Asian Journal of Case Reports in Medicine and Health

Advanced Squamous Cell Carcinoma of Gallbladder: A Case Report

Ravi Shankar B — 2026-01-05

Gallbladder carcinoma is the fifth most common gastro-intestinal neoplasm and the most common biliary tract malignancy in the world. Primary squamous cell carcinoma of the gallbladder is a rare entity comprising around 1%-3% of all primary gallbladder cancers. We report the case of a 72-year- old woman who was diagnosed with a locally invasive squamous cell carcinoma of the gallbladder. The tumor was unresectable and considered for palliative care in the form of endotherapy (SEMS) and chemotherapy.

Hypokalaemia Potentially Linked to Meropenem Therapy in a Patient with End-Stage Renal Disease

Anusha C K — 2026-01-08

Hypokalemia is a frequently encountered electrolyte abnormality in hospitalized patients and is most often linked to recognizable factors such as gastrointestinal losses, diuretic therapy, or shifts of potassium into cells. In contrast, hypokalemia related to drug therapy is reported less often, and its association with meropenem remains uncommon and may be easily overlooked in clinical practice. A 60-year-old woman with a history of diabetes, hypertension, and chronic kidney disease was admitted with a diagnosis of urosepsis and fluid overload. Her initial potassium levels were within the normal range. She was treated with intravenous meropenem as part of the sepsis treatment. After a few days of therapy, her potassium levels unexpectedly and gradually decreased, leading to significant hypokalaemia. No other identifiable cause of potassium loss was found during the evaluation, suggesting that meropenem likely caused hypokalaemia. Although Meropenem is generally considered a safe antibiotic, few reports have described its association with hypokalaemia following discontinuation of meropenem, serum potassium levels gradually improved with supportive management. This case report highlights the importance of regular electrolyte monitoring in patients receiving meropenem, especially those with underlying comorbidities or at increased risk of electrolyte imbalance.

Categories: Internal Medicine, Nephrology, Infectious Disease.

Infection-Induced Cardiac Decompensation in a Patient with Severe Mitral Stenosis and Multisystem Comorbidities: A Case Report

Nayana Jayachandran — 2026-01-13

Background: Multimorbidity involving respiratory infection, chronic lung disease, valvular heart disease, coronary artery disease, and chronic liver disease presents significant diagnostic and therapeutic challenges. Lower respiratory tract infections are known to precipitate acute cardiovascular events through systemic inflammation, hypoxia, and increased myocardial oxygen demand, particularly in patients with pre-existing cardiac disease.

Case Presentation: A 47-year-old male with bronchial asthma, chronic lung disease, severe mitral stenosis, prior coronary artery disease, and chronic liver disease who presented with symptoms of lower respiratory tract infection complicated by non–ST-elevation myocardial infarction.

Conclusion: This case highlights the complex interaction between infection and cardiac decompensation and emphasizes the importance of early recognition and multidisciplinary management in patients with significant comorbidities.

Physiotherapy for Functional Recovery in Sexual Trauma Survivors: Breaking the Cycle of Tonic Immobility

Sandipkumar Kumawat — 2026-01-24

Introduction: Tonic immobility (TI) is an involuntary defensive “freeze” response reported in some individuals following extreme threat, including sexual trauma. Persistent movement avoidance and altered breathing patterns may coexist with musculoskeletal pain and gait deviations, potentially affecting function.

Case Description: A 35-year-old woman with a history of sexual trauma presented with right-sided sacroiliac (SI) joint pain, gait deviation (right out-toeing), and fear of movement. Clinical examination identified SI joint tenderness, lower-limb muscle tightness, and shallow upper-chest breathing during movement tasks and trauma-related discussion. A physiotherapy clinical impression of TI-associated movement dysfunction with SI joint pain and gait deviation was made, with trauma history considered a relevant contextual factor.

Intervention: A structured physiotherapy program integrating somatic awareness exercises, breathing retraining, and manual therapy (including muscle energy technique), alongside strengthening and ergonomic advice, was provided over a 6-week period (intervention plus follow-up).

Outcomes: Over the program, pain decreased (NPRS 6 to 0), post-traumatic stress symptom severity as measured by PCL-5 decreased (33 to 20), and the right foot progression angle improved (19° to 13°). Functional disability (ODI category) improved from moderate to minimal disability. No adverse events were reported.

Conclusion: In this single case, a trauma-informed physiotherapy approach was associated with improvements in pain, gait parameters, and self-reported symptoms. While causality cannot be inferred from a case report, these findings suggest that physiotherapy may be a feasible component of multidisciplinary rehabilitation for individuals presenting with musculoskeletal dysfunction in the context of TI following sexual trauma.

Epithelial-myoepithelial Carcinoma of Parotid Gland: A Diagnostic and Therapeutic Conundrum

Saarthak Miglani — 2026-01-29

Introduction: Epithelial-Myoepithelial Carcinoma (EMC) is a rare, biphasic salivary gland tumour primarily affecting the parotid gland, with an oddly high tendency to recur locally after surgical excision. Owing to its infrequent incidence, there are no established treatment protocols. Wide local excision with adequate margins remains the primary treatment modality. It is often supplemented by adjuvant radiotherapy, particularly in cases with high-risk features.

Case Report: A 60-year-old female presented with a painless, progressive swelling in the right pre-auricular region. Imaging and cytological examination suggested pleomorphic adenoma. She underwent right superficial parotidectomy. Histopathological examination revealed EMC with capsular invasion. Immunohistochemistry confirmed biphasic epithelial- myoepithelial differentiation. Adjuvant radiotherapy (60Gy/30#) was delivered owing to close margins and perineural invasion. Patient is currently disease free since last 3 years.

Conclusion: EMC poses a diagnostic challenge due to its morphological resemblance to benign counterparts. Complete excision with or without adjunctive radiotherapy offers excellent local control and long term disease-free survival.

Dieulafoy’s Lesion, a Cause of Gastrointestinal Bleeding: A Case Report

Ahmed Lutful Moben — 2026-02-07

Dieulafoy’s lesion is a rare but important cause of gastrointestinal bleeding as it may be life-threatening at times. This condition accounts for 1-2% of all gastrointestinal bleedings. The diagnosis is often challenging due to intermittent nature of bleeding and may require repeated investigations, before a diagnosis can finally be attained. If ignored for long duration Dieulafoy’s lesion necessities repeated blood transfusions and may confuse diagnosis with inflammatory bowel disease. Approach to Dieulafoy’s lesion may require repeated upper gastrointestinal tract endoscopies with biopsies as well use of antibacterial, antiprotozoal and antiviral medications among others. Here we report a case of Dieulafoy’s lesion from Bangladesh.

A Case Report of Juvenile Systemic Lupus Erythematosus Presenting with Suspected Lupus Nephritis Flare: A Diagnostic and Therapeutic Challenge

Bhukya Swecha Sanjana Rathod — 2026-02-07

Background: Juvenile systemic lupus erythematosus (JSLE) is an autoimmune disease, in most cases major organ systems are involved and the lupus nephritis flares are the major contributors to morbidity. A quick diagnosis and early treatment are important in preventing long-term renal damage.

Case Presentation: We present a 10-year-old female child, a case of a known juvenile case of SLE with history of nephritis since 2022 and presenting with sudden-onset abdominal distension, lack of appetite, nausea, low urine volume, abdominal pain, vomiting, fever, rashes, polyarthralgia, and melena. Laboratory investigations revealed leukopenia, anemia, hypoalbuminemia, increased ESR, 3+ proteinuria, high level of proteinuria 24 hours, and increasing urea levels. SLEDAI of 12 indicated flare and SLICE of 4+ indicated flare of lupus nephritis. She was treated using corticosteroids, diuretics, antibiotics, immunosuppressive therapy, and supportive therapy. She demonstrated progressive clinical and biochemical improvement, normalization of renal parameters by day nine and was discharged in stable condition.

Conclusion: The case demonstrates the relevance of early recognition of the nephritis flares in JSLE and the efficiency of timely immunosuppressive treatment in eliminating the further worsening of the renal condition.

Enhancing Lumbar Stability in Fast Bowlers through Advanced Physiotherapy Intervention Focused on the Multifidus Muscle: A Case Report

Sharma Deepak — 2026-02-07

Introduction: Fast bowlers are highly susceptible to overuse injuries, with lumbar spine problems being the most common. While 8% of cricket players experience low back pain, the incidence rises to 14% in fast bowlers, with lumbar instability affecting up to 57% of individuals with chronic low back pain (CLBP). This case report aimed to evaluate the combined effect of lumbar Sustained Natural Apophyseal Glides (SNAGs) and core stabilization exercises on lumbar stability, pain, and multifidus muscle thickness.

Case Description: A 27-year-old male fast bowler with over eight years of bowling experience and a two-time state-level cricket player. The athlete regularly attended daily training sessions at a cricket academy, including intensive bowling practice, and reported persistent low back pain following training and matches, along with frequent episodes of a sudden jerking sensation in the lumbar region during the bowling action.

Intervention: A six-week program combining conventional core stabilization exercises with lumbar SNAGs was administered after informed consent.

Outcomes: Post-intervention assessments using the Oswestry Disability Index (ODI), Prone Lumbar Extension Test (PLET), and rehabilitative ultrasound imaging showed marked improvements. The ODI score reduced from 35.5% to 11.1% (68.7% improvement). Multifidus resting thickness increased from

6.2 mm to 8.3 mm, and contraction thickness rose from 7.2 mm to 9.2 mm, though percentage change during contraction declined (16.13% to 10.84%). PLET changed from positive to negative.

Conclusion: In conclusion, the integration of SNAG manual therapy and targeted core stabilization exercises in this preventive intervention program showed simple and effective in improving lumbar stability, reducing disability, and enhancing multifidus muscle function.

Phenobarbitone Poisoning Complicated by Pneumonia: A Case Report

Nayana R — 2026-02-07

Phenobarbitone poisoning remains a clinically significant condition due to its prolonged half-life, narrow therapeutic index, and risk of severe systemic complications. We report the case of a 21-year-old female who presented with altered sensorium following an intentional overdose of phenobarbitone (30 tablets of 60 mg each; total 1.8 g). On admission, her Glasgow Coma Scale (GCS) score was 8/15. She was managed in the ICU with airway protection, gastric lavage, activated charcoal, forced alkaline diuresis, and supportive care. Due to persistent central nervous system depression, charcoal hemoperfusion was performed, resulting in neurological improvement (GCS = 15/15). During her hospital stay, pneumonia developed after gastric lavage and was successfully treated with antibiotics. The patient made a complete clinical recovery and was discharged with advice for psychiatric follow-up. This case highlights the importance of early recognition, intensive supportive care, and vigilance for secondary complications, such as pneumonia, in phenobarbitone poisoning.

SIADH Mimicking Drug-Induced Hyponatremia Secondary to Viral Pneumonia with Acute Ischemic Stroke: A Case Report

Nahiya Fathima — 2026-02-10

Background: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a prevalent aetiology of hyponatraemia, frequently induced by drugs, pulmonary infections, or central nervous system disorders. It is challenging to differentiate between drug-induced hyponatraemia and SIADH caused by an infection, especially in the elderly with numerous other medical issues.

Case Presentation: We present a case of a 68-year-old female with type 2 diabetes mellitus and hypertension, exhibiting high-grade fever, disorientation, and a dry cough. Laboratory investigations revealed hypotonic hyponatraemia, hypokalaemia and hypo-osmolality. The patient was on chlorthalidone and glimepiride, raising initial suspicion for drug-induced hyponatremia. Even after withdrawal of these medications and giving supportive care, sodium levels stayed low. Imaging showed pulmonary oedema, thickening of the interlobular septum, and lymphadenopathy in the mediastinum, which are all signs of viral pneumonia. On Day 6 acute ischaemic stroke was confirmed by an MRI. Careful fluid restriction, electrolyte supplementation, and carefully monitored low dose tolvaptan lead to normalization of serum sodium and neurological improvement

Discussion: This case highlights the diagnostic complexity of hyponatraemia in elderly individuals undergoing polypharmacy. Persistent hyponatraemia, despite modifications in medication, requires assessment for infection-related SIADH. Severe and prolonged hyponatraemia heightens the risk of neurological complications, such as ischaemic stroke. Targeted therapy with vasopressin receptor antagonists, combined with multidisciplinary care, facilitated safe correction of sodium and clinical recovery.

Conclusion: Drug-induced hyponatraemia can be clinically imitated by SIADH caused by viral pneumonia. To avoid complications and enhance results, early etiological re-evaluation, careful electrolyte monitoring, and tailored treatment—including safe tolvaptan use are crucial.

Dapsone Induced Methemoglobinemia in a 16-Year-Old Female with Dermatitis Herpetiformis: A Case Report

Rashmi Arora — 2026-02-14

Background: Methemoglobinemia is a rare but potentially life-threatening disorder of oxygen carrying capacity, requiring prompt diagnosis. It could be congenital or acquired. This study presents a rare case of dapsone induced methemoglobinemia in a 16-year-old girl, managed with intravenous methylene blue.

Case Presentation: A 16-year-old girl presented to the emergency department with a history of sudden loss of consciousness without seizure activity or trauma. The patient had a room air saturation of 76%. Despite high-flow oxygen therapy, oxygen

saturation did not improve. Methemoglobinemia was suspected based on clinical signs. Methemoglobin levels came back >30%. Treatment was initiated with intravenous methylene blue at a dose of 1mg/kg. Over the course of next 5 days, intravenous methylene blue was repeated as required to a maximum dose of 7 mg/kg. The patient’s cyanosis resolved, oxygen saturation normalized to 96% on room air, and methemoglobin levels decreased to 17%.

Conclusion: This case underscores the need for a high index of suspicion for methemoglobinemia in patients presenting with unexplained cyanosis and refractory hypoxia, especially in the context of known oxidizing agents like dapsone. Early diagnosis and intervention remain key to favorable outcomes.

Unilateral Exophthalmia Revealing an Orbital Metastasis from Esophageal Adenocarcinoma: A Case Report and Review of the Literature

Mohamed Tahiri — 2026-02-17

Orbital metastases are uncommon manifestations of systemic malignancies and are most frequently associated with breast, lung, and prostate cancers. Digestive tract tumors rarely metastasize to the orbit, and esophageal adenocarcinoma represents an exceptional cause. We report the case of a 56-year-old man in whom esophageal adenocarcinoma was revealed by unilateral exophthalmia secondary to an osteolytic orbital metastasis. The patient presented with progressive dysphagia and significant weight loss. Imaging revealed an orbital mass with fronto-temporal extension, and histopathological analysis confirmed metastatic disease of esophageal origin. Upper gastrointestinal endoscopy demonstrated a budding tumor of the lower esophagus, histologically consistent with moderately differentiated adenocarcinoma. Given the presence of liver metastases and altered general condition, the patient was managed with palliative intent. This case highlights the importance of considering esophageal cancer in the differential diagnosis of orbital masses and underscores the poor prognosis associated with such atypical metastatic presentations. A review of the literature is provided to place this case within the broader context of orbital metastases of digestive origin.

Double Chin Deception: A Case of Intraoral Dermoid Cyst in the Floor of the Mouth

Sunil Vasudev — 2026-02-21

Dermoid cysts of the oral cavity are rare, benign developmental lesions most commonly found in the midline of the floor of the mouth. They can present as painless swellings and may mimic other soft tissue masses, making diagnosis challenging. We report a case of a 35-year-old male who presented with a slow- growing, painless swelling in the submental region for over six months. Clinical examination revealed a midline swelling mimicking a “double chin” with intraoral extension elevating the floor of the mouth. MRI confirmed a well-defined, encapsulated cystic lesion situated above the mylohyoid muscle. Surgical excision was performed via an intraoral approach. Histopathology confirmed the diagnosis of a dermoid cyst. Although uncommon, dermoid cysts should be considered in the differential diagnosis of midline submental swellings, especially when intraoral involvement is present. Early diagnosis and complete excision are crucial to avoid complications and recurrence.

Extra pulmonary Manifestation of Legionella Pneumophila infection in Pregnancy Complicated with Foetal Loss: A Case Report

Aaron Ignatius — 2026-02-25

Legionella pneumonia during pregnancy is exceptionally rare however may lead to severe maternal sepsis and fetal compromise. We report a case of a 35-year-old gravida 4 para 3/ G4P3 at 36 weeks gestation who presented with nonspecific symptoms, later developing septic shock and intrauterine fetal demise, with Legionella antigen subsequently confirmed in urine. The patient’s course was complicated with disseminated intravascular coagulopathy (DIVC) and postpartum hemorrhage (PPH), requiring intensive care and multidisciplinary management. Early suspicion, prompt antimicrobial therapy, and coordinated critical care are crucial to improving maternal outcomes in such atypical presentations.

Spot Diagnosis of Gas-Forming Pyelonephritis in a Diabetic Woman: Underscoring the Value of Timely Radiological Evaluation

M. Nagarjuna — 2026-02-27

Background: Emphysematous pyelonephritis (EPN) is a fulminant, necrotizing, gas-forming infection of the kidney, encountered predominantly in diabetic patients and associated with high mortality when diagnosis is delayed.

Case Presentation: A 45-year-old woman with Type-II Diabetes Mellitus presented with five days of fever and left flank pain. A kidney, ureter, and bladder (KUB) radiograph demonstrated gas in the region of the left kidney. Subsequent CT of the kidneys and urinary bladder revealed destruction of more than one-third of the renal parenchyma with a mottled gas pattern, consistent with EPN. The disease was categorized as Type II emphysematous pyelonephritis and classified as Huang–Tseng Class 3b, showing gas within the renal parenchyma and extension into the pararenal space.

Management and Outcome: The patient was treated with prompt CT imaging-based diagnosis, aggressive intravenous antibiotic therapy, and appropriate urological intervention, which led to clinical improvement and renal preservation.

Conclusion: This case underscores the critical importance of early imaging in diabetic patients with suspected pyelonephritis. Timely radiologic evaluation enables accurate classification, guides appropriate management, and improves outcomes in emphysematous pyelonephritis.

Effect of Physiotherapy Regimen on Static & Dynamic Balance and Foot Function in Non-operative Lover’s Fracture: A Case Study

Sahu Vishal — 2026-02-27

Introduction: Lover's fracture," also known as a "Don Juan fracture" or "Casanova fracture" refers to a fracture of the calcaneus (heel bone), often caused by a fall from a height, and is named for the historical trope of a suitor jumping from a window to escape a jealous spouse. Over time, calcaneal burst fractures have been referred to as Lover’s fractures because the injury occurred when a suitor jumped off a lover's balcony to avoid detection. One of the seven tarsal bones is the calcaneus.

Case Description: The subject of this case study is a 65-year-old woman who lived on Goner Road in Jaipur and suffered a calcaneal fracture, also known as a lover's fracture, three months ago after falling down stairs. Because of her age-related surgical risk profile and the fact that there was little displacement, the injury was treated conservatively. Particularly in older persons, Lover's fracture, which is frequently caused by axial strain to the heel, has a major impact on postural stability and foot biomechanics. The patient complained of localised oedema, ongoing mild to moderate heel pain, and trouble standing and walking for extended periods of time at the time of the physiotherapy referral.

Intervention: A structured physiotherapy program, progressive strengthening, balance training and intrinsic foot muscles strengthening exercise. was provided over a 6-week period (intervention plus follow-up).

Outcomes: Over the program, improved static balance remained negative, foot posture index improved from 6 (near-normal), reflecting 33% improvements toward neutral alignment. Functional reach test at baseline improved to 33.78% cm (low risk fall) at day 42, representing 51.5% improvements. Cumberland ankle instability tool score 24/30 (functional stability), a 41.2% improvement of 7 points. No adverse events were reported.

Conclusion: In this single case, a patient with non-operatively treated Lover's fractures can greatly benefit from a systematic, progressive physiotherapy program in terms of their static and dynamic balance, foot function, and ankle stability. Over the course of six weeks, the intervention, which included progressive balance training and intrinsic foot muscle strengthening, produced clinically significant gains in functional reach, static and dynamic balance, foot function, and ankle stability.

Thalidomide in SLE with Skin Damage Refractory to Other Treatment Options: Two Case Reports

H. Omali — 2026-03-02

Background: Cutaneous manifestations of systemic lupus erythematosus (SLE) may persist despite antimalarials and conventional immunosuppressive therapy, causing substantial morbidity and prolonged corticosteroid exposure. Thalidomide has demonstrated activity in refractory cutaneous lupus erythematosus (CLE), but its use is limited by serious adverse effects, particularly teratogenicity and peripheral neuropathy.

Case Presentations: We report two patients with SLE and refractory CLE. Case 1 was an adult woman with longstanding SLE and chronic, treatment-resistant cutaneous lesions despite multiple prior systemic therapies and prolonged corticosteroids, complicated by steroid-related adverse events. Thalidomide was introduced after failure or intolerance of standard options, leading to marked clinical improvement of cutaneous disease and steroid-sparing benefit; however, peripheral neuropathy developed during treatment and required discontinuation. Case 2 was a 16-year-old girl with SLE and active CLE confirmed by clinicopathologic assessment, insufficiently responsive to standard therapy. Thalidomide was initiated as a rescue option with rapid improvement in skin lesions, but neuropathic symptoms occurred early, prompting cessation and transition to alternative immunosuppression.

Outcomes: In both cases, thalidomide was associated with clinically meaningful improvement of refractory cutaneous disease, but treatment-limiting neurotoxicity occurred, underscoring the narrow therapeutic window and the need for strict monitoring.

Conclusion: Thalidomide may be an effective short-term rescue therapy for carefully selected patients with refractory CLE when conventional agents are ineffective or not tolerated. Its use requires rigorous risk–benefit assessment, comprehensive counseling, adherence to pregnancy-prevention requirements, and proactive surveillance for peripheral neuropathy with prompt discontinuation at the earliest signs of neurotoxicity. Future prospective studies incorporating standardized cutaneous activity indices and structured safety monitoring are required to clarify optimal dosing, treatment duration, relapse prevention strategies, and predictors of adverse events, especially in adolescents and other high-risk populations.

Hypersensitivity Pneumonitis Presenting with Spontaneous Pneumomediastinum and Pneumopericardium: A Case Report

Palaniappan Inbamuthiah — 2026-03-07

Background: The severity and length of exposure determine hypersensitivity pneumonitis (HP) clinical presentation, as symptoms can vary from acute flu-like symptoms to chronic fibrotic lung disease. Inhaling organic or chemical antigens can cause HP, which is an inflammatory lung condition.

Aims: Here we present a rare case of hypersensitivity pneumonitis that presented with spontaneous pneumomediastinum and pneumopericardium.

Place and Duration of Study: This case study was carried out at Department of Internal medicine and Pulmonology in Kuwait hospital, Sharjah, United Arab Emirates.

Case Presentation: A 54-year-old man with no pre-existing illness presented with subacute worsening shortness of breath over 3 weeks, associated with cough, fever and sweating. There was history of recent occupational wood dust exposure. Clinical, radiological and bronchoscopy features were suggestive of hypersensitivity pneumonitis with spontaneous pneumomediastinum and pneumopericardium. Patient responded well with corticosteroids with complete recovery.

Discussion: Pneumomediastinum is a rare complication seen in interstitial lung disease patients alone or associated with pneumothorax. The importance of parenchymal remodelling in HP has been highlighted by recent research, which may increase the risk of barotrauma by altering lung mechanics. Those with a violent cough or honeycombing are especially predisposed. Areas of air trapping and regional pressure variations may lead to alveolar rupture and could be identified with the use of sophisticated imaging techniques, such as inspiratory and expiratory CT scans.

Conclusion: Hypersensitivity pneumonitis can be frequently mistaken for other infective conditions. Emphasis needs to be given on detailed occupational history taking. Spontaneous pneumomediastinum and pneumopericardium can be rare presenting symptoms of hypersensitivity pneumonitis.

Primary Cutaneous Leiomyosarcoma of the Gluteal Region: A Rare Case Report and Review of Literature

Saarthak Miglani — 2026-03-11

Primary Cutaneous Leiomyosarcoma is an infrequent malignant neoplasm of dermal or subcutaneous smooth muscle origin. This report highlights an unusual presentation of the disease as a painful, progressive gluteal swelling in a fifty-year-old male, initially mismanaged as a benign lesion. The mass was excised twice, with histology reported as a spindle cell neoplasm and treated as benign entity. Recurrence at the same site with progressive enlargement prompted referral to our centre, where our surgeons proceeded with wide local excision. Histopathology with immunohistochemistry confirmed the diagnosis of leiomyosarcoma. The unusual anatomical site, repeated recurrence and diagnostic delay highlight the complexity of this entity.

This case highlights the importance of maintaining a high index of suspicion for uncommon presentations and emphasizes the critical role of prudent histopathological assessment for accurate diagnosis. A multidisciplinary approach is needed in guiding an effective management & improving patient outcomes.

An Exceptional Femoral Artery Aneurysm in Severe Vasculo-Behçet Disease Associated with Hughes–Stovin Syndrome: A Case Report

H. Omali — 2026-03-20

Introduction: Arterial aneurysmal involvement in Behçet’s disease represents one of the most severe vascular manifestations and constitutes a major therapeutic challenge. This is a serious vascular complication, occurring in 3-5% of cases, often in young people. It results from an intense inflammatory process affecting the vascular wall, leading to destruction of the elastic and muscular components of the artery and consequently promoting the formation of pseudoaneurysms. These lesions are particularly concerning because of their often rapid and unpredictable progression, with a high risk of spontaneous rupture that may be life-threatening. The most frequently reported locations involve the pulmonary arteries, the aorta, and peripheral arteries, particularly the femoral arteries.

The management of these vascular complications primarily relies on strict control of inflammation through intensive immunosuppressive therapy aimed at stabilizing the disease and preventing the progression of vascular lesions. Surgical or endovascular intervention may subsequently be required in certain situations, particularly in the presence of large, symptomatic aneurysms or those at high risk of rupture. However, these procedures remain technically challenging due to the underlying inflammatory environment and the risk of aneurysmal recurrence or postoperative complications.

Hughes–Stovin syndrome is a rare disorder of still poorly understood etiology, characterized by the association of pulmonary artery aneurysms and deep venous thrombosis, and is often considered a particular or incomplete form of Behçet’s disease. We report the case of a patient hospitalized in the internal medicine department in whom the diagnosis of Behçet’s disease was established, presenting an exceptional vascular manifestation consisting of a thrombosed aneurysm of the left superficial femoral artery associated with Hughes–Stovin syndrome.

This case highlights the potential severity of arterial involvement in Behçet’s disease and emphasizes the importance of early diagnosis and prompt multidisciplinary therapeutic management. Close clinical and radiological monitoring is essential to detect early progression of vascular lesions and to reduce the risk of severe complications, particularly aneurysmal rupture, massive hemorrhage, and related morbidity.

Case Report: We report the case of a patient with Behçet’s disease presenting an unusual vascular manifestation consisting of a thrombosed aneurysm of the left superficial femoral artery associated with pulmonary artery aneurysm and deep venous thrombosis, suggesting Hughes-Stovin syndrome.

Discussion / Conclusion: Arterial aneurysmal involvement in Behçet’s disease represents a severe and potentially life-threatening manifestation. Early recognition and prompt initiation of immunosuppressive therapy combined with appropriate vascular intervention are essential to prevent catastrophic complications such as aneurysmal rupture.

Regular follow-up and strict therapeutic adherence are crucial to detect new vascular lesions and improve long-term prognosis.

Sjögren’s Syndrome Presenting with Multiple Cystic Lung Lesions: A Rare Pulmonary Manifestation

Lalitha Ramachandrappa — 2026-03-21

Aims: This case report aims to describe a rare presentation of primary Sjögren’s syndrome (pSS) manifesting as diffuse thin-walled cystic lung disease, emphasizing the need for autoimmune evaluation in such cases to avoid misdiagnosis and enable multidisciplinary management.

Case Presentation: A 60-year-old female farmer presented with progressive dyspnoea, dry cough, fever and longstanding sicca symptoms, along with a prior history of myocardial infarction. Examination revealed pallor, respiratory distress and bilateral basal crackles. High-resolution computed tomography (HRCT) demonstrated diffuse thin-walled pulmonary cysts with associated interstitial changes and bronchiectasis. Laboratory evaluation showed normocytic anaemia with elevated ESR and CRP. Autoimmune testing revealed positive antinuclear antibodies (ANA) and anti-Ro/SSA antibodies, while Schirmer’s test confirmed ocular dryness, supporting the diagnosis of pSS with pulmonary involvement consistent with lymphocytic interstitial pneumonia.

Discussion: Cystic lung disease in pSS is thought to result from lymphocytic infiltration causing small airway obstruction and cyst formation. Radiologically, these thin-walled cysts associated with interstitial changes may mimic other cystic lung disorders such as pulmonary Langerhans cell histiocytosis and lymphangioleiomyomatosis, posing diagnostic challenges.

Conclusion: Diffuse thin-walled cystic lung disease may represent an uncommon but important pulmonary manifestation of primary Sjögren’s syndrome. Recognition of this pattern is essential to prompt autoimmune evaluation, avoid misdiagnosis and enable timely multidisciplinary management.

Tubercular Liver Abscess: A Rare Manifestation of Extrapulmonary Tuberculosis

Ravi Kumar Sharma — 2026-03-23

Tubercular liver abscess (TLA) is an uncommon manifestation of extrapulmonary tuberculosis, often misdiagnosed as pyogenic or amoebic abscess. We report the case of a 30-year-old male presenting with right hypochondrial pain, diagnosed with TLA confirmed by CBNAAT positivity in aspirated pus. The patient was successfully managed with percutaneous pigtail drainage and antitubercular therapy (ATT). This case underscores the importance of considering tuberculosis in the differential diagnosis of hepatic abscesses in endemic regions and highlights the role of minimally invasive drainage combined with ATT. The clinical presentation of tubercular liver abscess (TLA) is often nonspecific, with patients typically reporting fever, vague abdominal pain, malaise, and weight loss. On physical examination, hepatomegaly is a frequent finding, whereas jaundice is uncommon and, when present, usually indicates biliary involvement due to extra‑ or intrahepatic obstruction. Importantly, the severity of liver disease does not correlate with the occurrence of jaundice. By recognizing and treating such manifestations early, clinicians can ensure timely recovery and strengthen the collective understanding of this uncommon presentation. This case reminds us that in the battle against tuberculosis, even its rarest shadows must be unmasked, because forewarned is forearmed.

Effect of Soleus Push-Up and Brisk Walking in Type 2 Diabetic Patient: A Case Study

A. Deepesh Sharma — 2026-03-24

Introduction: This case report presents a unique non-fatiguing intervention soleus push-up and brisk walking—for managing type 2 diabetes mellitus (T2DM), especially suited for sedentary individuals. Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder marked by insulin resistance and elevated blood glucose levels. While pharmacological treatments are foundational, complementary lifestyle interventions, those involving physical activity, play a critical role in long-term glycemic control.

Case Information: A 37-year-old female presented with fatigue and increased urination that disrupted daily household functioning. She had a family history of diabetes and was recently diagnosed with T2DM based on fasting blood tests and clinical features and taking diabetes medication from past 6 months.

Diagnosis: Baseline HbA1c and HOMA-IR confirmed insulin resistance and impaired glycemic control, consistent with newly diagnosed T2DM.

Intervention: The patient was enrolled in a 12-week exercise-based intervention including soleus push-ups and postprandial brisk walking. No medication and dietary changes were made during the study. Outcome measures included HOMA-IR and HbA1c values.

Outcomes: After 12 weeks, there was a reduction in HbA1c from 7.6% to 7.1%, and HOMA-IR from 2.43 to 1.93. The patient also reported improved energy levels, reduced fatigue, and high adherence due to the feasibility of the intervention.

Conclusions: This case suggests that muscle-activated strategies such as soleus push-ups and low-intensity walking can improve metabolic function in individuals with T2DM. These exercises are particularly valuable due to their ease, low fatigue level, and potential for broad implementation.

Takayasu Arteritis Presenting with Upper Limb Weakness and Subclavian Artery Thrombosis in a Young Female: A Case Report

H. B. Harshavardhan — 2026-03-26

Takayasu arteritis is a rare, chronic granulomatous large-vessel vasculitis that primarily affects young women and involves the aorta and its major branches. Owing to its nonspecific early manifestations, diagnosis is frequently delayed until significant vascular involvement develops. We present the case of a 32-year-old female who presented with sudden onset generalized weakness and breathlessness, along with a one-year history of headache, visual blurring, numbness, and progressive weakness of the upper limbs. On examination, she was hypotensive with asymmetric upper-limb motor power. Laboratory investigations revealed severe microcytic hypochromic anaemia with neutrophilic leukocytosis and thrombocytosis. Two-dimensional echocardiography demonstrated global left ventricular hypokinesia, moderate aortic regurgitation, and mild left ventricular systolic dysfunction. Doppler imaging of the upper-limb arterial system revealed diffuse circumferential wall thickening and significant luminal narrowing of the bilateral carotid and subclavian arteries, along with an echogenic thrombus causing critical stenosis of the right subclavian artery. These findings were consistent with large-vessel arteritis. Based on clinical features and imaging findings, a diagnosis of Takayasu arteritis was established. The patient was managed with high-dose intravenous corticosteroids, anticoagulation and supportive care, following which she was referred to a tertiary cardiac centre for further evaluation and definitive management. This case emphasizes the importance of maintaining a high index of suspicion for Takayasu arteritis in young women presenting with unexplained neurological and cardiovascular symptoms, as early diagnosis and timely immunosuppressive therapy are crucial to prevent disease progression and long-term complications.

Therapeutic Outcomes of Underwater Ultrasound Therapy for De Quervain’s Tenosynovitis: A Case Report

C. V. Praveen — 2026-03-27

De Quervain’s tenosynovitis is a common inflammatory condition of the wrist and thumb that causes pain and functional limitation. Therapeutic ultrasound is frequently used in conservative management; however, some patients are unable to tolerate conventional contact ultrasound due to localized hypersensitivity. Underwater ultrasound therapy may offer an alternative method of ultrasound. 42-year-old male software professional with a two-month history of radial-sided thumb pain and difficulty gripping objects presented with features consistent with De Quervain’s tenosynovitis. Previous conservative treatments provided only temporary relief, and the patient was unable to tolerate contact ultrasound due to pain hypersensitivity. Underwater ultrasound therapy was administered using a 1 MHz frequency at 1.0 W/cm² in continuous mode for 10 minutes per session for a total of 10 sessions. Pain intensity measured using the Numerical Pain Rating Scale (NPRS) reduced from 6 at baseline to 3 by Day 10 and reached 0 by Day 30. Functional outcomes assessed using the Patient-Rated Wrist Evaluation (PRWE) showed marked improvement. PRWE pain scores reduced from 30 at baseline to 7 by Day 15, and 0 by Day 30. Functional scores for specific activities improved from 28 to 0, and usual activity scores improved from 21 to 0 by Day 30, with sustained recovery at follow-up. This case report indicates that underwater ultrasound therapy may be a safe and well-tolerated physiotherapy intervention for achieving significant pain relief and functional recovery in patients with De Quervain’s tenosynovitis who are hypersensitive to conventional ultrasound applications.

Heparin-induced Thrombocytopenia: A Case Report

Deepak Yadav — 2026-04-01

Heparin-induced thrombocytopenia (HIT) is a serious immune-mediated adverse drug reaction that paradoxically increases thrombotic risk despite declining platelet counts. We present a case of a 75-year-old male admitted for bilateral knee osteoarthritis who developed thrombocytopenia following heparin administration. Local examination of both knees revealed mild varus deformity, diffuse tenderness, and palpable bony crepitus, with painful flexion and extension. The patient's platelet count showed a temporal decline from 2.21 to 1.94 lakhs/cumm (221 × 10⁹/L to 194 × 10⁹/L) during heparin therapy, with subsequent recovery to 2.85 lakhs/cumm (285 × 10⁹/L) after discontinuation. This case emphasises the importance of routine platelet monitoring, early recognition of HIT, and prompt intervention to prevent potentially life-threatening thrombotic complications.

Femoral and Popliteal Nerve Block for Left Foot Amputation: A Case Report in a Patient with Low Ejection Fraction and Recent Clopidogrel Use

Gülay Esen — 2026-04-03

Introduction: Patients with heart problems are very hard to give anesthesia to especially when they need surgery on their legs. Giving them anesthesia can be really risky because it can make their blood pressure go up and down a lot. This is because their heart is not strong enough and cannot handle the stress of the surgery.

There is another way to give anesthesia called anesthesia which is used for leg surgery. However this method can be dangerous for patients who are taking medications, such as clopidogrel because it can cause bleeding in the spine. The American Society of Regional Anesthesia and Pain Medicine says that doctors should be very careful when using this method on patients who are taking these kinds of medications.

Some doctors are now using a method, called peripheral nerve blocks, which can be safer for high-risk patients. This method involves numbing the nerves in the leg which can help the patient avoid feeling pain during surgery without affecting their blood pressure (Kopp et al., 2025). Using ultrasound to guide the needle makes this method even safer and more effective (Joubert and Duchalais, 2022).

There are not many reports about using peripheral nerve blocks for emergency leg amputations on patients with very bad heart problems who are also taking antiplatelet medications. So we want to share a story, about a patient who had a surgery using this method. The patient had a low ejection fraction and had recently taken clopidogrel but they were still able to have a safe and successful foot amputation using ultrasound-guided femoral and popliteal nerve blocks.

Case Presentation: A 57-year-old 90-kg male ASA IV, NYHA Class III with coronary artery disease, hypertension, diabetes, and chronic heart failure (ejection fraction 20%) presented for left foot amputation. He had taken clopidogrel 24 hours prior to surgery, contraindicating neuraxial anesthesia (Kopp et al., 2025). Ultrasound-guided femoral and popliteal nerve blocks were performed using 45 mL of 0.5% bupivacaine (total dose 225 mg, approximately 2.5 mg/kg), which was within the recommended safe dose range for the patient’s body weight. The procedure was completed successfully with stable hemodynamics throughout.

Conclusion: Ultrasound-guided femoral and popliteal nerve blocks are a safe, effective option for lower limb amputations in patients with severely reduced cardiac function and recent clopidogrel use (Joubert and Duchalais, 2022). This approach avoids risks of neuraxial blockade while preserving hemodynamic stability.

A Persistent Cough Misdiagnosed as Tuberculosis Revealing Pulmonary Aspergillosis: A Diagnostic Challenge in a High TB-Burden Setting

Adaobi S. Ikedilo — 2026-04-15

Chronic pulmonary aspergillosis (CPA) is an underrecognized but significant complication of prior pulmonary tuberculosis (TB), particularly in high TB-burden settings where overlapping clinical and radiological features often lead to misdiagnosis. We report the case of a 42-year-old male who presented with a six-month history of persistent productive cough, hemoptysis, weight loss, and fatigue. He had previously been treated empirically for smear-negative pulmonary tuberculosis without clinical improvement. Initial investigations, including sputum acid-fast bacilli microscopy and GeneXpert MTB/RIF, were negative. Despite this, anti-tuberculous therapy was continued for four months, with worsening symptoms. Further evaluation at our facility revealed bilateral upper lobe cavitary lesions on chest imaging, with intracavitary soft tissue densities suggestive of fungal balls on high-resolution computed tomography. Microbiological analysis demonstrated Aspergillus species on sputum microscopy and culture, while serological testing showed elevated Aspergillus-specific IgG levels, confirming the diagnosis of chronic cavitary pulmonary aspergillosis. Anti-tuberculous therapy was discontinued, and the patient was commenced on oral itraconazole, resulting in significant clinical and radiological improvement over a three-month follow-up period. This case highlights the diagnostic challenge of distinguishing CPA from pulmonary TB in resource-limited, high-burden settings. It underscores the importance of considering alternative diagnoses in patients with persistent respiratory symptoms who fail to respond to standard anti-tuberculous therapy, especially in the context of negative microbiological findings. Improved access to fungal diagnostics and heightened clinical awareness are essential to reduce misdiagnosis and ensure timely, appropriate management.

Hoffmann’s Syndrome Mimicking Polymyositis Secondary to Hypothyroidism: A Case Report

Luqman Bin Fahad — 2026-04-16

Background: Hoffmann’s syndrome is a rare and underdiagnosed form of hypothyroid myopathy that can closely mimic autoimmune inflammatory myopathies such as polymyositis, potentially leading to inappropriate immunosuppressive therapy.

Case Presentation: A 39-year-old female with inadequately controlled hypothyroidism presented with progressive proximal muscle weakness for one year, worsening after a febrile illness. Examination revealed predominant proximal weakness, reduced left hand grip, and left-sided sensory deficits from C2. Laboratory findings included hyperCKemia (CPK 5810 U/L), elevated transaminases, and raised TSH (9.86 mIU/mL). ENMG showed myopathic changes. Initial suspicion of polymyositis led to corticosteroid therapy, but the diagnosis was revised to Hoffmann’s syndrome after negative autoimmune markers, characteristic ENMG findings, and rapid improvement with levothyroxine.

Conclusion: This case highlights the importance of evaluating thyroid function in patients with proximal myopathy and hyperCKemia. Early levothyroxine replacement leads to significant recovery and avoids unnecessary immunosuppression. The concomitant periarticular osteopenia expands the clinical spectrum of long-standing hypothyroidism.

Rasmussen’s Encephalitis Presenting as Refractory Nocturnal Focal Seizures with Unilateral Cerebral Hemiatrophy in a 14-Year-Old Girl: A Case Report

Luqman Bin Fahad — 2026-04-21

Rasmussen’s encephalitis (RE) is a rare, chronic, progressive inflammatory neurological disorder that causes unilateral hemispheric inflammation, drug-resistant focal seizures, and progressive neurological deficits. It mainly affects children and often mimics other forms of refractory epilepsy, leading to diagnostic delays.

Case Presentation: A 14-year-old girl presented with a one-year history of refractory nocturnal seizures and chronic headaches that began at age 13. Despite one year of Brivaracetam therapy, seizures remained uncontrolled. Examination revealed right-sided hemiparesis (power 4/5) and brisk reflexes. Laboratory tests showed elevated serum creatinine kinase (652.7 U/L). MRI brain demonstrated left cerebral hemisphere atrophy with ex-vacuo dilatation of the left lateral ventricle, reduced left cerebral peduncle, and frontoparietal white-matter changes. EEG revealed abnormal frontotemporal discharges. The diagnosis was revised to Rasmussen’s encephalitis. Addition of Clobazam to ongoing Brivaracetam therapy resulted in complete seizure freedom during admission. Headache and photophobia resolved by Day 4.

Conclusion: This case highlights the importance of advanced neuroimaging and EEG in differentiating Rasmussen’s encephalitis from generalized epilepsy in children with drug-resistant seizures. Early diagnosis enables timely immunotherapy or surgery (e.g., hemispherotomy) to prevent irreversible brain damage and improve long-term functional and cognitive outcomes.

Immediate Implant Placement in a Type 2 Extraction Socket Using the Ice Cream Cone Technique: A Case Report

A. Lubna Firdose — 2026-04-23

Immediate implant placement in extraction sockets with buccal plate deficiency presents clinical and aesthetic challenges. The ice cream cone technique is a flapless guided bone regeneration approach designed to stabilize graft material and preserve soft tissue contours. This case report describes immediate implant placement in a Type 2 extraction socket using a Fix-Guide membrane shaped as an ice cream cone and an organic bovine bone graft (A-OSS), achieving adequate primary stability and favourable aesthetic outcome. Clinical and radiographic evaluation in this case report demonstrated successful osseointegration, stable peri-implant soft tissues, and preservation of ridge contours.

Renal Thrombotic Microangiopathy Revealing Systemic Lupus Erythematosus in a Young Woman: A Case Report

Safaa Mhaber — 2026-04-23

Background: Thrombotic microangiopathy (TMA) is a rare but severe manifestation of systemic lupus erythematosus (SLE), frequently associated with antiphospholipid syndrome (APS). Early recognition is crucial, as it significantly influences renal and overall prognosis (George & Nester, 2014, Gómez-Puerta & Cervera, 2014).

Case Presentation: We report the case of a 37-year-old woman with no prior medical history who presented with a multisystemic disease combining polyserositis, neurological involvement, arthritis, and renal impairment. Initial manifestations included inflammatory polyarthralgia, exudative pleuritis, pericardial tamponade requiring urgent drainage, and generalized seizures. Laboratory investigations revealed lymphopenia, microcytic anemia with elevated ferritin levels, prolonged activated partial thromboplastin time, and positive antiphospholipid antibodies. Immunological testing confirmed the diagnosis of SLE. Renal involvement was characterized by hypertension, active urinary sediment, and proteinuria ranging from 1.68 to 2.6 g/day. Kidney biopsy demonstrated class IV lupus nephritis associated with thrombotic microangiopathy. Immunofluorescence showed deposits of C3, C1q, IgG, and IgA. The patient was treated with high-dose corticosteroids, mycophenolate mofetil, hydroxychloroquine, and angiotensin-converting enzyme inhibitors, resulting in favorable clinical and biological outcomes.

Conclusion: TMA may reveal SLE and should be suspected in patients presenting with severe or atypical renal involvement. Early diagnosis based on histological findings and prompt immunosuppressive therapy are essential to improve outcomes.

An Overlooked Mass in The Nasal Cavity: A Case of Sinonasal Adenoid Cystic Carcinoma

Madira Krishna Asish — 2026-04-30

Background: Adenoid cystic carcinoma (ACC) is a rare malignant neoplasm of salivary gland origin, accounting for approximately 1% of head and neck malignancies. Sinonasal involvement is uncommon and often presents diagnostic challenges due to its indolent growth, nonspecific symptoms, and late presentation. ACC is characterized by perineural invasion, local aggressiveness, and a propensity for distant metastasis.

Case Presentation: We report a case of a 35-year-old male who presented with unilateral left-sided nasal obstruction of one-year duration without epistaxis or facial pain. Diagnostic nasal endoscopy revealed a non-tender, non-bleeding mass arising from the lateral wall of the left nasal cavity. Contrast-enhanced CT and MRI showed a well-defined enhancing lesion originating from the inferior turbinate with preserved bony margins, suggestive of a benign tumor. The patient underwent endoscopic surgical debulking. Histopathological examination demonstrated a cribriform pattern with pseudostratified columnar epithelium, consistent with adenoid cystic carcinoma, without evidence of perineural or lymphovascular invasion.

Management and Outcome: Postoperative PET-CT showed low FDG uptake without distant metastasis. The patient received adjuvant external beam radiotherapy using a linear accelerator along with concurrent weekly cisplatin chemotherapy. At six months follow-up, nasal endoscopy and PET-CT showed complete disease clearance.

Conclusion: Sinonasal ACC can masquerade as a benign lesion due to its slow growth and subtle presentation. Early diagnosis, surgical debulking, and adjuvant chemoradiation play a crucial role in achieving locoregional control. Long-term follow-up is essential due to the risk of late recurrence and distant metastasis.

Rhinosporidiosis of the Nasolacrimal Duct: An Uncommon Presentation of a Common Entity

Doodala Keerthana — 2026-05-01

Background: Rhinosporidiosis is a chronic granulomatous disorder caused by Rhinosporidium seeberi, an aquatic protistan organism classified within the class Mesomycetozoea. The disease primarily involves the mucosal surfaces of the nasal cavity and nasopharynx and is considered endemic in tropical regions, with a particularly high prevalence in southern parts of India. Recurrence is frequently observed, largely attributed to the poorly understood immunopathogenesis of the organism and its limited responsiveness to conventional medical therapy.

Case Presentation: A 27-year-old male presented with complaints of right-sided epiphora for six months and progressive nasal obstruction for three months. He had undergone two previous endoscopic surgeries for rhinosporidiosis. Syringing showed regurgitation from opposite punctum suggestive of chronic dacryocystitis. Intraoperatively, a rhinosporidial mass was identified on the lateral nasal wall and one more was detected within the nasolacrimal duct (NLD). Complete excision with endoscopic dacryocystorhinostomy and marsupialization of the NLD was performed. Histopathology confirmed rhinosporidiosis with characteristic thick-walled sporangia containing endospores. Postoperatively, the patient was treated with Dapsone 100 mg once a day for two months. No recurrence was noted at six-month follow-up. The case was unique since there was no exposure to stagnant water throughout.

Discussion: Isolated involvement of the nasolacrimal duct is an exceptionally rare presentation and is believed to occur via retrograde spread through the valve of Hasner. Surgical excision with cauterization remains the mainstay of treatment due to the organism’s resistance to antimicrobial therapy.

Conclusion: This case highlights a rare presentation of recurrent rhinosporidiosis with nasolacrimal duct involvement, emphasizing the need for meticulous surgical clearance and long-term follow-up to prevent recurrence.

Membranous Tonsillitis as a Manifestation of Diphtheria: A Case Report

R. Rajesh — 2026-05-04

Diphtheria is a toxin-mediated infectious disease caused by Corynebacterium diphtheriae, which remains a public health concern in regions with inadequate immunization coverage. We report a case of a 21-year-old partially vaccinated male who presented with dysphagia, throat pain, and fever. Clinical examination revealed grade 3 tonsillar hypertrophy with an adherent whitish pseudomembrane, raising strong suspicion of diphtheria. Laboratory investigations showed neutrophilic leukocytosis and elevated inflammatory markers. The patient was promptly admitted in isolation and started on diphtheria antitoxin (DAT) and erythromycin prior to microbiological confirmation. Throat swab culture later confirmed Corynebacterium diphtheriae. The patient received 120,000 IU of DAT following desensitization and was closely monitored for systemic complications. He showed progressive clinical improvement with complete resolution of symptoms and pseudomembrane by day 14, and no evidence of cardiac involvement on serial monitoring. This case highlights the importance of early clinical recognition and immediate initiation of antitoxin therapy without waiting for laboratory confirmation. Maintaining high vaccination coverage and ensuring booster doses in adults are essential to prevent re-emergence of diphtheria.

Necrotizing Fasciitis of the Lower Abdominal Wall and Thigh Caused by Klebsiella oxytoca in a Patient with Diabetes Mellitus and Filariasis: A Case Report

Tahura Imama — 2026-05-09

Background: Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection associated with high morbidity and mortality, particularly in patients with diabetes and other comorbidities.

Case Presentation: We report a 61-year-old woman with poorly controlled type 2 diabetes mellitus, hypertension, and filariasis who presented with progressive swelling of the lower abdominal wall and left thigh, foul-smelling discharge, and ulceration. Contrast-enhanced computed tomography demonstrated extensive soft tissue edema with multiple air foci extending from the left thigh to the pubic symphysis and lower abdominal wall, consistent with necrotizing fasciitis. Laboratory findings revealed severe hyperglycemia, anemia, leukocytosis, acute kidney injury, hyperkalemia, and hypoalbuminemia. The patient underwent emergency surgical debridement under high anesthetic risk and received broad-spectrum antibiotics, intensive insulin therapy, fluid resuscitation, and multidisciplinary supportive care. Vacuum-assisted closure therapy was initiated for wound management. Over 20 days, her clinical condition, renal function, and glycemic status improved, and she was discharged stable.

Discussion: Necrotizing fasciitis carries high mortality, particularly in uncontrolled diabetes. Klebsiella oxytoca suggests an aggressive gram-negative etiology. Early diagnosis, prompt debridement, and appropriate antimicrobial therapy with strict glycemic control are critical.

Conclusion: Early diagnosis and timely surgical and medical management are essential to reduce morbidity and improve outcomes.

Autonomic Dysfunction and Plasmapheresis Intolerance in Guillain-Barré Syndrome: A Case Report

Abu Talha Dakhani — 2026-05-16

Guillain-Barré syndrome is an acute immune-mediated polyradiculoneuropathy and a major cause of acute flaccid paralysis, often triggered by antecedent infections through molecular mimicry. Autonomic dysfunction is a significant complication that contributes to morbidity, mortality, and challenges in treatment. We report a case of a 27-year-old previously healthy male who developed progressive ascending weakness following an episode of acute gastroenteritis. Clinical evaluation and electrophysiological findings were consistent with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) with secondary axonal involvement. The patient developed significant dysautonomia, manifesting as tachycardia, hypotension, diaphoresis, and respiratory discomfort during therapeutic plasma exchange. Plasmapheresis had to be discontinued after three sessions due to intolerance related to autonomic instability. The case highlights the clinical complexity of managing GBS with severe autonomic dysfunction and emphasizes the importance of close hemodynamic monitoring and individualized therapeutic strategies in patients undergoing immunomodulatory treatment.

The Contribution of Molecular Allergology to the Diagnosis of Allergies: A Report of Cases Series

B. Abdaoui — 2026-05-20

Background: Component resolved Diagnosis (CRD) is an essential tool in modern allergology, allowing a more precise and personalized approach.

Case Presentation: We report five patients with suspected allergy investigated using component-resolved diagnostics by the ALEX biochip.

Case 1: A 31-year-old man presented with recurrent episodes of urticaria. Subsequently, the patient developed respiratory manifestations. Molecular diagnostic testing revealed sensitization to the component Pru p 3, consistent with lipid transfer protein (LTP) allergy, which allowed for an accurate diagnosis and guided appropriate avoidance measures.

Case 2: A young woman experienced exercise-induced anaphylaxis after ingestion of wheat-containing food. Conventional testing was inconclusive, but molecular analysis revealed sensitization to ω5-gliadin, confirming wheat-dependent exercise-induced anaphylaxis.

Case 3: A 42-year-old woman presented with generalized urticaria and pruritus, particularly following the ingestion of seafood. Molecular diagnostic testing revealed sensitization to tropomyosin and enabled assessment of the risk of severe reactions, which correlated with specific IgE levels to shrimp tropomyosin.

Case 4: A 28-year-old man presented with perennial rhinitis and atopic dermatitis. Immunoallergological evaluation revealed concomitant sensitization to serum albumins, particularly Fel d 2 and Sus d 1, suggesting cross-reactivity consistent with pork–cat syndrome.

Case 5: A 40-year-old woman with birch pollen allergy developed oral allergy syndrome after ingesting food. Molecular testing identified sensitization to PR-10 proteins, confirming pollen–food syndrome and allowing targeted dietary advice.

Conclusion: CRD must be integrated into the allergological exploration in order to optimize management.

A Rare Association of Situs Inversus Totalis and Pulmonary Carcinoma: A Case Report

Yahya Mokhlis — 2026-05-22

Situs inversus totalis is a laterality disorder, consisting of a complete mirror image of thoracic, visceral organs, and vessels. It is a congenital condition, with ciliary dyskinesia suggested as an etiological factor among others. The incidence rate varies from 1/8000 to 1/25,000. It is an asymptomatic anatomical variation that may be revealed in different circumstances. Imaging techniques such as CT scan and MRI can diagnose SIT and assess other fine anatomical variations. Our case is about an association between SIT and pulmonary carcinoma. The surgical treatment in this case requires pre-operative planning to study the vascular and bronchial variation, and it can be a challenging procedure for the surgeon. We present a case of a 70-year-old man with situs inversus totalis and disseminated inoperable pulmonary carcinoma.

Cocoon Syndrome (Primary Encapsulating Peritonitis): A Rare Cause of Mechanical Intestinal Obstruction

Mokhlis Yahya — 2026-05-22

Cocoon syndrome, or primary encapsulating peritonitis, is a rare cause of small bowel obstruction belonging to the spectrum of mechanical intestinal obstruction. It is characterized by a thick fibro-collagenous membrane that partially or completely encases the small intestine, leading to impaired bowel motility and obstruction. Clinical presentation is nonspecific and may include nausea, vomiting, abdominal distension, constipation, and features of subacute or acute intestinal obstruction. The condition can occur at any age, and its etiology remains unclear, although it is thought to be either idiopathic or secondary to chronic inflammatory processes within the peritoneal cavity. Diagnosis is primarily radiological, with abdominal CT scan playing a key role in identifying the characteristic clustering of small bowel loops encased within a sac-like membrane. Surgical management is the treatment of choice and consists of careful excision of the fibrous membrane, with or without adhesiolysis, depending on intraoperative findings.

In this context, we report the case of a 42-year-old male patient who presented with signs of intestinal obstruction. Abdominal CT imaging was suggestive of cocoon syndrome. The patient underwent exploratory laparotomy, during which a dense fibrous membrane encasing the small bowel was identified and completely excised. The postoperative course was uneventful, with favorable clinical recovery.

Delayed Presentation of Acute Copper Sulfate Poisoning with Persistent Acute Kidney Injury and Hemolytic Anemia: A Case Report

Vemula Archana — 2026-05-25

Aims: Copper sulfate poisoning is an uncommon but potentially life-threatening toxicological emergency frequently encountered in agricultural settings due to the easy availability of copper-containing pesticides. It can result in severe multi-organ dysfunction involving the gastrointestinal, hematological, hepatic, renal, and neurological systems. This case report aims to describe the clinical presentation, management, and outcome of delayed copper sulfate poisoning with significant systemic complications and to highlight the importance of early recognition and supportive care.

Presentation of Case: A 37-year-old male agricultural worker presented five days after intentional ingestion of approximately 20–30 mL of Mastercop (copper sulfate 50% WP). He developed recurrent vomiting, diarrhea, melena, jaundice, reduced urine output, generalized weakness, and altered sensorium. Initial laboratory investigations revealed acute kidney injury with markedly elevated serum creatinine and blood urea levels, hemolytic anemia, elevated lactate dehydrogenase, leukocytosis, and hypoalbuminemia. Prior to referral, the patient underwent three sessions of hemodialysis and received three units of packed red blood cells. During hospitalization, he was managed conservatively with intravenous fluids, antibiotics, proton pump inhibitors, antioxidants, hematinics, electrolyte correction, and nutritional supplementation, along with close monitoring of renal and hepatic parameters.

Discussion: Copper sulfate toxicity produces corrosive gastrointestinal injury, oxidative hemolysis, hepatic dysfunction, methemoglobinemia, and acute tubular necrosis. Delayed presentation is associated with increased morbidity due to progressive oxidative tissue injury. Persistent renal impairment despite hemodialysis in this case reflects the poor dialyzability of copper and the severity of systemic toxicity.

Conclusion: Early supportive management, timely hemodialysis, and multidisciplinary care contributed to patient survival despite delayed presentation and severe poisoning. Psychiatric counseling, public awareness, and stricter pesticide regulation remain essential for prevention and reduction of poisoning-related morbidity and mortality.

Polycystic Kidney Disease in an Elderly Male Patient: A Case Report

Sukumar Naidu — 2026-05-28

Polycystic kidney disease truncated as PKD/PCKD, a prominently serious inherited disorder in which groups of cysts (non-cancerous non-functional round fluid filled sacs) formed in the kidney causing abnormal renal tubule structure, making them enlarge and lose their ideal function. The 2 proteins (polycystin 1,2) together form a receptor-ion-channel complex on primary cilia of renal endothelial and epithelial cells. PKD is of 2 types i.e. autosomal recessive and autosomal dominant PKD (ARPKD and ADPKD). The actual reason for cyst formation is not clearly understood but is thought to be related to distortions in signaling pathways that are regulated by intracellular calcium, cyclic adenosine monophosphate (cAMP), Wnt/β-catenin, or planar cell polarity (PCP). The 2 genes effected in ADPKD are PKD1 account for 78% of cases and PKD2 around 15% of cases. About 50% of cases are inherited to ADPKD condition whereas 25% of cases are non-inherited. In the progressed disease state, abnormal cell proliferation causes persistent tubular dilation, fluid secretion (sodium retention), and detachment from main tubule to from cysts.

Unusual Subcutaneous Metastasis of a Malignant Granular Cell Tumor Mimicking Desmoid Fibromatosis: A Case Report

Abdallah Said Abdallah — 2026-05-28

Background: Malignant granular cell tumor of the larynx is an exceptionally rare Schwann cell neoplasm with high metastatic potential, and metastatic soft-tissue lesions may mimic benign entities such as desmoid-type fibromatosis on imaging, posing a significant diagnostic challenges.

Aims: To report an unusual case of subcutaneous abdominal wall metastasis from a malignant laryngeal granular cell tumor (Abrikossoff tumor) mimicking a desmoid-type fibromatosis on magnetic resonance imaging (MRI), and to highlight the contribution of diffusion-weighted imaging (DWI) and of a multidisciplinary approach in this diagnostic challenge.

Presentation of Case: A 54-year-old woman with a 9 cm laryngeal granular cell tumor, treated by total laryngectomy with focally positive margins (R1 resection) and adjuvant radiotherapy, developed locoregional and pulmonary recurrence approximately 24 months postoperatively, both confirmed as the same histological type. Thirteen months later, a subcutaneous mass of the right anterolateral abdominal wall was detected. Contrast-enhanced computed tomography (CT) showed a well-circumscribed soft-tissue mass with mild post-contrast enhancement and regular contours. MRI demonstrated a lobulated lesion with intermediate T2 signal, marked diffusion restriction with a low apparent diffusion coefficient (ADC) value of 0.9 × 10⁻³ mm²/s, and intense homogeneous post-gadolinium enhancement, initially suggestive of a desmoid-type fibromatosis. Percutaneous biopsy confirmed a granular cell tumor metastasis identical to the laryngeal primary.

Discussion: Subcutaneous metastases from a malignant granular cell tumor may share several morphological MRI features with abdominal wall desmoid-type fibromatosis. In this case, the lesion showed marked diffusion restriction with a low ADC value, a finding not typical of desmoid-type fibromatosis, which usually shows mild to moderate diffusion restriction with intermediate to high ADC values. The laryngeal primary had been initially labeled benign, yet its subsequent metastatic behavior — together with clinicopathological features such as large size and focally positive margins — indicated an underestimated malignant granular cell tumor.

Conclusion: In a patient with a previously treated granular cell tumor, a new soft-tissue mass should raise the suspicion of metastasis. Multiparametric MRI, particularly DWI, combined with a multidisciplinary correlation of clinical, radiological and pathological data, is valuable in differentiating this entity from desmoid-type fibromatosis and in guiding histological confirmation.

Adult-Onset Nephrotic Syndrome in a Young Male: A Case Report with Clinical and Pharmacological Management

Rahul Devarampally — 2026-06-01

Background: Nephrotic syndrome is a glomerular disorder characterised by heavy proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia, resulting from podocyte and filtration barrier injury and seen in diverse primary and secondary renal diseases.

Aims: To present and discuss a case of adult-onset nephrotic syndrome in a young male, describing its clinical features, laboratory profile, diagnostic approach, and pharmacological management in the light of current evidence.

Presentation of Case: A 30-year-old male with no prior comorbidities presented with bilateral pitting pedal oedema of three days' duration. Laboratory investigations confirmed significant proteinuria (+++), markedly reduced serum albumin (2.3 g/dL), reduced total serum protein (5.7 g/dL), and mild lymphopenia. Elevated alkaline phosphatase (142 U/L) was also noted. Nephrotic-range proteinuria was strongly suspected clinically, although quantitative 24-hour urinary protein estimation was unavailable. Ultrasonography identified an incidental gallbladder polyp and non-obstructive left renal calculus. A clinical diagnosis of adult-onset nephrotic syndrome was established on the basis of the cardinal biochemical and clinical features.

Discussion and Conclusion: The clinical, biochemical, and urinalysis findings were consistent with the diagnostic criteria for nephrotic syndrome. Management comprised a sequential diuretic regimen (furosemide IV, furosemide–spironolactone oral, metolazone), empirical antimicrobial therapy (ceftriaxone, cefpodoxime proxetil), supportive haemostatic therapy (phytomenadione, tranexamic acid), and antiemetic cover (ondansetron). Clinical improvement was achieved. The case underscores the importance of early recognition, systematic investigation, and evidence-based pharmacological intervention in adult-onset nephrotic syndrome, with renal biopsy recommended for definitive histological diagnosis and targeted therapy.

A Case of Neurobrucellosis Mimicking Brucellosis and Acute Q Fever: Diagnostic Challenges

Hale Turan Özden — 2026-06-02

Brucellosis and Q fever are zoonotic bacterial infections with overlapping epidemiological exposure risks, nonspecific clinical manifestations, and potential diagnostic challenges, particularly in endemic regions. Neurological involvement in brucellosis is uncommon but may raise suspicion of neurobrucellosis in patients presenting with persistent neurological symptoms. We report a 25-year-old male shepherd with occupational exposure to farm animals and a history of unpasteurized dairy consumption who was initially diagnosed with brucellosis and received appropriate antimicrobial treatment at an external center. Despite therapy, he continued to experience persistent headache, dizziness, fatigue, syncope, tinnitus, arthralgia, and generalized body pain, prompting referral for further evaluation with suspected neurobrucellosis. Neurological examination, cranial magnetic resonance imaging, computed tomography, and cerebrospinal fluid analysis were unremarkable, excluding central nervous system involvement. Brucella serology remained positive, while additional serological investigation for persistent symptoms demonstrated Coxiella burnetii Phase I IgG of 1:128 and Phase II IgG of 1:256. Follow-up testing four weeks later revealed seroconversion with disappearance of Phase I IgG and a marked rise in Phase II IgG to 1:1280, strongly supporting acute Q fever. The patient received streptomycin, doxycycline, and rifampicin, resulting in complete clinical recovery and declining serological titers during follow-up. This case highlights the importance of considering concomitant zoonotic infections and carefully interpreting serological dynamics in patients with persistent symptoms despite adequate brucellosis treatment.

Effect of Muscle Energy Technique of Pectoralis Minor along with Conventional Exercises on Pectoralis Minor Length & Rounded Shoulders in an Individual Working in Culinary Industry: A Case Study

Noor Khan — 2026-06-13

Background: Musculoskeletal disorders represent a critical occupational health challenge in the culinary industry, with epidemiological research revealing alarming prevalence rates. Studies indicate that up to 64.3% of professional chefs report at least one musculoskeletal disorder, with the risk escalating significantly among experienced workers. The most pronounced issue is shoulder region pain, affecting 62.3% of culinary professionals, which underscores the substantial physical demands inherent in kitchen work.

Methodology: The research employed a single-subject case study design conducted over eight weeks at the Department of Physiotherapy, Jaipur National University. The study focused on a 26-year-old male professional chef with 4.5 years of culinary experience, characterized by a six-hour average daily work duration, visible rounded shoulder posture, and difficulty maintaining an upright position during extended work periods. The intervention protocol integrated the Muscle Energy Technique (MET) targeting the pectoralis minor, combined with a comprehensive conventional physiotherapy exercise regime. Outcome measures were carefully assessed on Day-0, Day-30, and Day-60, focusing specifically on Acromion Height and Pectoralis Minor Length Test measurements.

Results: The results demonstrated significant improvements in musculoskeletal parameters. Pectoralis Minor Length measurements showed notable changes, with the left limb improving from 139.1mm to 150.6mm and the right limb changing from 140.1mm to 152.5mm. Acromion height measurements decreased from 90.3mm to 86.7mm on the left and from 112.1mm to 96.3mm on the right. Critically, follow-up measurements four weeks after the intervention maintained these improvements, suggesting the sustained effectiveness of the integrated approach.

Conclusion: This research introduces an evidence-based intervention tailored to the biomechanical demands of kitchen work, offering targeted rehabilitation strategies to improve occupational health, reduce discomfort, and enhance well-being in culinary professionals.

Hollow Adrenal Gland Sign as an Emerging Imaging Marker of Septic Shock: A Case Report

Salma El Aouadi — 2026-06-17

The hollow adrenal gland sign (HAGS) is a recently described computed tomography (CT) finding characterised by central hypoenhancement of the adrenal glands with peripheral hyperenhancement on arterial-phase contrast-enhanced imaging. It has been reported in patients with septic shock and may reflect severe haemodynamic compromise. We report the case of a 31-year-old man with no significant medical history who was admitted for surgical drainage of purulent pericarditis and subsequently developed progressive abdominal distension with clinical deterioration. On examination, he was haemodynamically unstable, with a blood pressure of 90/50 mmHg, heart rate of 140 beats/min and respiratory rate of 33 breaths/min. Laboratory investigations showed a marked inflammatory syndrome, positive infectious work-up and markedly elevated serum lactate, supporting tissue hypoperfusion and septic shock. Contrast-enhanced CT of the chest and abdomen demonstrated a moderately abundant pericardial effusion with smooth peripheral enhancement, bilateral pulmonary consolidations and bilateral HAGS. The adrenal glands were normal in size, with preserved contours and no evidence of haemorrhage or focal lesion. Additional CT findings included diffuse hepatic hypoenhancement, marked reduction in the calibre of the abdominal aorta and a large volume of intraperitoneal fluid, consistent with systemic hypoperfusion. The patient was transferred to the intensive care unit and received broad-spectrum intravenous antibiotics, fluid resuscitation, vasopressor support and close haemodynamic monitoring. Despite intensive supportive management, his condition progressed to refractory septic shock with multi-organ failure, and he died during his intensive care unit stay. This case illustrates the imaging appearance of bilateral HAGS in severe septic shock and supports its potential role as a radiological marker of shock severity.

Neurohistiocytosis Presenting as Central Diabetes Insipidus and Right Exophthalmos in a 6-Year-Old Child: A Multimodal Radiological Case Report

Soukaina Bahha — 2026-06-22

Neurohistiocytosis is an uncommon manifestation of histiocytic disorders in children and may involve the central nervous system, craniofacial bones, meninges, and hypothalamic-pituitary axis. Its clinical presentation is variable, and early recognition may be challenging when endocrine symptoms precede other systemic manifestations. We report the case of a 6-year-old child referred for evaluation of central diabetes insipidus associated with progressive right-sided exophthalmos. The patient had a polyuro-polydipsic syndrome, while neurological and systemic examinations were otherwise unremarkable. Initial pituitary magnetic resonance imaging demonstrated infiltrative lesions involving the skull base and cranial vault with diffuse pachymeningeal thickening and enhancement. Abdominopelvic computed tomography showed homogeneous hepatosplenomegaly without focal lesions or significant lymphadenopathy. Bone marrow aspiration revealed normal marrow elements, with no evidence of blastic proliferation or malignant infiltration. Further cerebral computed tomography demonstrated multiple osteolytic lesions of the skull base and calvarial bones, adjacent extra-axial soft-tissue thickening, pituitary stalk thickening with pituitary infiltration, bilateral irregular enhancing choroid plexus thickening, right orbital bone involvement causing grade I exophthalmos, and a right parietal dural-based mass associated with ipsilateral parietal bone osteolysis and temporopolar meningeal thickening. Taken together, these clinical and radiological findings raised strong suspicion of neurohistiocytosis with craniofacial and hypothalamic-pituitary involvement. This case emphasises the value of multimodal imaging in identifying disease extent, supporting diagnostic orientation, and guiding multidisciplinary management in paediatric patients presenting with central diabetes insipidus and orbital manifestations.

Severe Pancytopenia with Marked Bone Marrow Plasmacytosis in a Young Adult: A Diagnostic Dilemma in Differentiating Reactive Plasmacytosis from Plasma Cell Dyscrasia

Safaa Mhaber — 2026-04-22

Bone marrow plasmacytosis is most commonly associated with plasma cell dyscrasias such as multiple myeloma; however, it may also arise as a reactive phenomenon in various clinical contexts. Distinguishing between these entities is particularly challenging in young adults, in whom plasma cell malignancies are uncommon, yet misdiagnosis may lead to unnecessary and potentially harmful therapy.

We report the case of a 30-year-old male presenting with hemorrhagic manifestations including gingival bleeding, diffuse purpura, and macroscopic hematuria. Laboratory evaluation revealed severe pancytopenia, and fundoscopic examination showed bilateral retinal hemorrhages. Bone marrow analysis demonstrated marked plasmacytosis (23–30%) without morphologic atypia. Immunohistochemistry confirmed polyclonal plasma cells. Extensive workup, including serum protein electrophoresis, immunofixation, serum free light chain assay, autoimmune panel, and infectious screening, showed no evidence of monoclonality or underlying systemic disease.

The patient was managed conservatively with supportive care only. Progressive and complete recovery of hematologic parameters occurred within six weeks, supporting a reactive etiology.

This case highlights the diagnostic challenge of differentiating reactive plasmacytosis from plasma cell dyscrasias and underscores the importance of integrating clinical, biological, and histopathological findings to avoid overtreatment.

Thoracic Solitary Fibrous Tumors: Imaging Findings in Five Cases

Jihad Karimi — 2026-05-06

Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms, most commonly arising from the pleura, with a broad spectrum of clinical behavior ranging from benign to aggressive malignant forms. Because of their rarity, variable presentation, and overlapping imaging features with other thoracic tumors, SFTs remain a diagnostic challenge. Reporting this case series highlights uncommon and diverse thoracic imaging presentations, illustrates the radiologic–pathologic correlation, and emphasizes the value of multimodality imaging in improving diagnostic confidence and guiding management.

Case Presentation: This case series includes five Moroccan patients with thoracic solitary fibrous tumors, aged between 30 and 80 years, comprising both male and female patients. Clinical presentations ranged from incidental radiographic findings to respiratory symptoms such as dyspnea, chest pain, cough, or hemoptysis. Imaging assessment using chest radiography, computed tomography, and magnetic resonance imaging revealed large pleural-based or thoracic masses with heterogeneous enhancement and variable degrees of local invasion or mass effect. The diagnosis of solitary fibrous tumor was established in all cases by histopathological analysis following image-guided biopsy or surgical intervention. Management strategies included surgical resection or biopsy-guided diagnosis, and patients were referred for appropriate multidisciplinary management based on tumor behavior.

Conclusion: This case series underscores the significant diagnostic variability of thoracic solitary fibrous tumors and highlights the essential role of cross-sectional imaging in their detection, characterization, and assessment of local extension. Awareness of the diverse imaging features of these rare tumors may improve diagnostic accuracy, facilitate appropriate multidisciplinary management, and contribute to better therapeutic decision-making and patient outcomes.

Significance of the Study: Solitary fibrous tumors are rare entities and remain particularly challenging to diagnose in the thoracic region. This case series provides valuable insights that may assist researchers and clinicians in better understanding their presentation. The findings may also contribute to improved preoperative planning and highlight the essential role of multimodality imaging, particularly CT and MRI, in tumor characterization and classification.

The H-Shaped Vertebra on MRI: A Clue to Previously Undiagnosed Chronic Hemolytic Anemia

Hafsa Riache — 2026-05-26

Background: H-shaped (Lincoln log) vertebrae are a radiologic hallmark of chronic hemolytic anemia, often associated with sickle cell disease, resulting from repeated central endplate infarctions and may be an initial clue to undiagnosed systemic hematologic disorders.

Aims: To highlight the characteristic MRI appearance of the H-shaped vertebra as a diagnostic clue to previously unrecognized chronic hemolytic anemia.

Study Design: Case report.

Presentation of Case: A 27-year-old man presented with chronic low back pain without known hematologic disease. Lumbar MRI demonstrated symmetric central depression of the vertebral endplates producing the characteristic H-shaped configuration. Diffuse low marrow signal intensity was observed on both T1- and T2-weighted sequences, consistent with marrow reconversion and fibrosis. Subsequent laboratory evaluation confirmed regenerative normocytic anemia related to chronic hemolytic anemia.

Discussion: The H-shaped vertebra is a characteristic imaging finding most commonly associated with sickle cell disease and other chronic hemolytic disorders. Recognition of its symmetric multilevel endplate depression and associated marrow signal abnormalities may help differentiate it from vertebral compression deformities and degenerative endplate changes.

Conclusion: Recognition of the characteristic MRI appearance of the H-shaped vertebra may facilitate early diagnosis of underlying hematologic disease and prevent diagnostic confusion with vertebral deformities.

Unmasking the Causes of Pediatric Refractory Status Epilepticus: Insights from Three Challenging Cases

Wasim Akram — 2026-06-15

Status epilepticus (SE) refers to a neurological emergency where the condition can escalate even after treatment to refractory status epilepticus (RSE) with a high rate of both morbidity and mortality. According to the International League Against Epilepsy, seizures going beyond 5 minutes (t1) are more likely to persist, and those going beyond 30 minutes (t2) lead to irreversible neuronal injury. Case 1 was tuberculous meningoencephalitis with hydrocephalus, necessitating ventriculoperitoneal shunting. Case 2 was on the topic of highly resistant bacterial neonatal meningitis caused by Elizabethkingia meningoseptica. Case 3 was a study report on mtDNA depletion syndrome, which is a form of Alpers-Huttenlocher syndrome. Continuous midazolam infusion along with ventilatory support was the only way through which all the cases could be controlled from further seizure activity.

This study aims to investigate the causes of pediatric refractory status epilepticus and provide clinical insights through the presentation of three challenging cases.

This case series highlights that acute symptomatic etiologies, such as infections and metabolic disorders, are the main reasons behind pediatric RSE. It also emphasizes the importance of early neuroimaging, accelerated etiological diagnosis, and protocol-based EEG-guided anesthesia for achieving good neurological outcomes.