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 ical Sciences, Tehran, Iran. Faeze Salahshour Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Centre (ADIR), IKHC, Tehran University of Medical Sciences, Tehran, Iran. Mahdi Zangi PhD Candidate, University of Otago, Christchurch, New Zealand. Somayeh Mirbagheri Emergency medicine resident, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Eftekhari Assistant Professor, Emergency Medicine Department, Tehran University of Medical Sciences, Keshavarz Blvd., Tehran, Iran 2023 10 04 2024 02 26 The abdomen is the second most common site for sepsis. This potentially life- threatening condition necessitates finding the source and providing prompt medical and/or surgical treatment. This presentation reveals an uncommon cause of intra- abdominal sepsis.A 43-year-old woman presented to the emergency department with abdominal pain, tachycardia, tachypnea, and generalized abdominal tenderness. The evaluation of the laboratory tests showed an elevation in white blood cell count and liver enzymes. Ultrasonography of the liver revealed the presence of hydatid cysts, and the abdomino- pelvic computed tomography scan with contrast displayed multiple pyogenic cysts in her liver, one of which had ruptured into the peritoneum. She underwent surgery, received antimicrobial agents, and was successfully discharged without experiencing any complications.One clinical presentation of a hepatic hydatid cyst could be intra-abdominal sepsis, which requires emergency surgery along with antibiotic and anti-helminthic drugs. https://crcp.tums.ac.ir/index.php/crcp/article/view/877 https://crcp.tums.ac.ir/index.php/crcp/article/download/877/594

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 6 2024 09 29 270 274 EN Matineh Sadat Tabatabaei School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Mostafa Mortazi Faculty of Medicine, Alborz University of Medical Sciences, Alborz, Iran 2023 12 03 2024 05 05 Granulomatosis with polyangiitis, previously known as Wegener’s, is a necrotizing vascular disease that affects small blood vessels and may cause damage to the respiratory tract and kidneys. In this article, we report on a 50-year-old male with a complicated disease process who experienced rare bladder and renal complications and several adverse drug reactions. Despite using drug alternatives, the side effects remained mostly the same. Therefore, by studying different cases and articles, we establish the relation between these findings and the specifications of granulomatosis with polyangiitis. This case underscores the complexity of managing this condition and the need for personalized treatment strategies. https://crcp.tums.ac.ir/index.php/crcp/article/view/901 https://crcp.tums.ac.ir/index.php/crcp/article/download/901/595

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 6 2024 09 29 275 280 EN Azadeh Tarafdari Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran Sanaz Ghashghaee Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran Zeinab Mansouri Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohammadamin Parsaei Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran 2024 01 15 2024 05 05 Gestational choriocarcinoma, a rare variant of gestational trophoblastic disease, typically arises from abnormal trophoblastic cell proliferation post-pregnancy, often associated with a hydatidiform mole. While most choriocarcinoma cases develop within the uterine cavity, an exceedingly rare manifestation occurs within a previous cesarean section scar. In our study, a 31-year-old woman with a history of hydatidiform mole presented with amenorrhea and spotting. Initial assessments revealed elevated beta-human chorionic gonadotropin (βhCG) levels and a heteroechoic mass at her prior cesarean section scar in sonographic examination. Histopathologic findings and the metastatic workup categorized the patient as FIGO stage I, indicating no metastasis. Due to the absence of metastasis, adjuvant chemotherapy was omitted. Total abdominal hysterectomy confirmed choriocarcinoma. Post-surgery, βhCG levels notably decreased, remaining negative during the two-year follow-up with no reported symptoms. Our findings suggest that surgical resection and meticulous βhCG monitoring may be a promising treatment strategy for non-metastatic choriocarcinoma. https://crcp.tums.ac.ir/index.php/crcp/article/view/918 https://crcp.tums.ac.ir/index.php/crcp/article/download/918/596

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 6 2024 09 29 281 283 Mohammad Hossein Azizi Associate Professor of Otolaryngology, Academy of Medical Sciences of the I.R. of Iran, Tehran, Iran Frough Aghanejad Audiologist, Tehran, Iran