Indian Journal of Case Reports <pre><strong>ISSN:</strong> <strong>p-ISSN</strong> - 2454-129X; <strong>e-ISSN</strong> - 2454 -1303 <br /><strong>Discipline:</strong> All medical, surgical and dental specialties<br /><strong>Starting Year:</strong> 2015<br /><strong>Current volume: </strong>Volume 6 <br /><strong>Issue per year: </strong>12 (monthly)<br /><strong>Editor-in-chief:</strong> Dr. Amit Agrawal, India<br /><strong>Indexing:</strong> Index Copernicus, Journal Guide, BASE, Research Bible, Google Scholar<br /><strong>E-mail: <a href="" target="_blank" rel="noopener"></a> </strong></pre> en-US (Amit Agrawal) (Dr. Rashmi Agrawal) Sat, 26 Sep 2020 00:00:00 +0530 OJS 60 Toe walking in children with autism spectrum disorder and comorbid attention deficit hyperactivity disorder: An early marker of a heterogeneous disorder? <p>Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder (NDD). Toe walking has been reported in children with NDDs. However, the relationship between ASD and toe walking is still unclear. The aim of the paper is to describe toe walking in four children with ASD and comorbid attention deficit hyperactivity disorder (ADHD). Their age ranged between 28 months and 42 months and three of the cases had moderate to severe toe walking on both feet. All the cases scored in the high-risk category (8–20) of the Modified Checklist for Autism in Toddlers and above the cut-off scores (24 for girls and 32 for boys) of the ADHD RS-IV-P. In addition, they all met DSM-V diagnostic criteria for ASD and ADHD. Clinicians diagnosing ASD may be omitting an important element of the disorder in the form of toe walking, which could contribute to delayed or inaccurate diagnoses. Consideration of including motor function deficits such as toe walking in the diagnostic criteria for ASD might improve early detection and intervention.</p> Yetunde Celia Adeniyi, Ade Fatai Adeniyi, Olugboyega Abimbola Oyewole Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Ruptured hepatocellular carcinoma presenting as Cullen’s and Grey-Turner’s sign <p>Hepatocellular carcinoma (HCC), the most common malignant liver tumor, is usually asymptomatic but rarely bleeds into the peritoneal cavity which can be a serious catastrophe. In this case report, we are presenting a case of ruptured HCC, who came to our emergency room with hepatic decompensation in the form of jaundice and progressive abdominal distention and on evaluation were found to have ruptured HCC and the classical findings associated with it were the signs of intraperitoneal bleed like Cullen’s and Grey-Turner’s sign which are classically mentioned in acute pancreatitis.</p> Ghulam Nabi Yattoo, Syed Mushfiq Shafi, Neeraj Dhar, Saurabh Kaushik, Ghulam Mohd Gulzar, Jaswinder Singh Sodhi Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Epstein-Barr virus-positive diffuse large B-cell lymphoma, not otherwise specified: A diagnostic challenge <p>Epstein-Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) is an entity included in the 2016 World Health Organization classification of lymphoid neoplasms. EBV+DLBCL, NOS, is an aggressive B-cell lymphoma associated with chronic EBV infection and poor prognosis with standard chemotherapeutic approaches. We present the case of a 71-year-old male hospitalized for generalized lymphadenopathy, unexplained weight loss, and intermittent fever with pancytopenia and a very high EBV viral load. An inguinal lymph node was biopsied and reported at two different centers as Classic Hodgkin lymphoma and EBV associated lymphoproliferative, respectively. The patient was subsequently rebiopsied and a cervical lymph node was subjected to detail histopathologic and immunohistochemical evaluation by clonality studies resulting in a final diagnosis of EBV positive DLBCL, NOS. This case highlights the potential diagnostic pitfalls due to the morphologic heterogeneity of this entity and immunohistochemical overlap with Hodgkin lymphoma, T-cell rich large B-cell Lymphoma, and diffuse large B-cell lymphoma (DLBCL, NOS).</p> Prachi , Hema Malini Aiyer Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Multifocal adenomatous oncocytic hyperplasia of the parotid gland: A report of two cases with review of the literature <p>Multifocal adenomatous oncocytic hyperplasia (MAOH) is a rare non-neoplastic condition of the parotid gland. It is also referred to as “Oncocytosis.” It accounts for approximately 0.1% of all the salivary gland lesions. The existence of this entity needs more understanding compared to its counterpart oncocytoma due to limited identification and studies. Here, we report a case series of two cases of MAOH in a 63-year-old man and in a 54-year-old woman over the left and right parotid region, respectively, both clinically operated for malignant parotid tumors. Fine-needle aspiration of both the lesions was reported with differentials of oncocytic rich lesions oncocytoma, Warthin’s tumor, and an oncocytic variant of mucoepidermoid carcinoma. Histology was proven as MAOH as it showed multiple unencapsulated nodules composed of oncocytes. Cytology alone is not sufficient for its diagnosis as they overlap with<br>other oncocytic rich lesions. Awareness of this entity is essential for surgeons and practicing pathologists as it is a benign condition, thereby avoiding extended surgeries.</p> Rakshith Vittal, Jayaram Iyengar Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Flatbush diabetes – An entity not to be missed- interesting case report <p>Diabetes is an endocrinological disorder and one of the most common diseases for which admission is warranted. To classify, diabetes is important as various subtypes have different natural history and management. Atypical diabetes or Flatbush diabetes is an entity between Types I and II. Its pathophysiology is poorly understood as the patients usually present with episodes of diabetic ketoacidosis but has glutamic acid decarboxylase antibodies negative and no insulin deficiency. Here, we present an interesting case of atypical diabetes which is an entity not to be missed by clinicians in their practice.</p> Anurag Thakur, Sujeet Raina, Aradhna Sharma, Tarun Sharma Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Cavernous cervical hemangioma: An incidental finding <p>Cavernous hemangiomas of the uterine cervix are very rare benign tumors. They are usually more common around the third decade, but around the fifth decade, their frequency is even rarer. Sometimes, they can cause obstetric and gynecological complications, but most are asymptomatic and are detected by chance. Surgical treatment is usually the means of choice, which, in most cases, is performed in connection with other pathologies. We present a case of cervical hemangioma in a 58-year-old woman who was diagnosed accidentally. The reason for consulting a gynecologist was the weak postmenopausal bleeding for 6 months. Ultrasonographically, intramural leiomyoma of the uterine corpus was detected. Atrophic endometrium was found from the test abrasion. A total hysterectomy with salpingo-oophorectomy was performed. The histological examination confirmed the diagnosis: Cavernous hemangioma of the cervix. This case supports the fact that postmenopausal bleeding may also be due to cavernous hemangioma of the cervix.</p> Spasimir Todorov Shopov Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Diagnostic challenge in a rare case of neuroendocrine tumor of the pancreas <p>A pancreatic neuroendocrine tumor is a rare disease with varying behavior, clinical, and microscopic appearances. We present a case of neuroendocrine tumor of the pancreas in a 63-year-old female. Right from the beginning, our case was a diagnostic challenge from the clinical and radiological perspective. Radiological features can often be misleading and microscopic confirmation is all-important. This case report describes the approach to the diagnosis of such a case combining clinical, radiological, and pathological aspects to ensure proper management of the patient.</p> Hareesh Chandran, Kamala V V Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Prosthetic rehabilitation of an adolescent with ectodermal dysplasia utilizing multidisciplinary approach: A case report <p>Ectodermal dysplasia (ED) is a hereditary disorder characterized by abnormal development of two or more embryonic ectodermal structures such as skin, nails, teeth, hair, eyes, and sweat glands. The main oral manifestations of ED include oligodontia, malformed teeth and, deficient alveolar ridges. Inheritance of ED is X-linked and expressed typically in males. This case report explains a multidisciplinary treatment of a 16-year-old adolescent suffering from ED with underdeveloped premaxilla, underdeveloped alveolar ridges, retained deciduous teeth, and thick fibrous frenal attachment. Prosthetics rehabilitation was done using removable cast partial dentures with lip support. It also enumerates the important role of a multidisciplinary approach in dental treatment, helping the patient’s healthy transition from childhood to adulthood. Dental professionals should be able to identify the oral features of ED and provide proper oral care (as early as 3–4 years) to restore the oral functional demands and esthetics.</p> Abid Sharifullah Khan, Smita Musani, Ramandeep Dugal, Mitesh Lodha, Pallavi Madanshetty, Aamir Godil Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Bleeding oesophageal varices in a 9 months old infant as a complication of neonatal umbilical catheterization – A case report <p>Esophageal variceal bleeding following portal hypertension (PHT) is rare in children but associated with significant morbidity and mortality. Neonatal umbilical catheterization is a risk factor for portal vein thrombosis and subsequent development of PHT. We report the case of a 9-month-old male infant that presented with upper gastrointestinal bleeding from esophageal varices. He was delivered at 32 weeks of gestation and had neonatal umbilical catheterization for intravenous fluids and antibiotics administration. Barium meal done after resuscitation revealed esophageal varices. He had a blood transfusion while on admission and was discharged home on oral propranolol. This case report highlights a rare case of bleeding esophageal varices secondary to PHT occurring in an infant who had neonatal umbilical catheterization.</p> Ibrahim Ahmadu, Nuhu Abubakar Garba, Muhammad Shakur Abubakar, Apollos Daniel, Mustafa O Asani, Ibrahim Aliyu Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Unraveling the mysteries of a costoclavicular block: A case report <p>The outcome of regional anesthesia with respect to the sensory and motor effects of local anesthetics has been a mystery to anesthesiologists. However, testing these effects is subjective with the currently available scoring/grading systems. We report an unusual case where the author himself is a patient, a 37-year-old male with no comorbidities, who underwent plating of distal radius fracture under costoclavicular block (CCB). He took this opportunity to record changes in the sensory and motor functions that he experienced until he regained them completely. This case report is a narration of his own experiences related to CCB during the perioperative period.</p> Kartik Sonawane, Hrudini Dixit, Jagannathan Balavenkatasubramanian Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 An interesting case of placenta percreta <p>Placenta percreta is a condition where chorionic villi penetrate the entire myometrium, extending beyond uterine serosa. Here, we present an interesting case of placenta percreta in a 32-year-old lady with a previous history of the lower segment cesarean section. Initial ultrasonography had revealed oligohydramnios and an anterior low lying placenta with myometrial invasion, suggestive of placenta increta. Subsequently, a pre-operative magnetic resonance imaging demonstrated further invasion of the uterine serosa and bladder dome involvement which confirmed placenta percreta.</p> Likitha Thangella, Vaishali Upadhyaya, Vaishali Jain Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Congenital asymmetric crying facies: A case report with review of the literature <p>Asymmetric crying facies (ACF) in a newborn is a condition which occurs in one in 160 live births, with an estimated prevalence in<br>0.2–0.6% of infants and the left-sided predominance was determined in 80% of neonatal ACF cases. When ACF is associated with other anomalies, it is known as ACF syndrome. Congenital ACF in a newborn is a rare condition caused by unilateral hypoplasia or agenesis of the depressor anguli oris muscle resulting in an ACF in the neonatal period. ACF is often confused with facial nerve compression of the fetus in the uterus or facial nerve palsy secondary to trauma. The present review is having a baseline single case study of ACF due to the left-sided congenital hypoplasia of depressor angularis oris muscle with no other anomalies. The differential diagnosis and complete physical examination are essential to rule out other associated anomalies in ACF cases.</p> Pravin M Bhat, Sunil S Kewat Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Emphysematous gastritis: A case report <p>Emphysematous gastritis, a rare clinical entity is characterized by the presence of gas in the stomach wall. It is potentially fatal disease and usually presents with systemic toxicity. We are presenting a case of a young female who has presented to our emergency room with systemic signs and contrast-enhanced computed tomography abdomen was showing gas within the gastric wall. The patient was managed conservatively and subsequently discharged.</p> Ghulam Nabi Yattoo, Syed Mushfiq, Saurabh Kaushik, Neeraj Dhar, Ghulam Mohd Gulzar, Jaswinder Singh Sodhi Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Onychocryptosis complicated with osteomyelitis – A case report from tertiary wound care center in South India <p>Onychocryptosis or in-grown nail is a painful condition caused by the nail plate’s penetration into the soft surrounding tissue. If left untreated, it leads to infection, discharge, and difficulty in walking, seriously impeding the quality of life of the person. We present a case study of 26-year-old male non-diabetic, in-grown toenail involving the right great toe with osteomyelitis and lymphedema in the right leg. Onychectomy was performed to the patient’s right great toe followed by bone curettage to remove the infected bone. The patient was prescribed with analgesics and antibiotics and he was under constant medical follow- up once a week to change the dressing. Consecutive and careful administration revealed that the growth of healthy matrix and lymphedema is significantly under control.</p> Rajesh Kesavan, Changam Sheela Sasikumar, Anya Gandeban Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Torsion of the gravid uterus: A rare cause of abdominal pain <p>Uterine torsion in pregnancy is a rare clinical entity with a non-specific clinical presentation. Here, we present a case of uterine torsion,<br>which was diagnosed at laparotomy done for the lower segment cesarean section (LSCS) in a case of central placenta previa with the<br>fetus in transverse lie. At 36.4 weeks period of gestation, the patient complained of severe left-sided abdominal pain which was not<br>suggestive of labor. This abdominal pain was refractory to analgesics. Emergency LSCS was done which confirmed uterine torsion as<br>well as anterior sacculation.</p> R Dhaimode Mangirish, B Karmali Deepa, A Nagarsenkar Ajit, M Menezes Roy, P Pednekar Guruprasad Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Newborn with classical Cornelia de Lange syndrome: A rare case report <p>Cornelia de Lange syndrome (CdLS) is a rare multisystem developmental disorder associated with multiple congenital malformations including facial dysmorphism, upper-extremity malformations, hirsutism, cardiac defects, gastrointestinal abnormalities, and central nervous system anomalies. In the neonatal period, typical facial features help in diagnosing it. Here, we report a neonate with facial features (bushy eyebrows, synophrys, long eyelashes, micrognathia, hirsutism, and low hairline), gastroesophageal reflux disease, large atrial septal defect, and neonatal seizures diagnosed as classic CdLS.</p> Ayush Sopori, Mohit Bajaj, Jyoti Sharma, Chetna Jangwal Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 White sponge nevus: A case report of a rare keratinopathy and its novel treatment approach <p>White sponge nevus (WSN) is a hereditary mucocutaneous leukokeratosis due to an altered expression of CK 4 and CK 13 genes, thereby causing a defect in keratinization. We report the case of WSN in a 27-year-old who presented with a complaint of white, painless patches in both the cheek mucosa since childhood. The patient was examined and the biopsy was done. Based on the clinical findings, inheritance pattern, and histopathological features, a diagnosis of WSN was made. The patient responded well to our novel treatment approach with amoxicillin suspension (250 mg/5 ml). Regarding the treatment of WSN, no definite pharmacological therapy is available till date. We report this case to emphasize that amoxicillin suspension topical therapy may be used as a novel treatment measure with its unique advantages.</p> Debasish Pramanick, Sandip Ghose, Piyali Polley, Rahul Patel Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Diagnostic imaging of a Rare Intraosseous Mandibular Schwannoma using Cone Beam Computed Tomography – A case report <p>Intraosseous schwannoma is a very rare (&lt;1%), slow-growing, benign tumor of Schwann cells. The mandible is the most common site for intraosseous schwannoma. Here, we report the case of a 35-year-old female reported with extraoral and intraoral swelling with bicortical expansion on the left side of the mandible for the past 6 months. Two-dimensional imaging modalities (intraoral periapical radiograph, orthopantomogram, and occlusal radiograph) showed giant well-defined false multilocular radiolucency appearance in the left body of the mandible and external root resorptions of the premolars and molars. Aspiration was non-productive. Cone-beam computed tomography (CBCT) study showed a bicortical expansile unilocular hypodense lesion in continuity with the widened mandibular canal suggesting a tumor of neural tissue origin. Radiological diagnosis of intraosseous schwannoma was given and histopathological examination after an excisional biopsy confirmed the same. The postsurgical phase was uneventful and the patient is under follow-up. This article highlights the importance of three-dimensional modality like CBCT in narrowing the diagnosis of such rare clinically misleading presentations</p> Shilpa Shree Kuduva Ramesh, Sadaksharam Jayachandran Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530 Conservative treatment by halo vest for a 63-year-old male with traumatic spondylolisthesis of the second cervical Levine-Edwards type 2 (hangman’s fracture): A case report <p>The hangman fracture is used to describe the traumatic spondylolisthesis of C2. The management strategies and surgical indications for executioner fractures are still controversial. However, conservative treatment has usually been effective in stable and neurologically normal patients when treated with appropriate immobilization in an extended position. We reported a case of a 63-year-old male patient with a hangman fracture on the second cervical vertebra that was treated with conservative treatment using a halo vest. After 1 month of halo vest application, the pain was decreased without neurological deficit evidence. The halo vest was released and a soft collar neck application was done. Three months after the removal of the halo vest and soft collar application, there were no pain and neurological deficit. We found evidence of displaced fracture of processus spinosus of the first and sixth cervical vertebrae and union of the third cervical vertebrae, union fracture of the pars interarticularis second vertebrae, and osteophytes on the anterior body fifth and seventh cervical with narrowing disc fifth-sixth cervical.</p> Fajar Ivan Effendi, Pamudji Utomo, Romaniyanto, Raden Andhi Prijosedjati, Abdaud Rasyid Yamani Copyright (c) 2020 Sat, 26 Sep 2020 00:00:00 +0530