International Journal Of Medical Case Reports
International Journal of Medical Case Reports (ISSN- 2455-0574) is open access, peer-reviewed journal. It strives for the publication of high-quality case reports as well as case reviews in the field of medicine. All published papers will be available immediately from the date of publication on the journal’s website. The journal and its editorial board are committed to providing immediate, full, and unconditional access to all its published papers for everyone to read. The journals main aim is to publish original research papers in clinical as well as non-clinical subjects including anatomy, physiology, biochemistry, forensic medicine, microbiology, pathology, pharmacology, medicine including pediatrics, surgery including orthopedics, Obstetrics and Gynecology psychiatry, radiology, dermatology, anesthesiology, ophthalmology, ENT and preventive and social medicine. International Journal of Medical Case Reports (IJOMCR) not only aims to publish rare case reports but also rare presentations of not so rare cases. It also particularly emphasizes publication of case reviews, conference abstracts, and interesting image-based short articles and brief communication provided that they are beneficial for other medical professionals. Our emphasis is on publications of case reports by residents working as Junior residents as they come across different cases during their residency. To start with International Journal of Medical Case Reports (IJOMCR)will be published quarterly but sooner than later we strive to publish it every month. Our emphasis is on the quality of papers rather than the number of papers published. This journal strives to comply with requirements as prescribed by International Committee for Medical Journal Editors.
Nursing Perspectives on Managing Pregnancy with Unicornuate Uterus: A Case Report.
Background: `Unicornuate uterus is a rare congenital uterine malformation resulting from incomplete development of one of the paired Müllerian ducts. It is associated with adverse reproductive outcomes such as infertility, recurrent pregnancy loss, increased miscarriages, preterm labor and adverse pregnancy outcomes. Diagnosis is often incidental during routine ultrasound or advanced imaging like 3D ultrasonography. Management of pregnancy in women with unicornuate uterus requires a multidisciplinary approach due to the increased risk of cervical insufficiency and other complications. Prophylactic cervical cerclage is considered an effective intervention to prevent preterm birth in such high-risk pregnancies. Nursing care plays a crucial role in antenatal monitoring, patient education, and supporting adherence to treatment plans. Case summary: We report the multidisciplinary management case of a 27-year-old pregnant woman with a unicornuate uterus who conceived naturally and underwent prophylactic cervical cerclage to prevent cervical insufficiency. Emphasizing nursing and midwifery perspectives. Discussion: Our present case study described the successful antenatal management of a 27-year-old woman with a unicornuate uterus. Despite a poor obstetric history observed natural conception and received prophylactic cervical cerclage to prevent cervical insufficiency. Although the patient remained asymptomatic inspite of associated anomalies throughout pregnancy. Early detection through routine ultrasound and 3D imaging enabled timely multidisciplinary intervention. Nurses and midwives played a pivotal role through regular antenatal monitoring, psychological support, and individualized health education. Counseling on signs of preterm labor, activity restriction, and hygiene maintenance empowered the patient to participate actively in her care. This case emphasizes that with early intervention and vigilant nursing care, favorable maternal and fetal outcomes are achievable even in complex pregnancies involving uterine anomalies.
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From Toxin to Triage: Nursing Strategies in Paraquat Poisoning Management.
Background: Paraquat (N,N′-dimethyl-4,4′-bipyridinium dichloride) is a widely used herbicide that is associated with high fatality rates following ingestion. Despite global bans, paraquat remains available in India which is an important factor contributing to intentional and accidental poisonings. Its toxicity results in severe multiorgan dysfunction, particularly pulmonary fibrosis, renal failure, and hepatic injury, with no specific antidote available. Supportive care and evidence-based nursing interventions are therefore central to improving outcomes. Case Report: We report the case of a 19-year-old male who presented to the medical intensive care unit following intentional ingestion of approximately 100 mL of a 24% paraquat solution. The patient developed systemic manifestations including vomiting, respiratory distress, acute kidney injury, hepatic dysfunction and leukocytosis. He required non-invasive ventilation, haemodialysis, and multimodal pharmacotherapy, including N-acetylcysteine, corticosteroids, antioxidants, antibiotics and hepatoprotective agents. Laboratory investigations showed derangements in renal and liver function, elevated bilirubin, and leukocytosis, with gradual biochemical improvement after supportive therapy. Nursing care emphasized airway and oxygenation monitoring, fluid balance, neurological status, infection prevention, and psychological support. Despite aggressive supportive measures, the prognosis in paraquat poisoning remains guarded, underscoring the importance of early recognition, comprehensive medical management, and structured nursing protocols. Conclusion: This case highlights the lethal nature of paraquat poisoning and the absence of a curative antidote. Multidisciplinary collaboration, vigilant nursing interventions, and early supportive care are pivotal in mitigating morbidity and mortality. Nursing strategies that combine physiological monitoring with psychosocial support play a crucial role in patient recovery.
One Anaesthesia, One Surgery: Synchronous Bilateral Robot-Assisted Laparoscopic Pyeloplasty in a 1.5-Month-Old Infant
Background: Robot-assisted laparoscopic pyeloplasty (RALP) is increasingly being utilized for pediatric ureteropelvic junction obstruction (UPJO). It is reported to offer outcomes comparable to open surgery. However, its application in infants is technically challenging due to limited intraperitoneal space and potential instrument collision. In cases of bilateral UPJO, synchronous bilateral repair provides advantages of reduced anesthesia exposure and shorter hospital stay, but its use in very young infants remains scarcely reported. Case Report: We report the case of a 1.5-month-old male with antenatally detected bilateral hydronephrosis. Postnatal imaging and renography confirmed obstructed bilateral UPJO with suboptimal renal function. Following recurrent episodes of urinary tract infection he underwent synchronous bilateral RALP using the da Vinci Si system. Conclusion: This case demonstrates the technical feasibility and safety of synchronous bilateral RALP in very young infants. Benefits of single-stage robotic approach reduces
Uterine Ischemia Secondary to Chronic Procidentia: A Rare Complication of Advanced Pelvic Organ Prolapse
Background: Uterine ischemia is an uncommon condition typically associated with uterine artery embolization or malignancy. Case Report: We report a rare case of uterine ischemia secondary to complete uterine prolapse in a generally healthy 53-year-old woman with fourth degree prolapse (procidentia). The patient had undergone significant weight loss prior to elective pelvic reconstructive surgery. At the time of the planned abdominal subtotal hysterectomy and sacrocervicopexy unexpected findings included uterine ischemia with necrotic areas and diffuse peritoneal inflammation. Due to concerns about tissue integrity the intended procedure was modified. Conclusion: This case highlights a previously unreported complication of advanced uterine prolapse and raises the possibility of vascular compromise exacerbated by mechanical factors and rapid weight loss. Awareness of this rare complication may aid surgical planning in similar cases.
Sinister Masquerade: A Rare Case of Primary Bone Follicular Lymphoma Mimicking Chronic Osteomyelitis and Tuberculosis
Background: Primary bone lymphoma (PBL) is a rare extra-nodal manifestation of non-Hodgkin lymphoma (NHL), constituting less than 1% of all NHLs and approximately 7% of malignant bone tumors. While diffuse large B-cell lymphoma is the predominant subtype, follicular lymphoma (FL) rarely presents as isolated primary bone disease. Accurate histopathological evaluation is therefore pivotal for diagnosis and management. Case Report: We describe a 26-year-old immunocompetent male presenting with progressive pain and swelling over the left humerus. Imaging revealed a destructive lytic lesion with soft tissue extension, initially suggestive of chronic osteomyelitis. Empiric antibiotic and anti-tubercular therapies were initiated without improvement. The patient subsequently developed pathological fracture, chest wall extension, lymphadenopathy, systemic “B” symptoms, and a cavitary lung lesion. Laboratory evaluation revealed anemia, elevated inflammatory markers, and markedly raised β2-microglobulin. Definitive diagnosis was achieved by excisional lymph node biopsy and bone marrow examination, which demonstrated Grade 3A follicular lymphoma with positive immunohistochemistry for CD20, CD10, BCL-2, BCL-6, and C-Myc, and a high Ki-67 index. The patient deteriorated rapidly and succumbed before initiation of definitive oncologic therapy. Conclusion: Primary bone follicular lymphoma represents a rare and diagnostically challenging entity that may masquerade as chronic osteomyelitis or skeletal tuberculosis. This case highlights the need for early consideration of lymphoproliferative disorders in atypical, treatment-refractory bone lesions.
From Blister to Breakthrough: A Case Report on Pemphigus Vulgaris with Early Rituximab Intervention.
Background: Pemphigus vulgaris (PV) is a rare, chronic autoimmune blistering disorder characterized by IgG autoantibodies targeting desmoglein-3. This results in loss of keratinocyte adhesion and intraepidermal blistering. While systemic corticosteroids have historically formed the cornerstone of therapy, long-term use is associated with significant morbidity. Rituximab, an anti-CD20 monoclonal antibody has recently emerged as a first-line agent due to its superior efficacy and safety profile. Early intervention with targeted immunotherapy is critical in improving disease outcomes and minimizing complications. Case Report: We report the case of a 50-year-old woman who presented with a one-month history of painful flaccid bullae and erosive, crusted lesions predominantly affecting the trunk, with extension to the chest, neck, scalp, ears, and oral cavity. Histopathological analysis revealed suprabasal clefting with acantholysis, and direct immunofluorescence demonstrated intercellular IgG deposition in a fishnet pattern, confirming the diagnosis of PV. The patient was started on rituximab as primary systemic therapy, combined with oral prednisolone, topical clobetasol, and dexamethasone elixir as adjunctive treatment. Supportive wound care and prophylactic supplementation with calcium and vitamin D were also provided. At two-week follow-up, the patient demonstrated reduced blister formation, improved healing of erosions, and no treatment-related complications. Conclusion: This case highlights the importance of early diagnosis and initiation of rituximab-based therapy in pemphigus vulgaris. Early intervention with B-cell–directed immunotherapy, combined with corticosteroids and supportive care, can reduce disease activity, limit steroid exposure, and improve long-term prognosis. A multidisciplinary, patient-centred approach remains essential to optimize outcomes in this potentially life-threatening disease.
Eosinophilic Granulomatosis with Polyangiitis Revealed by Cutaneous and Neurologic Manifestations in a Young Woman
Background: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare immune-mediated vasculitis classified under anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides. It typically involves small- to medium-sized vessels and manifests as a triad of asthma, peripheral eosinophilia, and necrotizing vasculitis with extravascular eosinophilic granulomas. Due to its heterogeneous presentation, diagnosis is challenging and relies on clinical, laboratory, radiological, and histopathological correlation. Case report: We present the case of a 37-year-old woman with a history of asthma who developed painful cutaneous lesions, sensory-motor neuropathy, and respiratory complaints. Laboratory investigations revealed marked leukocytosis with eosinophilia, elevated inflammatory markers, and positive ANA with negative ANCA. Skin biopsy confirmed necrotizing vasculitis with eosinophilic infiltration. Imaging demonstrated bilateral ground-glass opacities and peribronchovascular nodules, while bronchoalveolar lavage showed eosinophilic predominance. Electroneurography indicated early polyneuropathy. Based on asthma, eosinophilia, pulmonary infiltrates, neuropathy, and histological findings, EGPA was diagnosed. The patient was treated with high-dose prednisone and cyclophosphamide pulses, leading to rapid hematological and clinical improvement, including resolution of cutaneous lesions and weight recovery, although neuropathic symptoms persisted. Conclusion: This case illustrates the multisystemic involvement of EGPA and highlights the diagnostic significance of cutaneous findings in the appropriate clinical context. EGPA should be suspected in patients with adult-onset asthma, unexplained eosinophilia, and systemic manifestations, even in the absence of ANCA positivity. Early recognition and initiation of immunosuppressive therapy are crucial to achieve remission and prevent irreversible organ damage.
Eosinophilic granulomatosis with polyangiitis
A Rare Case of Aortic Arch Penetrating Stab Wound Masked and Occluded by Mediastinal Hematoma: A Case Report and Literature Review.
Background: Penetrating injuries to the aortic arch are extremely rare and are associated with a very high prehospital mortality rate. Most patients succumb to massive hemorrhage even before reaching definitive care. In hemodynamically stable patients such injuries may be radiologically silent posing significant diagnostic and therapeutic challenges. Mediastinal hematoma can occasionally tamponade bleeding obscuring radiologic evidence of vascular injury, and delaying intervention. Case Report: An 18-year-old male presented to the emergency department after sustaining a penetrating stab wound over the suprasternal notch. He was hemodynamically stable with no external bleeding or signs of respiratory compromise. Initial investigations including transthoracic echocardiography and noncontrast computed tomography (CT) showed no evidence of major vascular injury however a retrosternal hematoma and mediastinal widening was evident. Surgical exploration via median sternotomy was done which revealed a full-thickness tear at the superior aspect of the aortic arch. This tear was seen to be involving the origins of the innominate and left common carotid arteries. The hematoma had effectively tamponaded the lesion thereby masking active bleeding. Cardiopulmonary bypass was instituted to provide optimal visualization. The tear was successfully repaired and the patient had an uneventful recovery. Conclusion: A high index of suspicion is essential in cases of penetrating chest injuries. Early surgical exploration should be strongly considered when clinical presentation and mechanism of injury raise concern for major vascular trauma regardless of reassuring imaging findings.
Complications of Robotic Gastrointestinal Surgery : A Case Report of An Adhesive Small Bowel Obstruction
Background: Robotic surgery is increasingly used in gastrointestinal surgical procedures for its precision, threedimensional visualization and smaller incisions. However, postoperative complications can still occur including adhesive small bowel obstruction (ASBO). ASBO results from fibrous bands that kink or entrap bowel loops and its diagnosis is primarily clinical and supported by CT imaging. Although overall safety profiles approximate laparoscopy studies have documented postoperative complications after robotic surgery. Case summary: A 74-year-old man underwent robotic umbilical hernia repair with mesh. Four months later, he presented with cessation of stool, abdominal distension and bilious vomiting, with a distended, tympanic abdomen on examination and air–fluid levels on plain radiography. Contrast-enhanced CT demonstrated small-bowel distension with a transition point in the right iliac fossa. Intraoperatively the small bowel was dilated without any signs of ischemia and the obstruction was caused by a fibrous band between the small intestine and mesentery (small bowel–mesenteric adhesion). Adhesiolysis with division of the adhesive band was performed. Bowel transit resumed within 24 hours and the patient was discharged on postoperative day two and had an uneventful 6-week follow-up with return to normal activity. Conclusion: This case highlights ASBO as a potential delayed complication after minimally invasive robotic abdominal surgery even following seemingly straightforward procedures such as umbilical hernia repair with mesh. Early recognition with CT to localize the transition point and timely operative adhesiolysis can yield rapid recovery and excellent short-term outcomes. Vigilance for ASBO should be maintained in post-robotic surgery patients presenting with obstructive symptoms and clinicians should counsel patients regarding this risk despite the overall favorable safety profile of robotic techniques.
Synchronous Breast and Prostate Cancer in a 76-Year-Old Male: A Case Report
Background: Synchronous primary malignancies defined as two or more distinct tumors diagnosed within six months are rare clinical entities. Male Breast Carcinoma (MBC) accounts for less than 1% of all breast cancers and about 1% of male malignancies, whereas prostate cancer is among the most common male cancers globally. Their coexistence is extremely uncommon often raising questions of shared hormonal and genetic aetiologies. Mutations in BRCA genes, particularly BRCA2, increase the risk of both cancers, though sporadic cases without genetic predisposition are also observed. Case Report: We present a 76-year-old male with type 2 diabetes mellitus, ischemic heart disease, and a family history of breast cancer who presented with left nipple retraction and a palpable retro-areolar mass. Ultrasound breast confirmed presence of spiculated mass with microcalcifications and nipple retraction. A biopsy was done which showed grade 3 invasive ductal carcinoma, ER/PR-positive, HER2-negative and Ki-67 50%. PET-CT unexpectedly identified a hypermetabolic prostate lesion. Further evaluation with MRI and targeted biopsy confirmed adenocarcinoma, Gleason score 4+3=7. Prostatic tumor was confined to the left lobe. The patient underwent left mastectomy with sentinel node biopsy (pT2N0) followed by tamoxifen. For the prostate cancer, androgen deprivation therapy was initiated, followed by brachytherapy and external beam radiotherapy. The patient tolerated treatment well and achieved excellent biochemical response with PSA suppressed to 0.012 ng/mL at 11 months without evidence of recurrence. Conclusion: Synchronous male breast and prostate cancer represents an exceptionally rare clinical scenario. This case highlights the importance of high index of suspicion, multimodal imaging and multidisciplinary planning in elderly patients presenting with atypical findings.
Small Bowel Intussusception Secondary to a Peutz-Jeghers Hamartomatous Polyp: A Rare Cause of Acute Abdominal Pain
Background: Intussusception in adults is an uncommon cause of intestinal obstruction, differing from pediatrics cases where idiopathic aetiologies predominate. In adults, it is usually associated with an underlying pathological lead point, frequently neoplastic. Peutz-Jeghers syndrome (PJS), an autosomal dominant disorder characterized by mucocutaneous pigmentation and hamartomatous gastrointestinal polyps, is a rare but important cause. Although PJS predisposes to both benign and malignant neoplasms, small bowel intussusception secondary to hamartomatous polyps is infrequently reported. Case Report: We present the case of a 27-year-old male with no significant past medical history who presented with progressive severe abdominal pain, nausea, and a single episode of vomiting. Physical examination revealed a vague abdominal mass, and laboratory investigations demonstrated leucocytosis and mild lactic acidosis. Contrast-enhanced abdominal CT showed a whirlpool sign and mural hematoma suggestive of volvulus or intussusception. Emergency laparoscopy converted to mini-laparotomy revealed a 20–30 cm ischemic small bowel segment with intussusception approximately 140 cm proximal to the ileocecal junction. A firm intraluminal polypoid lesion served as the lead point. Segmental small bowel resection with primary anastomosis was performed. Histopathological analysis confirmed a Peutz-Jeghers-type hamartomatous polyp without dysplasia or malignancy. The patient had an uneventful postoperative recovery and was discharged in stable condition. Conclusion: This case highlights the diagnostic and therapeutic challenges of small bowel intussusception in adults. Although rare, PJS-related intussusception should be considered in young adults presenting with nonspecific abdominal pain and bowel obstruction. Early recognition with cross-sectional imaging and prompt surgical intervention are essential to prevent ischemia and improve outcomes.Surveillance strategies remain critical in patients with PJS to prevent recurrence and other complications.
Successful Peripartum Management of Placenta Percreta with Bladder Invasion Using Prophylactic Internal Iliac Artery Balloon Occlusion and obstetric hysterectomy: A Rare Case Report.
Out of the placenta accreta spectrum (PAS), Placenta percreta is the most invasive form and it causes significant risk of haemorrhage. Prophylactic bilateral internal iliac artery balloon occlusion (PBO-IIA) has been proposed to reduce haemorrhage during surgical procedure, though its effectiveness remains questionable. We are reporting a case of 29-year-old multigravida (G3 P2 L2) pregnant women at 30 weeks of gestation with prior 2 caesarean sections who was referred to us from district hospital with antepartum haemorrhage first episode . Imaging investigations revealed placenta previa with MRI showing features of placenta accreta spectrum with placenta percreta with possibility of bladder and psoas muscle invasion. Patient was haemodynamically stable . patient was given corticosteroids for lung maturity , magnesium sulphate for neuroprotection, and tranexamic acid to control bleeding . The case was discussed with intervention radiologist and planned for elective cesarean section with prophylactic internal iliac artery ballon placement as and when required. On day 4 of admission , patient had sudden episode of bout of bleeding of around 400 cc blood transfusion started ,, and simultaneously intervention radiologist informed and patient was shifted for mri based PBO-IIA placement . Procedure done and then patient shifted for emergency cesarean, pt was haemodynamically stable . Prophylactic bilateral internal iliac artery balloon occlusion i.e., PBO-IIA was Performed through femoral access before surgical intervention. The balloon of the armada catheter was not inflated till the delivery of baby. The placenta was seen completely invading the myometrium and coming onto the surface and uterovesical plane and therefore the baby was delivered by classical scar and then the decision for hysterectomy taken , Balloons were intermittently inflated and deflated with 10 mins on and 1 min off by radiologist which made the procedure easy and the bladder could be dissected away from uterus with average blood loss and devascularisation helped in delineating the planes clearly. . The patient recovered without any complications. Intraoperatively pt was throughout haemodynamically stable with average blood loss of 1400 cc .and received only 2 units of packed red cells and no other blood products. This case supports the selective use of PBO-IIA in placenta percreta with bladder invasion to assist in surgical treatment of condition with minimal blood loss and less time of surgery .
AN OVERLOOKED TRACHEOBRONCHIAL FOREIGN BODY IN AN IMMUNOCOMPROMISED UNRESPONSIVE PATIENT
Tracheobronchial foreign body (TFB) aspiration is a rare but serious event in adults, often missed due to atypical or nonspecific presentations. We report the case of a 67-year-old male with multiple comorbidities including HIV, hepatitis B, type 2 diabetes mellitus (DM-2), and hypertension (HTN), who was brought to the emergency room in an unconscious state and found to have severe hypoglycaemia. Despite prompt correction, his Glasgow Coma Scale (GCS) did not improve, requiring endotracheal intubation and mechanical ventilation. During his ICU stay, he developed a right-sided pneumothorax on day 3, presumed to be barotrauma-related and managed with an intercostal drain (ICD). Subsequently, the patient developed left lung collapse, prompting flexible bronchoscopy, which revealed a large, previously overlooked intrabronchial foreign body. This foreign body, likely aspirated during his initial unconscious state, was the actual underlying cause of both the right pneumothorax—due to a ball-valve mechanism—and the later left lung collapse following its migration. This case underscores the importance of early suspicion of TFB aspiration in critically ill, neurologically compromised adults, especially in the absence of clear history.
Presentation of Pulmonary Hypertension Treated with Sotatercept
Pulmonary hypertension (PH) is a complex, progressive disease often leading to acute kidney injury (AKI), right heart failure (RHF), and multi-organ dysfunction. This case involves a 64-year-old woman with severe pulmonary arterial hypertension who required intensive care after repeated episodes of AKI and RHF. The case explores the interconnected pathophysiology of reduced renal perfusion, ascites-induced intra-abdominal hypertension, and venous congestion. Management included continuous renal replacement therapy (CRRT), non-invasive ventilation (NIV) to avoid hemodynamic compromise, and later conventional dialysis for volume overload and worsening renal function. Oxygen therapy was carefully titrated due to significant right-to-left shunting through a patent foramen ovale (PFO). After conventional treatments failed, she was started on Sotatercept, a novel therapy targeting pulmonary vascular remodeling.
Partial Androgen Insensitivity Syndrome in a 16-Year-Old Presenting with Primary Amenorrhea: A Case Report
Partial Androgen Insensitivity Syndrome (PAIS) is a rare X-linked recessive disorder of sex development (DSD) characterized by resistance to androgen activity, affecting the morphogenesis and differentiation of androgen-responsive tissues. Caused by X-linked mutations in the androgen receptor (AR) gene, AIS encompasses a range of phenotypes from infertile males to phenotypically female individuals. It often presents with ambiguous genitalia and primary amenorrhea in adolescence, leading to diagnostic challenges and delayed management. We report the case of a 16-year-old phenotypically female patient from Pakistan who presented with primary amenorrhea. Clinical evaluation revealed ambiguous genitalia including clitoromegaly, hypospadias, a blind vaginal pouch, and bilateral inguinal masses. Hormonal assays demonstrated elevated gonadotropins with low testosterone levels. Karyotyping confirmed a 46,XY genotype. Imaging revealed the absence of Müllerian structures and bilateral inguinal testes. The patient and her family elected to pursue male gender identity, and a multidisciplinary team coordinated bilateral orchidopexy and excision of the vaginal sinus. This case underscores the importance of early recognition and comprehensive evaluation of primary amenorrhea, particularly in resource-limited settings. Timely diagnosis of PAIS allows for appropriate gender-affirming decisions, surgical management, and long-term hormonal therapy. Psychological support and family counselling are critical in optimizing patient outcomes.
A Rare Cause of Massive Upper GI Bleeding in a Young Adult: Gastric Cavernous Hemangioma Mimicking GIST
Gastric hemangiomas are exceedingly rare benign vascular tumors, representing less than 0.05% of all gastrointestinal neoplasms and often misdiagnosed as submucosal tumors like gastrointestinal stromal tumors (GISTs). We present a case of a 33-year-old woman who arrived with acute upper gastrointestinal bleeding, presenting as multiple episodes of coffee-ground emesis and signs of hypovolemia. Imaging identified a hyperenhancing lesion in the gastric fundus with active contrast extravasation. Endoscopic evaluation revealed a friable submucosal lesion with central ulceration, initially suspected to be a GIST. Due to bleeding risk, biopsies were inconclusive, and an elevated chromogranin A level further complicated the diagnosis. The patient underwent a laparoscopic-assisted partial gastrectomy for definitive diagnosis and treatment. Histopathological analysis confirmed a benign cavernous hemangioma involving the mucosa and muscularis propria, with negative margins and no malignant features. The patient recovered uneventfully postoperatively. This case emphasizes the diagnostic challenges of gastric hemangiomas, especially when imaging and endoscopic findings mimic more common neoplasms. Surgical resection remains the cornerstone for both diagnosis and management, particularly in cases where biopsy is unsafe or inconclusive. Early recognition and a multidisciplinary approach are critical for optimal outcomes in such rare presentations.
A rare case of Esophageal fibroma: A case report
Benign tumors of the esophagus are rare, with fibrovascular polyps being an uncommon intraluminal type that can lead to symptoms such as dysphagia, odynophagia, and airway obstruction. We report a case of esophageal fibroma in a 51-year-old male with a three-year history of neck swelling and painful swallowing. Imaging revealed a 5.7 × 4.5 cm intraluminal mass in the upper esophagus with tracheal deviation. Rigid esophagoscopy was attempted but led to significant bleeding, prompting surgical intervention. A left cervicotomy and esophagotomy allowed for complete excision of the lobulated tumor. Histopathology confirmed a solitary fibrous tumor. The patient recovered without complications. This case underscores the importance of recognizing fibrous tumors as a potential diagnosis in esophageal masses and supports surgical excision for large, vascular lesions to prevent severe complications
Gilbert Syndrome Presenting as Jaundice in an adolescent Boy : A Case Report
Gilbert Syndrome (GS) is a hereditary condition characterized by intermittent hyperbilirubinemia due to a mutation in the UGT1A1 gene. This case report discusses a 12-year-old male presenting with jaundice and mild abdominal discomfort. Laboratory investigations revealed isolated unconjugated hyperbilirubinemia with normal liver function tests, leading to the suspicion of GS. Genetic testing confirmed a homozygous polymorphism in the UGT1A1 gene. Management included patient education and regular monitoring, with no specific treatment required. This case highlights the importance of considering GS in the differential diagnosis of jaundice in adolescents and the role of genetic testing in its confirmation. Early diagnosis can prevent unnecessary interventions and ensure appropriate management.
Autoimmune Hemolytic Anemia In Pediatric Age Group: A Case Report.
Autoimmune hemolytic anemia (AIHA) is a rare condition in which the immune system destroys red blood cells, leading to hemolysis and anemia. This case report describes a 6-year-old male presenting with fatigue, pallor, and jaundice. Laboratory investigations revealed hemolytic anemia with positive direct antiglobulin test (DAT) for IgG antibodies. The child was diagnosed with warm antibody AIHA and treated with corticosteroids and supportive care. Hemoglobin levels stabilized, and symptoms improved with treatment. This case highlights the importance of early recognition and management of AIHA in children to prevent complications and improve outcomes.
Henoch-Schönlein Purpura in a 5-Year-Old Boy : Case Report
Henoch-Schönlein Purpura (HSP) is a common vasculitis in children, characterized by a purpuric rash, abdominal pain, arthritis, and renal involvement. This case report describes a 5-year-old boy presenting with these classic symptoms. Laboratory findings included elevated serum IgA and microscopic hematuria without thrombocytopenia. Diagnosis was confirmed based on clinical presentation and laboratory results. The patient was managed with supportive care, including pain management and hydration, and monitored for renal complications. This case highlights the importance of recognizing HSP's clinical features and the need for careful monitoring of renal function to prevent long-term complications.
Vitamin D Resistant Rickets in a 4-Year-Old Male Child
Vitamin D resistant rickets is a rare disorder characterized by impaired bone mineralization despite adequate vitamin D levels. This case report describes a 4-year-old male with growth retardation and leg bowing. Clinical examination and laboratory findings suggested rickets, with normal vitamin D levels but hypophosphatemia and elevated 1,25-dihydroxyvitamin D. Radiographs confirmed rickets. Since the patient was non-affording so PHEX gene testing was not done however patient responded well to oral phosphate supplementation. Treatment with phosphate supplements and calcitriol improved the patient's condition. This case highlights the importance of recognizing genetic rickets forms and the role of targeted therapy in management.
Management of HELLP Syndrome with ARDS in a Primigravida: A Case Report
HELLP syndrome, characterized by hemolysis, elevated liver enzymes, and low platelets, is a severe complication of pregnancy often associated with preeclampsia and eclampsia. We report a case of a 32-year-old primigravida who presented with HELLP syndrome and seizures at 35 weeks of gestation, necessitating emergent cesarean delivery. Postoperatively, the patient developed acute respiratory distress syndrome (ARDS), requiring prolonged intensive care management. Laboratory findings revealed hemolytic anemia, elevated liver enzymes, thrombocytopenia, and acute kidney injury. The patient was managed with mechanical ventilation, intravenous fluids, antihypertensives, corticosteroids, and platelet transfusions. Over six weeks, the patient's respiratory and renal functions normalized, and she was discharged in stable condition. The neonate also recovered well without significant complications. This case underscores the importance of early recognition and aggressive management of HELLP syndrome to prevent severe maternal and fetal complications. The development of ARDS as a complication highlights the need for a multidisciplinary approach in managing such cases.
Epidermoid Cyst of Forearm In A Young Male Showing Classical Pseudotesticular Pattern.
Epidermoid cysts are benign, slow-growing lesions commonly seen in young adults. This case report describes a 21-year-old male with a painless, progressively enlarging nodule on his right forearm. USG showed Presence of an epidermoid cyst characterized by a pseudotesticular pattern. The lesion was well-defined with a homogeneous echotexture, resembling testicular tissue. There was no significant internal vascularity on color Doppler imaging, further supporting the benign nature of the cyst. The surrounding tissues appeared normal with no signs of inflammation or other abnormalities. Clinical examination revealed a firm, mobile nodule with a central punctum. The cyst was excised under local anesthesia, and histopathology confirmed the diagnosis of an epidermoid cyst. The patient had an uneventful recovery with no recurrence at follow-up. This case underscores the effective management of epidermoid cysts through complete surgical excision.
Amiodarone-Induced Hypothyroidism: A Case Report
Amiodarone is an effective antiarrhythmic medication used for the treatment of various cardiac arrhythmias, but its use is associated with thyroid dysfunction, particularly hypothyroidism. This case report discusses a 61-year-old male who developed hypothyroidism following prolonged amiodarone therapy for ventricular arrhythmia. The patient presented with symptoms of fatigue, weight gain, and cold intolerance, and was found to have elevated TSH and low free T4 levels. He was managed with levothyroxine while continuing amiodarone therapy due to its necessity for arrhythmia control. Regular thyroid function monitoring was crucial in managing his condition effectively. The case highlights the need for awareness and regular screening for thyroid dysfunction in patients on long-term amiodarone therapy. Similar cases in the literature emphasize the variable incidence of amiodarone-induced hypothyroidism, particularly in iodine-sufficient regions. Early detection and appropriate management can prevent complications and improve patient outcomes.
A Case Report Of Haemolytic Uraemic Syndrome Following An Episode Of Gastroenteritis
Haemolytic uraemic syndrome (HUS) is a serious condition characterized by haemolytic anemia, thrombocytopenia, and acute kidney injury, frequently following an infection with Shiga toxin-producing Escherichia coli. We present the case of an 11-year-old female who developed HUS two weeks after an episode of gastroenteritis. She presented with decreased urine output, pallor, and hypertension. Laboratory findings revealed microangiopathic haemolytic anemia, thrombocytopenia, and acute renal failure, confirming the diagnosis of HUS. She was managed with supportive care, including intravenous fluids, blood transfusions, and renal replacement therapy. Her condition gradually improved, and she was discharged after three weeks with normalized renal function and hematologic parameters. This case highlights the critical importance of early recognition and management of HUS in pediatric patients presenting with post-diarrheal symptoms and acute kidney injury. Reviewing similar cases underscores the variability in clinical presentations and outcomes, emphasizing the need for prompt, individualized care strategies.
Antenatal Diagnosis of Hypoplastic Left Heart Syndrome at 22 Weeks of Gestational Age: A Case Report
Hypoplastic left heart syndrome (HLHS) is a severe congenital heart defect characterized by the underdevelopment of the left-sided heart structures, leading to systemic blood flow obstruction. This case report details the antenatal diagnosis of HLHS at 22 weeks of gestation in a 29-year-old woman. Fetal echocardiography confirmed severe hypoplasia of the left ventricle, mitral valve atresia, aortic valve stenosis, and a hypoplastic ascending aorta. The patient was counselled on the prognosis and management options, including staged surgical palliation. At 39 weeks, a male infant was delivered via planned cesarean section and underwent the Norwood procedure at 5 days old. The infant's postoperative course was uneventful, and he was discharged with plans for further surgical interventions. Early antenatal diagnosis and coordinated care significantly improve outcomes for HLHS, highlighting the importance of detailed fetal echocardiography and multidisciplinary management.
Hypernatremic Dehydration in an Exclusively Breastfed Infant: A Case Report
Hypernatremic dehydration is a critical condition characterized by elevated serum sodium levels due to an imbalance between water and sodium in the body. This case report details a 40-day-old male infant, exclusively breastfed, who presented with lethargy, poor feeding, and decreased urine output. Examination revealed signs of severe dehydration, including dry mucous membranes, poor skin turgor, and a sunken fontanelle. Laboratory investigations confirmed hypernatremia with a serum sodium level of 158 mmol/L and elevated serum osmolality. Management involved careful rehydration with intravenous fluids and continued breastfeeding support. The infant responded well, with normalization of sodium levels and improvement in clinical status. This case underscores the importance of early recognition and intervention in hypernatremic dehydration, particularly in exclusively breastfed infants. It also highlights the need for comprehensive parental education on proper breastfeeding practices and monitoring of infant hydration status. Similar cases in the literature emphasize the significance of timely diagnosis and gradual correction of hypernatremia to prevent complications.
A Case of Thalassemia Trait Misdiagnosed as Iron Deficiency Anemia
Thalassemia trait is a common inherited disorder characterized by microcytic, hypochromic anemia, often misdiagnosed as iron deficiency anemia (IDA). This report describes a 3-year-old boy with persistent anemia unresponsive to oral iron therapy. Initial laboratory findings suggested IDA, but further investigation using the Mentzer index (MCV/RBC) indicated thalassemia trait. The diagnosis was confirmed by hemoglobin electrophoresis showing elevated Hb A2 levels. Discontinuation of iron supplementation and initiation of folic acid therapy led to clinical improvement. This case underscores the importance of the Mentzer index in differentiating thalassemia trait from IDA, ensuring accurate diagnosis and appropriate treatment. Prompt recognition and correct diagnosis are essential for effective management and better patient outcomes.
Spontaneous Tumor Lysis Syndrome in a 62-Year-Old Male with Acute Myeloid Leukaemia: A Case Report
Spontaneous tumor lysis syndrome (sTLS) is a rare but severe oncological emergency that occurs without the initiation of chemotherapy, characterized by the rapid release of intracellular components leading to metabolic disturbances. This case report details a 62-year-old male with acute myeloid leukemia (AML) who presented with fatigue, weakness, and metabolic abnormalities indicative of TLS. Laboratory investigations revealed elevated serum uric acid, potassium, phosphate, and creatinine levels, along with hypocalcemia, confirming sTLS. The patient was managed with aggressive hydration, allopurinol, rasburicase, and correction of electrolyte imbalances. Hemodialysis was initiated due to worsening renal function. The patient showed significant improvement with normalization of metabolic parameters and was subsequently started on induction chemotherapy for AML. This case highlights the importance of early recognition and prompt management of sTLS in AML patients to prevent severe complications and improve outcomes.
Doxepin Induced Torsades de Pointes in a Middle-aged Female: A Case Report
This case report describes a 45-year-old female with no previous cardiac history who developed Torsades de Pointes (TdP) after initiation of doxepin for depression. The patient presented with dizziness and near-syncope, and her ECG showed significant QT prolongation and episodes of TdP. Investigations ruled out electrolyte imbalances and other common causes of QT prolongation. Immediate treatment with intravenous magnesium successfully terminated the TdP, and doxepin was discontinued. Subsequent monitoring showed normalization of the QT interval and resolution of symptoms. This case highlights the necessity for clinicians to be vigilant about the cardiovascular side effects of doxepin, even in patients without pre-existing risk factors. Regular monitoring of the QT interval and consideration of alternative medications should be considered in patients at risk of prolonged QT intervals.