Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 88 92 EN Somayeh Livani Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran. Alireza Fatemi Minimally Invasive Surgery Research Center, Rasool Akram Hospital Iran,University of Medical Sciences, Tehran, Iran. Moghadese Jahanshahi Department of Obstetrics and Gynecology, School of Medicine, Sayyad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran. 2024 07 23 2024 10 19 Retained products of conception (RPOC) occur when fragments of the placenta or decidual tissue remain in the uterus, often leading to postpartum hemorrhage. Early and accurate diagnosis, aided by ultrasonography, is essential for appropriate management and prevention of complications. We report a case of a 22-year-old woman admitted to our tertiary medical department with irregular vaginal bleeding and abdominal pain. She had no significant past medical history. Abdominal ultrasonography revealed a normal-sized uterus with homogeneous myometrial echogenicity. However, a heterogeneous echogenic mass, exhibiting considerable vascularity and feeding vessels from the endometrial cavity, was observed in the cervix. Additionally, the patient’s beta human chorionic gonadotropin (Beta-HCG) concentration was positive, with a titer of 201 µ/l, despite her claim of being a virgin. Subsequently, the patient underwent hysteroscopy, during which an infected and malodorous lesion was removed from the uterus, confirming the diagnosis of RPOC. In follow-up assessments, she experienced no complications. To the best of our knowledge, no cases of RPOC located in the cervix have been reported previously, as RPOC is typically expected to be found in the endometrial cavity. This study aims to share our experience in considering the differential diagnosis of RPOC as cervical lesions and highlights the importance of ultrasonography in early pregnancy management. https://crcp.tums.ac.ir/index.php/crcp/article/view/431 https://crcp.tums.ac.ir/index.php/crcp/article/download/431/663

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 93 98 EN Amit Kumar Department of Radio-Diagnosis, IGIMS, Patna, Bihar, India. Vinod Kumar Department of Radio-Diagnosis, IGIMS, Patna, Bihar, India. Priyam Sharma Department of Radio-Diagnosis, IGIMS, Patna, Bihar, India. 2023 10 15 2024 11 09 Non-puerperal uterine inversion (NPUI) is an extremely rare condition. Our case is the second, where a young female (adolescent age group) presented with uterine inversion, and is the first without any identifiable cause of uterine inversion. Her chief complaints were chronic menorrhagia, abdominal pain, and episodes of acute urinary retention. Most of the reported cases have identifiable etiology for the inversion. The reporting of this case is worthwhile because of its rarity in such age groups and even without any defined cause (spontaneous occurrence), making the diagnosis of uterine inversion in this condition challenging, particularly in this very young age. In our case, she was initially misdiagnosed as having a cervical polyp clinically and radiologically, especially on ultrasonography (USG). Finally, it was diagnosed as uterine inversion by magnetic resonance imaging (MRI) of the pelvis and retrospective evaluation of USG. Magnetic resonance imaging (MRI) thus plays a pivotal role in the diagnosis of uterine inversion. Treatment of uterine inversion is either mostly by manual repositioning, and if not possible, surgery is contemplated. https://crcp.tums.ac.ir/index.php/crcp/article/view/883 https://crcp.tums.ac.ir/index.php/crcp/article/download/883/664

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 99 103 Maghsoud Nader Pilehroud Clinical Psychology, Shahed University, Tehran, Iran. Mohammad Ebrahim Maddahi Clinical Psychology, Shahed University, Tehran, Iran. 2023 11 25 2024 10 20 The impact of anxiety and injuries caused by severe stress can contribute to the manifestation of more severe disorders in children. The authors of this article have reported a case involving a five-and-a-half-year-old child who formed an insecure attachment or reliance on his father after experiencing several instances of anxiety attacks (panic attacks). The child was assessed utilizing the Conner’s QEEG test (Conner Rating Scale-Revised) parent version and the Spence Children’s Anxiety Scale (SCAS). Subsequently, a treatment plan incorporating drug administration, Loretta neurofeedback, and psychological counseling was implemented. Notably, session three of QEEG demonstrated a decline in anxiety levels. However, no changes were observed in the child’s insecure attachment and reliance on the father. Hence, adopting a trans-diagnostic and dimensional approach is crucial when assessing uncommon cases and developing treatment protocols tailored to each disorder. https://crcp.tums.ac.ir/index.php/crcp/article/view/899 https://crcp.tums.ac.ir/index.php/crcp/article/download/899/665

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 104 107 Omid Ghaderzadeh R&D Coordinator, DanaWell Company, Incubator Center of Tehran University of Medical Sciences, Tehran, Iran. Sarvin Soleymanipoor School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Roholah Ghodsi CEO, DanaWell Company, Incubator Center of Tehran University of Medical Sciences, Tehran, Iran. Zahra Namazi Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 08 08 2024 10 28 A 15-year-old male presented at a neurosurgeon’s office following a traffic accident. A CT scan revealed bone deficiency in the temporoparietal area. The surgical solution involved implanting a 3D-printed prosthesis into the skull. Axial 3D created the model using stereolithography 3D printing technology with Poly Methyl Methacrylate (PMMA). The use of 3D printing as a surgical aid is gaining popularity. Our experience with the presurgical model demonstrates its utility in individualized surgical planning for skull defects. https://crcp.tums.ac.ir/index.php/crcp/article/view/977 https://crcp.tums.ac.ir/index.php/crcp/article/download/977/666

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 108 113 EN Shweta Jangam Biomedical Genetics, Greenarray Genomic Research and Solutions, a Division of Accurate Diagnostics Pvt. Ltd., Kothrud, Pune, Maharashtra, India. Manju Kurup Greenarray Genomic Research and Solutions, a Division of Accurate Diagnostics Pvt. Ltd., Kothrud, Pune, Maharashtra, India. Preeti Arora Microbiology, Research Division of Accurate Diagnostics Pvt. Ltd., Kothrud, Pune, Maharashtra, India. Shruti Jawale Research Division of Accurate Diagnostics Pvt. Ltd., Kothrud, Pune, Maharashtra, India. Prashant Duraphe Shikhana Prasaraka Mandali’s Late Prin. B. V. Bhide Foundation, Pune, Maharashtra, India. Sanjay Gupte Research Division of Accurate Diagnostics Pvt. Ltd., Kothrud, Pune, Maharashtra, India. AND Gupte Hospital, Postgraduate Institution and Centre of Research in Reproduction, Pune, India. 2024 08 12 2024 10 27 In the present case report, we have found a novel variant for TRIOBP in a patient with congenital hearing loss. The patient is an 8-year-old female with hearing loss, the first child of consanguineous parents. To identify the underlying genetic defect, whole genome sequencing was performed. Carrier screening of the parents was also conducted. The results showed a homozygous autosomal recessive missense c.5849C>T (p.Pro1950Leu) variant in exon 16 of the TRIOBP gene. To our knowledge, this variant has not been previously reported as either a pathogenic or a benign variant. The novel TRIOBP variant found in the present study broadens the range of TRIOBP mutations implicated in hearing loss. Accordingly, the results of this study may be important for genetic counseling. https://crcp.tums.ac.ir/index.php/crcp/article/view/979 https://crcp.tums.ac.ir/index.php/crcp/article/download/979/667

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 114 118 EN Pedram Beigvand Gastroenterologist and Hepatologist, Babol University of Medical Sciences and Health Services, Babol, Iran. Niloofar Moradi Pediatrician, Babol University of Medical Sciences and Health Services, Babol, Iran. Sepehr Ramezani Student Research Committee,Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. Faezeh Firuzpour Student Research Committee, Babol University of Medical Sciences, Babol, Iran. AND USERN Office, Babol University of Medical Sciences, Babol, Iran. 2024 10 02 2024 10 19 Crigler-Najjar syndrome type II is a metabolic disorder stemming from mutations in the UGT1A1 gene, resulting in heightened levels of unconjugated bilirubin. Here is a case report of a 17-year-old male patient with minor thalassemia and G6PD deficiency who was referred due to worsening jaundice. He has had a history of lifelong jaundice, which has intensified over the past year and a half. Subsequently, the patient was diagnosed with Crigler-Najjar type II based on his medical history, clinical examination, and laboratory findings. Furthermore, the patient’s positive response to phenobarbital treatment confirmed the diagnosis. Consequently, it is imperative to consider CriglerNajjar syndrome in cases of unexplained unconjugated hyperbilirubinemia. https://crcp.tums.ac.ir/index.php/crcp/article/view/989 https://crcp.tums.ac.ir/index.php/crcp/article/download/989/668

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 119 124 Victor Olaiya Department of Internal Medicine, Izhevsk State Medical University, Izhevsk, Russia. Vincentia Agyekum Department of Internal Medicine, Izhevsk State Medical University, Izhevsk, Russia. Adefunke Omotoso Department of Internal Medicine, School of Medicine & Dentistry, University of Central Lancashire, Fylde Rd, Preston PR1 2HE. 2024 10 15 2024 10 28 Superior vena cava syndrome (SVCS) is a clinical condition caused by the obstruction of venous return through the superior vena cava (SVC). This report presents a 71-year-old male diagnosed with central lung cancer and chronic obstructive pulmonary disease (COPD) complicated by SVCS. The report details his clinical presentation, diagnostic workup, and management, including chemotherapy and symptomatic treatment. SVCS can significantly affect patient outcomes, especially in cases of malignancy, and requires timely intervention. https://crcp.tums.ac.ir/index.php/crcp/article/view/992 https://crcp.tums.ac.ir/index.php/crcp/article/download/992/669

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 125 132 Morteza Daraei Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Khajeh-Mehrizi Department of Hematology and Medical Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Behrooz Amirzargar Department of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Fereshteh Ameli Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Fahimeh Zeinalkhan Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2024 10 18 2024 10 20 Sudden sensorineural hearing loss (SSNHL) as the initial manifestation of multiple myeloma (MM) is rare. We present a 45-year-old woman with hyperviscosity syndrome (serum viscosity of 10.2 cP) from MM who presented with hearing disturbance that responded dramatically to plasma exchange with saline and intratympanic steroid treatment. Serum protein electrophoresis confirmed the presence of a monoclonal band, and bone marrow biopsy showed a hypercellular marrow with 90% plasma cells, which demonstrated lambda monoclonal restriction. https://crcp.tums.ac.ir/index.php/crcp/article/view/993 https://crcp.tums.ac.ir/index.php/crcp/article/download/993/670

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 133 136 Ali Goudarzi Radiology Department, Shiraz University of Medical Sciences, Shiraz, Iran. AND Student Research Commitee, Shiraz University of Medical Sciences, Shiraz, Iran. Leila Ostovar Diagnostic Radiologist, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 2024 11 01 2024 11 04 Pulmonary spindle cell carcinoma (PSCC) is a rare and highly aggressive form of nonsmall cell lung cancer with sarcomatoid differentiation. It poses significant diagnostic challenges due to its histological resemblance to other malignancies, including inflammatory myofibroblastic tumors. This case report details the clinical presentation, histopathological findings, and treatment of a patient with PSCC, to further elucidate the clinical features, diagnosis, and management of this rare tumor. https://crcp.tums.ac.ir/index.php/crcp/article/view/996 https://crcp.tums.ac.ir/index.php/crcp/article/download/996/671

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 3 2024 12 08 137 140 Seyed Hamzeh Hosseini Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Hamed Ghazvini Department of Neuroscience, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Seyedeh Masoumeh Seyedhosseini Tamijani Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. Raheleh Rafaiee Department of Neuroscience, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2024 11 04 2024 11 16 Sertraline is classified as a selective serotonin reuptake inhibitor (SSRI) that is extensively employed in the management of a range of psychiatric conditions, encompassing major depressive disorder and anxiety disorders. While the overall incidence of hair loss is not extensively documented, it is recognized as a possible cutaneous reaction to SSRIs, including sertraline. In the present study, we report the case of a 16-year-old Iranian female of Persian ethnicity who had been treated for panic disorder. She developed severe hair loss two weeks post-initiation of treatment with sertraline 50 mg per day. She stopped the medication after two months when she had lost 50% of her hair. The exact mechanism remains unclear, but it is suggested that SSRIs like sertraline may induce hair loss by pushing hair follicles into the telogen phase prematurely, leading to diffuse hair shedding. Management typically involves dose adjustment or discontinuation of sertraline, which has been shown to resolve hair loss in multiple cases. Understanding this phenomenon is crucial for both patients and healthcare providers. Although rare, this side effect can considerably affect a patient’s overall quality of life and compliance with therapeutic regimens. https://crcp.tums.ac.ir/index.php/crcp/article/view/997 https://crcp.tums.ac.ir/index.php/crcp/article/download/997/672