ISSN: p-ISSN - 2454-129X; e-ISSN - 2454 -1303 Discipline: All medical, surgical and dental specialties Starting Year: 2015 Current volume: Volume 10 Issue per year: 12 (monthly) Editor-in-chief: Dr. Amit Agrawal, India Indexing: Index Copernicus, Journal Guide, BASE, Research Bible, Google Scholar E-mail: editor.ijcr@mansapublishers.com
Primary ciliary dyskinesia in an infant with post-infectious bronchiolitis obliterans and failure to thrive: A case report
We report the case of a 9-month-old male infant with recurrent severe viral pneumonia, culminating in bronchiolitis obliterans and chronic respiratory morbidity. The clinical course was marked by multiple pediatric intensive care unit admissions, prolonged oxygen dependency, and recurrent bacterial superinfections. High-resolution computed tomography revealed bronchiectasis and fibrotic changes. Given the chronicity of symptoms, a clinical suspicion of Primary Ciliary Dyskinesia (PCD) was raised. Genetic analysis detected heterozygous variants of uncertain significance in the DNAH1 and LRRC6 genes. This case highlights the diagnostic and management complexities in infants with post-viral chronic lung disease and the importance of early consideration and evaluation for underlying genetic etiology, such as PCD.
Copyright (c) 2025 S Shubhranshu Shekhar, Sanjukta De https://creativecommons.org/licenses/by-nc-nd/4.0
Individualized approach to infertility management with dydrogesterone: insights from case series
Infertility is a growing global concern, affecting about one in six individuals of reproductive age. In India, reported prevalence ranges from 3.9% to 16.8%, influenced by age, infections, lifestyle factors, and sociocultural elements. This case series highlights six women, aged 30–34 years, each presenting with different infertility challenges: Tubal factor infertility, male factor infertility, recurrent pregnancy loss, unexplained infertility, and early-stage endometriosis. All cases were managed with a personalized treatment approach that included oral dydrogesterone for luteal phase support (LPS). Dydrogesterone, a selective oral progestin with high bioavailability and endometrial specificity, was used to improve luteal phase adequacy and endometrial receptivity. Each patient received tailored care involving either natural conception support, ovulation induction, intrauterine insemination, or assisted reproductive technology, depending on their clinical profile. Oral dydrogesterone was administered as part of LPS in all six cases. Outcomes included successful conception or sustained pregnancy, demonstrating clinical benefit in each scenario. These real-world clinical cases emphasize the importance of individualized infertility management and illustrate the versatile role of dydrogesterone across varied reproductive conditions. Its incorporation into treatment protocols supported favorable outcomes, reinforcing its value in both spontaneous and assisted conception pathways.
Copyright (c) 2025 Pratik Tambe, Maneesha Khalse, Kamlesh Patel, Reshma Parekar https://creativecommons.org/licenses/by-nc-nd/4.0
Primary extranodal classical Hodgkin lymphoma presenting as a chest wall mass mimicking tuberculosis: A rare case report with long-term follow-up
Classical Hodgkin lymphoma (CHL) is usually nodal, with primary extranodal disease being rare. Thoracic involvement without nodal disease is particularly unusual and may mimic tuberculosis (TB). We report the case of a 61-year-old male initially diagnosed with tubercular pleural effusion and treated with anti-tubercular therapy. Six months into treatment, he developed an intrathoracic mass. Imaging revealed extrapleural lesions involving the anterior chest wall muscle. Histopathology and immunohistochemistry confirmed CHL. He was staged IIAx and received 2 cycles adriamycin, bleomycin, vinblastine, dacarbazine, followed by 4 cycles adriamycin, etoposide, vinblastine, dacarbazine to avoid bleomycin toxicity, plus involved-field radiotherapy. He achieved a complete metabolic response and remains disease-free without long-term complications for 9 years. This case underscores the diagnostic challenges of primary extranodal CHL and the importance of thorough evaluation of atypical chest lesions, especially in TB -endemic regions.
Copyright (c) 2025 Priyanka Jujjuvarapu, Shilpa Gupta, Vijay Dalal https://creativecommons.org/licenses/by-nc-nd/4.0
Trinucleotide repeat containing adaptor 6B protein deficiency syndrome – A rare cause for language delay and attention deficit hyperactivity disorder
Copyright (c) 2025 Somarajan Anandan, Sajeesh Rajendran, Ananthu Suresh, Sourav Asha Somarajan https://creativecommons.org/licenses/by-nc-nd/4.0
Disseminated tuberculosis presenting as lytic bone lesions: A diagnostic challenge in pediatric oncology
Lytic bone lesions in children often raise concern for malignancy, with differentials including Langerhans cell histiocytosis, Ewing’s sarcoma, lymphoma, and metastatic neuroblastoma. In tuberculosis (TB) endemic regions, however, infectious causes must also be considered to avoid misdiagnosis and unnecessary oncologic interventions. We report a case series of two immunocompetent children who presented to a pediatric oncology unit with multiple lytic skull lesions. Both had a family history of TB. Initial suspicion was for malignant disease, but histopathological examination confirmed TB. One child had disseminated craniofacial and vertebral involvement, while the other showed multifocal osseous disease, including the mandible, sternum, and scapula. Both children were managed successfully with anti-tubercular therapy in accordance with National TB Elimination Program (NTEP) guidelines. Although osseous TB accounts for only 5–6% of extrapulmonary TB, and multifocal skeletal involvement is rare, TB remains an important differential diagnosis for pediatric lytic lesions in endemic regions. Pediatric oncologists should remain vigilant for TB when evaluating children with multifocal lytic lesions, as early recognition can prevent unnecessary invasive procedures and inappropriate oncologic treatments.
Copyright (c) 2025 Samneet Singh Arora, Nishma Dhand, Kavita Saggar, Bhawna Malhotra, Preethi Anni Mercy Paul, Shruti Kakkar https://creativecommons.org/licenses/by-nc-nd/4.0
Aplastic anemia with paroxysmal nocturnal hemoglobinuria clones at diagnosis: Overlap, challenges, and therapeutic dilemmas
Aplastic anemia (AA) is a rare, potentially life-threatening bone marrow failure syndrome characterized by pancytopenia and hypocellular marrow. Clonal evolution, particularly the coexistence of paroxysmal nocturnal hemoglobinuria (PNH) clones, has important diagnostic and prognostic implications. We report the case of a 25-year-old male who presented with recurrent mucosal bleeding, progressive fatigue, exertional dyspnea, weight loss, and fever. Initial evaluation revealed severe pancytopenia with reticulocytopenia and markedly hypocellular bone marrow showing aplasia. Flow cytometry demonstrated PNH clones within red cells (0.03%), granulocytes (8.35%), and monocytes (6.45%). The absence of hemolysis, elevated lactate dehydrogenase, or thrombosis supported AA as the primary disease. The patient was managed with transfusion support, antifibrinolytics, and was listed for hematopoietic stem cell transplantation. The coexistence of PNH clones in AA complicates diagnosis due to overlapping clinical features but also carries prognostic implications. Small PNH clones are increasingly detected with high-sensitivity fluorescent labeled aerolysin-based flow cytometry and may predict a favorable response to immunosuppressive therapy. However, clonal expansion over time can lead to classical PNH with hemolysis and thrombosis, underscoring the need for serial monitoring. This case highlights the importance of routine PNH clone screening in AA patients at diagnosis. Even small, asymptomatic clones can influence prognosis and necessitate long-term surveillance.
Paroxysmal nocturnal hemoglobinuria clones
Copyright (c) 2025 Abulkalam Atiqurrehman Sirajwala, Rajvi Dinesh Raval , Rahenuma Yusuf Patel , Deven Atul Bodar https://creativecommons.org/licenses/by-nc-nd/4.0
Laparo-therapy for abdominal tuberculosis: Case report with review of literature
Abdominal tuberculosis (TB) has many varied clinical presentations. It can vary from small bowel obstruction to peritoneal disease to lymphadenopathy to rare colonic TB to a combination of any or all of the above. Herein, the authors present the case of a 25-year-old female patient who had dense parietal adhesions of mesentery and small bowel loops and a large collection of pus in her lower abdomen. She had already been on anti-microbial therapy for 2.5 months for ascites. Investigations (imaging and laboratory) pointed toward worsening and increasing peritoneal collection. She underwent a successful laparoscopic adhesiolysis, drainage of the collection, along with excision of the wall and toilet. The first line anti-Koch’s medical therapy (which was already on since 2.5 months), as per culture report, was continued for 1 year. Subsequent surveillance imaging reports revealed no recurrence of the collection and, eventually, a complete cure.
Copyright (c) 2025 Richa Verma, Abhijit Sharadchandra Joshi https://creativecommons.org/licenses/by-nc-nd/4.0
A rare cause of drop attacks in a young male
Copyright (c) 2025 Krishnan Balagopal, Jain George , Elizabeth kuruvilla , Ameen Abdul Khader, Jobin John, Nikhil Philip https://creativecommons.org/licenses/by-nc-nd/4.0
Three-dimensional debulking of eyelids in a case of pachydermoperiostosis: A case report
Pachydermoperiostosis (PDP) is a rare genetic disorder marked by skin thickening, digital clubbing, and periostitis. We present the case of a 53-year-old male with a 20-year history of progressive skeletal changes who developed severe eyelid hypertrophy and ptosis, leading to visual obstruction and cosmetic concerns. Diagnosis was confirmed through clinical findings, imaging, and histopathology. The patient underwent staged surgical correction, including horizontal debulking and levator plication for the upper eyelids, and wedge resections for the lower eyelids. Post-operative results showed a significant reduction in eyelid bulk, improved visual axis, and enhanced facial appearance. Histopathology of the excised tissue revealed sebaceous gland hyperplasia, mucin deposition, and foreign body granulomas, consistent with PDP. This case demonstrates that individualized surgical intervention can effectively manage the functional and aesthetic complications of eyelid involvement in PDP.
Copyright (c) 2025 Sara Ahmed Elbannan, Ahmed Mostafa Ibrahim, Ahmed Hamdy Shawky Elzekaity, Eman Mohamed Elsayed Emam, Sarah Ahmed Hassan https://creativecommons.org/licenses/by-nc-nd/4.0
Insights on the development and clinical implications of internal jugular vein anomalies – A report on fenestrated internal jugular vein encountered during neck dissection
In this fascinating clinical report, we explore the case of a 70-year-old male patient diagnosed with T2N1MO squamous cell carcinoma of the lip at the otolaryngology department. Diagnostic imaging before surgery unveiled an intriguing anomaly involving fenestration of the internal jugular vein (IJV), adding a layer of complexity to the surgical plan. With careful preparation, our surgical team skilfully executed a wide local excision of the primary tumor and performed a modified radical neck dissection, complemented by Abbe Estlander flap reconstruction. Identifying this rare IJV anomaly preoperatively enabled meticulous planning, allowing our team to navigate with precision, safeguarding nearby nerves and blood vessels. This exceptional case underscores the importance of recognizing anatomical variations during intricate procedures such as neck dissections. Through this report, we elucidate the pre-operative suspicion, intraoperative identification, and successful management of this rare IJV fenestration encountered during a challenging neck dissection.
Copyright (c) 2025 Pankhuri Mittal, Sarah S Sangma https://creativecommons.org/licenses/by-nc-nd/4.0
Ferric carboxymaltose-induced posterior reversible encephalopathy syndrome: A rare case report
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition characterized by acute neurological symptoms and distinctive imaging findings. It is commonly linked to hypertension, immunosuppressants, or chemotherapy, but rarely to intravenous (IV) iron infusion. We describe a 40-year-old female who developed PRES following IV ferric carboxymaltose (1 g) for severe anemia. Soon after infusion, she experienced anaphylactic shock with hypotension, bradycardia, facial swelling, vision loss, headache, and vomiting. Magnetic resonance imaging brain revealed bilateral parieto-occipital hyperintensities on T2/fluid-attenuated inversion recovery sequences, consistent with PRES. Labs showed worsening anemia (hemoglobin 7.4 → 6.3 g/dL), thrombocytopenia, leukocytosis, and a sharp rise in serum iron (362 μg/dL). She was managed with mannitol, levetiracetam, antibiotics, and supportive care. Gradual neurological recovery was observed, with vision improving over 1 week. This report highlights a rare instance of PRES triggered by ferric carboxymaltose. Timely recognition and appropriate treatment are essential to prevent long-term complications. Clinicians should remain vigilant for PRES in patients presenting with acute neurological symptoms after IV Iron therapy.
Posterior reversible encephalopathy syndrome
Copyright (c) 2025 Amit Shankar Singh, Deepak Saini, Arshpreet Singh https://creativecommons.org/licenses/by-nc-nd/4.0
Eyebrow ptosis: Barely mentioned and frequently overlooked
Copyright (c) 2025 Somarajan Anandan, Sajeesh S Rajendran, Joesni Joy, Anandhu Suresh https://creativecommons.org/licenses/by-nc-nd/4.0
Unraveling isolated polycystic pancreatic disease: A clinical rarity and its review in literature
Pancreatic cysts are common, with pseudocysts being the most frequent. Polycystic pancreatic disease usually coexists with cysts in other solid organs, but isolated involvement of the pancreas is rare. This report presents a case of a 40-year-old female who presented with vague abdominal discomfort and pain with no history of pancreatitis or trauma. Radiological imaging showed multiple variable-sized thin-walled pancreatic cysts with no cystic lesions in the liver, spleen, kidneys, or brain. The patient was diagnosed with isolated polycystic disease of the pancreas and is on conservative management with regular follow-up. In summary, idiopathic isolated macro-polycystic disease of the pancreas is a rare condition that is usually asymptomatic with a benign outcome and is primarily diagnosed through imaging techniques, with magnetic resonance imaging being the most accurate. Further data and experience are needed to develop standardized treatment protocols in case of significant symptoms.
Copyright (c) 2025 Namit Gupta, Ashok Jhajharia, Vidhyadhar Singh Nitar, Anirudh Gupta, Rupesh Kumar Pokharna, Prachis Ashdhir https://creativecommons.org/licenses/by-nc-nd/4.0
Neglected cleft lip Teisser Type 4 deformity: Anesthesiologist concerns
Since craniofacial anomalies are one of the most common causes of predicted difficult airway, they present a problem to anesthesiologists. To prevent serious issues, it is important to anticipate and prepare for difficult airway management beforehand. Developing a safe anesthetic plan requires an understanding of the development, features, and unique anesthetic problems of the more prevalent anomalies. The successful airway care of a Tessier No. 4 anomalous infant with cleft lip, cleft palate, and left orofacial cleft is described.
Copyright (c) 2025 Lally Komal, Kaur Haramritpal, Kaur Amanpreet, Rana Rubina, Kaur Rajvir https://creativecommons.org/licenses/by-nc-nd/4.0
Recognizing hypokalemic periodic paralysis in the differentials of acute flaccid paralysis: A case-based approach
Hypokalemic periodic paralysis (HypoPP) is a rare but important cause of acute flaccid paralysis that may be easily overlooked during initial evaluation. Timely recognition is essential, as management differs significantly from other neurological or metabolic causes of weakness. We report the case of a 51-year-old male who presented with an acute onset of flaccid quadriparesis. Despite initial treatment, the patient exhibited persistently low serum potassium levels, which did not respond adequately to standard potassium replacement. This unusual biochemical profile, combined with the clinical picture, led to a focused diagnostic approach that confirmed HypoPP. This case highlights the importance of including HypoPP in the differential diagnosis of acute flaccid paralysis, especially in patients with recurrent or persistent hypokalemia. Early identification and appropriate management can significantly alter patient outcomes and are essential to establish appropriate long-term management strategies to prevent recurrent episodes.
Copyright (c) 2025 Pravesha Chandrasekaran, Satish J Wagh https://creativecommons.org/licenses/by-nc-nd/4.0
Cholecystocolonic fistula: A rare complication of calculous cholecystitis with pre-operative diagnosis and surgical management
Cholecystocolonic fistula (CCF) is a rare complication of chronic gallstone disease, often diagnosed intraoperatively due to non-specific clinical features and limited radiological sensitivity. We report the case of a 76-year-old female with dyspepsia, low-grade fever, and vomiting, in whom contrast-enhanced computed tomography demonstrated a fistulous tract between the gallbladder and hepatic flexure. Laparotomy with cholecystectomy and segmental colectomy was performed, and histopathology confirmed the diagnosis. The postoperative course was uneventful. This case underscores the diagnostic challenges of CCF, the need for high clinical suspicion, and the importance of timely surgical intervention to prevent complications such as perforation and sepsis.
Copyright (c) 2025 T A Chandralathan, Ravisankar Palaniappan, Padma Priya Camalarajan, S Rajmohan, Udaya Kumar Kuppan https://creativecommons.org/licenses/by-nc-nd/4.0
Communication interventriculaire in a 12-year-old boy as a rare congenital heart disease in Tunis: A case report
Communication interventriculaire, or ventricular septal defect (VSD), is the most common congenital heart malformation in children, accounting for nearly 37% of cases worldwide. While small defects may remain asymptomatic, larger perimembranous defects are frequently associated with significant hemodynamic compromise and progressive valvular dysfunction. We describe the case of a 12-year-old boy with a large perimembranous VSD who presented with recurrent dull, intermittent chest pain, dyspnea, and easy fatigue, symptoms not typically emphasized in pediatric VSD cases. Echocardiography revealed a 5 mm left-to-right shunt (Vmax 4.6 m/s), severe subaortic stenosis due to a subaortic membrane (aortic Vmax 5.4 m/s), and grade II aortic insufficiency. Laboratory tests demonstrated markedly elevated C-reactive protein levels (36.1), indicating systemic inflammation and possible infectious complications. Management included infection control, daily Tansopril therapy, and surgical intervention, with plans for long-term follow-up using echocardiography and laboratory monitoring. When compared with published pediatric cases from Argentina and India, which primarily reported progressive aortic regurgitation and left ventricular outflow tract obstruction, respectively, our case is distinctive due to its initial dominant presentation of chest pain and its strong inflammatory profile. This underscores the heterogeneity of clinical manifestations in VSD and highlights the need for individualized evaluation and treatment strategies to prevent progression and long-term morbidity.
Copyright (c) 2025 Aulia Rahman Puteri, Raouf Denguir, Galih Santoso Putra https://creativecommons.org/licenses/by-nc-nd/4.0
Isotretinoin-induced dermographism and urticaria: A rare cutaneous hypersensitivity reaction
Isotretinoin is a systemic retinoid extensively used for intense pimples, with not unusual, place-damaging results like mucocutaneous dryness being well-documented. This record highlights an extraordinary case of isotretinoin-triggered dermographism and urticaria. A 27-year-old girl on 20 mg/day of oral isotretinoin for intense pimples developed chronic pruritus, linear erythematous streaks, and urticarial plaques on her lower limbs after 4 weeks. With no records of allergies, a likely damaging drug response became recognized through the usage of the Naranjo evaluation tool. Isotretinoin was discontinued, and the affected person was treated with oral bilastine and tapered methylprednisolone, attaining complete healing within 10 days. This case underscores the significance of spotting odd cutaneous reactions to isotretinoin to ensure the protection of affected person and beautify pharmacovigilance.
Copyright (c) 2025 Sekhar Sharma, Mohan V, Rajendra Dhakal, Basant Kumar Rai https://creativecommons.org/licenses/by-nc-nd/4.0
Drain catheter-induced urinary bladder fistula: A rare complication following exploratory laparotomy for duodenal ulcer
Pelvic drains are commonly used in abdominal surgeries to prevent fluid accumulation, identify post-operative complications, and allow early detection of anastomotic leakage. We report a rare case of a 35-year-old male who developed a urinary bladder fistula a few days after exploratory laparotomy for a perforated duodenal ulcer. The patient initially presented with generalized abdominal pain, fever, and peritonitis. Imaging confirmed pneumoperitoneum, and an emergency laparotomy revealed a perforated duodenal ulcer. A right subhepatic drain and a pelvic drain were placed. On post-operative day 5, the pelvic drain output increased and resembled urine. Further imaging revealed that the drain tip had entered the bladder, causing a fistula. Conservative management with urethral catheterization and drain repositioning was successful. This case highlights the importance of vigilance during drain placement, awareness of risk factors such as prolonged drain retention, and early recognition of atypical drain output. It also underscores the role of conservative management in selected cases.
Copyright (c) 2025 Omer Hamza Ali Ahmed, Reem Mubark Abdelrheem Subahi, Fatin Abdelmoneim Omer Alameen, Abdelazim Hussein Khalafalla, Mohamed Obaid Mohamed Obaid https://creativecommons.org/licenses/by-nc-nd/4.0
Tailored surgical management of a giant calculus in urethral diverticulum following post-hypospadias repair
Giant urethral calculi are rare, particularly within diverticula arising as late complications of hypospadias repair. We report a 30-year-old male with prior childhood hypospadias surgery who presented with a 2-year history of dysuria and lower urinary tract symptoms. Examination revealed a hard mass along the penile urethra, and imaging confirmed a 6×2 cm calculus within an anterior urethral diverticulum. After managing an associated urinary tract infection, the patient underwent Stage I Johansson’s urethroplasty with longitudinal incision, stone extraction, and diverticulectomy. Recovery was uneventful, with Stage II urethroplasty planned. This case highlights the importance of a tailored surgical approach addressing stone burden and anatomical anomalies, which is crucial for successful long-term outcomes.
Copyright (c) 2025 Abhishek Saini, Hemant Kumar Goel, Umesh Sharma, Anoop Yadav, Dhirendra Singh https://creativecommons.org/licenses/by-nc-nd/4.0
Hypocalcemic tetany unveiling Vitamin B12 deficiency: A rare manifestation coupled with hyperventilation
Hypocalcemic tetany is a clinical condition characterized by involuntary muscle contractions and spasms due to low levels of ionized calcium in the blood, commonly associated with conditions such as hypoparathyroidism, Vitamin D deficiency, and chronic kidney disease. We report the case of a 16-year-old vegetarian girl who presented with recurrent episodes of tetany, muscle cramps, and fainting. Initial management with calcium supplementation and anxiolytics provided partial relief. But as tetany was recurrent, respiratory alkalosis was found to be the contributing factor. Anxiety-induced hyperventilation leads to respiratory alkalosis. Despite correction of alkalosis, tetany persisted, and the patient developed gait abnormality. Anxiety and gait abnormality were both found to be due to Vitamin B12 deficiency. Parenteral Vitamin B12 supplementation resulted in complete recovery from tetany, gait disturbance, and anxiety. Hence, this is a rare manifestation of Vitamin B12 deficiency, pertaining to anxiety-induced hyperventilation, leading to respiratory alkalosis and presenting clinically as recurrent tetany. Treatment only by parenteral calcium was not enough, and unmasking the hidden etiology of Vitamin B12 deficiency was key to recovery.
Copyright (c) 2025 Ajeet Kumar Chaurasia, Poonam Gupta https://creativecommons.org/licenses/by-nc-nd/4.0
The 5q-syndrome is a myelodysplastic syndrome (MDS) characterized by a defect in erythroid differentiation. Patients have severe macrocytic anemia, normal/elevated platelet counts, normal/reduced neutrophil counts, erythroid hypoplasia, and hypolobated micro-megakaryocytes in the bone marrow. A thalidomide analogue, lenalidomide, induces transfusion independence and cytogenetic remission in a substantial number of patients. This case is presented for its rarity and therapeutic challenge. A postmenopausal female patient presented to the Outpatient Department with a history of progressive drop in hemoglobin and white blood cells for the last 6 months, for which she was on oral hematinics. The peripheral smear and bone marrow showed classical findings of pseudo-Pelger-Huet neutrophils and hypolobated megakaryocytes with no excess of blasts, respectively. Molecular studies were positive for 5q deletion (46, XX, del[5][q33q35]). Lenalidomide therapy was started, a year after starting treatment, the patient progressed to MDS with increased blasts-2 and subsequently to acute myeloid leukemia within 2 months. The karyotyping done at this time suggested evolution of a complex karyotype and presence of an additional translocation 46, XX, del (3) (q12), t (5;7) (q13; q22). The patient succumbed to multiple infections approximately 1.5 years after diagnosis.
Copyright (c) 2025 Preeti Singh, Vazifdar Archana, Shah Samir https://creativecommons.org/licenses/by-nc-nd/4.0
Concomitant acute alopecia and profound bone marrow suppression: An unusual manifestation of azathioprine toxicity
Azathioprine is a cytotoxic drug used frequently as a steroid-sparing agent in multiple dermatological diseases. Myelosuppression is known to occur with azathioprine, but severe pancytopenia and hair loss are uncommon. Hair loss usually occurs with long-term use, but sudden onset and rapidly progressive alopecia are extremely rare. In this report, we present an unusual case of a patient with chronic spontaneous urticaria, accompanied by elevated serum immunoglobulin E levels, who developed sudden-onset, rapidly progressing alopecia areata concurrent with azathioprine-induced bone marrow suppression. The patient’s condition improved following discontinuation of azathioprine, with concurrent resolution of leukopenia and gradual hair regrowth, suggesting a temporal and possibly causative relationship between the drug and both the hematologic and dermatologic manifestations. This case emphasizes the unpredictable nature of immunomodulatory therapy and highlights a paradox wherein a drug intended to suppress autoimmune activity potentially triggers a separate autoimmune condition. It also emphasizes the importance of vigilant monitoring for both common and rare adverse effects during azathioprine therapy.
Copyright (c) 2025 Joyjit Das, Prakash Narayan Gupta , Rupayan Bhattacharya https://creativecommons.org/licenses/by-nc-nd/4.0
Systemic lupus erythematosus with cardiorenal and neuropsychiatric involvement complicated by macrophage activation syndrome in a young female
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with highly variable presentations. Since no definitive diagnostic criteria exist, clinicians often rely on classification criteria to establish the diagnosis. A 22-year-old female presented to our hospital with a 2–3 month history of fever and weakness, along with breathlessness for 15 days. She had previously sought treatment at multiple peripheral centers, where only symptomatic therapy was provided, but no investigations were done till a few initial visits. At the time of presentation, clinical examination and investigations revealed neuropsychiatric symptoms, pancytopenia, pericardial effusion, renal involvement, and positive SLE serology. During hospitalization, she developed macrophage activation syndrome and multiorgan dysfunction. She was treated aggressively with high-dose corticosteroids, plasmapheresis, cyclophosphamide, dialysis, and mechanical ventilation. However, her condition rapidly deteriorated and progressed to a fatal outcome, which probably could have been prevented if the case had been investigated, diagnosed, and referred early. SLE flare is a highly fatal condition that can present abruptly. In view of this, prompt diagnosis and treatment of SLE is mandatory. Recommending specific diagnostic criteria and increasing awareness amongst the primary care physicians so that they also have a high index of suspicion for the condition in the presence of constitutional symptoms can reduce chances of missed diagnosis and reduce morbidity and mortality.
Copyright (c) 2025 Sona Mitra, Arti Muley, Hardik Gajera, Priyal Patel, Vrushti Doshiyad, Hasmukh Chaudhary, Ritesh Patel https://creativecommons.org/licenses/by-nc-nd/4.0
Gallbladder neuroendocrine carcinoma: A rare entity case report with review of literatures
Neuroendocrine neoplasm (NEN) of the gallbladder (GB) is an extremely rare malignancy, accounting for only 0.2% of all NENs. GB-neuroendocrine carcinomas (NEC) are difficult to differentiate from adenocarcinoma on routine imaging. These tumors do not present with specific symptoms. Histopathological examination is the gold standard for the diagnosis of GB-NEC. They have worse outcomes than GB-adenocarcinoma and have disseminated metastases at the time of diagnosis. We present the case of a 65-year-old woman who presented with a GB mass and abdominal pain. Histopathological and immunohistochemical findings revealed GB-NEC.
Copyright (c) 2025 Barasha Sharma, Harani Brahma, Muktanjalee Deka, Jagannath Dev Sharma https://creativecommons.org/licenses/by-nc-nd/4.0
Disseminated melioidosis in a young adult with undiagnosed diabetes mellitus: A case report
Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infection endemic to Southeast Asia and Northern Australia. We present the case of disseminated melioidosis in a 27-year-old fisherman from South India with previously undiagnosed diabetes mellitus. He presented with prolonged low-grade fever, encephalopathy, and hyperosmolar hyperglycemic state. Blood cultures identified B. pseudomallei, and imaging revealed multiple hepatic abscesses, pulmonary nodules, splenic infarction, and renal involvement. Intensive care management included meropenem therapy, insulin infusion, and mechanical ventilation. The patient experienced secondary infections and complications such as pressure ulcers and cavitating lung lesions. Following a prolonged intensive care unit stay and antibiotic therapy, he recovered and was discharged in stable condition. This case emphasizes the need for heightened clinical suspicion of melioidosis in febrile patients from endemic regions, even in the absence of overt risk factors. Early microbiological diagnosis and targeted treatment are key to reducing morbidity and mortality in disseminated melioidosis.
Copyright (c) 2025 Annika Doddapaneni, Anusha Cherian https://creativecommons.org/licenses/by-nc-nd/4.0
Apparent mineralocorticoid excess syndrome with nephrocalcinosis and renal complications: A case series of two siblings
Apparent mineralocorticoid excess (AME) syndrome is a rare autosomal recessive cause of secondary hypertension, especially in children and young adults. Its heterogeneous presentation often delays diagnosis. We report a case series of two siblings, born of a 2nd-degree consanguineous marriage, both with AME syndrome complicated by nephrocalcinosis. The elder sibling developed renal osteodystrophy, progressive renal dysfunction, and cardiovascular complications, whereas the younger sibling remained stable with early diagnosis and therapy. This case series highlights the prognostic impact of early diagnosis and treatment, as well as diagnostic challenges in differentiating AME from Liddle syndrome. Awareness is crucial in consanguineous populations where genetic risk is higher.
Apparent mineralocorticoid excess syndrome
Copyright (c) 2025 P Aravindhmozhi, Sheik Sulthan Alavudeen , Jayalakshmi Seshadri , R Rajakumar, Charankumar Swamikkannu, Seenivasan Mookaiah https://creativecommons.org/licenses/by-nc-nd/4.0
A case report of bilateral ovarian luteinized thecoma with sclerosing peritonitis masquerading as a malignant mass
Luteinized thecoma with sclerosing peritonitis (LTSP) is a very uncommon syndrome, characterized by the presence of single or bilateral ovarian thecomas and peritoneal fibrotic lesions. The disease occurs in young women, and it can lead to peritoneal fibrosis and bowel obstruction. We present the case of an ovarian mass in a 20-year-old woman. Radiologically, the patient had bilateral large, well-defined, heterogeneously enhancing solid mass lesions in the bilateral adnexa. The lesion extends into the lower abdomen, abutting the compressed fat planes. Her serum carcinoembryonic antigen (1.26 ng/mL) was within normal limits, but the cancer antigen 125 (CA125) (882/mL) level was high. Total abdominal hysterectomy with bilateral adnexal mass, along with part of the omentum, was removed. Histopathological diagnosis was LTSP and was confirmed by immunohistochemistry. Postoperatively, the patient was managed conservatively and was kept in follow-up.
Copyright (c) 2025 Madhusmita Choudhury, Barasha S Bharadwaj, Muktanjalee Deka, Jagannath D Sharma, Ganesh Das, Sarvagya Mishra, Upasana Kalita https://creativecommons.org/licenses/by-nc-nd/4.0
A rare case report on Chiari malformation and syringomyelia-related Charcot arthropathy
Charcot arthropathy is a progressive and often underrecognized joint condition typically resulting from impaired sensory innervation. Although commonly associated with diabetes, it may also occur in the context of less frequent neurological disorders. This report discusses the case of a 27-year-old woman who presented with chronic swelling and restricted movement of the right elbow, without a history of trauma or systemic symptoms. Imaging studies eventually revealed syringomyelia and Chiari malformation as the underlying causes. This case underscores the need for clinicians to consider neuropathic arthropathy in the differential diagnosis of unexplained joint dysfunction, particularly in the upper limbs, and to use advanced imaging techniques like magnetic resonance imaging for timely identification and intervention before irreversible joint damage occurs.
Copyright (c) 2025 Soofia Naaz, Shasthara Paneyala , Pallavita Chirravuri, C V Thejesh https://creativecommons.org/licenses/by-nc-nd/4.0
Symptomatic neuroglycopenia secondary to oral hypoglycemic agents: A case report
We present the case of a 55-year-old man with Type 2 diabetes mellitus who developed symptomatic neuroglycopenia due to oral hypoglycemic agents (OHAs). He presented with confusion and disoriented speech after taking his usual morning dose of medication following a period of poor adherence. The laboratory evaluations confirmed hypoglycemia and ruled out other potential causes, including liver disease. He was successfully managed with intravenous dextrose (10%; 75 mL/h), and then supportive care was initiated after discontinuing OHA’s. This case highlights the increased risk in diabetic patients on sulfonylurea-based regimens, especially with renal dysfunction and poor adherence.
Copyright (c) 2025 Ghanta Vijaya Kumar, Tandra Lakshmi Srinidhi, Ankam Chandana, Kudaravalli Hemanvi, Alaparthi Bhavana, Bathina Leela Jyothi, Kaja Chandrika Devi, Viswa Srujani Kanagala https://creativecommons.org/licenses/by-nc-nd/4.0