ISSN: p-ISSN - 2454-129X; e-ISSN - 2454 -1303 Discipline: All medical, surgical and dental specialties Starting Year: 2015 Current volume: Volume 10 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
Bacterial synovitis: An unusual pathogen
A 40-year-old male patient presented with pain and swelling in both knee joints for 2 months. On examination and investigation, the patient was diagnosed with suspected acute synovitis, and arthrotomy with synovectomy was performed. The patient’s condition worsened with fever, collection of fluid in the joint, and an increase in blood leukocyte count. Upon performing culture and identification by an automated system, Staphylococcus haemolyticus was isolated, which was sensitive to doxycycline and vancomycin but resistant to linezolid. The patient was initiated on intravenous Vancomycin at a dosage of 1 g every 12 hours. The regimen was continued for a total duration of 7 days, after which the patient demonstrated complete clinical recovery.
Copyright (c) 2026 M Ravish Kumar https://creativecommons.org/licenses/by-nc-nd/4.0
Malignant transformation in long-standing hypertrophic lichen planus
Copyright (c) 2026 Prateek Maharana, Swapnil Surajsingh Thakur, Mahima Soni https://creativecommons.org/licenses/by-nc-nd/4.0
HbQ India variant in an epileptic patient – a rare case report
Thalassemias and structural variations such as HbS, HbE, and HbD, as well as Hb Lepore, HbD-Iran, Hb-H illness, and HbQ India, are examples of inherited hemoglobin disorders. North and West India are home to the rare alpha-chain structural hemoglobin type known as HbQ India. The majority of patients are asymptomatic, and they frequently exhibit heterozygosity or co-inherited beta-thalassemia. We present the case of a 30-year-old Indian male epileptic patient coexisting with beta-thalassemia and HbQ India heterozygous variant. This case highlights the importance of screening hemoglobin variants in beta-thalassemia, interpreting normal HbA2 in coexisting iron deficiency anemia, and recognizing anti-seizure drug effects on hematological profiles. To measure different hemoglobin, a complete blood count, peripheral blood smear analysis, and cation exchange high-performance liquid chromatography (HPLC) were performed. The HPLC chromatogram showed hemoglobin of 22.5% and a retention time of 4.39 min. The normal HbA2 despite beta-thalassemia was attributed to iron deficiency anemia. HbQ India is a rare structural variant of hemoglobin. Despite being asymptomatic, it could make diagnosing beta thalassemia in the compound heterozygous state more challenging. HPLC provides a quick, precise, and reproducible method for screening this condition, enabling the identification and guidance of affected individuals.
Copyright (c) 2025 Bhuvan Nagpal, Rujuta Patil, Geetpriya Kaur, Aparna Pathak https://creativecommons.org/licenses/by-nc-nd/4.0
Effective intraocular pressure management and vision preservation in secondary glaucoma associated with carotid-cavernous fistula: A case report
Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous connections between the cavernous sinus and branches of the internal or external carotid arteries. Although uncommon, CCFs are an important cause of secondary glaucoma due to increased episcleral venous pressure, and they present significant diagnostic and therapeutic challenges. Uncontrolled intraocular pressure (IOP) can lead to irreversible blindness, highlighting the urgency of timely and effective management. We report the case of a 65-year-old woman with a history of hypertension and dyslipidemia who presented with persisting bilateral redness and dry sensation in both eyes (BE), along with visual decline, leftsided proptosis, conjunctival injection (more severe in the left eye [LE]), and a palpable bruit. IOP was elevated in the LE despite maximal topical therapy. Imaging with computed tomography angiography and digital subtraction angiography confirmed a Type C CCF. This case highlights the importance of addressing the underlying cause of secondary glaucoma, as maximal anti-glaucoma medications alone may be insufficient if the primary pathology remains unresolved.
Copyright (c) 2026 Tiara Azriena Dzulkarnain, Ardiella Yunard https://creativecommons.org/licenses/by-nc-nd/4.0
Cholelithiasis as the presenting feature of polycythemia vera: An extremely rare case report
Polycythemia vera (PV) is a JAK2-mutated myeloproliferative neoplasm that typically presents with erythrocytosis related symptoms or thrombotic events. Usually, it presents at the age of 40–60 years, and the majority are in females. Gallstone disease, though common in older women, is an exceedingly uncommon initial manifestation of PV. We describe a 63-year-old postmenopausal female with congenital talipes equinovarus who presented with intermittent right upper quadrant abdominal pain and was found to have cholelithiasis and hepatosplenomegaly on ultrasonography. Routine laboratory tests revealed persistently elevated hemoglobin and hematocrit with suppressed serum erythropoietin (EPO), and subsequent JAK2 V617F testing confirmed PV. This case illustrates how a common gastrointestinal complaint may unmask an extremely rare occurrence of an underlying hematological malignancy, PV, which was otherwise silent, emphasizing the need for thorough evaluation of unexplained erythrocytosis in patients presenting with otherwise typical biliary pathology.
Copyright (c) 2026 Poonam Gupta, Divya Chutani, Ajeet Kumar Chaurasia https://creativecommons.org/licenses/by-nc-nd/4.0
Unusual pattern of magnetic resonance imaging findings in congenital cytomegalovirus infection presenting with congenital sensorineural hearing loss: A case report
Congenital cytomegalovirus (cCMV) infection is the leading non-genetic cause of sensorineural hearing loss (SNHL) in children. This report highlights an atypical magnetic resonance imaging (MRI) presentation: Bilateral anterior temporal pole cysts and diffuse white matter abnormalities in an infant with isolated bilateral SNHL. We present a case of a male infant with bilateral congenital SNHL. MRI showed bilateral anterior temporal cysts and diffuse periventricular white matter hyperintensities with no suspicious antenatal history or more common features such as microcephaly, calcifications, or cortical anomalies. Confirmatory testing revealed cCMV infection. This case underscores the diagnostic value of MRI in detecting subtle manifestations of cCMV. Recognition of anterior temporal pole cysts, even in the absence of classic features, can guide timely diagnosis and treatment, potentially improving auditory and neurodevelopmental outcomes.
Copyright (c) 2026 Shweta Sharma, Shubhankar Tiwari https://creativecommons.org/licenses/by-nc-nd/4.0
Primary ciliary dyskinesia in an infant with post-infectious bronchiolitis obliterans and failure to thrive: A case report
We report the case of a 9-month-old male infant with recurrent severe viral pneumonia, culminating in bronchiolitis obliterans and chronic respiratory morbidity. The clinical course was marked by multiple pediatric intensive care unit admissions, prolonged oxygen dependency, and recurrent bacterial superinfections. High-resolution computed tomography revealed bronchiectasis and fibrotic changes. Given the chronicity of symptoms, a clinical suspicion of Primary Ciliary Dyskinesia (PCD) was raised. Genetic analysis detected heterozygous variants of uncertain significance in the DNAH1 and LRRC6 genes. This case highlights the diagnostic and management complexities in infants with post-viral chronic lung disease and the importance of early consideration and evaluation for underlying genetic etiology, such as PCD.
Copyright (c) 2025 S Shubhranshu Shekhar, Sanjukta De https://creativecommons.org/licenses/by-nc-nd/4.0
An unwelcome intruder: Burkholderia cepacia invades the testis in a renal transplant recipient – a rarit
Testicular abscesses are rare complications of epididymo-orchitis and are usually caused by Staphylococcus aureus or enteric Gram-negative bacilli. The Burkholderia cepacia complex (BCC) comprises multidrug-resistant, opportunistic organisms that commonly affect immunocompromised individuals and patients with indwelling devices. Although BCC has been associated with intra-abdominal, splenic, and prostatic abscesses, testicular involvement has not been previously described. A 51-year-old man with end-stage renal disease on long-term hemodialysis through an arteriovenous fistula and two prior failed renal transplants, who presented with fever and severe unilateral scrotal pain. Imaging revealed a testicular abscess, and cultures from blood, pus, and excised tissue grew B. Cepacia. He required orchidectomy and prolonged targeted antimicrobial therapy, with complete recovery. This case illustrates an exceptionally rare genitourinary manifestation of BCC infection in a chronically immunocompromised host and underscores the need to consider opportunistic pathogens when evaluating acute scrotal conditions in transplant patients.
Copyright (c) 2026 Ananta Mishra, Kalpana, Prabhat Chauhan, Vaidehi Rajwadkar, Jes Raphael https://creativecommons.org/licenses/by-nc-nd/4.0
Minimally invasive approaches for esthetic enhancement in dental fluorosis: A case report
Dental fluorosis is a developmental enamel disorder characterized by hypomineralization and increased enamel porosity, which results in esthetic concerns that can impact a patient’s quality of life. This case report highlights the importance of minimally invasive approaches for the management of moderate dental fluorosis in a 22-year-old patient, employing a combined treatment regimen comprising microabrasion and resin infiltration therapy. The patient exhibited symmetrical white-to-light-brown, with opaque areas affecting the maxillary front teeth. The treatment sequence started with microabrasion using 6.6% hydrochloric acid combined with silicon carbide microparticles, followed by resin infiltration with a low-viscosity methacrylate-based resin. The treatment produced immediate esthetic improvements by removing all brown stains and concealing white spots/opacities. These stable results persisted for 2 years without any adverse effects. This case demonstrates that the management of moderate dental fluorosis through microabrasion combined with resin infiltration can serve as an effective alternative to more invasive dental procedures
Copyright (c) 2026 Muskan Jain, Rakesh Kumar Yadav, Rhythm Bhains, Promila Verma, Ramesh Bharti https://creativecommons.org/licenses/by-nc-nd/4.0
Mediastinal space-occupying lesion – Mature teratoma: A case report
Mediastinal teratomas are germ cell tumors located in the anterior mediastinum, representing the most common extra-gonadal germ cell tumors. They account for approximately 15% of anterior mediastinal masses in adults and approximately 25% of anterior mediastinal masses in children. Here, we report a case of successful surgical management of a large mediastinal mature teratoma in a 6-year-old boy. This case highlights an uncommon cause of chest pain in children and underscores the importance of considering mass lesions in the differential diagnosis
Teratoma, Germ cell tumors, mediastinal mass, Video Assisted thoracoscopic Surgery.
Copyright (c) 2026 Tarun Jakkula, Kalyan S Kunchupudi, Parag S Dekate, Yoga Nagendhar, Avinash Reddy, Sri Vidhya Lukka https://creativecommons.org/licenses/by-nc-nd/4.0
Beyond the venom: Unmasking leukoencephalopathy in snakebite envenomation
Snakebite envenomation remains a significant public health challenge in India, yet central nervous system complications such as leukoencephalopathy are exceptionally rare. This report describes a 24-year-old farmer who presented with rapidly progressive neurological deterioration over 12 h following a snakebite. Despite standard treatment, persistent neurological deficits prompted neuroimaging, which revealed leukoencephalopathy. Comprehensive treatment involving mechanical ventilation, polyvalent anti-snake venom, corticosteroids, and neuroprotective agents facilitated a gradual recovery from an initial akinetic-mute state to functional independence. This case underscores the critical importance of early neuroimaging in unexplained acute neurological presentations within endemic regions to ensure accurate diagnosis and prompt, targeted therapy.
Copyright (c) 2026 Saurabh Srivastava, Deepak Sharma, Preeti Solanki, Mohd Laraib, M Sakthidhasan https://creativecommons.org/licenses/by-nc-nd/4.0
Occult transethmoidal encephalocele with Chiari I malformation leading to recurrent meningitis – An unusual presentation
Transethmoidal encephalocele, as a non-traumatic variant, is a rare subtype of basal encephaloceles, characterized by herniation of meninges and brain tissue through defects of the cribriform plate or ethmoid roof. It may present in adulthood with persistent postnasal drip, cerebrospinal fluid rhinorrhea or recurrent meningitis, and can be easily overlooked. Chiari I malformation is characterized by caudal descent of the cerebellar tonsils through the foramen magnum and may or may not be associated with a syrinx. Transethmoidal encephalocele and Chiari malformation can coexist and can be the preceding factor for the other. We report a case of occult transethmoidal encephalocele with cerebellar descent and cervical cord syrinx presenting with recurrent meningitis in an 18-year-old patient
Copyright (c) 2026 Sai Monika Mandepudi, Anil Kumar Abburi, Ravi Kiran Dasari, Krishna Raja Sadasiveni https://creativecommons.org/licenses/by-nc-nd/4.0
Intentional sodium nitrite ingestion with severe methemoglobinemia
Sodium nitrite (NaNO2) is a commonly available chemical that can be fatal even in small amounts when ingested. It acts by oxidizing iron in hemoglobin, converting it from its ferrous to ferric state, known as methemoglobin. Methemoglobin cannot directly bind with oxygen, leading to decreased oxygen delivery and subsequent cyanosis, along with systemic effects such as hypotension, metabolic acidosis, hyperlactatemia, and coronary ischemia. Methemoglobinemia can be suspected when a patient presents with severe cyanosis despite normal oxygen saturation, is otherwise asymptomatic, and shows no improvement with supplemental oxygen. We present a case of a nineteen-year-old woman who was brought in with intentional ingestion of NaNO2, with a subsequent serum methemoglobin level of 65%. The patient was treated with intravenous methylene blue, leading to restoration of normal methemoglobin levels within twenty-four hours. Severe methemoglobinemia can be fatal at high levels, but early clinical recognition and urgent initiation of its antidote, methylene blue, can rapidly reverse the condition. This case highlights the value of co-oximetry in the work-up of hypoxemia and cyanosis, and the need to suspect methemoglobinemia when cyanosis does not improve with supplemental oxygen.
Copyright (c) 2026 V S Megha, Ritu Panchakshari, Ipe Jacob, Pradeep Rangappa, Karthik Rao, Satish Kumar Anumala https://creativecommons.org/licenses/by-nc-nd/4.0
Nodular hidradenoma presenting as a scalp swelling: A case report and histopathological analysis
Among the myriad pathologies presenting as scalp swellings, benign adnexal tumors are a very small subset, with nodular hidradenoma being a rare cause. Nodular hidradenoma is a skin tumor with eccrine or apocrine differentiation, mostly seen in the scalp or in the axilla. These tumors can raise the suspicion of being malignant in nature, especially due to their varied presentation as having irregular margins and pain, rapid increase in size, and bleeding, or ulceration. As no clear-cut diagnosis can be made till now, a histopathological examination is performed, it presents a challenge in establishing a diagnosis and its management. We encountered a case of a woman presenting with a scalp swelling with atypical features, which raised the suspicion of it being a pyogenic granuloma, that is either highly vascular or a malignancy due to its firm consistency and irregular margins with multiple bleeding points. The case with its diagnostic dilemma and its confirmation in histopathological examination has been presented here
Copyright (c) 2026 Shristy Prakash, Bhavinder Kumar Arora https://creativecommons.org/licenses/by-nc-nd/4.0
Efficacy of heme iron polypeptide in managing iron deficiency anemia in pregnancy: A case series
Iron deficiency anemia (IDA) is a major global health concern, especially affecting pregnant women and posing significant risks to both maternal and fetal health. Conventional iron therapies are often limited by gastrointestinal intolerance and poor adherence. Heme iron polypeptide (HIP), a new-generation oral iron supplement, offers improved bioavailability and tolerability. This case series reports outcomes in four women with IDA treated with HIP (12 mg/day). All patients showed significant hematological improvements with HIP; hemoglobin levels rose from 8.0 to 9.0 g/dL at baseline to 11.0–11.8 g/dL within 3 months. Serum ferritin levels were increased from 10 to 20 μg/L to 29–50 μg/L. Patients experienced better energy and well-being, with no gastrointestinal side effects or compliance issues. One patient initially treated with ferrous fumarate switched to HIP due to intolerable side effects, achieving similar hematological correction without adverse events. Overall, HIP demonstrated effective anemia correction with excellent tolerability and compliance, supporting its role as a safe alternative to conventional iron therapies during pregnancy.
Copyright (c) 2026 Arun Madhab Boruah, Dibyendu Banerjee, Asha Baxi, Sadhana Gupta, Maneesha Khalse, Kamlesh Patel, Reshma Ramesh Parekar https://creativecommons.org/licenses/by-nc-nd/4.0
Compassionate use of β-lactam enhancer/β-lactam combination zidebactam/cefepime (WCK 5222) for the treatment of recurrent pyelonephritis caused by extensively drug-resistant Klebsiella pneumoniae with high zidebactam/cefepime: A case report
Infections in immunocompromised individuals often present as recalcitrant or recurrent infections. Due to recurrent healthcare system exposure, these patients are at risk of infections due to multidrug-resistant organisms. Due to limited treatment options available, such infections pose a challenge to successful treatment outcomes in this population. Zidebactam/cefepime (WCK 5222) is a β-lactam enhancer/β-lactam combination being studied in a Phase 3 trial for use in adult patients with complicated urinary tract infections. Here, we report a case of complicated pyelonephritis caused by colistin and carbapenem-resistant Klebsiella pneumonia in a 62-year-old patient with ovarian carcinoma using this drug under compassionate use grounds with a successful treatment outcome.
Copyright (c) 2026 Sowmya Sridharan, Aishwarya Govindaswamy, J Prashanth, Prasad Easwaran https://creativecommons.org/licenses/by-nc-nd/4.0
Thrombo-occlusive left lateral medullary syndrome (Wallenberg syndrome) with iron deficiency anemia: A case report with clinical insights
Left lateral medullary syndrome (Wallenberg syndrome) is a rare ischemic stroke caused by infarction in the lateral medulla, typically presenting with vertigo, ataxia, and sensory deficits. This case reports a rare presentation of Wallenberg syndrome in a 48-year-old female with coexisting severe iron deficiency anemia (IDA). The patient presented with acute dizziness, vomiting, left-sided ptosis, and contralateral limb weakness. Magnetic resonance confirmed infarcts in the left lateral medulla and cerebellum, as well as the anterior capsulo-ganglionic region, explaining the atypical presentation of limb weakness. Angiography revealed complete thrombo-occlusion of the left vertebral artery. Laboratory evaluation identified significant IDA as a potential exacerbating risk factor. The patient was managed with antiplatelets, statins, and intravenous iron replacement, resulting in significant neurological recovery. This case underscores the importance of evaluating IDA as a potential contributing factor in ischemic stroke, particularly in women without traditional vascular risk factors.
Copyright (c) 2026 Raj Ahmad Rain, G Anil Kumar Reddy, Mohit Badhai, Aajmi Khatoon; S P Srinivas Nayak https://creativecommons.org/licenses/by-nc-nd/4.0
Splenium infarction presenting as incongruous homonymous hemianopsia: A case report and narrative review
Splenium, the posteriormost part of the corpus callosum, has the thickest collection of commissural fibers with most fibers extending into the occipital lobes; however, the exact functions are yet to be known. As such, isolated infarctions of the corpus callosum are rare due to the dual blood supply from the anterior and posterior cerebral arteries. We describe the case of a 52-year-old female who presented with a 1-week history of right-sided incongruous homonymous hemianopsia, with no other evidence of focal deficit. Neuroimaging confirmed acute infarction with intense restriction of diffusion in the left splenium involving the periventricular part. There are a few case reports available of isolated splenium infarction. There is only one case described of a splenium infarct presenting as homonymous hemianopsia, to our knowledge. Our case might shed some light on the clinical presentation in splenium infarcts, with an understanding of the visual processing pathways involving the commissural fibers.
Copyright (c) 2026 Shivank, Manish Bhartiya https://creativecommons.org/licenses/by-nc-nd/4.0
Challenging management of a corneal ulcer in a patient affected with rosacea
This case report is intended to describe the challenging diagnostic process and management of a severe corneal ulcer in a patient with rosacea, initially misdiagnosed as herpetic keratitis, and subsequently considered as peripheral ulcerative keratitis (PUK), before reaching the correct diagnosis of rosacea-related marginal keratitis. Here, we present the case of an 80-year-old male presenting with long-standing ocular pain, tearing, and reduced vision in his left eye, unresponsive to intensive antiviral therapy. A complete ophthalmic and systemic workup was performed. Despite antiviral withdrawal, topical antibiotics, and a multilayer amniotic membrane transplantation, corneal thinning progressed to a descemetocele requiring a Gunderson flap. Reassessment of eyelids and skin revealed severe blepharitis and erythematotelangiectatic rosacea. Introduction of systemic doxycycline, topical steroids, topical antibiotics, and eyelid hygiene resulted in gradual improvement. Rosacea may cause severe, sight-threatening marginal keratitis that mimics herpetic keratitis or PUK. Careful evaluation of eyelids and periocular skin is essential. Early recognition of rosacea-related ocular disease is crucial in preventing progression of corneal damage.
Copyright (c) 2026 Eduardo Bianchi, Davide Tucci, Marco Messina https://creativecommons.org/licenses/by-nc-nd/4.0
Rare cause of whitish gastric mucosal plaque on upper gastrointestinal endoscopy
Copyright (c) 2026 Srinu Deshidi, Gaurav Mahajan, Amrutha Guguloth, Sreekanth Appasani https://creativecommons.org/licenses/by-nc-nd/4.0
Acquired Moebius-like palsy in uncontrolled diabetes: An uncommon manifestation of a common metabolic disease
We report the case of a 58-year-old woman with poorly controlled type 2 diabetes mellitus who presented with acute horizontal binocular diplopia due to isolated right abducens nerve (cranial nerve VI) palsy. Laboratory evaluation revealed severe hyperglycemia with glycated hemoglobin of 15.8%. She improved significantly after structured glycemic optimization. This case highlights a rare but reversible presentation of diabetic cranial mononeuropathy.
Copyright (c) 2026 Avi Singh, Deepak Sharma, Saurabh Srivastava https://creativecommons.org/licenses/by-nc-nd/4.0
Bilateral spontaneous pneumothorax- A late complication of COVID-19 infection- case report and review of literature
We report a case of bilateral spontaneous pneumothorax in a 32-year-old non-smoker male. The patient presented to the emergency department with complaints of sudden-onset left-sided chest pain and breathlessness. A chest X-ray was taken, which revealed a left pneumothorax. Immediately, left-sided intercostal chest drain was placed. The patient gave a history of similar complaints 1 week back and was diagnosed with right-sided pneumothorax, for which right-sided chest drain was placed in an outside hospital. The patient was a non-smoker and had no comorbidities. He reported having a COVID-19 infection 1 month back, which was treated symptomatically under home quarantine, not requiring any hospitalization or supplemental oxygen. After 1 week of placement of chest drain, as air leak persisted, a computed tomography-chest was done, which revealed a left mild hydropneumothorax and communication with the apical segment and pleural cavity suggestive of bronchopleural fistula. The right lung had expanded. After ruling out secondary infection, the patient was referred to cardiothoracic surgery for decortication and surgical closure of the bronchopleural fistula. The patient recovered with no complications in the post-operative period. Spontaneous pneumothorax in post-COVID patients can happen as a late complication, which requires high clinical suspicion and vigilance for timely diagnosis and treatment.
amputation, peripheral arterial disease, internal carotid artery, stroke.
Copyright (c) 2026 Sandhya Balasundaram, Sumeeth Sutrave https://creativecommons.org/licenses/by-nc-nd/4.0
Insufficiency fracture in normal pressure hydrocephalus – A case report
Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological disorder in the elderly, marked by gait disturbance, cognitive decline, and urinary incontinence. This case report describes a 77-year-old male with untreated iNPH who developed a spontaneous insufficiency fracture of the proximal femur without any history of trauma. Investigations revealed Vitamin D deficiency, secondary hyperparathyroidism, and early signs of chronic kidney disease, contributing to compromised bone health. Prolonged immobility due to iNPH likely exacerbated bone demineralization and muscle atrophy, increasing fracture risk. Surgical intervention was chosen over conservative management to facilitate early mobilization and prevent complications. This case underscores the need for heightened clinical vigilance for insufficiency fractures in cognitively impaired, immobile elderly patients and highlights the importance of proactive nutritional and metabolic bone health management in those with iNPH.
Copyright (c) 2026 Ratnashree Biswas, Nilanchal Chakraborty https://creativecommons.org/licenses/by-nc-nd/4.0
Primary pericardial synovial sarcoma presenting as cardiac tamponade
Primary malignant cardiac neoplasms are a rare entity. Malignant pericardial tumors may present with pericardial effusion or non-specific symptoms. We report about a middle-aged male patient who presented with cardiac tamponade and was diagnosed with biphasic phenotype of primary pericardial synovial sarcoma, using histopathology and immunohistochemistry. Diagnosis of pericardial synovial sarcoma requires a multipronged approach involving clinical, imaging, histopathological and cytogenetic evaluation. Demonstration of a specific cytogenetic alteration (chromosomal translocation t(X;18)(p11.2;q11.2) SYT-SSX) remains the ideal confirmatory test. However, in resource constrained settings, a detailed histopathological examination combined with immunohistochemistry, specifically nuclear staining for Transducin like enhancer of slit-1 in tumor cells is useful for accurate diagnosis, due to its high sensitivity and specificity. Early diagnosis followed by prompt initiation of therapy may lead to improved outcomes despite the dismal prognosis associated with this neoplasm
Copyright (c) 2026 Jaideep Dey, Ratna Sud, Kumaresh Vaidya, Ranjan Kachru, Tapan Ghose https://creativecommons.org/licenses/by-nc-nd/4.0
Individualized approach to infertility management with dydrogesterone: insights from case series
Infertility is a growing global concern, affecting about one in six individuals of reproductive age. In India, reported prevalence ranges from 3.9% to 16.8%, influenced by age, infections, lifestyle factors, and sociocultural elements. This case series highlights six women, aged 30–34 years, each presenting with different infertility challenges: Tubal factor infertility, male factor infertility, recurrent pregnancy loss, unexplained infertility, and early-stage endometriosis. All cases were managed with a personalized treatment approach that included oral dydrogesterone for luteal phase support (LPS). Dydrogesterone, a selective oral progestin with high bioavailability and endometrial specificity, was used to improve luteal phase adequacy and endometrial receptivity. Each patient received tailored care involving either natural conception support, ovulation induction, intrauterine insemination, or assisted reproductive technology, depending on their clinical profile. Oral dydrogesterone was administered as part of LPS in all six cases. Outcomes included successful conception or sustained pregnancy, demonstrating clinical benefit in each scenario. These real-world clinical cases emphasize the importance of individualized infertility management and illustrate the versatile role of dydrogesterone across varied reproductive conditions. Its incorporation into treatment protocols supported favorable outcomes, reinforcing its value in both spontaneous and assisted conception pathways.
Copyright (c) 2025 Pratik Tambe, Maneesha Khalse, Kamlesh Patel, Reshma Parekar https://creativecommons.org/licenses/by-nc-nd/4.0
Gender dysphoria presenting as genital self-mutilation: A case report
Genital self-mutilation is a rare but critical clinical event that commonly reflects severe psychological distress, often linked to psychiatric illness or unresolved gender identity conflict. We describe a 20-year-old biological male who presented after intentionally amputating his penis and testes as part of an unsupervised attempt at self-directed gender transition. The procedure was carried out at home under self-administered local anesthesia, and the patient arrived hemodynamically stable, enabling immediate surgical wound care and stabilization. Subsequent psychiatric assessment confirmed a diagnosis of gender dysphoria with coexisting major depressive disorder, neither of which had been previously treated. This case illustrates the degree of distress that may accompany persistent, unsupported gender incongruence and emphasizes the need for timely mental-health intervention, structured gender-affirming care pathways, and coordinated multidisciplinary management. Improving awareness, reducing stigma, and ensuring accessible medical and psychological support for individuals with gender dysphoria are crucial measures to prevent irreversible self-harm and improve long-term outcomes.
Copyright (c) 2025 Arun Kumar, Santosh Kumar Singh, Atreyee Saha, Vivek Kumar, Chandrak Dwivedi https://creativecommons.org/licenses/by-nc-nd/4.0
Uncommon fungal infection in a renal transplant recipient: A case report from Northern India
Although fungal infections can occur, their reported incidence in India is significantly lower than that of other infections, making them uncommon findings in renal transplant patients. Here, we present an unusual case of a fungal infection that developed in a 32-year-old Indian male renal transplant recipient. After correlating clinical, microbiological, and histopathological findings, a final diagnosis of fungal infection was established. The patient responded well to anti-fungal medications. This case report highlights that though tuberculosis is the most commonly observed infection in the Indian scenario, the occurrence of a fungal infection is an unusual finding in post-renal transplant cases, thus posing a massive diagnostic and therapeutic challenge. Their prompt diagnosis is imperative for the patient’s survival.
Copyright (c) 2026 Ishita Tyagi, Ansh Choudhary https://creativecommons.org/licenses/by-nc-nd/4.0
De quervain tenosynovitis is an atypical presentation of Graves’ disease
De Quervain tenosynovitis is a commonly found wrist pain in women, usually occurring due to autoimmune diseases, overuse, infections and trauma. In Graves’ disease, antibodies stimulate the thyroid gland, leading to diffuse enlargement of the thyroid gland and hypersecretion of thyroid hormones. The association between de Quervain tenosynovitis and Graves’ disease is rarely discussed in the literature. We present the case of a 57-year-old female patient with Graves’ disease with an uncommon initial feature and de Quervain tenosynovitis, before the manifestation of traditional symptoms, which delayed the diagnosis and treatment plan.
Copyright (c) 2026 Ajit Kumar Pradhan, Priyanka Giri, Santosh Kumar Sahu https://creativecommons.org/licenses/by-nc-nd/4.0
Melioidosis masquerading as metastatic lung disease: A diagnostic challenge from coastal Karnataka, India
Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease in India that can closely mimic tuberculosis or malignancy, leading to diagnostic delays and mismanagement. A 54-year-old diabetic farmer from coastal Karnataka presented with fever, dry cough, anorexia, and weight loss. Imaging revealed multiple bilateral pulmonary nodules with intense fluorodeoxyglucose uptake on positron emission tomography-computed tomography (CT), suggestive of metastatic malignancy. CT-guided lung biopsy showed suppurative granulomatous inflammation, and both blood and tissue cultures confirmed B. pseudomallei. The patient received intravenous meropenem for 3 weeks followed by oral trimethoprim-sulfamethoxazole for 12 weeks, resulting in complete clinical recovery and radiological resolution. This case highlights the importance of considering melioidosis as a differential diagnosis for metastatic-appearing lung lesions in endemic regions, particularly among diabetics with soil exposure. Early microbiologic confirmation is crucial to avoid unnecessary oncologic evaluation and ensure effective antimicrobial therapy.
Positron emission tomography-computed tomography
Copyright (c) 2025 G O Bharath, Adithya Bharadhwaj, Vijaya Kumar, B V Kedarnath, P K Salfi, Nabisath Shamna Minaz, K M Augustine https://creativecommons.org/licenses/by-nc-nd/4.0
When E. Faecalis strikes beyond the globe: Orbital cellulitis requiring exenteration
We report the case of an 80-year-old woman affected by Enterococcus faecalis endophthalmitis complicated by orbital cellulitis. Despite maximal medical therapy, including topical fortified antibiotics, intravitreal injections, and intravenous systemic treatment, infection control was not achieved, and the condition progressed into an orbital abscess with worsening proptosis and ophthalmoplegia. Considering the lack of visual potential and the imminent risk of intracranial spread, a subtotal orbital exenteration was performed. Reconstruction was achieved with a vascularized temporalis muscle flap through a transorbital approach. This case highlights the aggressive nature of E. faecalis ocular infections and supports exenteration as a life-saving measure when conventional therapy fails.
Copyright (c) 2025 Eduardo Bianchi, Nicola De Santi, Davide Tucci, Michael Spinosi, Francesco Giovacchini https://creativecommons.org/licenses/by-nc-nd/4.0