Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 51 53 Shokouh Gheibi Razi Educational and Therapeutic Psychiatric Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Mohammad Aidin Farahvash School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Morvarid Ahadi Psychiatry Department, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 2025 04 10 2025 08 31 Pseudologia fantastica is characterized by habitual, elaborate, and often fantastical fabrications that the patient recognizes as untrue. We report a case of a 24-year-old male with bipolar disorder and adult ADHD whose treatment included mood stabilizers and atomoxetine, which improved psychiatric symptoms but had minimal effect on the pseudologia. This case highlights the persistent nature of pseudologia fantastica and its diagnostic and therapeutic complexity, calling for further investigation into its management. https://crcp.tums.ac.ir/index.php/crcp/article/view/1038 https://crcp.tums.ac.ir/index.php/crcp/article/download/1038/713

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 90 92 Maryam Mohebiniya Department of Oral and Maxillofacial Radiology, School of Dentistry, Arak University of Medical Sciences, Arak, Iran. Soheila Jadidi Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2025 07 02 2025 08 30 A 51-year-old female presented for her routine annual dental check-up. During the intraoral examination, she reported pain upon pressure applied to the apical portion of the mandibular left first premolar. She was referred for a panoramic radiograph, which revealed a suspected radiolucency in the interradicular region of the left mandibular canine and premolars (Figure 1). A periapical radiograph confirmed the finding (Figure 2), and cone beam computed tomography (CBCT) was performed.CBCT revealed a localized, unilocular radiolucent lesion with well-defined corticated borders, extending from the alveolar crest to the apex of the first premolar, measuring 11 mm vertically, 10 mm buccolingually, and 4.2 mm anteroposteriorly. The lesion caused thinning of the lingual cortical plate, as well as thinning, expansion, and perforation of the buccal cortical plate. The lamina dura and periodontal ligament were not visible in the mesial portion of the first premolar and the distal aspect of the canine. The lesion resulted in severe root resorption of the first premolar and mild resorption of the adjacent canine (Figure 3). Differential diagnoses included radicular cyst,  ameloblastoma, and central giant cell granuloma. Radicular cyst was ruled out through vitality tests. Biopsy and histopathological evaluation confirmed the diagnosis of ameloblastoma, and the patient was referred for surgical management. Although rare, ameloblastoma is the second most common odontogenic tumor [1]. It grows slowly and often remains asymptomatic in its early stages [2].Smaller lesions may be detected incidentally during routine dental check-ups. As the tumor enlarges, facial asymmetry and cortical bone perforation may occur due to failed periosteal bone formation [2]. If left untreated, it can reach significant dimensions [2]. This highlights the critical importance of regular dental check-ups for the early detection of such tumors. Regular dental examinations are essential for early detection, allowing timely intervention and reducing the risk of complications, disfigurement, or functional impairment. https://crcp.tums.ac.ir/index.php/crcp/article/view/1062 https://crcp.tums.ac.ir/index.php/crcp/article/download/1062/724

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 54 58 EN Simin Soltaninejad Department of Radiotherapy Oncology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran. Samira Yazdani Department of Medical Physics, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran. Mojgan Sanjari Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran. maryam bahador Department of Radiotherapy Oncology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran. 2025 04 12 2025 07 30 This is the first reported case of the coexistence of nasopharyngeal carcinoma and pituitary adenoma in a 36-year-old female. The case is significant due to the rarity of these two tumors occurring simultaneously and the diagnostic challenges posed by overlapping symptoms. The patient presented with a history of chronic nocturnal headaches localized to the temporal region. Initial symptoms included six months of amenorrhea, massive bilateral galactorrhea, and classic clinical signs of acromegaly. The nasopharyngeal mass was initially missed during early evaluations, as the patient was primarily assessed for a secreting pituitary adenoma. The nasopharyngeal mass was detected for the first time during rhinoplasty using an endoscope. Histopathological examination confirmed differentiated nonkeratinizing nasopharyngeal carcinoma alongside a pituitary adenoma. During radiotherapy for the nasopharyngeal carcinoma, the patient developed visual symptoms, including ptosis and outward deviation of the eye. The patient declined surgical excision of the pituitary adenoma; therefore, the radiotherapy field was expanded to include the adenoma. The radiotherapy dose was 70 Gy, delivered in 35 sessions. After three months of expanded radiotherapy, all symptoms, including headaches and visual disturbances, were completely resolved. Follow-up after 14 months showed no evidence of recurrence or disease progression. https://crcp.tums.ac.ir/index.php/crcp/article/view/1040 https://crcp.tums.ac.ir/index.php/crcp/article/download/1040/714

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 59 63 Anoop Vazhipokkil Department of ENT and Head Neck Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India. Vishwanathan Kavathur Department of ENT and Head Neck Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India. 2025 06 25 2025 08 27 Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare but important differential diagnosis in cases of persistent middle ear effusion. We report a case of a 45-yearold female who presented with persistent aural fullness and hearing loss in the right ear immediately following an airplane flight. She was initially diagnosed with middle ear effusion and underwent myringotomy with grommet ventilation tube insertion. However, the patient continued to experience profuse watery otorrhea for two months postoperatively. Subsequent computed tomography of the temporal bone confirmed a CSF leak from a defect in the tegmen tympani near the anterior epitympanum. The patient underwent successful endoscopic CSF otorrhea repair under general anaesthesia. Three months postoperatively, the patient’s hearing improved, and her aural symptoms resolved. This case highlights the importance of considering spontaneous CSF leaks in cases of sudden-onset conductive hearing loss, even in the absence of trauma or prior surgical history. https://crcp.tums.ac.ir/index.php/crcp/article/view/1059 https://crcp.tums.ac.ir/index.php/crcp/article/download/1059/715

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 64 68 Mohammad Hossain Validad Department of Ophthalmology, Faculty of Medicine, University of Zahedan, Zahedan, Iran. Alireza Salimi-Khorashad Department of Parasitology and Mycology, Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran. Fateme Rezaei Kahkhaei Department of Surgical Technology,School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran. 2025 07 06 2025 09 08 Amebic keratitis is a rare but serious corneal infection that is occasionally seen in contact lens wearers. In the early stages, the disease may be mistaken for bacterial keratitis due to corneal inflammation and a reduced visual field, which can delay diagnosis and treatment. In this case report, we present a young female who exhibited symptoms of a corneal ulcer associated with contact lens use and was initially treated for bacterial keratitis. Upon further evaluation, the diagnosis of Naegleria amebic keratitis was confirmed.   https://crcp.tums.ac.ir/index.php/crcp/article/view/1067 https://crcp.tums.ac.ir/index.php/crcp/article/download/1067/716

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 69 74 EN Mohammad Ali Nahayati Neurology Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Maryam Payere Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran. Amir Khanmirzaei School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran. Bahar Karimikhoshnoudian School of Medicine, Islamic Azad University of Tehran Medical Sciences, Tehran, Iran. Soheil Shokri-shakib Cardiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 07 09 2025 09 08 Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid (CSF) leakage, which can lead to complications such as cerebral venous thrombosis (CVT), occurring in 1–2% of SIH patients. This case report describes the presentation, diagnosis, and management of SIH complicated by CVT. A 36-year-old woman with no comorbidities presented with a three-week history of severe, initially orthostatic headaches. Neurological examination revealed mild bilateral disc oedema, and imaging showed generalized brain oedema. MRI with MRV confirmed cerebral venous sinus thrombosis along with typical SIH features, including pachymeningeal enhancement and venous engorgement. She was treated with heparin infusion and isotonic saline, responding well without seizures or hemorrhagic complications. This case highlights the risk of CVT in SIH and underscores the importance of early diagnosis through neuroimaging and lumbar puncture. The patient’s favorable response to anticoagulation demonstrates effective management, though further studies are needed to establish definitive treatment guidelines for SIH-associated CVT. https://crcp.tums.ac.ir/index.php/crcp/article/view/1068 https://crcp.tums.ac.ir/index.php/crcp/article/download/1068/717

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 75 78 EN Behrokh Sahebdel Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hossein Golzar Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran. Azita Zare Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Golshahi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Nafiseh Saedi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Mahboobeh Shirazi Department of Obstetrics and Gynecology, Maternal Fetal and Neonatal Research Center, Yas Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. 2025 07 14 2025 08 25 Heterotopic pregnancy is the simultaneous presence of intrauterine and ectopic gestations. It is typically diagnosed in the first trimester via sonography or when patients present with vaginal bleeding or abdominal pain. We report a case of a 26-year-old Asian primigravida woman who conceived through ovulation induction and presented at 19 weeks and 4 days of gestation—one week after a successful Macdonald cerclage, with severe abdominal pain and hemodynamic instability. Bedside ultrasound revealed significant hemoperitoneum and a viable intrauterine fetus. Emergency laparotomy identified an unruptured right fallopian tube containing a 5 × 6 cm mass. A right salpingectomy was performed due to suspected ectopic pregnancy, and no other bleeding source was found. Histopathology confirmed tubal ectopic pregnancy. The postoperative course was uneventful, and the intrauterine pregnancy successfully progressed to term. Heterotopic pregnancy should be considered in the differential diagnosis of hemoperitoneum, even in the second trimester. https://crcp.tums.ac.ir/index.php/crcp/article/view/1070 https://crcp.tums.ac.ir/index.php/crcp/article/download/1070/720

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 2 2025 10 15 79 82 Dariush Taghilou Clinical Toxicology, Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Reyhaneh Soleymani Department of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Fatemeh Alizadeh Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Farzaneh Mohammad nezhad Department of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Med 171 175 EN Mobin Faghih Soleimani Faghih Soleimani Medical Student, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran Ali Yamini Assistant Professor of Surgery, Ward of Surgery, Besat Hospital, Hamadan, Iran Ehsan Amiri Medical Student, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran Saman Khosronezhad Medical Student, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran 2023 10 09 2023 10 24 Accidental esophageal intubation is a preventable human error that complicates airway management and continues to occur despite advances in medical devices. Perforation of the stomach has been associated with esophageal intubation in several case reports.This report presents a case of an elderly woman suspected of having COVID-19-related pneumonia. She was intubated due to respiratory dysfunction. In the initial few minutes, the patient became desaturated, leading to a second intubation. An hour later, the patient’s abdomen was distended, and the chest computed tomography (CT) showed a massive pneumoperitoneum. During laparotomy, a 6 cm long rupture was found in the lesser curvature, which was attributed to accidental esophageal intubation. To avoid such a fatal condition, it is imperative for physicians to ensure the correct positioning of the endotracheal tube. To achieve this goal, further investigation into readily available and highl y sensitive techniques is recommended. https://crcp.tums.ac.ir/index.php/crcp/article/view/882

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 4 2024 01 10 176 180 Zeba Siddiqi Department of Medicine, Era’s Lucknow Medical College and Hospital, Lucknow, India Mateen Saboor Department of Medicine, Era’s Lucknow Medical College and Hospital, Lucknow, India Shivesh Singh Department of Medicine, Era’s Lucknow Medical College and Hospital, Lucknow, India Haneen Shah Department of Emergency Medicine, Era’s Lucknow Medical College and Hospital, Lucknow, India 2023 10 21 2023 11 11 Pheochromocytoma is a rare catecholamine-secreting tumours of chromaffin tissues that cause a constellation of symptoms. It is closely associated with endocrine hypertension that can be masked, sustained or paroxysmal leading to hypertensive crisis, resulting in vascular and non-vascular complications and rarely cerebral ischaemia and stroke.A healthy 22 year old male reported with acute Right upper limb(RUL) monoplegia and Motor aphasia for five days with raised blood pressure levels. hypertonia was present, deep tendon reflexes were exaggerated in RUL and Right Plantar was extensor. General and systemic findings were nonsignificant . Routine investigations showed thrombocytosis and M.R.I. Brain was suggestive of acute infarction of Left Parieto-Temporal region. Renal doppler, Carotid Intima Media Thickness, Cerebral Angiogram, 2D-E.C.H.O. and Fundoscopy were normal. AntinuclearAntibody was negative. Contrast CT of abdomen revealed right adrenal mass suggestive of isolated Pheochromocytoma. Vanyl-Mandelic Acid was positive. Pa