoe-shaped Dermoid

Suwarna Suman — 2024-11-06

Dermoid cysts are congenital choristomas. Orbital dermoids are usually encapsulated cystic lesions and are oval, round, or hourglass in shape. Here, we present an unusual case of an external angular dermoid with a unique horseshoe-shaped appearance in a 19-year-old male.