pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Vol 11 No 1 (2026): January-February
Case Report(s)
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Coronavirus Disease 2019 (COVID-19) has been associated with both acute and longterm complications, spanning cardiorespiratory and neuropsychiatric domains. The neuropsychiatric sequelae may stem from immune system dysregulation, inflammatory cytokines, and psychosocial stressors, including threats to personal health, economic
stability, and social standing. This case report presents a 55-year-old male with no prior psychiatric history who developed treatment-resistant depression following COVID-19 infection. The study emphasizes the psychological repercussions of the pandemic, particularly in individuals with fragile premorbid personality structures. -
Port catheters are recommended for patients requiring long-term intravenous therapy, particularly in cancer patients who are debilitated and require administration of chemotherapy or cytotoxic drugs. Mechanical complications of port placement include port occlusion, displacement, and catheter fracture. In this case report, we present the endovascular retrieval of a fractured chemotherapy port catheter fragment from the superior vena cava using a snare device. A 60-year-old woman with metastatic breast cancer presented with infusion difficulty through her 18-monthold subclavian chemotherapy port. The surgeon noticed that the port had not been fully extracted, prompting an urgent consultation for intervention. Fluoroscopyguided retrieval of an SVC catheter fragment was achieved via femoral access using an Amplatz snare after failed EN Snare attempts. The patient was discharged postprocedure without complications. Proactive chemotherapy port surveillance enables early complication management. Catheter fractures necessitate multidisciplinary care,
where endovascular snare retrieval augmented by surgical excision demonstrates optimal safety and efficacy. -
The deformity around the knee joint is considered extra-articular when it is proximal in relation to the distal femur epicondyle for the femur and distal to the level of the fibula neck for the tibia deformity. The presence of extra-articular deformity plays a significant role in arthritis around the adjacent joint. The present study shows a case of malunited proximal tibia fracture with knee osteoarthritis treated with restricted kinematic alignment total knee arthroplasty. For end-stage OA with extraarticular deformity, a well-balanced total knee replacement with robotic assistance can be done without complete intra-articular correction of extra-articular deformity.
A 65-year-old male presented to the outpatient department (OPD) with a complaint of bilateral knee pain from the past six months. The radiographs showed end-stage knee osteoarthritis with a malunited proximal tibia fracture on the right side. For the right knee, total knee arthroplasty (TKA) was planned using robotic assistance with restricted kinematic alignment, which consists of bone cuts of the distal femur, proximal tibia, and soft tissue release. For the management of knee arthritis as a result of tibial side extra-articular deformity, it can be managed with bone resections and soft tissue balancing followed by total knee replacement. -
We report a rare case of polyautoimmunity in a 40-year-old male presenting with massive pericardial effusion, severe primary hypothyroidism, primary Sjögren’s syndrome (SS), and leukocytoclastic vasculitis. While hypothyroidism and SS are predominantly female disorders, their confluence in a male patient presents unique
diagnostic challenges. The patient exhibited progressive dyspnoea, generalized weakness, xerosis, and purpuric rashes. Diagnostic workup revealed massive pericardial effusion requiring pericardiocentesis, TSH >100 mIU/L, and positive antiSSA/Ro and anti-SSB/La antibodies. He was treated with levothyroxine, corticosteroids, and supportive care, resulting in the resolution of the effusion, vasculitic lesions, and renal impairment. This case highlights the importance of screening for multiple autoimmune pathologies in patients presenting with complex, multisystemic illness to ensure timely and appropriate multidisciplinary management. -
A Morel-Lavallée lesion (MLL) is a closed internal degloving injury where the skin and subcutaneous tissue separate from the underlying fascia, creating a fluid-filled space. Typically linked to high-energy trauma, such as pelvic or thigh injuries, it can also occur in unusual contexts and have delayed presentations. This case describes a 60-year-old lady who developed a painless swelling at her right thigh split-thickness skin graft donor site six months after surgery for a humerus fracture and forearm degloving injury. Imaging confirmed an MLL, but conservative drainage failed. Surgical excision and histopathology confirmed the diagnosis. This case emphasises the diagnostic challenge of MLLs without overt trauma, especially in post-operative settings. Management options include imaging for diagnosis, percutaneous drainage, quilting sutures, and surgical excision for chronic lesions. Early recognition is critical to prevent complications and morbidity, underscoring that MLL should be considered in recurrent post-operative soft tissue swellings even without a history of trauma.
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The extravasation of anthracyclines during chemotherapy can harm the surrounding soft tissue, necessitating prompt management. In this report, we discuss a four-yearold boy who was treated with daunorubicin (an anthracycline) for acute lymphoblastic leukemia (ALL), during which extravasation occurred, and we addressed this issue using dexrazoxane. A four-year-old boy undergoing chemotherapy for ALL received daunorubicin, which extravasated. This led to cutaneous inflammation, prompting the discontinuation of the drug. Dexrazoxane was administered for three days, along with dimethyl sulfoxide spray. Severe cutaneous irritation and burning sensations occurred immediately after the application of the spray and continued until the
site was washed. Subsequently, the patient developed a catheter-related infection, exhibiting severe dyspnea, hypotension, and pulmonary edema. He was admitted to the pediatric intensive care unit for appropriate treatment. Dexrazoxane is a valuable option for managing anthracycline extravasation; however, our case revealed a severe reaction to the initial dose of dimethyl sulfoxide spray, suggesting that dexrazoxane
may be the safer choice for handling such extravasation cases. -
Intrahepatic cholangiocarcinoma (ICC) is an uncommon and aggressive hepatobiliary malignancy characterized by high recurrence rates and poor long-term survival. Although ICC frequently metastasizes to the liver, lungs, peritoneum, and lymph nodes, metastasis to the small intestine is extremely rare. The diagnostic challenge is further increased by its often-asymptomatic course and the low specificity of radiological imaging modalities. We present a rare case of terminal ileum metastasis from ICC manifesting as focal subileus, diagnosed during postoperative surveillance. A 44-year-old male underwent left hepatic lobectomy, hepaticojejunostomy, and cholecystectomy for well-differentiated ICC (pT2N1) in July 2023. Despite adjuvant capecitabine therapy, follow-up computed tomography revealed segmental pathological wall thickening of the terminal ileum with luminal narrowing, proximal dilatation, and associated mesenteric lymphadenopathy. Colonoscopic biopsy was not feasible due to the lesion’s location. Further evaluation suggested malignancy, raising suspicion of metastatic ICC versus primary small bowel adenocarcinoma. The
patient underwent right hemicolectomy with partial small bowel resection. Pathology demonstrated poorly differentiated adenocarcinoma (pT2) with lymphovascular and perineural invasion, and isolated tumor cells in one lymph node. Loss of MLH1 and PMS2 expression indicated MSI-H status. The findings were consistent with
metastatic ICC. Postoperative recovery was complicated by intra-abdominal ascites requiring catheter drainage. The patient was referred to medical oncology for further management. Metastasis of ICC to the terminal ileum is exceptionally rare but should be considered in patients presenting with unexplained small bowel obstruction or mural thickening during postoperative follow-up. Complete surgical resection can be effective when the patient’s performance status allows. Multidisciplinary evaluation is essential for accurate diagnosis, differentiation from primary small bowel tumors, and appropriate oncological treatment planning. -
Germinal matrix hemorrhage/intraventricular hemorrhage (GMH-IVH) is a significant neurological complication of prematurity, particularly in infants born before 32 weeks of gestation. Severe GMH-IVH may lead to long-term sequelae including post-hemorrhagic ventricular dilatation, white matter injury, cystic degeneration, and neurodevelopmental impairment. Delayed large cystic transformation with progressive hydrocephalus remains an uncommon and underrecognized complication. We report the case of a 10-month-old premature female infant born at 32 weeks of gestation with a birth weight of approximately 1700 g from a twin pregnancy. Neonatal cranial ultrasonography demonstrated right-sided Grade III germinal matrix/intraventricular hemorrhage. After an initial period of relatively acceptable growth and neurodevelopment, the patient progressively developed macrocephaly, developmental delay, poor feeding,
and lethargy between 6 and 10 months of age. Brain magnetic resonance imaging (MRI) revealed a large right parieto-occipital intra-axial cystic cavitary lesion with cerebrospinal fluid signal intensity, peripheral hemosiderin staining on susceptibility-weighted imaging, marked thinning of the adjacent cortical mantle, ipsilateral white matter loss, and severe supratentorial hydrocephalus. Imaging findings were most consistent with delayed posthemorrhagic cystic transformation, likely representing porencephalic evolution secondary
to prior periventricular hemorrhagic injury. The patient subsequently underwent ventriculoperitoneal shunt placement with early postoperative reduction in ventricular size. However, during follow-up, the patient developed a severe systemic infection complicated by septic shock. No definite evidence of shunt malfunction, recurrent intracranial hemorrhage, or progression of the intracranial lesion was identified. Despite intensive
medical management, the patient died approximately two months after surgery. This case highlights a rare delayed complication of severe neonatal GMH-IVH with progressive cystic cavitary transformation and hydrocephalus presenting months after the initial hemorrhagic insult. The report emphasizes the importance of long-term neuroimaging surveillance and careful neurodevelopmental follow-up in premature infants
with severe GMH-IVH, particularly those at risk for periventricular hemorrhagic injury and post-hemorrhagic ventricular dilatation. -
Functional urinary retention is an uncommon but important cause of lower urinary tract symptoms in children and adolescents. We report three pediatric patients with retention despite negative evaluations for obstruction, infection, or neurological disease. In each case, psychosocial stressors (developmental anxiety, family
reinforcement, school distress) contributed. Multidisciplinary management improved symptoms in two patients; outcome was uncertain in one. These cases highlight the need to consider functional urinary retention when organic causes are excluded and to involve mental health professionals early. -
Epithelioid sarcoma (ES) is a rare malignant soft tissue tumor, with the proximal-type variant (PES) representing an uncommon and aggressive subtype. Vulvar sarcoma predominantly affects young women, with a mean age of approximately 38 years. We report a case of a 22-year-old G1L1 Asian woman presenting with a painless, solid mass in the right labia majora, without tenderness or surface ulceration. Surgical
management consisted of a right hemi-vulvectomy with a 2 cm margin from the tumor. Histopathological evaluation confirmed the diagnosis of epithelioid sarcoma of the vulva, and the surgical margins were free of tumor involvement. Postoperatively, the patient was followed every three months for the first two years and
annually thereafter. Over a ten-year follow-up period, no evidence of local recurrence or metastasis was observed, and the patient experienced two successful pregnancies during this time. This case highlights the importance of considering vulvar sarcomas in the differential diagnosis of nonspecific vulvar lesions to ensure early recognition, accurate diagnosis, and appropriate management.
