pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Current Issue
Vol 9 No 4 (2024): July-August
Case Report(s)
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Human Brucellosis is a zoonotic disease with various clinical manifestations, ranging from asymptomatic infection to multisystem involvement. Cases with hematological abnormalities and lymphadenopathy, which were referred to the hematology department of the hospital, were described from September 2021 to August 2022. These Iranian patients included a 38-year-old man and two 64- and 24-year-old women. Due to the region’s endemicity and strong clinical suspicion of brucellosis, therapeutic management and invasive procedures such as splenectomy were avoided in one case. Based on the available literature, it is evident that the infrequent symptoms that accompany the typical symptoms of brucellosis may give rise to uncertainty and
hinder prompt diagnosis. The reason is that patients presenting with indications of pancytopenia, coupled with splenomegaly or lymphadenopathy, are typically referred to hematologists. Hence, the purpose of these case reports is to highlight the symptoms of brucellosis that mimic a primary hematologic disorder, facilitating faster and more accurate diagnosis. -
While presentations of novel severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) were observed to be mild in children, multi-system inflammatory syndrome in children (MIS-C) has emerged as one of the most critical phenomena in the era of Coronavirus disease 2019 (COVID-19). We present an eight-year-old boy with
prolonged fever, weakness, myalgia, arthralgia, oliguria, hematuria, hemoptysis, and periumbilical pain. With regards to the history of contact with SARS-CoV-2 four weeks prior to symptom onset and prominent gastrointestinal symptoms, MIS-C was highly suspected. Furthermore, based on the compatible symptoms and history of white-water rafting and exposure to contaminated soil two weeks prior to admission, leptospirosis was probable. Of note, Leptospirosis immunoglobulin M and COVID-19 immunoglobulin G were detectable. Lifesaving supportive measures, empirical antibiotic therapy, Remdesivir, Dexamethasone, and Prednisolone pulse therapy were prescribed. Afterward, gradual clinical improvement was shown. We aimed to report a case with MIS-C accompanied by severe leptospirosis to emphasize that in endemic areas of leptospirosis, considering the co-occurrence of MIS-C and other inflammatory disorders is crucial for multidisciplinary management. -
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disorder characterized by hyperplasia of pulmonary neuroendocrine cells. It is frequently asymptomatic and can be challenging to differentiate from other forms of reactive pulmonary neuroendocrine cell hyperplasia (NECH). Presented is a case report of DIPNECH along with a review of the diagnosis and management. A 50-year-old
female patient with a history of airway disease presented to the pulmonary ward with complaints of Functional Class III dyspnea and productive cough. The HRCT revealed the presence of multiple bilateral nodules in both lungs. The histopathology report from the nodule resection confirmed the presence of a carcinoid tumor, specifically identified as DIPNECH. As many similar cases have favorable treatment responses and satisfactory prognoses due to multidisciplinary treatment methods, the necessity of evidence-based management guidelines for DIPNECH and the accuracy of the disease definition is emphasized. -
Pelvis rupture secondary to renal colic is an exceptionally rare but severe complication of nephrolithiasis. This case report describes a 32-year-old male who presented with intense flank pain, gross hematuria, and urinary obstruction. A computed tomography (CT) scan revealed a 3-mm calculus at the ureterovesical junction causing hydronephrosis and, notably, a rupture of the renal pelvis with urine extravasation into the retroperitoneal space. Immediate intervention included ureteroscopic lithotripsy, stent placement, and antibiotic therapy, leading to symptom resolution and improved renal function. This report highlights the diagnostic challenges associated with pelvis rupture, which often mimics typical renal colic symptoms, and emphasizes the critical role of contrast-enhanced CT in detection. Prompt management is essential to prevent
complications such as sepsis and long-term renal damage. The case underscores the importance of recognizing this rare entity to optimize patient outcomes and guide future clinical approaches to similar presentations. -
Spontaneous pneumorrhachis and pneumoperitoneum are very rare conditions that involve the presence of air within the spinal canal and peritoneum, respectively, without any traumatic or underlying disease.During the COVID-19 pandemic,there have been reports of spontaneous pneumomediastinum occurring in some patients with severe cases of the virus. Herein, we present a case of spontaneous pneumomediastinum,
pneumothorax, pneumoperitoneum, pneumoretroperitoneum, pneumorrhachis, and subcutaneous emphysema in a young male without any past medical history of pulmonar y dise ase and PCR positive for COVID-19. He complained of mild dyspnea with sudden non-painful facial edema. One possible explanation for SPM in COVID-19 patients is the severe inflammation and damage to lung tissue caused by the virus. Also, now that the pandemic is over and the disease is not as severe as it was at the beginning, unknown aspects of the complications of this disease will appear. These complications are typically self-limiting and follow a benign clinical course. -
Dyskinesia, marked by involuntary and irregular movements, can result from various pharmaceutical agents. The case presented features a patient undergoing thoracotomy, experiencing dyskinesia, likely attributed to antipsychotics, antiemetics, and antibiotics, and subsequently treated with amantadine.
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Spinal tuberculosis (TB) is a rare extrapulmonary manifestation that can cause vertebral fractures, neurological deficits, and paraplegia. This report presents a 43-year-old male with sudden paraplegia, back pain, and sensory loss. MRI revealed fractures in T10, T11, and L5, and histopathology confirmed spinal TB with concurrent pulmonary TB and pleural effusion. The patient’s history of chronic dexamethasone misuse contributed to immunosuppression and disease dissemination. Classified as Grade 4 paraplegia, his condition required surgical stabilization, anti-TB therapy, and supportive care. This case highlights the rarity of multilevel vertebral fractures and severe neurological deficits in spinal TB, emphasizing the importance of early imaging,
tissue biopsy, and prompt multidisciplinary intervention to prevent permanent disability. -
As a rare subtype of delusional misidentification syndromes (DMSs), Fregoli Delusion involves the belief that two or more individuals are actually the same person disguised as another. In this case report, a 23-year-old male presents with Fregoli Delusion, self-inflicted harm, and a history of being kidnapped and abused. While the patient had abstained from alcohol and drugs for two years, neuroimaging revealed non-specific developmental anomalies, adding to the complexity of the clinical situation. Diagnoses and treatments are complicated by the coexistence of psychotic symptoms, mood dysregulation, and complex delusional constructs. A combination of antipsychotic medication and cognitive behavioural therapy is more effective in
treating schizophrenic patients. It is important to closely monitor this patient due to their history of non-adherence to their treatment plan and drug abuse. As a result of this situation, trauma-focused care and personalized interventions are necessary, as well as additional research to enhance the treatment of Fregoli Delusions resulting from this situation. -
Top of the Basilar Syndrome (TOBS) is a rare neurological condition caused by occlusion of the distal basilar artery, often resulting in significant morbidity. TOBS is particularly challenging to diagnose in younger patients with atypical risk factors. A 34-yearold man presented with vertigo following strenuous exercise. Initial misdiagnoses delayed treatment, and subsequent imaging revealed left vertebral artery dissection and basilar artery occlusion. Endovascular thrombectomy performed 41 hours and 45 minutes after symptom onset achieved a Thrombolysis in Cerebral Infarction (TICI) score of 2B. Despite complications, including hydrocephalus and pneumonia, multidisciplinary management led to significant recovery, with the patient’s modified Rankin Scale (mRS) score improving from 4 at discharge to 1 at one year. This case underscores the importance of clinical vigilance, advanced imaging, and endovascular thrombectomy in managing TOBS. Even with delayed intervention, multidisciplinary care can facilitate favorable outcomes in young patients with rare presentations.
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Kearns-Sayre syndrome is a rare mitochondrial disease that presents before the age of 20 years with ptosis, external ophthalmoplegia, and pigmentary retinopathy associated with endocrine and cardiac conduction abnormalities. Here we report an 18-year-old female presenting with fever, cough, secondary amenorrhea, diabetes ptosis, external ophthalmople gia, and ataxia . Fundosc opy revealed pigmen tary retinopathy. ECG showed intraventricular conduction abnormalities, and 2D echocardiography revealed global left ventricular hypokinesia with reduced ejection fraction. Hence, the diagnosis of Kearns-Sayre syndrome was made.
