pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Vol 8 No 5 (2023): September-October
Case Report(s)
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Cardiac involvement can occur in lymphoma, with the right heart being predominantly affected. The prognosis for patients with cardiac involvement is poor. A 28-year-old man, with a 4-year history of Hodgkin’s lymphoma, presented with progressive shortness of breath and ascites. Chest X-ray (CXR) and CT scan revealed multiple masses in the mediastinum. To exclude a pulmonary embolism, the patient underwent CT angiography, which incidentally revealed a filling defect in the right atrium. Trans-esophageal echocardiography confirmed the presence of a mass in the right atrium. Surgery was performed to obtain samples of the mediastinal masses and the right atrium mass. Pathological results indicated that the nature of the right atrium mass was diffuse large B-cell lymphoma (DLBCL), suggesting that the Hodgkin’s lymphoma had transformed into DLBCL. The transformation of Hodgkin’s lymphoma to DLBCL can occur, and cardiac involvement is not common. Given that the transformation of Hodgkin’s lymphoma into DLBCL can occur many years after the initial diagnosis, the authors recommend follow- up of these patients, as the prognosis may be worse than for non-transformed subtypes.
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Paraurethral leiomyoma is a rare benign mass. Its rarity and complex anatomical proximities pose challenges in management. The authors report a case of a 35-year-old woman with a paraurethral leiomyoma that was successfully excised without complications. Histopathological examination is the gold standard for diagnosis; however, imaging can also assist in diagnosis before intervention.
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Pompe disease or type 2 glycogen storage disease (GSD), is an autosomal recessive disorder, occurs by deficiency of an enzyme (acid maltase) which degrades glycogen in lysosomes. It is classified into infantile and late onset types.Identifying PD presents several challenges due to the wide range of phenotypes and phenotype overlap with other neuromuscular disorder. However, in cases of suspected Pompe disease, performing genetic testing and starting treatment immediately after proving the disease has an effective role in reducing the rate of progression of disease symptoms.With the progress made in genetic tests, sometimes new mutations are added to the existing genetic bank.So far, more than 600 mutations are known to cause many signs and symptoms, and some of these mutations are more common in certain breeds and cause more symptoms and more deaths.In this case report, we introduce a Pompe patient with a new genetic mutation that is of pathogenic types. This patient had presented with sign of severe hypotonia and cardiomegaly, increased cardiac enzymes, and abnormal liver tests. Despite enzyme therapy immediately after diagnosis, she died.
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This study aims to present an unusual combination of choroidal folds and a myelinated nerve fibre layer. The right eye of a 45-year-old male had been experiencing vision loss for the past six months.An ophthalmic examination revealed a distinct peripapillary white striated patch with feathered borders approximately two disc diameters in size at the nasal pole of the optic disc in both eyes. Choroidal folds involving the macula were also observed in the right eye. This is the first report of an association between a myelinated nerve fiber layer (MNFL) and choroidal folds.
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Chronic idiopathic hypertrophic pachymeningitis (IHP) is a rare inflammatory entity with unknown etiopathogenesis, resulting in dural thickening and fibrosis. This mimics the illuminated night view of the Eiffel tower on contrast-enhanced MRI. The authors report a characteristic MRI sign of chronic IHP on contrast-enhanced MRI. The authors present a case of a 30-year-old male presenting with a headache for the past 3 years with recent aggravation of symptoms. Laboratory and imaging results were reviewed. Follow-up imaging with ongoing treatment was also reviewed. The etiology could not be determined even after extensive investigations. Contrast-enhanced MRI revealed diffuse enhancing thickening of the pachymeninges along the posterior cerebral hemispheres, falx cerebri, and tentorium cerebelli, giving the typical ‘Night view of the Eiffel tower’ appearance on coronal images. There was cerebral venous sinus thrombosis secondary to IHP. The patient was treated with corticosteroids and anticoagulants. The follow-up scan revealed reduced thickness and enhancement of the meninges.
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Endocarditis of cardiac implanted electronic devices is a complex and serious disease. Commensal bacteria of the skin are commonly considered as contamination of blood culture. Herein, the authors report the case of a pacemaker endocarditis with cultures positive for Cutibacterium acnes. These were already found 3 and 6 years ago but not observed during hospitalisation. The PET-scan was of great help in guiding the diagnosis. The management was particularly difficult with 9 leads to extract. A sequential approach in the operating room from endovascular procedure to surgery under cardio-pulmonary bypass was used. A second procedure was necessary to extract a small forgotten foreign body already visible on the preoperative chest X-ray. This experience shows the importance of having a high level of suspicion in case of culture positive for Cutibacterium with intracardiac devices, and of looking for foreign bodies on the preoperative chest X-ray in case of a history of multiple rhythmological procedures.
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Reporting clinical cases of high-grade endometrial stromal sarcoma tumors is essential for a better understanding of their natural course and for the development of appropriate diagnostic and treatment strategies. To date, only a few cases have been studied in this regard.In the present study, the authors present the case of a 69-year-old Iranian woman diagnosed with high-grade endometrial stromal sarcoma involving the myometrium and ovaries. The diagnosis was confirmed after pathology, which revealed myometrial and vascular involvement. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and adjuvant chemotherapy with chemotherapy regimens.
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Lung Cancer is one of the most common types of cancer found among smokers. However, approximately 10% of lung cancer patients are non-smokers. Non-smokers are frequently seen developing Adenocarcinoma, a type of non-small cell carcinoma with a female predominance. The incidence of Squamous cell carcinoma among non-smokers is very low. Moreover, studies have shown that tetra site metastasis in the case of Squamous cell carcinoma of the lung is almost as rare as 0.6% [1]. The authors report here in this article a case report of a rare and aggressive presentation of Squamous cell carcinoma in a non-smoker. This is a case of a 50-year-old male patient who is a non-smoker, presented with complaints of exertional dyspnoea and cough with expectoration for 3 months which had aggravated since 15 days, associated with hoarseness of voice and diffuse headache since 15 days. There was a history of significant weight loss and loss of appetite for 3 months. CECT thorax revealed a heterogeneously enhancing mass lesion in the anterior segment of the left upper lobe encasing the left pulmonary artery with evidence of liver, adrenal and vertebral metastasis. During the hospital stay, the patient developed complete ptosis of the right eye. MRI brain was done which showed features suggestive of metastasis involving bilateral cerebral and cerebellar hemispheres. USG guided lung biopsy was done and was suggestive of moderately differentiated Squamous cell carcinoma. The patient was planned to be further worked up for IHC markers and PET CT scan to determine the further line of treatment however, unfortunately, the patient succumbed to the disease within 1 week of histopathological diagnosis.
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Isaacs Syndrome (IS) is an autoimmune disease characterized by fasciculations, dysautonomia, and hyperactivity of muscle fibers due to hyperexcitability of the peripheral nerve system. Patients with IS often express voltage-gated potassium channels (VGKCs), contactin-associated protein 2 (CASPR2), and leucine-rich glioma- inactivated protein (LGI1) antibodies. Slower rates of grouped fasciculation, known as myokymia, are a common presentation in IS patients. Recently, carbamazepine has been considered as the first-line treatment to alleviate the symptoms of IS patients. In this report, the authors present a case of a female patient with ramps and unintended movements in the abdomen and both lower limbs. She was diagnosed with IS after the detection of myokymia in the needle electromyography (EMG) and a positive paraneoplastic panel for CASPR2 and LGI antibodies. The patient is now symptom-free due to the administration of Carbamazepine, Gabapentin, and Baclofen. Additionally, due to her potential risk for solid tumors, she is under regular follow-up.
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Congenital pancreaticobiliary anomalies like pancreatic divisum (PD), choledochal cysts (CDC), anomalous pancreaticobiliary ductal union (APBDU) have been reported in 5.7% of patients undergoing magnetic resonance cholangiopancreatography. CDC’s are characterized by abnormal dilatations of the intrahepatic and/or extrahepatic portion of the biliary tree and can be complicated by cystolithiasis, cholangitis, pancreatitis and malignant transformation necessitating surgical managemnet. While CDCs are commonly associated with APBDU, combination of CDC with PD is rare and a potential surgical challenge. We report a case of recurrent cholangitis in a patient with CDC and coincidental classic PD and illustrate how preoperative identification, fastidious dissection technique to safeguard both the pancreatic ducts and simple intraoperative preemptive strategies may decrease consequences of distal stump blowout.
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Primary ovarian leiomyoma is a rare benign ovarian tumor that occurs in women between the ages of 20 and 65. This tumor is usually diagnosed incidentally through pelvic examination or histopathological study after surgery. A definitive preoperative diagnosis is difficult due to the lack of pathognomonic signs or specific imaging features. Therefore, histopathological examination and immunohistochemical analysis are considered necessary. The authors report a case of a 49-year-old woman with ovarian leiomyoma who had a history of heavy vaginal bleeding. She underwent laparotomy with a preoperative diagnosis of uterine fibroids.
