Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 82 85 Jafar Malmir Department of Emergency, Shohada-ye-Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. amin talebi Department of Nursing, Emergency Medicine and Operatng Room, Aligudarz School of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran. Mahdi Bodagh Department of Nursing, Emergency Medicine and Operatng Room, Aligudarz School of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran. Fatemeh Malasadi Department of Emergency, Shohada-ye-Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. 2020 06 17 2020 11 25 Traumatic Diaphragmatic Rupture (TDR) is a rare type of trauma. Small intestine injuries are the third most common type of injury resulting from blunt trauma to abdominal organs. The immediate diagnosis of TDR and bowel injuries is a daunting task. We reported a 53-year-old male patient who was transferred to the hospital by EMS because of a car accident. The chest X-ray showed the left diaphragm elevation. Also, a computed tomography scan revealed that the greater omentum, a portion of the colon, spleen, and stomach were transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy and the incidental findings in laparotomy showed bowel injuries. This case was a common cause of traumatic left-sided diaphragmatic rupture and intestinal injury. The suspicion of diaphragmatic rupture and intestinal injury in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only treatment for diaphragmatic rupture. The severe injury in a part of the intestine may result in the resection of that part. https://crcp.tums.ac.ir/index.php/crcp/article/view/367 https://crcp.tums.ac.ir/index.php/crcp/article/download/367/406

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 86 89 Mohammad Reza Khalilian Department of Pediatric Cardiology, School of Medicine, Modarres Hospital, Shahid Behesht University of Medical Sciences, Tehran, Iran. Seyyed Abdolhossein Tavallai Zavareh Department of Pediatric Cardiology, School of Medicine, Modarres Hospital, Shahid Behesht University of Medical Sciences, Tehran, Iran. Ali Reza Norouzi Pediatric Respiratory Diseases Research Center, Natonal Research Insttute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Behesht University of Medical Sciences, Tehran, Iran. Mohammad Ghazavi Department of Pediatric Cardiology, School of Medicine, Modarres Hospital, Shahid Behesht University of Medical Sciences, Tehran, Iran. Ali Ahmad Goudarzi Department of Pediatric Cardiology, School of Medicine, Modarres Hospital, Shahid Behesht University of Medical Sciences, Tehran, Iran. 2020 07 01 2020 08 10 A 9-year-old girl with signs and symptoms of acute toxic myocarditis and cardiogenic shock with elevated cardiac enzymes was admitted to the Critical Care Unit (CCU) of our hospital with an ejection fraction of 25%. The patient was managed with supportive care and the administration of polyvalent antivenom and inotropes, and after 8 days, she was discharged without any complication with normal ejection fraction. Toxic myocarditis can be a result of scorpion envenomation. After two months of follow-up, the patient recovered completely and medications were discontinued. https://crcp.tums.ac.ir/index.php/crcp/article/view/371 https://crcp.tums.ac.ir/index.php/crcp/article/download/371/407

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 90 93 Kamran Balighi Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Daneshpazhooh Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Mahmoudi Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Safoura Shakoei Department of Dermatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Zeinab Aryanian Autoimmune Bullous Disease Research Centre, Tehran University of Medical Sciences, Tehran, Iran. Soheil Tavakolpour Dana-Farber Cancer Insttute, Harvard Medical School, Boston, MA, United States. Arghavan Azizpour Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2020 07 14 2020 08 04 Acquired Hemophilia (AHA) is a relatively rare disease that occurs in patients with no previous family history of hemophilia. The spontaneous development of autoantibodies (IgG1 and IgG4) against factor VIII has been reported as the most probable cause of AHA. AHA has been reported in association with other conditions, including some autoimmune bullous skin diseases, such as bullous pemphigoid, pemphigus vulgaris, and pemphigus foliaceous. To the best of our knowledge, only 21 cases of AHA with skin autoimmune bullous diseases have been reported so far. Herein, we report a 63-year-old male with a previous history of pemphigus vulgaris who developed large ecchymotic areas on his lower abdomen and forearms after the second infusion of rituximab. Based on coagulation factors evaluation, he was diagnosed with AHA. Treatment with factor VII led to the improvement in his coagulation status, but unfortunately, he passed away because of inferior wall myocardial infarction four days later. https://crcp.tums.ac.ir/index.php/crcp/article/view/379 https://crcp.tums.ac.ir/index.php/crcp/article/download/379/408

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 94 98 EN Niayesh Mohebbi Department of Clinical Pharmacy, Schoolof Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Taghvaye-Masoumi Department of Clinical Pharmacy, Faculty of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran. Malihe Khosravi-Khezri Department of Clinical Pharmacy, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran. Mona Talaschian Department of Internal Medicine, Shariat Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2020 07 14 2020 08 04 Sulfasalazine, a non-antibiotic sulfonamide, is associated with severe hypersensitivity reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We report a case of sulfasalazine-induced DRESS syndrome that relapsed following the administration of visipaque® (iodixanol). Macular rashes, pruritus, and an acute exacerbation of dyspnea were immediately observed after the administration of contrast media. It seems that patients suffering from DRESS syndrome are sensitive to the administration of other new medications with a high possibility of hypersensitive reactions. It can be concluded that iodinated contrast media should be used cautiously in patients with DRESS syndrome. https://crcp.tums.ac.ir/index.php/crcp/article/view/380 https://crcp.tums.ac.ir/index.php/crcp/article/download/380/409

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 99 104 EN Hedieh Moradi Tabriz Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. elham nazar Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arezoo Efekhar Javadi Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Niousha Bakhshi Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2020 07 17 2020 08 04 Schwannoma is one of the most common benign intracranial tumors, which originates from the Schwann cells of neural structures in the upper part of the vestibular branch of the eighth cranial nerve. This report describes a 64-year-old woman with headache and vertigo who had a past surgical history of acoustic schwannoma about 10 years ago. The patient underwent excisional surgery. Histological examinations revealed schwannoma with extensive xanthomatous changes. Immunohistochemistry staining confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 6 months of close follow-up examinations, no recurrence and complication were observed. Schwannoma could be seen with a vast variety of histologic changes. Recurrence of Schownnoma is uncommon in patients without neurofibromatosis, but it should be considered in a proper clinical context. https://crcp.tums.ac.ir/index.php/crcp/article/view/382 https://crcp.tums.ac.ir/index.php/crcp/article/download/382/410

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 105 107 EN Ladan kashani Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Afsaneh Tehranian Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.AND Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shima Mohiti Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ladan Hosseini Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2020 07 29 2020 08 04 Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous women with total uterine inversion after a normal vaginal delivery. A 28 years old, gravid3 pregnant women was admitted to the hospital in the first stage of labor. She had a Past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery of the fetal  due to the history of placental adhesion, umbilical cord traction was avoided and after 20 minutes, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist. and subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta inccreta and The placenta was found completely adherent at the fundus. Conclusion Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in third stage of labor to manage the possibility of inversion. https://crcp.tums.ac.ir/index.php/crcp/article/view/390 https://crcp.tums.ac.ir/index.php/crcp/article/download/390/411

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 108 111 Acieh Es'haghi Eye Research Center, The Five Senses Insttute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Hossein Aghaei Eye Research Center, The Five Senses Insttute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.AND. Department of Ophthalmology, Imam Hossein Medical Center, Shahid Behesht University of Medical Sciences, Tehran, Iran. Shirin Rafatnia Student Research Commitee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Sanam Alilou Student Research Commitee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2020 07 30 2020 08 04 We report a rare case of bilateral corneal ghost vessels in a 6–year-old child with an unremarkable past ocular and past medical history. This study was a single observational case report. A 6-year-old girl was referred to our clinic for further evaluation, due to suboptimal visual acuity in both eyes. Her past medical and ocular history revealed no systemic, inflammatory, infectious, or degenerative disorders. Slit-lamp examination revealed regressed blood vessels (“ghost vessels”) in the anterior and mid-corneal stroma as the only pathologic finding. Confocal scanning microscopy of both corneas demonstrated scattered branching railroad-shaped ghost vessels at the level of the middle and anterior stroma. Complete systemic workup was performed for the patient. No identifiable risk factor for the development of corneal vascularization was found. According to our findings, we assume that in our patient, vasculogenesis occurred due to angioblast invasion to the presumptive cornea due to disequilibrium in mechanisms involved in vascular patterning during embryonic development. https://crcp.tums.ac.ir/index.php/crcp/article/view/393 https://crcp.tums.ac.ir/index.php/crcp/article/download/393/412

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 3 2021 10 06 112 115 EN razieh sangsari Divisionof Pediatrics, Departmentof Neonatology, Children’s Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. lth, State Ministry of Health, Ilorin, Kwara State, Nigeria. Oluwatosin Fakayode Department of Public Health, State Ministry of Health, Ilorin, Kwara State, Nigeria. Aanuoluwapo Afolabi Department of Community Health, Federal Medical Centre, Owo, Ondo State Olayinka Ilesanmi Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. 2021 03 16 2021 04 10 The spread of Lassa Fever (LF) cases across international borders call for cross-board management and collaboration. This case report describes a laboratory-confirmed index case of LF in Kwara state, Nigeria. The case of LF in Kwara state was a 30-year-old woman who presented with a history of fever, headache, and abdominal pain and had been treated for malaria. On 13th February 2020, the Kwara State Ministry of Health was notified of a suspected case of LF. The case visited health facilities in Kwara state, Nigeria, and the Republic of Benin during her illness. Blood samples were obtained from her, and she was confirmed a positive LF case in the Republic of Benin. Although LF diagnosis is challenging, multisectoral collaboration and effective community engagement within the framework of the International Health Regulations is required to control the LF outbreak promptly. https://crcp.tums.ac.ir/index.php/crcp/article/view/500

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 1 2022 06 15 37 40 Carla Coppola Department of Intensive Rehabilitation, Faculty of Medicine and Surgery, Casa di Cura Alma Mater, Villa Camaldoli, Naples, Italy. Valerio Massimo Magro Department of Internal Medicine and Geriatry, Faculty of Medicine and Surgery, University of Campania “Luigi Vanvitelli'', Naples, Italy. 2021 03 20 2021 04 10 Cervical dystonia is a common malaise in the doctor's office. It is a movement disorder characterized by sustained involuntary muscle contractions and abnormal postures: the patient ehibits involuntary left head and neck turning. It can recognize various more or less severe conditions as etiologicals agents and still remains a difficult disorder to treat. We reviewed a clinical case, analyzing both the moments of differential diagnostics and the therapeutic choices, with particular interest in cerebral electrostimulation.  https://crcp.tums.ac.ir/index.php/crcp/article/view/501

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 1 2022 06 15 41 44 Azadehh Hajati Taba Medical Imaging Center Zand BLVD, Moadel st; Taba building Shiraz, Fars, Iran. 2021 03 20 2021 04 10 This case describes a female with long-term primary infertility, labelled with polycystic ovarian syndrome, who showed no response to the given treatments. Hysterosalpingography, performed as part of the in vitro Fertilisation (IVF) preparation, showed Asherman syndrome and calcified lymph nodes. Subsequently, further evaluations confirmed tuberculosis. The case highlights the necessity and importance of the proper assessment of the patients presenting with infertility for early detection of genital TB to prevent end-stage disease. https://crcp.tums.ac.ir/index.php/crcp/article/view/502

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 1 2022 06 15 45 49 Leila Aghaghazvini Department of Radiology, Shariati Hospital, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Milad Sanginabadi Department of Radiology, Shariati Hospital, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Bahman Rasuli Department of Radiology, Schoolof Medicine, Tehran University of Medical Sciences, Tehran, Iran. Salma Sefidbakht Department of Radiology, Shariati Hospital, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Ala Torabi Department of Radiology, Shariati Hospital, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. 2021 05 05 2021 05 30 Introduction: Cystic meningioma is an unusual shape of meningioma, and the imaging manifestations and site of the solid/cystic components of the mass increase our difficulties in making a diagnosis. Case report: We report a case of a 78-year-old right-handed woman who presented with right-sided hemiparesis, urinary incontinency, and Broca aphasia. A large left-sided frontal region cystic extra-axial mass with a suspicious small solid nodule and adjacent bony erosion was detected on non-contrast CT of the brain. Brain Magnetic resonance imaging (MRI) with gadolinium depicted t