Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 192 195 EN Homayoun Nikkhah Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Department of Ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. Kiana Hassanpour Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamid Ahmadieh Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sadid Hooshmandi Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohamad javad Babaki Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 06 06 2025 01 13 Endogenous endophthalmitis is caused by the hematogenous dissemination of infectious organisms, resulting in intraocular infection. This entity is uncommon and accounts for 5–15% of all forms of endophthalmitis. Patients with compromised immune systems are most at risk for endogenous endophthalmitis. An immunocompetent 20-year-old man, following a recent hospitalization and ventilator-associated pneumonia (VAP), presented with blurred vision in the left eye. Fundoscopy revealed dense white-toyellow, pus-like subfoveal material originating from the choroid, breaking through the retina, and dispersing into the vitreous. According to polymerase chain reaction (PCR) findings, the infection had a bacterial origin and caused irreversible damage to the macula. https://crcp.tums.ac.ir/index.php/crcp/article/view/959 https://crcp.tums.ac.ir/index.php/crcp/article/download/959/683

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 196 202 Haniyeh Esfandiar Non-Communicable Pediatric Disease Research Center, Babol University of Medical Sciences, Babol, Iran. 2024 07 21 2025 01 13 Disseminated tuberculosis (TB) is rare, can affect any organ system, and predominantly presents in immunocompromised populations. While pulmonary tuberculosis (TB) is prevalent in developing countries, it is an uncommon cause of disseminated TB. In pediatric populations, particularly in the first and second decades of life, disseminated TB is often secondary to lung infections. However, there have been few reports of disseminated TB complicated by disseminated intravascular coagulation (DIC). Disseminated TB is defined as the involvement of two or more noncontiguous sites due to the lymphohematogenous spread of Mycobacterium tuberculosis. Extrapulmonary involvement occurs in one-fifth of all TB cases and may present without histological or radiological evidence of pulmonary infection. An eleven-year-old girl presented to the emergency department (ED) with complaints of weight loss and abdominal pain. She had no history of immunodeficiency but had been in contact with TB patients. On admission, she exhibited refractory coagulopathy, necessitating transfer to the pediatric intensive care unit (PICU). In the PICU, intravenous vitamin K, fresh frozen plasma (FFP), and packed red blood cells (PRBCs) were administered on the 14th day of admission, following the initiation of antibiotics and a combination of standard anti-tuberculous drugs. It can be speculated that many pediatric cases of TB-induced pneumonia leading to acute respiratory distress syndrome (ARDS) remain unreported in the literature. More robust data on the epidemiology of childhood TB are necessary to better understand its contribution to ARDS and to develop pediatric-specific therapeutic strategies. Some risk factors for disseminated TB include young age, recent measles infection, immunodeficiency, malnutrition, and malignancies. Children, especially infants and immunocompromised patients, are at higher risk of developing miliary and disseminated TB. However, none of these contributing factors were identified in this child. In the present case, the patient had no HIV infection or immunodeficiency but was an immigrant from an endemic country and had a history of contact with TB patients. The onset of her symptoms closely resembled those of inflammatory bowel disease (IBD), and she later developed coagulation disorders and DIC. We successfully treated disseminated TB complicated by DIC using antibiotics, FFP, PC, vitamin K, and anti-tuberculous therapy. The follow-up indicated an improvement in her condition and the resolution of symptoms. https://crcp.tums.ac.ir/index.php/crcp/article/view/971 https://crcp.tums.ac.ir/index.php/crcp/article/download/971/684

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 203 207 Elham Zare Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Beheshti Namdar Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2024 12 01 2025 02 02 Leiomyomas are most commonly encountered in the genitourinary and gastrointestinal systems, with primary hepatic leiomyomas (PHL) being a rare occurrence. We present the case of a 62-year-old man with an incidentally discovered voluminous lesion in the left lobe of the liver, initially suspected to be a hemangioma. The patient was referred for further evaluation, during which advanced imaging modalities were utilized for accurate diagnosis, and tissue biopsies were obtained. A definitive diagnosis of PHL was established through immunohistochemistry based on pathological findings.   https://crcp.tums.ac.ir/index.php/crcp/article/view/1003 https://crcp.tums.ac.ir/index.php/crcp/article/download/1003/685

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 208 211 Hosseinali Abdolrazaghi Hand & Reconstructive Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hossein Zabihi Mahmoudabadi Minimally Invasive Surgery Department, of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alireza Naghdipur General Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hojjat Molaei Plastic & Reconstructive surgery Department, Imam Khomeini Hospital Complex, of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2024 12 26 2025 02 02 Inguinal hernia repair is a common surgery that can result in incarceration in some cases. Catastrophic events may be encountered in specialized circumstances, such as Fournier’s gangrene, which is an emergent condition. Treatment of debrided skin of the abdominal wall is always challenging, particularly in large defects. A 69-year-old man suffered from complications following inguinal hernia repair, which included laparoscopic mesh repair, subsequent right hemicolectomy with anastomosis, leading to ileostomy, Fournier’s gangrene, and eventually a large skin defect in the lower abdomen and perineal area. After multiple sessions of wound therapy, he underwent abdominal wall reconstruction with two large pedicled anterolateral thigh flaps. Anterolateral thigh flaps, with their robust blood supply, can easily reach the lower abdomen and cover extensive abdominal skin defects when transferred bilaterally. Level of Evidence: Level V, therapeutic study https://crcp.tums.ac.ir/index.php/crcp/article/view/1011 https://crcp.tums.ac.ir/index.php/crcp/article/download/1011/686

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 212 216 Mahmoud Ali Kaykhaei Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Shahin Nosratzehi Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. 2025 01 03 2025 03 10 Silent thyroiditis during pregnancy is an under-recognized clinical condition and a rare case, often manifesting as transient hypothyroidism. We report a 23-year-old woman at 8 weeks of gestation who presented with newly diagnosed hypothyroidism [TSH = 85 mIU/L (0.4–4.5), FT4 = 0.4 ng/dL (0.7–2.5), and anti-TPO = 78 IU/mL (up to 16)]. Thyroid function tests had been normal eight months prior. Levothyroxine (LT4) therapy was initiated, restoring euthyroidism. Treatment was discontinued postpartum, and the patient maintained normal thyroid function for over one year. Our case is unique in that silent thyroiditis occurred unusually early in pregnancy and differed from the more common postpartum cases. Silent thyroiditis should be considered in pregnancy-related hypothyroidism, particularly when prior thyroid function was normal. Prompt diagnosis and treatment can prevent adverse maternal and fetal outcomes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1012 https://crcp.tums.ac.ir/index.php/crcp/article/download/1012/687

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 217 220 Marzie Abutorabi Zarchi Department of Neurology, Shahid Sadoghi University of Medical Sciences, Yazd, Iran. Amirmasoud Kazemzadeh Houjaghan School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2025 01 04 2025 02 16 Cervicocranial arterial dissection is not a common disease (2.5% of total brain infarction), and its pathogenesis is still not fully understood. However, it appears to be multifactorial and is rarely seen in the postpartum period. A 40-year-old woman presented to the emergency department with sudden right lower limb paresis 10 days after vaginal delivery. She had no history of DM, HTN, preeclampsia, or underlying cerebrovascular disease. Upon evaluation, left extracranial carotid artery dissection was found on cervical MRA. The likelihood of postpartum dissection is rare, but it could be due to vascular damage associated with the Valsalva maneuver during labor; hemodynamic and hormonal changes due to pregnancy may also play a role. https://crcp.tums.ac.ir/index.php/crcp/article/view/1013 https://crcp.tums.ac.ir/index.php/crcp/article/download/1013/688

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 221 223 Sattar Jafari Department of Gastroenterology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Shalaleh Aghaei Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Behnam Sajedi Department of Gastroenterology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. Samira Akbarieh Department of Infectious and Tropical Diseases, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. 2025 01 18 2025 02 02 Clostridium difficile infection (CDI) is commonly associated with nosocomial diarrhea; however, certain atypical presentations can challenge its diagnosis. We report a case of CDI in a 25-year-old male with inflammatory bowel disease (IBD), presenting with unusual clinical features, including abdominal distension, lower extremity edema, and persistent non-bloody diarrhea. Diagnostic uncertainty arose due to the patient’s prior IBD diagnosis and atypical symptoms. Nevertheless, CDI was confirmed through stool toxin assay and colonoscopy findings of pseudomembranes. Treatment with oral vancomycin resulted in complete symptom resolution, underscoring the importance of considering CDI in cases with atypical symptoms. Prompt diagnosis is essential for effective management and prevention of complications. https://crcp.tums.ac.ir/index.php/crcp/article/view/1015 https://crcp.tums.ac.ir/index.php/crcp/article/download/1015/689

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 224 228 Marzieh Abutorabi Zarchi Department of Neurology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Roghayeh Razavi Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Nasim Namiranian Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2025 01 24 2025 02 02 SARS-CoV-2 causes an inflammatory disease characterized by symptoms such as fever, cough, shortness of breath, and myalgia, along with leukopenia, lymphopenia, elevated serum aspartate aminotransferase levels, and abnormal chest computed tomography findings. It may also lead to respiratory distress, unilateral complications, and secondary infections. COVID-19 infection can result in severe neurological complications, including viral encephalitis, cerebrovascular disorders, acute diffuse encephalomyelitis, and acute necrotizing encephalopathy. Here, we report a case of hemorrhagic encephalitis due to SARS-CoV-2 in a 27-year-old patient with a history of type 1 diabetes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1019 https://crcp.tums.ac.ir/index.php/crcp/article/download/1019/690

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 229 236 Ghazaleh Salehabadi Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Shahla Meshgi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hamidreza Pouraliakbar Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Azin Alizadeh Asl Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Ali Mohammadzadeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2025 02 17 2025 03 03 A Calcified Amorphous Tumor (CAT) consists of calcified nodules embedded within an amorphous fibrous material and represents an uncommon non-neoplastic intracavitary cardiac mass. In this article, we present the case of a 38-year-old Iranian gentleman who experienced a sudden loss of consciousness and right hemiparesis. Brain imaging revealed acute infarction in the left basal ganglia. Echocardiography identified a large heterogeneous echodensity in the posterior AV groove, with central echolucency extending to the base of the posterior left ventricular (LV) wall and the basal posterior mitral valve leaflet (PMVL), findings consistent with CAT. Cardiac Magnetic Resonance Imaging (CMR) demonstrated an intramural calcified mass with a necrotic core located in the lateral annulus of the mitral valve, extending into the left atrium and ventricle. The mass was deemed responsible for the cerebral infarction, which was classified as cardioembolic. This case report highlights Calcified Amorphous Tumor (CAT) as a potential embolic source, underscoring the importance of early recognition through multimodality imaging. Comprehensive management, which may include regular follow-ups or surgical intervention, is crucial for patients diagnosed with CAT. https://crcp.tums.ac.ir/index.php/crcp/article/view/1025 https://crcp.tums.ac.ir/index.php/crcp/article/download/1025/691

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 237 241 Arash Heroabadi Brain and Spinal Cord Injury Research Center, NeurosciencesInstitute, Tehran University of Medical Sciences, Tehran, Iran. Reza Atef Yekta Pain Research Center, NeurosciencesInstitute, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Iman Asdaghi Jahromi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Keihan Shabankhani Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2025 02 20 2025 03 03 Ankylosing spondylitis (AS) is a progressive inflammatory disease characterized by spinal rigidity, kyphotic deformities, and significant challenges in airway management during surgery. We report the case of a 50-year-old male with severe kyphosis caused by long-standing AS, scheduled for corrective spinal surgery. Preoperative assessment revealed restricted cervical mobility, a “chin-on-chest” deformity, and a high risk of difficult intubation. Awake video-laryngoscopy-assisted intubation, combined with regional airway blocks, was successfully performed to minimize complications. Intraoperative neuromonitoring, strategic positioning, and meticulous hemodynamic management were implemented to ensure patient safety. The surgery was completedwithout neurological deficits, and the patient was discharged in stable condition. This case underscores the importance of thorough airway planning, neuromonitoring, and intraoperative vigilance in AS patients undergoing spinal correction. It highlights the critical role of a multidisciplinary approach in achieving successful surgical outcomes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1027 https://crcp.tums.ac.ir/index.php/crcp/article/download/1027/692