Case Reports in Clinical Practice

Lymphoma or Brucellosis: A Case Series Study

Parsa Rostami — 2025-02-26

Human Brucellosis is a zoonotic disease with various clinical manifestations, rangingfrom asymptomatic infection to multisystem involvement. Cases with hematologicalabnormalities and lymphadenopathy, which were referred to the hematologydepartment 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-oldwomen. Due to the region’s endemicity and strong clinical suspicion of brucellosis,therapeutic management and invasive procedures such as splenectomy were avoidedin one case.Based on the available literature, it is evident that the infrequent symptoms thataccompany the typical symptoms of brucellosis may give rise to uncertainty andhinder prompt diagnosis. The reason is that patients presenting with indicationsof pancytopenia, coupled with splenomegaly or lymphadenopathy, are typicallyreferred to hematologists. Hence, the purpose of these case reports is to highlight thesymptoms of brucellosis that mimic a primary hematologic disorder, facilitating fasterand more accurate diagnosis.

A Pediatric Case of Leptospirosis Developed After COVID-19 Associated Multisystem Inflammatory Syndrome

Kiana Razavi — 2025-02-26

While presentations of novel severe acute respiratory syndrome coronavirus 2 (SARS- CoV-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) in a 50-Year-Old Woman

Reza Mohseni Ahangar — 2025-02-26

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rarepulmonary disorder characterized by hyperplasia of pulmonary neuroendocrine cells.It is frequently asymptomatic and can be challenging to differentiate from other formsof reactive pulmonary neuroendocrine cell hyperplasia (NECH). Presented is a casereport of DIPNECH along with a review of the diagnosis and management. A 50-year-oldfemale patient with a history of airway disease presented to the pulmonary ward withcomplaints of Functional Class III dyspnea and productive cough. The HRCT revealedthe presence of multiple bilateral nodules in both lungs. The histopathology reportfrom the nodule resection confirmed the presence of a carcinoid tumor, specificallyidentified as DIPNECH. As many similar cases have favorable treatment responses andsatisfactory prognoses due to multidisciplinary treatment methods, the necessity ofevidence-based management guidelines for DIPNECH and the accuracy of the diseasedefinition is emphasized.

Always Take Renal Colic Seriously: A Rare Complication of Renal Stone

Sepideh Aarabi — 2025-02-26

Pelvis rupture secondary to renal colic is an exceptionally rare but severe complicationof nephrolithiasis. This case report describes a 32-year-old male who presentedwith intense flank pain, gross hematuria, and urinary obstruction. A computedtomography (CT) scan revealed a 3-mm calculus at the ureterovesical junction causinghydronephrosis and, notably, a rupture of the renal pelvis with urine extravasation intothe retroperitoneal space. Immediate intervention included ureteroscopic lithotripsy,stent placement, and antibiotic therapy, leading to symptom resolution and improvedrenal function. This report highlights the diagnostic challenges associated with pelvisrupture, which often mimics typical renal colic symptoms, and emphasizes the criticalrole of contrast-enhanced CT in detection. Prompt management is essential to preventcomplications such as sepsis and long-term renal damage. The case underscores theimportance of recognizing this rare entity to optimize patient outcomes and guidefuture clinical approaches to similar presentations.

Spontaneous Extensive Subcutaneous Emphysema, Pneumothorax, Pneumorrhachis, Pneumoperitoneum and Pneumoretroperitoneum in a Young Man with Covid-19

Behgam Fatehi — 2025-02-26

Spontaneous pneumorrhachis and pneumoperitoneum are very rare conditions thatinvolve the presence of air within the spinal canal and peritoneum, respectively, withoutany traumatic or underlying disease. During the Covid-19 pandemic, there have beenreports of spontaneous pneumomediastinum occurring in some patients with severecases 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 ofpulmonary disease and PCR positive for Covid-19. He complained of mild dyspneawith sudden non-painful facial edema. One possible explanation for SPM in Covid-19patients 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 thebeginning, unknown aspects of the complications of this disease will appear. Thesecomplications are typically self-limiting and follow a benign clinical course.

Pharmaceutical-Induced Dyskinesia: A Case Study of Thoracotomy Treated with Amantadine

Mojtaba Mojtahedzadeh — 2025-02-26

Dyskinesia, marked by involuntary and irregular movements, can result fromvarious pharmaceutical agents. The case presented features a patient undergoingthoracotomy, experiencing dyskinesia, likely attributed to antipsychotics, antiemetics,and antibiotics, and subsequently treated with amantadine.

A Case Report of Spinal Tuberculosis with Multilevel Vertebral Fractures and Paraplegia

Matineh Sadat Tabatabaei — 2025-02-26

Spinal tuberculosis (TB) is a rare extrapulmonary manifestation that can causevertebral fractures, neurological deficits, and paraplegia. This report presents a43-year-old male with sudden paraplegia, back pain, and sensory loss. MRI revealedfractures in T10, T11, and L5, and histopathology confirmed spinal TB with concurrentpulmonary TB and pleural effusion. The patient’s history of chronic dexamethasonemisuse contributed to immunosuppression and disease dissemination. Classified asGrade 4 paraplegia, his condition required surgical stabilization, anti-TB therapy, andsupportive care. This case highlights the rarity of multilevel vertebral fractures andsevere neurological deficits in spinal TB, emphasizing the importance of early imaging,tissue biopsy, and prompt multidisciplinary intervention to prevent permanent disability.

Fregoli Delusion: A Rare Subtype of Delusional Misidentification Syndromes (DMSs)

Farnaz Ghannadi — 2025-02-26

As a rare subtype of delusional misidentification syndromes (DMSs), Fregoli Delusioninvolves the belief that two or more individuals are actually the same persondisguised as another. In this case report, a 23-year-old male presents with FregoliDelusion, self-inflicted harm, and a history of being kidnapped and abused. While thepatient had abstained from alcohol and drugs for two years, neuroimaging revealednon-specific developmental anomalies, adding to the complexity of the clinicalsituation. Diagnoses and treatments are complicated by the coexistence of psychoticsymptoms, mood dysregulation, and complex delusional constructs. A combinationof antipsychotic medication and cognitive behavioural therapy is more effective intreating schizophrenic patients. It is important to closely monitor this patient due totheir history of non-adherence to their treatment plan and drug abuse. As a result ofthis situation, trauma-focused care and personalized interventions are necessary, aswell as additional research to enhance the treatment of Fregoli Delusions resultingfrom this situation.

Successful Recovery After Delayed Thrombectomy for Acute Basilar Artery Occlusion: A Case Report

Leila Afshar Hezarkhani — 2025-02-26

Top of the Basilar Syndrome (TOBS) is a rare neurological condition caused by occlusionof the distal basilar artery, often resulting in significant morbidity. TOBS is particularlychallenging to diagnose in younger patients with atypical risk factors. A 34-year-old man presented with vertigo following strenuous exercise. Initial misdiagnosesdelayed treatment, and subsequent imaging revealed left vertebral artery dissectionand basilar artery occlusion. Endovascular thrombectomy performed 41 hours and45 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 modifiedRankin Scale (mRS) score improving from 4 at discharge to 1 at one year. This caseunderscores the importance of clinical vigilance, advanced imaging, and endovascularthrombectomy in managing TOBS. Even with delayed intervention, multidisciplinarycare can facilitate favorable outcomes in young patients with rare presentations.

Kearns Sayre Syndrome: A Rare Cause of Mitochondrial Diabetes and Hypogonadotropic Hypogonadism

Sriram Mudraje — 2025-02-26

Kearns-Sayre syndrome is a rare mitochondrial disease that presents before theage of 20 years with ptosis, external ophthalmoplegia, and pigmentary retinopathyassociated with endocrine and cardiac conduction abnormalities. Here we report an18-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 2Dechocardiography revealed global left ventricular hypokinesia with reduced ejection fraction. Hence, the diagnosis of Kearns-Sayre syndrome was made.