Case Reports in Clinical Practice

Persistent Pseudologia Fantastica in a Patient with Bipolar Disorder and ADHD: A Case Report

Shokouh Gheibi — 2025-10-14

Pseudologia fantastica is characterized by habitual, elaborate, and often fantasticalfabrications that the patient recognizes as untrue.We report a case of a 24-year-old male with bipolar disorder and adult ADHD whosetreatment included mood stabilizers and atomoxetine, which improved psychiatricsymptoms but had minimal effect on the pseudologia.This case highlights the persistent nature of pseudologia fantastica and its diagnosticand therapeutic complexity, calling for further investigation into its management.

A Rare Coincidence of Non-keratinizing Nasopharyngeal Squamous Cell Carcinoma (SCC) and Pituitary Adenoma: A Case Report

Simin Soltaninejad — 2025-10-14

This is the first reported case of the coexistence of nasopharyngeal carcinoma and pituitary adenoma in a 36-year-old female. The case is significant due to the rarity of these two tumors occurring simultaneously and the diagnostic challenges posed by overlapping symptoms. The patient presented with a history of chronic nocturnal headaches localized to the temporal region. Initial symptoms included six months of amenorrhea, massive bilateral galactorrhea, and classic clinical signs of acromegaly. The nasopharyngeal mass was initially missed during early evaluations, as the patient was primarily assessed for a secreting pituitary adenoma. The nasopharyngeal mass was detected for the first time during rhinoplasty using an endoscope. Histopathological examination confirmed differentiated non- keratinizing nasopharyngeal carcinoma alongside a pituitary adenoma. During radiotherapy for the nasopharyngeal carcinoma, the patient developed visual symptoms, including ptosis and outward deviation of the eye. The patient declined surgical excision of the pituitary adenoma; therefore, the radiotherapy field was expanded to include the adenoma. The radiotherapy dose was 70 Gy, delivered in 35 sessions. After three months of expanded radiotherapy, all symptoms, including headaches and visual disturbances, were completely resolved. Follow-up after 14 months showed no evidence of recurrence or disease progression.

Spontaneous CSF Otorrhea Masquerading as Middle Ear Effusion: A Case Report

Anoop Chandran Vazhipokkil — 2025-10-14

Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare but important differentialdiagnosis in cases of persistent middle ear effusion. We report a case of a 45-year-old female who presented with persistent aural fullness and hearing loss in theright ear immediately following an airplane flight. She was initially diagnosed withmiddle ear effusion and underwent myringotomy with grommet ventilation tubeinsertion. However, the patient continued to experience profuse watery otorrheafor two months postoperatively. Subsequent computed tomography of the temporalbone confirmed a CSF leak from a defect in the tegmen tympani near the anteriorepitympanum. The patient underwent successful endoscopic CSF otorrhea repairunder general anaesthesia. Three months postoperatively, the patient’s hearingimproved, and her aural symptoms resolved. This case highlights the importance ofconsidering spontaneous CSF leaks in cases of sudden-onset conductive hearing loss,even in the absence of trauma or prior surgical history.

Naegleria Amebic Keratitis (Corneal Abscess) in the Use of Color Cosmetic Soft Contact Lens Wear: A Case Report

Mohammad Hossain Validad — 2025-10-14

Amebic keratitis is a rare but serious corneal infection that is occasionally seen incontact lens wearers. In the early stages, the disease may be mistaken for bacterialkeratitis due to corneal inflammation and a reduced visual field, which can delaydiagnosis and treatment. In this case report, we present a young female who exhibitedsymptoms of a corneal ulcer associated with contact lens use and was initially treatedfor bacterial keratitis. Upon further evaluation, the diagnosis of Naegleria amebickeratitis was confirmed.

Cerebral Venous Thrombosis as a Complication of Spontaneous Intracranial Hypotension: A Case Report

Mohammad Ali Nahayati — 2025-10-14

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused bycerebrospinal fluid (CSF) leakage, which can lead to complications such as cerebralvenous thrombosis (CVT), occurring in 1–2% of SIH patients. This case report describesthe presentation, diagnosis, and management of SIH complicated by CVT. A 36-year-oldwoman with no comorbidities presented with a three-week history of severe, initiallyorthostatic headaches. Neurological examination revealed mild bilateral disc oedema,and imaging showed generalized brain oedema. MRI with MRV confirmed cerebralvenous sinus thrombosis along with typical SIH features, including pachymeningealenhancement and venous engorgement. She was treated with heparin infusion andisotonic saline, responding well without seizures or hemorrhagic complications.This case highlights the risk of CVT in SIH and underscores the importance of earlydiagnosis through neuroimaging and lumbar puncture. The patient’s favorableresponse to anticoagulation demonstrates effective management, though furtherstudies are needed to establish definitive treatment guidelines for SIH-associated CVT.

Heterotopic Pregnancy Presenting as Maternal Acute Abdomen at 19 Weeks of Gestation: A Case Report

Behrokh Sahebdel — 2025-10-14

Heterotopic pregnancy is the simultaneous presence of intrauterine and ectopicgestations. It is typically diagnosed in the first trimester via sonography or when patientspresent with vaginal bleeding or abdominal pain. We report a case of a 26-year-oldAsian primigravida woman who conceived through ovulation induction and presentedat 19 weeks and 4 days of gestation—one week after a successful Macdonald cerclage,with severe abdominal pain and hemodynamic instability. Bedside ultrasoundrevealed significant hemoperitoneum and a viable intrauterine fetus. Emergencylaparotomy identified an unruptured right fallopian tube containing a 5 × 6 cm mass.A right salpingectomy was performed due to suspected ectopic pregnancy, and noother bleeding source was found. Histopathology confirmed tubal ectopic pregnancy.The postoperative course was uneventful, and the intrauterine pregnancy successfullyprogressed to term. Heterotopic pregnancy should be considered in the differentialdiagnosis of hemoperitoneum, even in the second trimester.

Acute Ischemic Stroke Following Snakebite: A Case Report

Dariush Taghilou — 2025-10-14

Snakebite envenomation is associated with a wide spectrum of complications, ranging from local tissue damage to life-threatening systemic effects. This case report describes a rare presentation of acute ischemic stroke in a 77-year-old man following envenomation by a suspected Montivipera raddei albicornuta in northwestern Iran. The patient initially presented with right lower limb cellulitis, thrombocytopenia, coagulopathy, and acute kidney injury. Within six hours, he developed left-sided hemineglect, hemiparesis, hemifacial weakness, dysarthria, and a decreased level of consciousness. Neuroimaging revealed a non-hemorrhagic infarct localized to the right parietal lobe within the distribution of the middle cerebral artery. This case underscores the potential for thrombotic events, including ischemic stroke, in the context of venom-induced disseminated intravascular coagulation (DIC). It also highlights the need to reassess the efficacy and dosing strategies of available antivenoms and to establish protocols for early identification of thrombotic events following envenomation in high-risk snakebite patients.

A Rare Heteroplasmic MT-ND5 Mutation (m.13094T>C) in an Iranian Patient with Adult-Onset MELAS: Diagnostic Challenges and Therapeutic Implications

Hamed Amirifard — 2025-10-14

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes [MELAS] is arare multisystem mitochondrial cytopathy that is highly heterogeneous in severity andclinical presentation, mostly caused by diverse mutations in the mitochondrial DNA.While m.3243A>G is the most common variant, rare mutations like m.13094T>C inMT-ND5 are increasingly recognized but poorly characterized.This report documents the case of a 37-year-old Iranian woman diagnosed withMELAS. Her clinical manifestations include recurrent episodes of stroke-like events,focal seizures, and elevated serum and CSF lactate. Mitochondrial DNA analysis[mtDNA] was positive for a very rare pathogenic point mutation [mtDNA; m.3243A>G]in the MT-ND5 gene, with a heteroplasmy level of 8.2%.This case highlights: 1. Adult-onset MELAS with MT-ND5 mutations is underdiagnosed.2.Low heteroplasmy (8.2%) may still cause severe phenotypes, suggesting tissue-specific effects. 3.Ethnic diversity in mtDNA mutations warrants broader geneticscreening in non-classical cases.

The Importance of Regular Dental Check-Ups in the Early Diagnosis of Neoplasms: A Case Report of Ameloblastoma

Maryam Mohebiniya — 2025-10-14

The Article Abstract is not available.