Case Reports in Clinical Practice

Endogenous Endophthalmitis with an Unusual Presentation

Homayoun Nikkhah — 2025-04-21

Endogenous endophthalmitis is caused by the hematogenous dissemination of infectiousorganisms, resulting in intraocular infection. This entity is uncommon and accounts for5–15% of all forms of endophthalmitis. Patients with compromised immune systemsare most at risk for endogenous endophthalmitis. An immunocompetent 20-year-oldman, following a recent hospitalization and ventilator-associated pneumonia (VAP),presented with blurred vision in the left eye. Fundoscopy revealed dense white-to-yellow, pus-like subfoveal material originating from the choroid, breaking through theretina, and dispersing into the vitreous. According to polymerase chain reaction (PCR)findings, the infection had a bacterial origin and caused irreversible damage to themacula.

Disseminated Tuberculosis Complicated with Disseminated Intravascular Coagulation (DIC) in an Immigrant Patient

Haniyeh Esfandiar — 2025-04-21

Disseminated tuberculosis (TB) is rare, can affect any organ system, and predominantly presents in immunocompromised populations. While pulmonary tuberculosis (TB) is prevalent in developing countries, it is an uncommon cause of disseminated TB. In pediatric populations, particularly in the first and second decades of life, disseminated TB is often secondary to lung infections. However, there have been few reports of disseminated TB complicated by disseminated intravascular coagulation (DIC). Disseminated TB is defined as the involvement of two or more noncontiguous sites due to the lymphohematogenous spread of Mycobacterium tuberculosis. Extrapulmonary involvement occurs in one-fifth of all TB cases and may present without histological or radiological evidence of pulmonary infection. An eleven-year-old girl presented to the emergency department (ED) with complaints of weight loss and abdominal pain. She had no history of immunodeficiency but had been in contact with TB patients. On admission, she exhibited refractory coagulopathy, necessitating transfer to the pediatric intensive care unit (PICU). In the PICU, intravenous vitamin K, fresh frozen plasma (FFP), and packed red blood cells (PRBCs) were administered on the 14th day of admission, following the initiation of antibiotics and a combination of standard anti-tuberculous drugs. It can be speculated that many pediatric cases of TB-induced pneumonia leading to acute respiratory distress syndrome (ARDS) remain unreported in the literature. More robust data on the epidemiology of childhood TB are necessary to better understand its contribution to ARDS and to develop pediatric-specific therapeutic strategies. Some risk factors for disseminated TB include young age, recent measles infection, immunodeficiency, malnutrition, and malignancies. Children, especially infants and immunocompromised patients, are at higher risk of developing miliary and disseminated TB. However, none of these contributing factors were identified in this child. In the present case, the patient had no HIV infection or immunodeficiency but was an immigrant from an endemic country and had a history of contact with TB patients. The onset of her symptoms closely resembled those of inflammatory bowel disease (IBD), and she later developed coagulation disorders and DIC. We successfully treated disseminated TB complicated by DIC using antibiotics, FFP, PC, vitamin K, and anti-tuberculous therapy. The follow-up indicated an improvement in her condition and the resolution of symptoms.

A Rare Case of Primary Hepatic Leiomyoma

Elham Zare — 2025-04-21

Leiomyomas are most commonly encountered in the genitourinary and gastrointestinalsystems, with primary hepatic leiomyomas (PHL) being a rare occurrence. We presentthe case of a 62-year-old man with an incidentally discovered voluminous lesion in theleft lobe of the liver, initially suspected to be a hemangioma. The patient was referredfor further evaluation, during which advanced imaging modalities were utilized foraccurate diagnosis, and tissue biopsies were obtained. A definitive diagnosis of PHLwas established through immunohistochemistry based on pathological findings.

Huge Abdominal Wall Reconstruction in a Complicated Inguinal Hernia

Hosseinali Abdolrazaghi — 2025-04-21

Inguinal hernia repair is a common surgery that can result in incarceration in somecases. Catastrophic events may be encountered in specialized circumstances, such asFournier’s gangrene, which is an emergent condition. Treatment of debrided skin ofthe abdominal wall is always challenging, particularly in large defects.A 69-year-old man suffered from complications following inguinal hernia repair,which included laparoscopic mesh repair, subsequent right hemicolectomy withanastomosis, leading to ileostomy, Fournier’s gangrene, and eventually a large skindefect in the lower abdomen and perineal area. After multiple sessions of woundtherapy, he underwent abdominal wall reconstruction with two large pedicledanterolateral thigh flaps.Anterolateral thigh flaps, with their robust blood supply, can easily reach the lowerabdomen and cover extensive abdominal skin defects when transferred bilaterally.Level of Evidence: Level V, therapeutic study

Silent Thyroiditis Presented as Transient Hypothyroidism During Pregnancy: A Case Report

Mahmoud Ali Kaykhaei — 2025-04-21

Silent thyroiditis during pregnancy is an under-recognized clinical condition and arare case, often manifesting as transient hypothyroidism. We report a 23-year-oldwoman at 8 weeks of gestation who presented with newly diagnosed hypothyroidism[TSH = 85 mIU/L (0.4–4.5), FT4 = 0.4 ng/dL (0.7–2.5), and anti-TPO = 78 IU/mL (upto 16)]. Thyroid function tests had been normal eight months prior. Levothyroxine(LT4) therapy was initiated, restoring euthyroidism. Treatment was discontinuedpostpartum, and the patient maintained normal thyroid function for over one year.Our case is unique in that silent thyroiditis occurred unusually early in pregnancyand differed from the more common postpartum cases. Silent thyroiditis should beconsidered in pregnancy-related hypothyroidism, particularly when prior thyroidfunction was normal. Prompt diagnosis and treatment can prevent adverse maternaland fetal outcomes

A Rare Case of Postpartum Carotid Dissection

Marzie Abutorabi zarchi — 2025-04-21

Cervicocranial arterial dissection is not a common disease (2.5% of total brain infarction), and its pathogenesis is still not fully understood. However, it appears to be multifactorial and is rarely seen in the postpartum period. A 40-year-old woman presented to the emergency department with sudden right lower limb paresis 10 days after vaginal delivery. She had no history of DM, HTN, preeclampsia, or underlying cerebrovascular disease. Upon evaluation, left extracranial carotid artery dissection was found on cervical MRA. The likelihood of postpartum dissection is rare, but it could be due to vascular damage associated with the Valsalva maneuver during labor; hemodynamic and hormonal changes due to pregnancy may also play a role.

Unusual Presentation of Clostridium Difficile Infection in a Patient with Inflammatory Bowel Disease

Sattar Jafari — 2025-04-21

Clostridium difficile infection (CDI) is commonly associated with nosocomial diarrhea;however, certain atypical presentations can challenge its diagnosis. We report a caseof CDI in a 25-year-old male with inflammatory bowel disease (IBD), presenting withunusual clinical features, including abdominal distension, lower extremity edema,and persistent non-bloody diarrhea. Diagnostic uncertainty arose due to the patient’sprior IBD diagnosis and atypical symptoms. Nevertheless, CDI was confirmed throughstool toxin assay and colonoscopy findings of pseudomembranes. Treatment with oralvancomycin resulted in complete symptom resolution, underscoring the importanceof considering CDI in cases with atypical symptoms. Prompt diagnosis is essential foreffective management and prevention of complications.

Does COVID-19 Cause Hemorrhagic Encephalitis? A Case Report

Marzieh Abotorabi Zarchi — 2025-04-21

SARS-CoV-2 causes an inflammatory disease characterized by symptoms such asfever, cough, shortness of breath, and myalgia, along with leukopenia, lymphopenia,elevated serum aspartate aminotransferase levels, and abnormal chest computedtomography findings. It may also lead to respiratory distress, unilateral complications,and secondary infections. COVID-19 infection can result in severe neurologicalcomplications, including viral encephalitis, cerebrovascular disorders, acute diffuseencephalomyelitis, and acute necrotizing encephalopathy. Here, we report a case ofhemorrhagic encephalitis due to SARS-CoV-2 in a 27-year-old patient with a history oftype 1 diabetes

Cerebral Infarction Due to Calcified Amorphous Tumor: A Rare Case Report

Ghazaleh Salehabadi — 2025-04-21

A Calcified Amorphous Tumor (CAT) consists of calcified nodules embedded withinan amorphous fibrous material and represents an uncommon non-neoplasticintracavitary cardiac mass. In this article, we present the case of a 38-year-old Iraniangentleman who experienced a sudden loss of consciousness and right hemiparesis.Brain imaging revealed acute infarction in the left basal ganglia. Echocardiographyidentified a large heterogeneous echodensity in the posterior AV groove, with centralecholucency extending to the base of the posterior left ventricular (LV) wall and thebasal posterior mitral valve leaflet (PMVL), findings consistent with CAT.Cardiac Magnetic Resonance Imaging (CMR) demonstrated an intramural calcifiedmass with a necrotic core located in the lateral annulus of the mitral valve, extendinginto the left atrium and ventricle. The mass was deemed responsible for the cerebralinfarction, which was classified as cardioembolic. This case report highlights CalcifiedAmorphous Tumor (CAT) as a potential embolic source, underscoring the importanceof early recognition through multimodality imaging. Comprehensive management,which may include regular follow-ups or surgical intervention, is crucial for patientsdiagnosed with CAT.

Anesthetic Challenges in a Patient with Ankylosing Spondylitis Undergoing Corrective Spinal Surgery: A Case Report

Arash Heroabadi — 2025-04-21

Ankylosing spondylitis (AS) is a progressive inflammatory disease characterized by spinal rigidity, kyphotic deformities, and significant challenges in airway management during surgery. We report the case of a 50-year-old male with severe kyphosis caused by long-standing AS, scheduled for corrective spinal surgery. Preoperative assessment revealed restricted cervical mobility, a “chin-on-chest” deformity, and a high risk of difficult intubation. Awake video-laryngoscopy-assisted intubation, combined with regional airway blocks, was successfully performed to minimize complications. Intraoperative neuromonitoring, strategic positioning, and meticulous hemodynamic management were implemented to ensure patient safety. The surgery was completed without neurological deficits, and the patient was discharged in stable condition. This case underscores the importance of thorough airway planning, neuromonitoring, and intraoperative vigilance in AS patients undergoing spinal correction. It highlights the critical role of a multidisciplinary approach in achieving successful surgical outcomes.