Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 167 171 EN Ebrahim Farashi Department of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Seyed Ziaeddin Rasihashemi Department of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Monireh Halimi Department of Pathology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 2021 04 16 2021 10 03 Adrenal ganglioneuromas are rare benign and non-secretory neoplasms that, in the majority of cases, are unexpectedly discovered during imaging studies. In this study, we reported a large adrenal ganglioneuromas in a young patient, clinically presented as a pheochromocytoma. Laboratory evaluation and tumor markers were also report- ed in the normal range. The mass was then resected through laparoscopy. Ultimate- ly, histopathology revealed the diagnosis of Ganglioneuroma. Large adrenal gangli- oneuromas can be resected laparoscopically without any complications. An accurate pathological examination is usually essential for definitive diagnosis. Prognosis of ma- ture adrenal ganglioneuromas is excellent. https://crcp.tums.ac.ir/index.php/crcp/article/view/515

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 174 178 Nesva Hamza Almas Hospital, Kottakkal, Malappuram, Kerala, India. Sethulakshmi Sureshkumar Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India. Abhilash Francis Badr Al Sama Group of Hospitals and Polyclinics, Oman. 2021 07 29 2022 01 16 Cysticercosis is an infection caused by Taenia Solium whose larval stage (cysticerci) can affect various human tissues. In this study, we present the case of a 32-year-old male who presented with a neck swelling of 2 months duration. High resolution ultraso- nography of neck showed features suggestive of cysticercosis of sternocleidomastoid muscle. He was managed conservatively with oral albendazole 400 mg twice daily for 4 weeks. Review of the patient after 4 weeks showed complete resolution of the swelling and a repetitive ultrasonography did not show any evidence of cysticercosis. Although a rare entity and isolated cysticercosis of skeletal muscle should come into consideration among the differential diagnoses of head and neck swellings. https://crcp.tums.ac.ir/index.php/crcp/article/view/578

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 179 182 Narges Radman Department of Psychiatry, Roozbeh Hospital,Tehran University of Medical Sciences, Tehran, Iran. Vajiheh Aghamollaii Department of Psychiatry, Roozbeh Hospital,Tehran University of Medical Sciences, Tehran, Iran. Zahra Mirsepassi Department of Psychiatry, Roozbeh Hospital,Tehran University of Medical Sciences, Tehran, Iran. 2021 08 23 2021 08 25 Myotonic Dystrophy type 1 (DM1) is a progressive life-threatening disorder that affects several systems in the human body. Besides physical involvements, previous studies reported various psychiatric and cognitive presentations in these patients. We presented a 65-year-old patient with adult-onset DM who suffered from multi- system involvement. She has also experienced a series of psychiatric symptoms including depressed mood, insomnia, fatigue, reference delusion, visual and auditory hallucinations besides impaired cognitive functions. With the diagnosis of major depressive disorder with psychotic features, she was treated with Sertraline and Haloperidol. The cognitive impairment was continued after improvement in mood, and donepezil 5 mg was prescribed. Whereas patients with DM1 and with psychiatric manifestations have significantly lower function than those without psychiatric symptoms, clinicians should be aware of the mental status examination and eventual psychiatric disorders in these patients. Our case presentation suggests a multidisciplinary approach to these patients to provide comprehensive health care. https://crcp.tums.ac.ir/index.php/crcp/article/view/589

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 183 186 Mahdi Khalili Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Mahboubeh Sadat Hoseini Schoolof Nursing and Midwifery, Islamic Azad University, Tehran Branch, Tehran, Iran. Fatemeh Bayat Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Mehrdad Jahani Baharan Nuclear Center, Tehran University of Medical Science, Tehran, Iran. 2021 09 12 2022 05 01 The use of dipyridamole for thallium imaging has proved very successful in demonstrating coronary arterial disease [1]. Dipyridamole causes coronary arteriolar vasodilation by increasing interstitial adenosine levels by inhibition of both adenosine deaminase and facilitated cellular adenosine uptake. Differential flow changes occur in coronary arteries if a significant luminal stenosis exists [2]. Intravenous infusion of dipyridamole is safe although transient noncardiac side effects are common. These side effects are mostly mild and not need to treat although can be treated with aminophylline [5]. High-grade AV block after dipyridamole has been described in few case reports and mostly was associated with transient myocardial ischemia [2-4]. We describe a case of long-lasting high grade AV block following dipyridamole infusion. In context of near normal baseline ECG. In our case the AV block occurred without evidence of ischemia in myocardial perfusion imaging and we think it can be an unexpected adverse effect of dipyridamole and clinicians should be aware of AV block as a possible adverse effect of dipyridamole. https://crcp.tums.ac.ir/index.php/crcp/article/view/596

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 187 189 Sahar Delavari Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Sogol Olamazadeh Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Nima Ameli Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Bahareh Pourghaz Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Abbas Tafakhori Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2021 10 23 2022 01 16 Lafora disease is a rare genetic disease caused by the accumulation of malformed glycogen products in the tissues. The disease usually manifests with idiopathic generalized tonic colonic seizures with poor response to antiepileptic drugs (AEDs). We report the case of a 19-year-old girl with the chief complaint of generalized refractory seizures, jerky movement, and cognitive deterioration with a positive history of epilepsy in her younger brother. The disease onset was at the age of 16 with jerky movement and blurred vision. She was admitted to our ward to have a long-term video EEG monitoring for further evaluation. Clinical presentation accompanied with abnormal EEG characteristics for Lafora disease, and the positive familial history were highly suggestive of Lafora disease. The disease was confirmed with genetic testing by which the mutation of EPM2A was detected. https://crcp.tums.ac.ir/index.php/crcp/article/view/609

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 190 194 Ghazaleh Salehabadi Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Ali Shamsedini Department of Cardiology, Rasoul-e-Akram Hospital Complex, Iran University of Medical Sciences, Tehran, Iran 2021 11 18 2022 04 19 Refractory vasospastic angina (RVSA) is a rare condition leading to several episodes of constriction of coronary arteries which eventually leads to myocardial ischemia. Calcium-channel blockers (CCBs) and nitrates are usually used, however, sometimes the vasospasm is refractory and recurrent leading to high morbidity and mortality. A 35-year-old man known case of hypertension underwent two times operation due to T9-T10 discopathy and decompressive laminectomy of three segments T8/T9/ T10 following a previous car accident 4 months before this admission. Three days postoperatively he developed chest pain, dyspnea and diaphoresis. Electrocardiography showed inverted T wave in leads I, II and ST elevation in pericardial leads of V1-V4. Left anterior descending (LAD) artery stenosis was present (99%) at mid part that resolved after Trinitroglycerin (TNG) injection during angiography. Totally, he underwent 3 times coronary angiography due to recurrent chest pain refractory to conventional management of Prinzmetal’s angina. Coronary stent could not be placed due to severe spasm. Finally, he developed refractory chest pain and dyspnea and cardiac arrest in the CCU despite receiving intravenous high dose TNG, Diltiazem, Nicorandil and Hydrocortisone. He expired after several times of cardiopulmonary resuscitation. Refractory VSA after spine surgery has not been reported in the literature yet. This patient was resistant to available medications. There is no consensus regarding the treatment unfortunately. Randomized clinical trials have to be done to find ways regarding unconventional treatment options such as alpha-2-agonists, Corticosteroids, rho-kinase-inhibitors, statins and magnesium. Despite the fact, some surgical interventions with sympathetic denervation like left-stellate-ganglion denervation must be assessed. https://crcp.tums.ac.ir/index.php/crcp/article/view/623

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 195 198 Ehsan Zaboli Department of Hematology and Oncology, Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Shakiba Heydari Schoolof Medicine, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran. Reza Alizadeh-Navaei Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Seyed Mohammad mehdi Ghaffari Hamedani Department of Surgery, Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 2021 12 07 2022 10 17 Mature cystic teratoma of the ovary (MCTO) is the most common ovarian germ cell tumor. Its malignant transformation is a rare complication that occurs in almost 2% of the MCTs. MCTO is benign and usually appears between 30 and 40 years of age, but patients with malignant ovarian MCT are 10–15 years older than those with benign MCT. The most common malignant transformation in MCTO is Squamous Cell Carcinoma (SCC) which is rarely diagnosed with pre-operative imaging.We report the case of a postmenopausal woman, presenting with severe abdominal pain and a large palpable mass in her abdomen. She was diagnosed postoperatively with SCC arising from MCTO which was confirmed histopathologically. The patient received postoperative chemotherapy and was well at 6-month follow-up after chemotherapy.MCTO is benign, but can rarely become malignant in older ages. So MCTO-arising SCC should be considered in elderly women with abdominal pain and mass, and also some other evident features such as large tumor diameter, elevated serum markers, and solid components in Magnetic resonance imaging (MRI). https://crcp.tums.ac.ir/index.php/crcp/article/view/638

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 199 203 Mahsa Akbari Oryani Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Azade Zare Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mohsen Soltani Sabi Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Taghi Mashhadi-Rajabi Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2021 12 23 2022 10 09 Renal cell carcinoma (RCC) accounts for 2-3% of the malignant tumors in adult patients. The most common sites of metastasis are the lung, bone, liver and brain respectively. Unusual metastatic sites require attention during follow-up of renal cell carcinoma. The duodenum and pancreas are uncommon sites for metastasis from renal cell carcinoma. We describe here a 62-year-old man with metastastic renal cell carcinoma to the duodenum and pancreas. The patient presented with melena and bowel obstruction, 10 years after nephrectomy for renal cell carcinoma, then with initial diagnosis of ampula vater adenocarcinoma undergo an exploratory laparotomy and a mass was found in duodenum, vater ampulla and pancreas, then pancreaticoduodenectomy was performed. histopathological examination of mass showed a metastatic renal cell carcinoma with sarcomatoid component. In conclusion, patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Gastrointestinal metastasis from Renal cell carcinoma should be considered in nephrectomized patients with gastrointestinal symptoms. https://crcp.tums.ac.ir/index.php/crcp/article/view/645

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 204 207 EN Ahmad Amin Department of Heart Failure and Transplantation, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Mozhgan Parsaee Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Homa Ghaderian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Zohrian Alborz University of Medical Sciences, Karaj, Alborz, Iran. Arezoo Mohamadifar Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Massih Daneshvari Educational and Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2022 02 04 2022 05 08 Aortopulmonary window is a rare congenital anomaly which is commonly associated with other lesions such as patent ductus arteriosus, interrupted aortic arch, Atrial Septal Defect (ASD), and Ventricular Septal Defect (VSD). Aortic aneurysm and dissection have not been reported as an associated anomaly in AP window.A 44 -year-old male, with inoperable AortoPulmonary Window (AP window) and Eisenmenger syndrome presented to our Emergency Department with back pain and shortness of breath. Transthoracic echocardiography and aortic CT angiography depicted aneurysmal dilatation of ascending aorta with a dissection flap which was extended to main pulmonary artery. Any intervention was very high risk, due to the risk of imminent RV failure. The patient was hemodynamically stable and the symptoms seemed to be chronic, so we decided to manage him medically.AP window is a rare congenital anomaly which is commonly associated with other anomalies. In this report, we represent a rare case of AP window and Eisenmenger syndrome with aortic aneurysm and dissecting flap in ascending aorta and pulmonary artery who was managed medically. https://crcp.tums.ac.ir/index.php/crcp/article/view/654

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 208 210 Alireza Rashidinejad Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Mahdi Khalili Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Shirin Habibi Khorasani Assistant professor of Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, School of medicine, Iran University of Medical Sciences, Tehran, Iran. Zahra Shahidzadeh Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2022 02 17 2022 05 10 Interventricular septal dissection is a rare Complication of the interventricular septum. It may result from an aneurysm of the sinuses of Valsalva, bacterial endocarditis, trauma, cardiac surgery, Myocardial infarction, endomyocardial biopsy, or a congenital myocardial developmental anomaly. Postmyocardial infarction ventricular septal rupture (VSR) is a rare complication (1/1000), and ventricular septal dissection is an even less common complication with only five case reports previously described, But unruptured post Myocardial Infarction (MI) dissection is even rarer with only one reported study before. In this case report we describe an unruptured post-MI Interventricular septal dissection following anterior wall MI. https://crcp.tums.ac.ir/index.php/crcp/article/view/660

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 211 215 Reza Taslimi Department of Internal Medicine, Division of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Taha Bayat Iranian Medical Students’ Association (IMSA-Iran), Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran. Behshad Pazooki Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Ali Nabipoorashrafi Department of Internal Medicine, Iran University of Medical Sciences, Tehran, Iran. 2022 02 26 2022 06 01 Salmonella typhi is the cause of an acute febrile illness with high morbidity and mortality, especially in countries with poor sanitation. Neurological complications of salmonella are severe and usually under-diagnosed. This article reports an extremely rare case of a woman with typhoid fever with a history of travel and consumption of raw fish. She had no sign of meningitis but developed diplopia and sixth nerve palsy, which was ultimately resolved by antibiotic therapy. https://crcp.tums.ac.ir/index.php/crcp/article/view/661

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 4 2023 01 07 172 173 Tahereh Davarpasand Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. ali hosseinsabet Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kyomars abbasi Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. shapoor shirani Department of Radiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2021 04 16 2022 07 30 Herein, we present a case with clinical and laboratory manifestations of infectious endocarditis but in echocardiography, the ventricular septal defect and bicuspid aortic valve were detected without any vegetation. However, an aortic root pseudoaneurysm was first suspected in transesophageal echocardiography and then confirmed in computed tomography angiography of the aorta that points to importance of searching infectious endocarditis complications even in absence of vegetation.  https://crcp.tums.ac.ir/index.php/crcp/article/view/517