Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 1 4 Maryam Jalili Sadrabad Oral and Maxillofacial Medicine Department, Dental School, Semnan University of Medical Science, Semnan, Iran. Elham Saberian PhD and research student, Pavol Jozef Šafárik University, Klinika Bacikova, Košice, Slovakia. 2022 05 08 2022 12 07 Medication-related osteonecrosis of the jaw (MRONJ) is a side effect of anti-bone resorption medications. Nowadays antiresorptive medications like bisphosphonate and monoclonal antibodies like denosumab that have been prescribed for bone disorders and metastatic cancer are becoming increasingly common. Although these medications are quite efficient at reducing bone resorption, they can develop osteomyelitis and jaw necrosis as a side effect. A 65-year-old woman was referred to the Oral Medicine Department of Semnan University of Medical Sciences with diffuse bilateral mandibular osteonecrosis, with a history of osteopetrosis and under-treatment of bisphosphonate. This complication started after tooth extraction and without any healing 5 years ago. After 3 sessions of plasma therapy, obvious improvement was seen. A proper medical history and a routine oral examination before treating with any invasive dental treatment are necessary to avoid any medication-related osteonecrosis of the jaw or mucosal abnormalities. https://crcp.tums.ac.ir/index.php/crcp/article/view/687

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 5 8 Shadi Zamansaraei Department of Gynecology Surgery, Isfahan University of medical Sciences, Isfahan, Iran. Milad Nazari Sabet Resident of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Parvin Bahrami Department of Cardiology, Alzahra University Hospital, Isfahan University of Medical Science, Isfahan, Iran. 2022 07 06 2023 02 12 Pulmonary Artery Aneurysm (PAA), defined as greater than 40 mm dilation of the main pulmonary artery wall, in female and above 43 mm in males is a rare and fatal defect. Since there is a high risk for rupture, especially in cases of symptomatic or severe dilatation, surgical intervention is suggested. There is no recommendation about therapeutic methods based on the diameter of the pulmonary aneurysm in pregnancy in the guidelines. In this rare and unique report, we described a 26-year-old pregnant woman with previous history of biologic pulmonary valve replacement referred to the joint clinic of heart disease and pregnancy at 15 weeks of pregnancy because transthoracic echocardiography showed an aneurysm of the main pulmonary artery (55mm). Due to pulmonary artery diameter and risk of dissection, we informed her about the risks and recommended therapeutic abortion, but she refused and, fortunately no complication occurred during close observation in pregnancy and few months later. There is no specific recommendation about therapeutic methods based on the diameter of the pulmonary aneurysm in pregnancy in the guidelines, but referring to the aortic aneurysm guidelines recommendation, pregnancy termination when PA diameter > 5.5 cm because of the higher risk of dissection. Other factors should be considered to determine the risk of dissection in pregnancy include; categorized PA aneurysms to high or low intravascular PA pressure, PA diameter growth rate, and causative mechanisms. Thus, if pregnancy occurs, decisions about each patient will vary depending on risk factors https://crcp.tums.ac.ir/index.php/crcp/article/view/709

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 9 13 Ali Mirabi Resident of Cardiology, Clinical Research and Development center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. Reihane Tabaraii Clinical Research and Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. Morteza Sedaqat Medical Student, Student Research Committee, Qom University of Medical Sciences, Qom, Iran. Saba Gaeini Medical Student, Student Research Committee, Qom University of Medical Sciences, Qom, Iran. Maryam Masoumi Clinical Research and Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. 2022 04 19 2023 04 26 Dressler syndrome is a type of secondary pericarditis that can be accompanied by pleural effusion or pericardial effusion resulting from injury of the pericardium or heart tissue. A 33-year-old male was admitted to the emergency department with pleuritic chest pain radiating to both shoulders and fever. Two months before the admission, the patient underwent traditional open-heart surgery with median sternotomy and pericardiectomy for atrial septal defect (ASD) closure. Blood tests showed elevated acute phase reactants (leukocytosis, high erythrocyte sedimentation rate, and C-reactive protein). Left-sided pleural effusion was revealed on chest CT scan. Diagnosis of Dressler syndrome was established. The patient’s pleuritic chest pain and shoulder pain improved clinically with a short course of colchicine. Although Dressler syndrome is rarely seen, it should be considered in the differential diagnosis of pleuritic chest pain. Special attention should be paid to Dressler’s syndrome because pericarditis can develop following cardiac surgery https://crcp.tums.ac.ir/index.php/crcp/article/view/677

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 14 15 Manzoor Hussain Senior Resident, Department of Radiology, SKIMS SOURA, J&K, INDIA. Nargis Banoo Senior Resident, Department of Paediatrics, GMC srinagar, J&K, INDIA. 2022 06 16 2023 02 12 Intestinal Ascariasis is a common helminthic infection in developing countries and in some rare cases, worms migrate to the biliary tract and gall bladder. Extraintestinal biliary ascariasis presents with jaundice, right upper quadrant abdominal pain, and vomiting. Ultrasonography is a useful diagnostic modality. Albendazole and Mebendazole are commonly used anti-helmintic agents for conservative management, whereas endoscopic removal is needed in rare cases. https://crcp.tums.ac.ir/index.php/crcp/article/view/702

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 22 16 20 Meraj Tavakoli Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Soghra Rabizadeh Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sara Seifouri Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran Alireza Esteghamati Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Manouchehr Nakhjavani Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2022 05 19 2022 12 07 To this day, millions of people in the world have been diagnosed with corona virus 2019 (COVID-19). This disease cannot only lead to higher mortality rates among those with underlying Diabetes Mellitus (DM), but also may trigger DM in susceptible patients. Therefore, incidence of new-onset DM increased during the pandemic as a result; treatment of patients with diabetes and COVID-19 is important and needs further investigations. Here, we report a 27-year- old woman with past medical history of premature ovarian failure (POF) since14 years ago, who initially presented with severe diabetic ketoacidosis (DKA) which was triggered by COVID-19 and later through her lab results hypoparathyroidism was also detected. She was treated for DKA and COVID-19 Infection concomitantly, and she was also diagnosed with autoimmune polyglandular syndrome due to her multiple autoimmune endocrine organ involvements.  https://crcp.tums.ac.ir/index.php/crcp/article/view/688

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 21 23 Narjes Zarei Jalalabadi Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. Nasim Khajavirad Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. Samaneh Parsa Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. Sahar Karimpour Reyhan Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. 2021 10 31 2023 02 12 Nowadays People use herbal medicines to try to maintain or improve their health but sometimes they cause side-effects and some herbal drug may also interact with medication. We reported a 37 -year-old man who presented to the emergency department with sever watery diarrhea, vomiting, dysphagia, bicytopenia, renal failure and Acute esophageal necrosis, also known as black esophagus which is a rare syndrome characterized by a striking diffuse circumferential black appearance of the esophageal mucosa that universally affects the distal esophagus, 2-days after use of herbal drug named suranjan. Suranjan is a herbal formulation used to treat Rheumatoid arthritis. https://crcp.tums.ac.ir/index.php/crcp/article/view/615

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 24 28 Zahra Masoumi Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran. Seyed Mojtaba Alavi Student Research Committee, Qom University of Medical Sciences, Qom, Iran. Morteza Sedaqat Student Research Committee, Qom University of Medical Sciences, Qom, Iran. Mohammad Shahidi Department of Emergency Medicine, Qom University of Medical Sciences, Qom, Iran. 2022 10 09 2023 02 22 Acute aortic dissection (AAD) is one of the most challenging and emergency conditions in the health care system. It`s associated with high mortality. A 55-year-old person was admitted to the emergency department due to numbness of his right leg. The patient had no complaints of chest pain on arrival. However, echocardiography revealed aortic dissection and computed tomography (CT) scan confirmed the diagnosis. The patient was immediately referred to Rajaei hospital for further specialized procedures. He went into the operating room directly and had a successful operation of aortic dissection repair. Rarely AAD has atypical manifestation and may have unusual clinical presentations. Thus, it could cause a delay in establishment of diagnosis of this emergent condition. The purpose of this report was to introduce a rare initial presentation of an atypical aortic dissection. https://crcp.tums.ac.ir/index.php/crcp/article/view/742

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 29 33 Zahra Yazdi Department of Obstetrics and Gynecology, School of Medicine, Nekouei-Hedayati-Forghani Hospital, Qom University of Medical Sciences, Qom, Iran. Seyed Mohammad Hashem Montazeri Student Research Committee, School of Medicine, Qom University of Medical Sciences, Qom, Iran 2022 04 15 2022 12 07 We report a 33 years multipara pregnant woman who presented with vaginal bleeding due to intramural myoma and preeclampsia. After cesarean section, the myoma changed to the peduncle type and entered the internal space from the inner thickness of the uterus. This infrequent phenomenon made it easier to operate and remove the myoma within a few hours after the cesarean section. Finally, the mother and baby were discharged from the hospital safely after a few days. https://crcp.tums.ac.ir/index.php/crcp/article/view/674

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 22 34 38 Fariba Rashidighader Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Mohammadrafie Khorgami Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Elio Caruso Department of Pediatric Cardiology,Mediterranean Pediatric Cardiology Center "Bambin Gesù", San Vincenzo Hospital, Taormina, Italy. Farruggio Silvia Department of Pediatric Cardiology,Mediterranean Pediatric Cardiology Center "Bambin Gesù", San Vincenzo Hospital, Taormina, Italy. Reza Masihi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2022 10 27 2023 05 08 Ectopic cordis is a rare anomaly with incidence of 5.5 to 7.9 per one million. In this anomaly, fetal heart is displayed towards outside of the thoracic cavity partially or completely. We describe a case of antenatal diagnosis of Thoracic Ectopia Cordis (EC) with CongenitalHeartDisease (CHD) without any other extracardiac malformations. The mother was referred to our center at 18 weeks of gestation due to abnormal sonography. Fetal Echocardiographic examination showed isolated thoracic ectopia cordis with Double Outlet Right Ventricle (DORV), large inlet to outlet Ventricular Septal Defect (VSD), malposition of Aorta, Pulmonary Atresia with retrograde flow, narrow Pulmonary Artery (PA) and PA branches. Amniocentesis and sonography revealed no other anomaly or chromosomal derangement. Because the diagnosis of Ectopia cordis may be difficult in the fetal period due to multiple factors, meticulous attention should be paid for true diagnosis. https://crcp.tums.ac.ir/index.php/crcp/article/view/750

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 22 39 41 Reena Patel Department Ear Nose Throat, Senior Consultant ENT. Aradhita Maheshwari Medical Executive Assistant, Medical Administration Department, Bhaktivedanta Hospital and Research Institute, Mira Road, Thane, Maharashtra Vijaykumar Gawali Head-Clinical Research & Education, Medical Research Department, Bhaktivedanta Hospital and Research Institute, Mira Road, Thane, Maharashtra. 2022 11 08 2023 02 12 Kimura disease is a rare chronic inflammatory disorder of unknown etiology. The disease is primarily seen in young Asian males and is characterized by painless subcutaneous swelling. It is often accompanied by renal involvement, predominantly manifesting as nephrotic syndrome. We describe a case of Kimura disease in a 69-year-old Indian male, presenting with left postauricular swelling. Clinical and histopathological characteristics are described along with a brief review of the literature. https://crcp.tums.ac.ir/index.php/crcp/article/view/753

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 22 42 45 Mohammad Taher Rajabi Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Abbas Mohammadi Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sajad Besharati School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2022 11 10 2023 04 10 Congenital orbital wall defects are very rare bone abnormalities that can cause protrusion of intracranial contents into the orbit. The protrusion of the meninges, which encompasses cerebrospinal fluid (CSF), result in a condition known as the orbital meningocele, a rare cause of pulsatile proptosis. Here, we present a 4-year-old female with left eye proptosis referred to our clinic. On magnetic resonance imaging (MRI), a cystic structure was present. The patient underwent surgery for cyst removal. CSF leakage was noted during surgery. Computed tomography (CT) scan revealed a bony defect in the sphenoid greater wing and the resulting meningocele. Craniotomy surgery was performed to close and fill the defect. https://crcp.tums.ac.ir/index.php/crcp/article/view/755

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 22 46 49 Seyed Mohsen Rafizadeh Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Aminizade Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fahime Asadi Amoli Farabi eye hospitalEye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahtab Rabbani Anari Department of Otorhinolaryngology - Head & Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahmoud khodabandeh Department of Infectious Diseases, Pediatric’s Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. abbas mohammadi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2022 11 10 2023 04 26 Rhino-orbital mucormycosis in an immunocompetent pediatric patient can present as an orbital mass. We report a 9-year-old male that presented with periorbital swelling and limitation of left eye movement from one month ago. The patient was treated at another center with a diagnosis of mucormycosis but was referred due to worsening symptoms. Orbital and paranasal sinus CT scan revealed opacities in the left paranasal sinus and soft tissue density in the medial and inferior orbital wall. The patient underwent orbitotomy and mass debulking surgery on suspicion of a possible neoplastic mass. Pathologic evaluations revealed mucormycosis. After receiving intravenous liposomal amphotericin-B that was followed by oral posaconazole syrup for two months and sinus debridement, the symptoms regressed. In immunocompromised pediatric patients, mucormycosis should be considered in the differential diagnosis of an orbital mass. https://crcp.tums.ac.ir/index.php/crcp/article/view/754