Ventriculoperitoneal (VP) shunt placement is the most common procedure used in the treatment of hydrocephalus. However, it has been associated with several complications. Herein, we report penetration of VP shunt into the transverse colon and anal extrusion in a 5-year-old child who was a case of congenital hydrocephalus. The patient underwent laparotomy. The tube was palpated to be in the sigmoid colon. The shunting tube was removed and transverse colon was repaired.

Pertussis incidence is increasing worldwide especially in infants < 2 months old with high mortality rate. Fulminant pertussis is characterized by refractory hypoxemia, cardiogenic shock, pneumonia, and intense leukocytosis that certainly needs intensive care and can lead to 75% mortality rate. Leukoreduction measures especially exchange transfusion (ET) have been used with some successful outcomes. We report ET as a treatment in a case of malignant pertussis with multi-organ failure syndrome. A 57-day-old infant who was admitted in pediatric intensive care unit with severe paroxysmal cough and extreme leukocytosis that despite appropriate treatment and full supportive care progressed to seizure, renal failure, pulmonary hypertension, and shock state, but his condition improved after ET. The patient was discharged from our hospital in good condition. ET even in the presence of multi-organ failure may be lifesaving and should be considered.

Acute myocardial infarction (MI) with a normal coronary angiogram is a well established abnormality, although it is usually related with stenosis in coronary arteries. We reported here a case of a 24-year-old man referring with acute inferior MI after MaxMan capsule consumption. The patient had not any related risk factors of coronary artery disease and a history of prior MI. The acute inferior infarction in this patient was detected in the electrocardiogram in the absence of any stenosis or obstruction in the angiogram. We do not recommend MaxMan intake as a usual drug before intercourse.

Lymphoma is the most common malignancy originating from hematopoietic systems. Diverse biological and clinical manifestations of non-Hodgkin lymphoma have been recognized. As an unusual type of non-Hodgkin lymphoma is Burkitt lymphoma. The variability of the initial presentation is not unusual. We present a 15-year-old boy with generalized abdominal pain, fever. He had massive orange pleural effusion and ascites. There were peritoneal seeding and omentum thickening in abdominal computed tomography scan. Pathological investigations of the peritoneal biopsy revealed B-cell lymphoma (starry sky in pathology). The clinical presentation of sporadic Burkitt lymphoma could mimic some other diseases. Therefore, the clinicians should consider Burkitt lymphoma between the multiple differential diagnoses. In the case of peritoneal involvement, its differential diagnosis could be usually, peritoneal carcinomatosis, malignant peritoneal mesothelioma, and tuberculous peritonitis.

Carbon monoxide (CO) concentration in the body will be decreased after smoking cessation. However, confounding factors may influence the results. Exhaled CO (eCO) assessment of lung is a simple, noninvasive tool, but confounder factors such as gas fireplaces might influence results. We thus quantified the effect of them in two smokers with chronic obstructive pulmonary disease (COPD). We described one of these confounder factors in two smokers with COPD in a clinical trial study setting with IRCT201609271457N11 coding in IRCT. The amounts of eCO and carboxyhemoglobin of these patients rose while the average daily smoking decreased (in the first patient) or stopped smoking (in the second patient). We found that they had used the fireplace to heat their home. These measures decreased in both patients by discontinuing the use of the gas fireplace. The gas fireplaces influence the results of eCO assessments in smoking cessation programs.

A 25-year-old man with 10 years history of a migraine headache noticed ecchymotic lesions involving anterior chest wall, both upper and lower limbs that were unrelated to trauma. His laboratory data revealed prothrombin time (PT) 32 seconds, partial thromboplastin time (PTT) 44 seconds, international normalized ratio 6, and normal bleeding time. Mixing study was performed and normalized PT to 13 seconds and PTT to 38 seconds. Factor activity assay revealed a low level of Factors II, VII, IX, and X but normal level of Factor V. Factitious disorders were in high priority in our differential diagnosis. Thus, we evaluated serum warfarin level which was positive. There were no doubts that we encountered Munchausen case that abused warfarin compounds. We decided to use factor eight inhibitor bypassing activity for rapid correction of coagulation disorder. He suddenly complained of chest pain and dyspnea. We encountered to pulmonary embolism.

Around 50% of patients with Addison disease (AD) have other autoimmune disorders. Neuropsychiatric symptoms may be presenting features of an Addisonian crisis or may be presented in patients with adrenoleukodystrophy (ALD) or Hashimoto encephalopathy; that these disorders are associated with primary adrenal insufficiency (AI). Nearly 5% of individuals with autoimmune AD develop pernicious anemia. X-linked ALD (X-ALD) is an inherited neurodegenerative disorder; a frequent but under-recognized cause of primary adrenocortical insufficiency. The classic picture of Vitamin B12 deficiency is subacute combined degeneration of the dorsal (posterior) and lateral spinal columns. The neuropathy is symmetrical, affects the legs more than the arms. It begins with paresthesia and ataxia and can progress to severe weakness, spasticity, paraplegia, even fecal, and urinary incontinence. We report a case of autoimmune AI who had presented with some neurologic symptoms. The challenging point was differentiating between X-ALD and other neurological syndromes that have an association with AI. We report a case of autoimmune adrenal insufficiency who had presented with some neurologic symptoms. The challenging point was differentiating between X-ALD and other neurological syndromes associating with adrenal insufficiency.

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