Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 02 94 100 Valerio Massimo Magro Echocardiography unit. Department of Internal Medicine and Geriatry, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80100, Naples, Italy Michele Caturano Department of Internal Medicine, AORN San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy Eugenio Boccalone Department of Internal Medicine and Geriatry, University of Campania “Luigi Vanvitelli”, Naples, Italy Giovanni Scala Geriatrician, doctor responsible for Home Care Center (CAD), RM2 ASL, Rome Walter Verrusio Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy 2021 03 20 2021 04 10 Tumors of the chest wall are uncommon lesions that comprise a heterogeneous group of neoplasms. These tumors may arise from osseous structures or soft tissues and may be malignant or benign. We describe the case of a proliferative swelling of uncertain origin that led us to suspect a neuroendocrine origin for the mass we observed and studied. Neuroendocrine tumors arise from neuroendocrine cells, which are peptide- and amine-producing cells dispersed throughout the body. Usually, these tumors occur in various organs as intrathoracic or abdominal masses that become manifest after a variable time, usually after inducing a heterogeneous symptomatology secondary to the secretion of various molecules. The case we describe, on the other hand, develops both exophytically and endophytically, first appearing as an externally developing thoracic mass. Subsequent appropriate investigations revealed bone and muscle involvement in the patient’s thoracic cavity. Therefore, we describe our management of a paucisymptomatic patient who presented with a rapidly developing swelling in the intermammary site that progressed equally rapidly. https://crcp.tums.ac.ir/index.php/crcp/article/view/503

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 02 91 93 Alireza Hasanzadeh Medical School, Tehran University of Medical Sciences, Tehran, Iran Saeed Nateghi Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran 2023 12 02 2023 12 02 No Abstract No Abstract No Abstract https://crcp.tums.ac.ir/index.php/crcp/article/view/900

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 02 101 103 Shubham Agarwal 3rd year PG resident, Department of Orthopedics, Dr. SN Medical College Kishore Raichandani Senior Professor and Unit Head, Department of Orthopedics, Dr. SN Medical College Hemant Jain Associate Professor, Department of Orthopedics, Dr. SN Medical College Surbhi Raichandani Resident PGY3, Department of Diagnostic Radiology, UAMS, Littlerock, USA 2021 04 09 2021 12 01 Myositis ossificans, in its literal translation, is defined as an inflammatory ossification of muscle and the neighboring soft tissues. A rare case of post-brain injury ossification of the Gluteus maximus muscle extending from the greater trochanter of the femur to the right wing of the iliac bone, leading to extra-articular bony ankylosis of the hip is reported. A 40-year-old male presented to the Outpatient department with a stiff right hip and restriction of its movements. The patient had a history of cerebral hemorrhage 18 months back and subsequently developed stiffness in the right hip since the last 3 months. X-ray and CT scan revealed the extension of an ossified bar extending between the lateral aspect of the right iliac wing above the right acetabulum and upper 1/3 of the anterior lateral aspect of the femur near the greater trochanter, measuring 1003240 mm. The patient was then allowed to go for rehabilitation with appropriate physiotherapy and anti-inflammatory drugs. Extensive hypertrophic ossification can occur at a totally unrelated site as a consequence of cerebral insult/ head injury. https://crcp.tums.ac.ir/index.php/crcp/article/view/510

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 104 107 mahmood khodabandeh Clinical Research Development Unit, Valiasr Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran maryam afshoon Department of Infectious Disease, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran 2022 10 26 2023 07 04 Necrotizing fasciitis is a rare and lethal bacterial infection of the subcutaneous tissue and fascia in pediatrics, particularly when Pseudomonas Aeruginosa is involved. The similarity between cellulitis and Necrotizing fasciitis can lead to misdiagnosis. A 5-month-old male is introduced, presenting with fever and ecchymoses on his left thigh, which was treated as cellulitis. However, the diagnosis was changed to necrotizing fasciitis due to rapid progression in infection and pseudomonas growth in cultures. The antibiotics were leveled up, and the surgeon debrided and grafted the skin. Finally, the patient was discharged in good condition. In the early stages of soft tissue infections, it is not possible to distinguish Necrotizing fasciitis from cellulitis, so empirical antibiotics should be started to cover poly-microbial infections, and the patient should be observed closely. When the infection does not respond to the antibiotics appropriately over 24 hours, the surgeon. https://crcp.tums.ac.ir/index.php/crcp/article/view/749

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 108 112 Arash Tabaraee Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Mahdi Rezai Emergency Medicine Management Research Center, Health management Research Institute, Iran University of Medical Sciences, Tehran, Iran. Hasan Amiri Emergency Medicine Management Research Center, Health management Research Institute, Iran University of Medical Sciences, Tehran, Iran. Taha Mohammad Ahmadivash School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Seyedamir Tabibzadeh dezfooli Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2022 12 14 2023 04 26 Facial rejuvenation and augmentation with autologous fat injection are common and effective techniques worldwide. This procedure has few complications and is usually used for soft-tissue augmentation. Although this procedure is considered safe, many patients have experienced different complications such as visual loss, stroke, or skin necrosis after these procedures. Herein, a case of embolic stroke along with blindness and facial necrosis due to facial filler injection is described. In this case, a patient developed decreased level of consciousness, left hemiparesis, and blindness that was finally diagnosed based on imaging as embolic stroke following facial autologous fat injection. The symptoms improved partially and gradually by conservative treatment and the patient was discharged with some sequels. https://crcp.tums.ac.ir/index.php/crcp/article/view/764

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 113 116 Somaya Elhout Cardiology Department, Alshifa Hospital, Gaza, Palestine Mohammed Habib Head of cardiology department, Alshifa Hospital, Gaza, Palestine 2023 01 03 2023 04 26 Median arcuate ligament syndrome (MALS) is a rare benign condition typically affecting young females. It usually presents with chronic abdominal pain, nausea, vomiting and weight loss. They are usually diagnosed incidentally on MDCT angiography. We report a rare adult male of MALS which presented with a recurrent hypertensive urgency without any abdominal pain leading to an extensive workup and incidental diagnosis of MALS which was successfully treated by angioplasty with stenting of celiac trunk without any complication. https://crcp.tums.ac.ir/index.php/crcp/article/view/779

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 117 120 Faria Hasanzadeh Haghighi Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Hadi Farsiani Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Pouran Layegh Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Mina Mostafavi Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Hassan Aelami Department of Pediatrics & Hand Hygiene and Infection Control Research Center Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2023 01 28 2023 02 12 Anthrax is a deadly, contagious bacterial infection. Skin anthrax is most frequent. Anthrax is a work-related illness, so it’s rare among kids. Children’s symptoms are similar to adults.In this article, we introduce a one-year-old infant who developed cutaneous anthrax due to contact with contaminated broth with a sore on the corner of the lip. A 1-year- infant from a village in Quchan, North-east Iran, with a swollen lesion with dark brown to black crust on its surface on the left side of upper lip presented to Akbar’s Children Hospital, Mashhad, Iran, in January 2021. Bacillus anthracis was seen in direct smear of wounds with Gram staining though the sample culture result was negative. Mortality from cutaneous anthrax can be up to 20%. Therefore, timely use of antibiotics is quite effective in decreasing mortality and reducing the effects of bacterial spread in the blood. https://crcp.tums.ac.ir/index.php/crcp/article/view/786

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 121 125 Abu Abbasi Loyola University Medical Center, Maywood, IL, USA Paul Hong Loyola University Medical Center, Maywood, IL, USA Aleksandra Marinkovic Saint James School of Medicine, Anguilla, BWI Adekunle Sanyaolu D'Youville University, Buffalo, NY, USA Ikponmwosa Enofe Loyola University Medical Center, Maywood, IL, USA 2023 02 03 2023 04 26 Spontaneous paracentesis is a life-threatening complication of liver cirrhosis. Importance of precise and early identification cannot be overstated, as early treatment improves the prognosis and survival. A 78-year-old woman with cirrhosis presented with ascitic fluid gushing out from an umbilical hernia. The patient received intravascular repletion with intravenous albumin, antibiotics, and rapid umbilical herniorrhaphy. Post-operatively, the patient experienced acute kidney injury and portal vein thrombosis, which was corrected with electrolyte replacement and transjugular intrahepatic portosystemic shunt with thrombectomy. The patient recovered completely and was discharged without difficulty. https://crcp.tums.ac.ir/index.php/crcp/article/view/789

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 126 129 Payam Sasannejad Department of Neurology, Faculty of Medicine, Mashhad university of Medical Science, Mashhad, Iran. Vahide Zamani Department of Neurology, Faculty of Medicine, Mashhad university of Medical Science, Mashhad, Iran. Zeinab Ameli Department of Neurology, Faculty of Medicine, Mashhad university of Medical Science, Mashhad, Iran. Parisa Ebrahimi Department of Neurology, Faculty of Medicine, Mashhad university of Medical Science, Mashhad, Iran. 2023 02 26 2023 04 26 Spinal anesthesia has been performed on patients who undergo cesarean section, for years. A variety of complications are reported which are followed by spinal anesthesia; but subarachnoid hemorrhage is not one of them. In this study, we present two cases of Subarachnoid hemorrhage resulting from spinal anesthesia. In both cases, patients suffered from a thunderclap sudden-onset headache after undergoing cesarean section. Imaging and laboratory investigations were performed in order to determine the reason contributing to the headache, which revealed subarachnoid hemorrhage. After investigation and excluding other underlying causes, normal imaging studies suggested that the occurrence of subarachnoid hemorrhage as a possible complication of spinal anesthesia should be considered. https://crcp.tums.ac.ir/index.php/crcp/article/view/802

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 3 2023 12 03 130 134 Nitin Gupta Department of Radiation Oncology and Nuclear Medicine, Dr Rajendra Prasad Government Medical College, Kangra at Tanda Himachal Pradesh, India Shalini Verma Department of Radiation Oncology and Nuclear Medicine, Dr Rajendra Prasad Government Medical College, Kangra at Tanda Himachal Pradesh, India Priyanka Thakur Department of Radiation Oncology, AIIMS, Bilaspur, Himachal Pradesh India. 2023 08 01 2023 08 15 Gastrointestinal stromal tumors (GIST) are rare tumors accounting for less than 1% of primary neoplasia of the digestive tract. They can also occur outside the GIT, where they are called extra gastrointestinal stromal tumors (EGIST), which are extremely rare tumors. GISTS and EGISTS have similar histo-pathological and molecular profiles. Though these are known to be FDG avid, some of the atypical GISTS can be FDG negative or only minimally FDG avid.Here, an unusual case of a 57-year-old female with FDG avid solitary chest wall mass is presented, which after biopsy and immune-histochemistry was proven as EGIST. She underwent en block resection of the tumor and is presently on adjuvant treatment with Imatinib mesylate. This case report highlights the importance of considering EGIST as a differential diagnosis of a solitary chest wall mass and the utility of 18F- FDG PET/CT in its management. https://crcp.tums.ac.ir/index.php/crcp/article/view/852