ISSN: p-ISSN - 2454-129X; e-ISSN - 2454 -1303 Discipline: All medical, surgical and dental specialties Starting Year: 2015 Current volume: Volume 12 Issue per year: 12 (monthly) Editor-in-chief: Dr. Amit Agrawal, India Indexing: Index Copernicus, Journal Guide, BASE, Research Bible, Google Scholar E-mail: editor.ijcr@mansapublishers.com
Endoxifen in the management of behavioral addiction – A case report exploring its use beyond mood stabilization
Impulsivity is one of the core features of behavioral addiction. Recent evidence suggests a role of increased protein kinase C (PKC) activity in the pathophysiology of impulsivity. Consequently, it has been hypothesised that endoxifen, a direct PKC inhibitor, may be useful in the management of impulsivity. We report the case of a 29-year-old woman with a 5–6-year history of impulsive high-risk behaviors in the form of dating-app overuse, substance use, and mood symptoms such as impaired self-care, irritability, disturbed sleep, and appetite, for which she was diagnosed to have a mood disorder with behavioral addiction. Addition of endoxifen at a dose of 8 mg/day led to marked improvement in impulsivity, cravings for substances, and mood symptoms, with good tolerability and sustained benefit over 3 months.
Copyright (c) 2026 Dnyanraj Choudhary, Rupali Karwa https://creativecommons.org/licenses/by-nc-nd/4.0
Mammary duct ectasia with periductal mastitis presenting as a painful subareolar lump confirmed on triple assessment
Mammary duct ectasia with periductal mastitis is a benign, non-proliferative breast condition commonly affecting perimenopausal women between 40 and 50 years of age. It is characterized by dilatation of the subareolar ducts, accumulation of inspissated secretions, and subsequent periductal inflammation and fibrosis. We report the case of a 43-year-old female who presented with an acutely painful, ill-defined, mobile subareolar lump in the right breast of 4-day duration, without nipple discharge, fever, or axillary lymphadenopathy. She had a background of hypothyroidism and recent menstrual irregularity. Ultrasonography revealed bilateral ductal ectasia with inspissated secretions and periductal fat stranding in the right breast, which was classified as BIRADS III. Fine needle aspiration cytology demonstrated benign ductal epithelial and myoepithelial cells against a hemorrhagic, inflammatory background with numerous cyst macrophages and no cytological atypia, consistent with a benign lesion (Yokohama Category 2). Concordance of clinical, radiological, and cytological findings allowed a confident benign diagnosis of duct ectasia with periductal mastitis, avoiding unnecessary biopsy. This case underscores the importance of the triple assessment approach in evaluating breast lumps and highlights the potential of duct ectasia to mimic malignancy clinically.
Copyright (c) 2026 Bhushan M Warpe, Shurta S Joshi, Rajeshwari Patil https://creativecommons.org/licenses/by-nc-nd/4.0
Case report – Solitary finger nail bed neurofibroma
Neurofibromas arise along a nerve fiber and usually involve nerves in or near the skin. They rarely develop in the hand and fingers. Nail bed solitary neurofibroma is an exceptionally rare event with no more than eight cases described in the literature. We present the case of a 39-year-old female patient with a lesion located in the radial side of the nail bed of the right-hand index finger. These tumors are slow-growing and rarely painful. Imaging tools are not very helpful in making the diagnosis. Final diagnosis rests on histopathology. No case of nail bed solitary neurofibroma showed recurrence. Complete surgical excision should be considered a diagnostic and therapeutic procedure.
Copyright (c) 2026 Prasad B Bane, Mrinmayee P Bavdhankar, Bhargavi Thalari, Keerthana A Kumar, Afsari A Bano, Seema Nair https://creativecommons.org/licenses/by-nc-nd/4.0
Reticulate Acropigmentation of Kitamura: A rare hyperpigmented genetic skin disorder
Reticulate acropigmentation of Kitamura is an exceptionally rare autosomal dominant genodermatosis characterized by reticulate hyperpigmented macules that interrupt the dermatoglyphics, primarily affecting the dorsa of the hands and feet. We report a case of a 65-year-old man who presented with multiple bilateral symmetrical, hyperpigmented, well-defined, discrete macules and plaques over the neck, both shoulders, both axillae, both cubital fossae, both knees, both legs, and the bilateral dorsa of the hands, present for approximately 1½ months with recent progression over the preceding 15 days. A positive family history in the patient’s brother supported the autosomal dominant inheritance pattern. Skin biopsy confirmed the diagnosis, demonstrating hyperkeratosis, irregular acanthosis, filiform elongation of rete ridges, and increased melanocytes within the elongated epidermal projections. The importance of clinicopathological correlation in achieving an accurate diagnosis of this rare pigmentary disorder is emphasized.
Copyright (c) 2026 Bhushan M Warpe, Shweta S Joshi, Bhavinkumar S Sharma https://creativecommons.org/licenses/by-nc-nd/4.0
Central diabetes insipidus secondary to neurocysticercosis in a pediatric patient: A rare clinical intersection
Neurocysticercosis (NCC), caused by the larval stage of Taenia solium, is a leading cause of acquired epilepsy in endemic regions. While neurological symptoms predominate, endocrine manifestations such as central diabetes insipidus (DI) are exceedingly rare. We report a unique case of a 12-year-old male who presented to the emergency department with a 5-day history of profound polyuria and polydipsia. Evaluation confirmed central DI via a desmopressin challenge. Neuroimaging revealed a solitary ring-enhancing lesion in the left high parietal lobe, without direct hypothalamic pituitary involvement. The patient responded rapidly to a regimen of albendazole, corticosteroids, and desmopressin. This case highlights the potential for NCC to cause distal inflammatory disruption of the pituitary stalk, necessitating clinical suspicion for atypical metabolic presentations in endemic areas.
Copyright (c) 2026 Abhinav Anil, Surabhi Das, Anil Kumar https://creativecommons.org/licenses/by-nc-nd/4.0
Systemic lupus erythematosus-related acute pancreatitis: An uncommon clinical manifestation
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations, ranging from mild to life-threatening complications. Acute pancreatitis (AP) is a rare but serious manifestation of SLE, occurring in <2% of cases. SLE-related AP is often associated with high disease activity and can result in multiorgan dysfunction. We report the case of a 27-year-old female who presented with abdominal pain, joint pain, malar rash, pedal edema, and facial puffiness. Laboratory investigations revealed elevated serum amylase and lipase, with active SLE markers, including elevated antinuclear antibody and anti-dsDNA levels with hypocomplementemia. Contrastenhanced computed tomography abdomen confirmed acute interstitial edematous pancreatitis. The patient was also diagnosed with lupus nephritis. A diagnosis of SLE-related AP with concurrent lupus nephritis was established. The patient was managed with pulse corticosteroid therapy, immunosuppressive agents, and supportive measures, leading to significant clinical improvement. SLE-related AP is a rare life-threatening complication with multifactorial pathophysiology involving autoimmunity, vasculitis, and complement activation. This case highlights the importance of recognising AP as a rare but serious manifestation of SLE. Early diagnosis and prompt immunosuppressive therapy are crucial for improving outcomes.
Copyright (c) 2026 Hemant Kumar Mahur, Neha Jain, Dheeraj Mittal, Arpit Agarwal, Daksh Labana, Yashu Bankal https://creativecommons.org/licenses/by-nc-nd/4.0
Isolated intramedullary tuberculoma as the initial presentation of disseminated tuberculosis: A case report
Spinal intramedullary tuberculoma is a rare manifestation of central nervous system tuberculosis (TB) and an uncommon cause of acute transverse myelitis. We report a 38-year-old man who presented with fever, low back pain, rapidly progressive paraplegia, sensory impairment, and urinary retention. Magnetic resonance imaging of the spine revealed intramedullary T2 hyperintensity extending from T11 to L1 with thick ring enhancement at T11, consistent with an intramedullary tuberculoma associated with tuberculous myelitis. HIV testing was negative. Additional imaging demonstrated pulmonary involvement with pleural effusion and multiple intracranial tuberculomas, suggestive of disseminated TB. The patient showed partial neurological improvement following initiation of corticosteroids and antitubercular therapy. This case highlights the importance of maintaining a high index of suspicion for TB in patients presenting with acute myelopathy in endemic regions, even in the absence of microbiological confirmation, as early diagnosis is crucial to prevent permanent neurological deficits.
Copyright (c) 2026 Rezwana Naher Begam, Ishan Sharma, Liyaqat Ali, Anjum Parvez, Syed Hasan Amir https://creativecommons.org/licenses/by-nc-nd/4.0
When viral invasion meets vascular catastrophe: A case report of herpes simplex virus-related stroke
Herpes simplex virus (HSV) encephalitis is the most common viral encephalitis in industrialized nations, typically affecting the temporal lobes. While seizures are frequent complications, cerebrovascular events such as hemorrhagic stroke are rare. We report an 85-year-old man with multiple comorbidities who presented with altered mental status and progressive weakness. Cerebrospinal fluid analysis confirmed HSV-1 DNA, and neuroimaging revealed diffuse microbleeds and a left cerebellar hematoma. The patient was managed conservatively with intravenous acyclovir and antibiotics, showing gradual improvement, and was discharged in stable condition. This case highlights the unusual occurrence of cerebellar hemorrhage in HSV encephalitis, likely due to necrotizing vasculitis and immune-mediated vascular injury. Awareness of such vascular complications is essential for timely diagnosis and management. Early antiviral therapy, supportive care, and close monitoring can improve outcomes, even in elderly patients with significant comorbidities
Copyright (c) 2026 Ratnashree Biswas, Nilanchal Chakraborty, Kishalaya Karan https://creativecommons.org/licenses/by-nc-nd/4.0
Fatal fulminant myocarditis and multiorgan failure following accidental Cassia occidentalis ingestion in a child: A case report and review of literature
Cassia occidentalis (Coffee Senna) is a toxic leguminous weed widely distributed across tropical and subtropical regions, including rural India, where accidental ingestion by children continues to pose a serious but underrecognized public health threat. Its seeds contain potent anthraquinone derivatives and toxalbumins that disrupt mitochondrial oxidative phosphorylation, leading to a fulminant multiorgan syndrome encompassing hepatic failure, rhabdomyolysis, toxic encephalopathy, and myocarditis. We report the case of a 4-year-old previously healthy child who presented to the pediatric intensive care unit 2 days after the accidental ingestion of C. occidentalis seeds, with progressive vomiting, lethargy, and hemodynamic instability. Clinical examination revealed hypotension, tachycardia, tachypnea, drowsiness, and hepatomegaly. Electrocardiography revealed ST-segment elevations in multiple leads, and echocardiography confirmed severe left ventricular systolic dysfunction with an ejection fraction of 25%, consistent with fulminant myocarditis. Despite aggressive intensive care management, including mechanical ventilation, inotropic support with dopamine and adrenaline, fresh frozen plasma transfusions and vitamin K. The child deteriorated rapidly and succumbed within 12 h of admission due to refractory cardiogenic shock and multiorgan failure. This case highlights the fulminant and near-universally fatal course of C. occidentalis toxicity when cardiac involvement occurs and underscores the critical need for early suspicion, prompt referral to tertiary pediatric critical care facilities, and robust community education campaigns for prevention in endemic rural areas.
Copyright (c) 2026 Chirag Deora, Nikhil Gupta https://creativecommons.org/licenses/by-nc-nd/4.0
Hepatitis E virus-associated Guillain-Barré syndrome: A case report
Guillain-Barré syndrome (GBS) is an acute immune-mediated neuropathy often triggered by infections. Hepatitis E virus (HEV), a common cause of viral hepatitis, has been increasingly linked to extrahepatic manifestations, including neurological syndromes. We report a 31-year-old man who developed progressive limb weakness and respiratory difficulty following acute diarrheal illness. Neurological examination revealed quadriparesis with reduced reflexes; nerve conduction studies showed axonal and demyelinating motor neuropathy. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis, and HEV-immunoglobulin M was positive with concurrent hepatic dysfunction. The patient was treated with intravenous immunoglobulin and supportive care, showing gradual recovery. This case highlights HEV-associated GBS as a rare but important diagnostic consideration, particularly in endemic regions. Early recognition of HEV as a trigger in GBS can guide timely management and improve outcomes, underscoring the need for heightened clinical awareness of its extrahepatic complications.
Copyright (c) 2026 Ratnashree Biswas, Nilanchal Chakraborty https://creativecommons.org/licenses/by-nc-nd/4.0
Squamous cell carcinoma arising from mucosal porokeratosis
Copyright (c) 2026 Prateek Maharana, Subrat Kumar Patel https://creativecommons.org/licenses/by-nc-nd/4.0
Diagnostic challenges in reporting a case of extraskeletal Ewing’s sarcoma of the prostate in a young Indian adult
Extraosseous prostatic Ewing’s sarcoma (ES) in young adults is extremely rare. We present a case of locally advanced prostate ES/primitive neuroectodermal tumor (PNET) in a 28-year-old male. He presented with difficulty in micturition and defecation for 6 months. On magnetic resonance imaging, a mass lesion was found involving the central and peripheral zones of the prostate, and it was provisionally diagnosed as a neoplastic lesion with a differential diagnosis of lymphoma or a neuroendocrine tumor. A transrectal ultrasound-guided fine needle aspiration cytology and needle biopsy, followed by histopathological examination, and immunohistochemistry confirmed the diagnosis of Extraosseous ES. The patient underwent a cystoprostatectomy followed by multi-agent chemotherapy. Presently, the patient is alive and is being followed up regularly. Nevertheless, this tumor has a very poor prognosis, with the longest reported survival of 24 months.
Copyright (c) 2026 Muktanjalee Deka, Lachit Kalita, Shriya Roy, Ranjumoni Konwar, Binoy Kumar Choudhury https://creativecommons.org/licenses/by-nc-nd/4.0
From coma to consciousness: Effective extracorporeal clearance in severe phenobarbital overdose
Phenobarbital remains widely used for epilepsy management in resource-limited settings, but severe overdose can lead to prolonged coma and life-threatening complications. We report a 22-year-old female who presented with deep coma and respiratory failure following intentional ingestion of approximately 100 phenobarbital tablets. Despite optimal supportive care, neurological recovery was delayed with persistently elevated serum drug levels. Two consecutive sessions of intermittent hemodialysis were performed, resulting in rapid clinical improvement and a significant reduction in serum phenobarbital concentration. The patient achieved complete neurological recovery without sequelae. This case highlights the effectiveness of hemodialysis as an accessible extracorporeal modality for enhanced drug elimination in severe phenobarbital poisoning and emphasizes the importance of early identification of candidates for such therapy.
Copyright (c) 2026 Bhayolina Bora, Moinul Islam, Amrit Jyoti Sonowal, Ananta Kumar Bora https://creativecommons.org/licenses/by-nc-nd/4.0
Mycotic aneurysm and it’s not so silent presentation – A case report
We report a rare case of mycotic aneurysm of the aortic arch caused by Salmonella typhi, initially manifesting as hoarseness of voice secondary to left recurrent laryngeal nerve compression. A 58-year-old diabetic and hypertensive male presented with intermittent fever, initially managed as a urinary tract infection with diabetic ketoacidosis. Progressive symptoms led to the diagnosis of a saccular mycotic aneurysm of the aortic arch with purulent pericardial effusion and bilateral pleural effusions. Serology confirmed typhoid etiology. The patient was stabilized on antibiotics and referred for thoracic endovascular aortic repair. This case highlights the importance of considering vascular pathology in patients with unexplained vocal cord palsy and systemic infection, and underscores the need for early recognition and multidisciplinary management.
Copyright (c) 2026 P Shahanas, Pooja Prathapan Sarada, K M Ganesh, Garud Suresh Chandan, Padmakumar Arayamparambil Vijayan https://creativecommons.org/licenses/by-nc-nd/4.0
Hidden in plain sight: Duane retraction syndrome diagnosed in an adult
Copyright (c) 2026 Somarajan Anandan, Sajeesh S Rajendran, Anu Anna Paul, Joesni Joy, Anandhu Suresh https://creativecommons.org/licenses/by-nc-nd/4.0
Probable atomoxetine-associated acute hepatitis with hyperammonemia in a child with autism spectrum disorder and attention-deficit/hyperactivity disorder: A case report
Drug-induced liver injury is an important cause of acute hepatic dysfunction in children receiving neuropsychiatric medications. Atomoxetine, a selective norepinephrine reuptake inhibitor used in the treatment of attention-deficit/ hyperactivity disorder (ADHD), is generally well tolerated, although rare cases of hepatotoxicity have been reported. We describe a 5-year-old boy with autism spectrum disorder and ADHD who presented with fever, respiratory symptoms, and acute irritability. Laboratory evaluation revealed severe transaminitis with hyperammonemia, whereas bilirubin and coagulation parameters remained normal. The child had been started on atomoxetine, memantine, and piracetam 2 months before presentation. Withdrawal of the suspected medications and supportive therapy, including N-acetylcysteine, resulted in progressive clinical and biochemical improvement. This case highlights the importance of considering drug-induced liver injury in children presenting with sudden behavioral deterioration and abnormal liver function tests.
Attention-deficit/hyperactivity disorder
Copyright (c) 2026 Prasad Manikrao Yadav https://creativecommons.org/licenses/by-nc-nd/4.0
Diagnostic challenges in multiple myeloma: A case series of atypical neurological, renal, and skeletal presentations
Multiple myeloma (MM) is a clinically heterogeneous plasma-cell malignancy in which reliance on conventional diagnostic markers, including CRAB features and serum protein electrophoresis, may contribute to delayed or missed diagnosis. This case series describes four patients presenting with atypical, organ-predominant manifestations that obscured early recognition of MM. Presentations included non-compressive conus medullaris syndrome due to diffuse vertebral marrow infiltration, nephrotic syndrome secondary to Amyloid Light chain (AL) amyloidosis, delayed diagnosis of kappa light-chain myeloma with progressive osteolytic disease despite initially non-diagnostic monoclonal studies, and true non-secretory myeloma identified during evaluation for acute infection. In two cases, initial serum monoclonal protein studies were negative, contributing to diagnostic delay. Contemporary evidence emphasizes the need for early integration of serum-free light-chain assays, advanced imaging, and bone marrow evaluation in patients with high clinical suspicion, even when classical features are absent.
Copyright (c) 2026 S Bharathwaj, N Sukanya, Kalpana Ramanathan, J Kiruthika, S Senthilkumar, S Chandrasekar https://creativecommons.org/licenses/by-nc-nd/4.0
Rectosigmoid endometriosis as a diagnostic chameleon mimicking colorectal carcinoma
Bowel endometriosis is an uncommon manifestation of endometriosis that can clinically and radiologically mimic colorectal malignancy. Because the disease predominantly involves the deeper layers of the bowel wall with relative sparing of the mucosa, endoscopic findings may be normal, posing a significant diagnostic challenge. A 38-year-old woman presented with abdominal distension, epigastric pain, vomiting, constipation, and loss of appetite for 3 months. Radiological imaging revealed circumferential wall thickening at the rectosigmoid junction with luminal narrowing and features suggestive of distal colonic obstruction suspicious for malignancy. Sigmoidoscopy demonstrated normal mucosa with the inability to negotiate the scope beyond the narrowing. Mucosal biopsy revealed chronic non-specific colitis. Due to persistent radiological suspicion of malignancy, surgical resection was performed. Histopathological examination demonstrated endometrial glands and stroma infiltrating the serosa, muscularis propria, and submucosa of the rectosigmoid colon, confirming the diagnosis of rectosigmoid endometriosis. Rectosigmoid endometriosis may closely mimic colorectal carcinoma on imaging, while endoscopic findings remain non-specific. Awareness of this diagnostic pitfall is essential in reproductive-age women presenting with colorectal obstruction to prevent misdiagnosis and unnecessary radical treatment.
Copyright (c) 2026 Shraddha Rakesh Singh, Vijay Dhondiraj Dombale, Rahul Yeshwant Sakpal, Amardeep Ajinath Patil https://creativecommons.org/licenses/by-nc-nd/4.0
Early genetic diagnosis of thymidine kinase 2-related mitochondrial DNA depletion syndrome in a neonate with respiratory failure: A rare case highlighting the role of early genetic diagnosis and ethical decision-making
Mitochondrial DNA (mtDNA) depletion syndromes represent a heterogeneous group of autosomal recessive disorders characterized by a significant reduction in mtDNA copy number, leading to impaired oxidative phosphorylation and severe multisystem disease. The myopathic form caused by mutations in the thymidine kinase 2 (TK2) gene is particularly rare and often presents in infancy with profound muscle weakness and respiratory failure. We report a rare case of infantile-onset TK2-related mtDNA depletion syndrome presenting in the immediate neonatal period with severe hypotonia and respiratory failure. Early genetic diagnosis enabled appropriate counseling and facilitated informed decision-making by the family. This case underscores the importance of considering mitochondrial disorders in neonates with unexplained hypotonia and respiratory insufficiency.
Mitochondrial DNA Depletion Syndrome, TK2 Gene Mutation, Neonatal Hypotonia, Respiratory Failure in Neonate, Rare Genetic Disease, Genetic Counseling.
Copyright (c) 2026 Mukesh Kumar, Tauhid Iqbali, Harpreet Singh, Ravi Shah https://creativecommons.org/licenses/by-nc-nd/4.0
An embryological surprise in the inguinal canal: Deep epidermoid cyst mimicking spermatic cord pathology – A case report
Epidermoid cysts are common benign lesions that typically arise from the skin and subcutaneous tissues; however, deep-seated inguinal epidermoid cysts are rare and may mimic spermatic cord pathology on imaging. We report a 23-year-old male presenting with left inguinal pain and swelling of 2-week duration. Magnetic resonance imaging demonstrated a well-defined cystic lesion along the spermatic cord showing T1 and T2 hypointensity, diffusion restriction, and no post-contrast enhancement, raising suspicion for an infected encysted hydrocele or spermatic cord abscess. Surgical exploration revealed a well-encapsulated deep inguinal cyst, which was excised completely. Histopathology confirmed an epidermoid cyst. This case highlights a diagnostic pitfall where diffusion restriction may mimic infection and emphasizes the importance of considering epidermoid cyst in the differential diagnosis of non-enhancing inguinal lesions.
Copyright (c) 2026 Nikita Mary Baby https://creativecommons.org/licenses/by-nc-nd/4.0
Dress syndrome induced by cefixime: A case report
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening hypersensitivity reaction characterized by fever, rash, hematological abnormalities, and internal organ involvement. Although it is most commonly associated with antiepileptic and sulfonamide drugs, cephalosporin-induced DRESS remains rare and underreported. We describe a case of a 19-year-old male who developed DRESS syndrome following administration of Cefixime, a third-generation cephalosporin widely prescribed for bacterial infections.
Drug reaction with eosinophilia and systemic symptoms syndrome
Registry of severe cutaneous adverse reactions
Copyright (c) 2026 Vidushi Saxena, Saim Kidwai, Abdul Rehman, Mohammad Ashraf Khan https://creativecommons.org/licenses/by-nc-nd/4.0
A rare presentation of Tolosa – Hunt syndrome in a young male
The primary care provider, nurse practitioner, and internist often encounter patients with a headache. However, when they encounter a patient with an intense headache and ophthalmoplegia, the care plan no longer resides with a general practitioner, and referral to a neurologist becomes mandatory. This is due to the vast differentials involved and rare pathologies that one may come across during their medical practice. One such case of a 45-year-old male with similar complaints encountered during a routine emergency day led to a diagnosis of a rare neuro-immunological disorder, possibly a diagnosis of exclusion.
Copyright (c) 2026 Rohit Jacob Manoj https://creativecommons.org/licenses/by-nc-nd/4.0
Pantoea agglomerans septicemia in a preterm neonate: A case report
Neonatal sepsis remains a significant cause of morbidity and mortality, particularly in preterm infants. We present a case of late-onset sepsis caused by atypical pathogen Pantoea agglomerans in a 27-day-old preterm male neonate, following traditional head shaving and application of an herbal poultice. Blood culture using an automated system flagged positive within 24 h, and identification with VITEK 2 confirmed P. agglomerans. The isolate demonstrated broad susceptibility to beta-lactams and carbapenems, intermediate susceptibility to aminoglycosides, and resistance to ciprofloxacin. Empiric therapy was modified based on susceptibility results, resulting in clinical recovery. This case emphasizes the significance of detailed exposure history and recognition of unusual pathogens with rapid microbial diagnostics in neonatal sepsis. Awareness and consideration of traditional cultural practices as potential infection sources may facilitate earlier diagnosis and targeted therapy, improving outcomes in high-risk neonates.
Copyright (c) 2026 Devi Asokan, Sundaram Supare, Dilip Gedam, Ravindra Kashinath Khadse https://creativecommons.org/licenses/by-nc-nd/4.0
Low-grade mucoepidermoid carcinoma of the parotid gland in a 5-year-old child: The youngest reported case from India
Mucoepidermoid carcinoma (MEC) of the parotid gland is scarce in the pediatric group and is exceedingly uncommon in children under 6 years. In spite of being the most frequent malignant salivary gland tumor in children, the majority of cases are reported in older age groups. Only a few cases in children under 5 years have been documented worldwide, and the youngest of these previously reported Indian cases was a 6-year-old child. We report a rare case of lowgrade MEC of the parotid gland in a 5-year-old boy, describing the youngest reported case from India to date. The presenting complaint was a painless parotid swelling, and pre-operative imaging and fine-needle aspiration cytology (FNAC) were suggestive of pleomorphic adenoma. FNAC has limited sensitivity in pediatric salivary gland tumors, particularly in low-grade MEC, due to superimposing cytomorphological features with benign lesions. The management comprised superficial parotidectomy with facial nerve preservation, with histopathological examination confirming low-grade MEC with clear margins. This case highlights the rarity of this condition, diagnostic pitfalls and limitations of FNAC, and the significance of histopathological confirmation.
Copyright (c) 2026 Harsh Preet Matta, Ripan Miglani, Manjeet Kaur, Tejas Kalayanpur https://creativecommons.org/licenses/by-nc-nd/4.0
We report a case of a 74-year-old asthmatic lady on inhalers who came with acute exacerbation of bronchial asthma with no evidence of hypercarbia or acidosis and during her course in hospital stay, she developed an acute onset of abdominal distension due to intestinal obstruction. She was extensively evaluated and was finally diagnosed with gastrointestinal mucormycosis. Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastrointestinal mucosa. Being a rare entity, the diagnosis is most often overlooked. The importance of this case is that a high index of suspicion is required for early diagnosis and management of the disease, and the mortality is very high, particularly in immunocompromised patients.
Copyright (c) 2026 B Adhira, V S Vinod, K Nikitha https://creativecommons.org/licenses/by-nc-nd/4.0
Moyamoya disease presenting as ischemic stroke and interventricular hemorrhage in a young adult: A case report
Moyamoya disease is a chronic, non-atherosclerotic cerebrovascular disorder characterized by progressive stenosis of the terminal internal carotid arteries along with the development of abnormal basal collateral networks. It typically presents with ischemic events in children, whereas hemorrhagic manifestations are more common in adults. We report the case of a 17-year-old female with a 10-day history of altered sensorium. Magnetic resonance imaging of the brain with contrast shows features suggestive of multiple acute infarcts with hemorrhagic transformation in the genu of the corpus callosum, along with interventricular hemorrhage. MR angiography shows occlusion of the supraclinoid right internal carotid artery, middle cerebral artery, posterior cerebral artery, bilateral anterior cerebral artery, and severe stenosis of the left supraclinoid internal carotid artery and left middle cerebral artery, along with extensive basal and cortical collateral vessels with ~95% distal basilar artery stenosis. This report highlights a rare presentation of combined ischemic and hemorrhagic stroke in a young adult female.
Copyright (c) 2026 Mridul Chaturvedi, Dhruv Mittal, Naveen Verma, Kartikeya Bhatt, Anshul Singh, Yograj Meena https://creativecommons.org/licenses/by-nc-nd/4.0
Successful twin pregnancy in a common variable immunodeficiency patient: Case study and clinical insights
Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by an increased vulnerability to recurrent respiratory and gastrointestinal infections, as evidenced by low immunoglobulin levels. Pregnancies in individuals diagnosed with CVID are classified as high-risk due to the considerable variability in disease presentation and potential complications that may arise. Principal concerns during pregnancy associated with CVID include infections, preterm labor, postpartum hemorrhage, thrombocytopenia, and a heightened incidence of eclampsia and pre-eclampsia. We provide a detailed overview of our clinical experience in managing pregnancy for a patient with CVID of a 30-yearold primigravida diagnosed with CVID at 17 weeks of gestation with a twin pregnancy. Implementing targeted care strategies in tertiary healthcare settings is expected to enhance pregnancy outcomes for women diagnosed with CVID.
Common variable immunodeficiency pregnancy
Copyright (c) 2026 Ipsita Mohapatra, Deepthy Balakrishnan, Saubhagya Kumar Jena, Soubhagya Majhi https://creativecommons.org/licenses/by-nc-nd/4.0
Perianal tuberculosis in an immunocompetent patient: A diagnostic enigma unraveled by caseating granulomas
Perianal tuberculosis (TB) is an exceptionally rare form of extrapulmonary TB (<1% of cases), often linked to immunocompromised states but increasingly reported in immunocompetent individuals in endemic areas. We describe the case of a 48-year-old immunocompetent male from a TB-endemic region presenting with a 4-year history of progressive left perianal nodular growths (initially solitary, evolving to multiple), associated with whitish seropurulent discharge for 1 year, perianal itching, and an unintentional 5 kg weight loss over 10 months. Examination showed multiple discharging sinuses at 1, 5, and 6 o’clock positions with a 3 × 2 cm irregular hyperpigmented nodular growth at 1 o’clock, 3 cm from the anal verge. Imaging revealed an 8 × 2 cm perianal abscess with sphincter involvement and fistulous tracts. Excisional biopsy demonstrated granulomatous inflammation with epithelioid histiocytes, Langhans giant cells, fibroblastic rimming, and central caseous necrosis, consistent with tuberculous etiology. Post-operative category I anti-tubercular therapy (2HRZE/4HR) led to complete resolution at 1-month follow-up. This case highlights perianal TB as a key differential in chronic perianal lesions in immunocompetent patients from endemic regions, stressing the role of early histopathological confirmation through caseating granulomas and combined surgical-medical management to prevent diagnostic delays and sphincter damage.
Copyright (c) 2026 Ajmeera Ranga, G Vamshi Yadav, Syed Arbaaz Ahmed, G Tarun Kumar https://creativecommons.org/licenses/by-nc-nd/4.0
Compromised gut–brain axis architecture in uremic encephalopathy: A case report with review of literature
Posterior reversible encephalopathy syndrome (PRES) is often clinically manifested by headaches, seizures, and altered sensorium, which coincide with clinical features of uremic encephalopathy (UE). Here, a case of a 12-year-old female with polycystic kidney and hepatic disease 1 positive polycystic chronic kidney disease (autosomal recessive polycystic kidney disease), presenting with non-specific abdominal pain, bloating, mouth ulcers, and vomiting, followed by status epilepticus, is reported. Magnetic resonance imaging of the brain showed features of atypical PRES. Gastrointestinal symptoms, UE, and PRES offer an interesting window into the common toxin-mediated damage to the gut–brain axis architecture. This report is followed by a crisp review of the literature.
Posterior reversible encephalopathy syndrome
Copyright (c) 2026 Varnit Shanker, Radhika Govil, Sanjay Shukla, Mohit Khandelwal https://creativecommons.org/licenses/by-nc-nd/4.0
Detection of 20ph+ in a woman with idiopathic recurrent pregnancy loss
Recurrent pregnancy loss (RPL) constitutes a multifactorial clinical entity, often necessitating an exhaustive diagnostic approach when routine investigations yield inconclusive results. We report the case of a 23-year-old female with two consecutive unexplained pregnancy losses, in whom comprehensive endocrine, thrombophilia, and radiological evaluations were unremarkable. However, cytogenetic analysis revealed a rare heterochromatic variant, 20ph+, in the female partner, whereas the male partner’s karyotype was normal. Although 20ph+ is typically regarded as a benign chromosomal polymorphism, its infrequent occurrence and detection in reproductive disorders invite reconsideration of its potential clinical significance. To our knowledge, this is the first study in India to report the presence of 20ph+ in the context of RPL. This case study underscores the importance of incorporating cytogenetic analysis into the diagnostic workup for idiopathic RPL, especially when standard investigations fail to identify a cause.
Copyright (c) 2026 Byapti Banerjee, Chandrima Ganguly, Sukanta Chatterjee, Ashis Kumar Saha, Atreyee Dutta https://creativecommons.org/licenses/by-nc-nd/4.0