Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 29 32 EN Abdolhamid Amouei Department of Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mojtaba Babaei-Zarch Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Fatemeh Ehsani General Surgeon, Yazd, Iran. Seyed Mostafa Tabataei Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Javad Asadi Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2017 02 08 2017 08 21 Ventriculoperitoneal (VP) shunt placement is the most common procedure used in the treatment of hydrocephalus. However, it has been associated with several complications. Herein, we report penetration of VP shunt into the transverse colon and anal extrusion in a 5-year-old child who was a case of congenital hydrocephalus. The patient underwent laparotomy. The tube was palpated to be in the sigmoid colon. The shunting tube was removed and transverse colon was repaired. https://crcp.tums.ac.ir/index.php/crcp/article/view/103 https://crcp.tums.ac.ir/index.php/crcp/article/download/103/72

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 50 54 EN Morteza Daraie Department of Internal Medicine, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyed Farshad Allameh Department of Internal Medicine, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Abbaszadeh Department of Internal Medicine, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2017 07 14 2017 08 26 A 25-year-old man with 10 years history of a migraine headache noticed ecchymotic lesions involving anterior chest wall, both upper and lower limbs that were unrelated to trauma. His laboratory data revealed prothrombin time (PT) 32 seconds, partial thromboplastin time (PTT) 44 seconds, international normalized ratio 6, and normal bleeding time. Mixing study was performed and normalized PT to 13 seconds and PTT to 38 seconds. Factor activity assay revealed a low level of Factors II, VII, IX, and X but normal level of Factor V. Factitious disorders were in high priority in our differential diagnosis. Thus, we evaluated serum warfarin level which was positive. There were no doubts that we encountered Munchausen case that abused warfarin compounds. We decided to use factor eight inhibitor bypassing activity for rapid correction of coagulation disorder. He suddenly complained of chest pain and dyspnea. We encountered to pulmonary embolism. https://crcp.tums.ac.ir/index.php/crcp/article/view/126 https://crcp.tums.ac.ir/index.php/crcp/article/download/126/77

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 60 62 EN Peyman Adibi Department of Gastroenterology and Hepatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Maryam Soheilipour Department of Gastroenterology and Hepatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2017 07 02 2017 08 19 No Abstract https://crcp.tums.ac.ir/index.php/crcp/article/view/125 https://crcp.tums.ac.ir/index.php/crcp/article/download/125/79

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 42 45 EN Masoud Mohammadpour Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Bahare Yaghmaie Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Meysam Sharifzadeh Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Behdad Gharib Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Noohi Department of Pediatric Intensive Care Unit, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 04 2017 08 21 Pertussis incidence is increasing worldwide especially in infants < 2 months old with high mortality rate. Fulminant pertussis is characterized by refractory hypoxemia, cardiogenic shock, pneumonia, and intense leukocytosis that certainly needs intensive care and can lead to 75% mortality rate. Leukoreduction measures especially exchange transfusion (ET) have been used with some successful outcomes. We report ET as a treatment in a case of malignant pertussis with multi-organ failure syndrome. A 57-day-old infant who was admitted in pediatric intensive care unit with severe paroxysmal cough and extreme leukocytosis that despite appropriate treatment and full supportive care progressed to seizure, renal failure, pulmonary hypertension, and shock state, but his condition improved after ET. The patient was discharged from our hospital in good condition. ET even in the presence of multi-organ failure may be lifesaving and should be considered. https://crcp.tums.ac.ir/index.php/crcp/article/view/117 https://crcp.tums.ac.ir/index.php/crcp/article/download/117/75

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 55 59 EN Mahboobe Hemmatabadi Department of Endocrinology and Metabolism, School of Medicine, Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Tina Deihim Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Neda Meftah Department of Endocrinology and Metabolism, School of Medicine, Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sahar Karimpour Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 10 2017 08 27 Around 50% of patients with Addison disease (AD) have other autoimmune disorders. Neuropsychiatric symptoms may be presenting features of an Addisonian crisis or may be presented in patients with adrenoleukodystrophy (ALD) or Hashimoto encephalopathy; that these disorders are associated with primary adrenal insufficiency (AI). Nearly 5% of individuals with autoimmune AD develop pernicious anemia. X-linked ALD (X-ALD) is an inherited neurodegenerative disorder; a frequent but under-recognized cause of primary adrenocortical insufficiency. The classic picture of Vitamin B12 deficiency is subacute combined degeneration of the dorsal (posterior) and lateral spinal columns. The neuropathy is symmetrical, affects the legs more than the arms. It begins with paresthesia and ataxia and can progress to severe weakness, spasticity, paraplegia, even fecal, and urinary incontinence. We report a case of autoimmune AI who had presented with some neurologic symptoms. The challenging point was differentiating between X-ALD and other neurological syndromes that have an association with AI. We report a case of autoimmune adrenal insufficiency who had presented with some neurologic symptoms. The challenging point was differentiating between X-ALD and other neurological syndromes associating with adrenal insufficiency. https://crcp.tums.ac.ir/index.php/crcp/article/view/120 https://crcp.tums.ac.ir/index.php/crcp/article/download/120/78

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 33 36 EN Darush Iranpoor Department of Internal Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran. 2017 02 25 2017 08 23 Acute myocardial infarction (MI) with a normal coronary angiogram is a well established abnormality, although it is usually related with stenosis in coronary arteries. We reported here a case of a 24-year-old man referring with acute inferior MI after MaxMan capsule consumption. The patient had not any related risk factors of coronary artery disease and a history of prior MI. The acute inferior infarction in this patient was detected in the electrocardiogram in the absence of any stenosis or obstruction in the angiogram. We do not recommend MaxMan intake as a usual drug before intercourse. https://crcp.tums.ac.ir/index.php/crcp/article/view/104 https://crcp.tums.ac.ir/index.php/crcp/article/download/104/73

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 37 41 EN Mohammadreza Salehi Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Talebi Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Alireza Ghanadan Department of Pathology, School of Medicine, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Niloofar Ayoobi Yazdi Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2017 05 14 2017 08 22 Lymphoma is the most common malignancy originating from hematopoietic systems. Diverse biological and clinical manifestations of non-Hodgkin lymphoma have been recognized. As an unusual type of non-Hodgkin lymphoma is Burkitt lymphoma. The variability of the initial presentation is not unusual. We present a 15-year-old boy with generalized abdominal pain, fever. He had massive orange pleural effusion and ascites. There were peritoneal seeding and omentum thickening in abdominal computed tomography scan. Pathological investigations of the peritoneal biopsy revealed B-cell lymphoma (starry sky in pathology). The clinical presentation of sporadic Burkitt lymphoma could mimic some other diseases. Therefore, the clinicians should consider Burkitt lymphoma between the multiple differential diagnoses. In the case of peritoneal involvement, its differential diagnosis could be usually, peritoneal carcinomatosis, malignant peritoneal mesothelioma, and tuberculous peritonitis. https://crcp.tums.ac.ir/index.php/crcp/article/view/114 https://crcp.tums.ac.ir/index.php/crcp/article/download/114/74

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 2 2017 10 10 46 49 EN Mehran Zarghami Department of Psychiatry, School of Medicine, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. Fatemeh Taghizadeh Department of Psychiatry, School of Medicine, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. Ali Sharifpoor Internal Ward, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran. 2017 07 23 2017 09 03 Carbon monoxide (CO) concentration in the body will be decreased after smoking cessation. However, confounding factors may influence the results. Exhaled CO (eCO) assessment of lung is a simple, noninvasive tool, but confounder factors such as gas fireplaces might influence results. We thus quantified the effect of them in two smokers with chronic obstructive pulmonary disease (COPD). We described one of these confounder factors in two smokers with COPD in a clinical trial study setting with IRCT201609271457N11 coding in IRCT. The amounts of eCO and carboxyhemoglobin of these patients rose while the average daily smoking decreased (in the first patient) or stopped smoking (in the second patient). We found that they had used the fireplace to heat their home. These measures decreased in both patients by discontinuing the use of the gas fireplace. The gas fireplaces influence the results of eCO assessments in smoking cessation programs. https://crcp.tums.ac.ir/index.php/crcp/article/view/127 https://crcp.tums.ac.ir/index.php/crcp/article/download/127/76