Indian Journal of Case Reports
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Chief-Editor: Dr. Amit Agarwal
ISSN:(Print) 2454-129X (Online) 2454-1303
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://atharvapub.net/index.php/IJCR/index
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Item A rare presentation of adrenal histoplasmosis in an immunocompetent patient as an adrenal crisis(Mansa STM Publishers, 2025-06) Sarkar, A; Misra, S; Roy, S; Roy, R; Paul, D.A 44-year-old diabetic male presented with hypovolemic shock along with cough-cold, weakness, and low-grade fever for the past 4 months. On laboratory investigation, there were hyponatremia, hyperkalemia, and hypercalcemia. Persistently low parathyroid levels along with a positive adrenocorticotropic hormone stimulation test confirmed primary Addison’s disease. On ultrasonography, there was a bilateral adrenal mass over which computed tomography-guided fine needle aspiration cytology was done. Periodic acid Schiff stain of the sample showed intracellular yeast cells resembling histoplasmosis and on culture at 25°C it showed microconidia with successful conversion of mycelium to yeast. The patient was treated with Liposomal Amphotericin B over 2 weeks and steroids, with which the patient gradually improved.Item Case-based review of isolated tentorial hypoplasia with herniation: Applying Occam’s Razor(Mansa STM Publishers, 2025-06) Tiwari, M; Jha, S; Pendyala, SK.Descriptions of isolated tentorium hypoplasia (TH) without any major clinical correlates have been confined to scarce clinical reports. This report entails the first case of an adult with a bilateral tentorial defect leading to herniation of bilateral occipital lobes, without any alarming neurological sequel. A 43?year?old gentleman presented to the outpatient department with a headache for 6 months. Neurological examination was normal. On neuroimaging, a “mass” was noted in the quadrigeminal and left superior cerebellar cistern. On careful evaluation, herniation of cuneus and precuneus in quadrigeminal plate cistern was observed bilaterally, more on the right side secondary to a bilateral defect in the superior part of tentorium cerebelli evident by non-visualization of the superior part associated with dilatation of posterior part of lateral ventricles. This case report aims to increase awareness about TH to prevent misdiagnoses along with careful follow-up so as not to dismiss the finding as clinically irrelevant. The sparse literature and vague clinical symptomatology contribute to inadequate identification of this entity.Item Sarcoidosis: A great mimicker of lymphoma: A case report(Mansa STM Publishers, 2025-06) Subramanian, VB; Basavanagowdappa, H; Kulkarni, T.Sarcoidosis is a chronic inflammatory condition of multifactorial origin. Positron emission tomography-computed tomography (PET-CT) is a useful tool for diagnosing and prognosticating the disease. Here, we present the case of a 62-year-old female, a known diabetic, who presented with a history of progressive weight loss despite optimal control of her diabetes. X-ray and ultrasound abdomen showed features of generalized lymphadenopathy, and PET-CT findings were suggestive of lymphoma. A biopsy of the lymph node revealed non-caseating granuloma, and serum angiotensin-converting enzyme levels were not elevated. Diagnosis of sarcoidosis was considered, and started on oral steroids. An interval CT scan showed a reduction in the size of the lymph nodes and an improvement in symptoms. Hence, physicians should use clinical, radiological, and pathological tools together to differentiate sarcoidosis from other inflammatory disorders with generalized lymphadenopathy.Item Ketamine-induced bladder syndrome: Recognition as a key differential diagnosis and the need to curb recreational use(Mansa STM Publishers, 2025-06) Malik, MN; Kumar, H; Perera, KK.The recreational use of ketamine is becoming increasingly widespread, largely due to its dissociative and anesthetic properties, as well as its accessibility and affordability. A significant and often irreversible impact on the urinary system has recently emerged as a concerning consequence of its recreational use. We present a case report of a young man who has been using ketamine recreationally for less than a year and has developed ketamine bladder syndrome. Within a few months, the patient developed acute kidney injury and some liver damage, as indicated by his blood tests, while continuing to take ketamine.Item Abrupt total iron binding capacity elevation in microcytic hypochromic anemia(Mansa STM Publishers, 2025-06) Krishna, KS; Vignesh, YHK; Waseem, SA; Kumar, AS; Gottipatti, SS; Puttagunta, SB.Iron deficiency is a leading global cause of anemia, responsible for approximately 841,000 deaths annually, with Africa and parts of Asia bearing 71% of the mortality burden. Key risk factors include heavy menstrual bleeding, pregnancy, and the post-partum period. Management typically involves oral iron supplementation, dietary changes, and intravenous iron therapy for severe cases. This report presents the case of a 48-year-old woman diagnosed with iron deficiency anemia and Vitamin B12 deficiency. She exhibited microcytic hypochromic anemia confirmed by a peripheral smear, which revealed characteristic red blood cell morphology. The case underscores the importance of early detection and management of iron and Vitamin B12 deficiencies to prevent complications. It also highlights the need to address healthcare disparities that limit access to diagnostic and treatment options in underserved regions.Item Small bowel bleed: The forgotten complication of chronic myeloid leukemia(Mansa STM Publishers, 2025-06) Agrawal, JB; Yadav, M; Purohit, K; Vanik, S.Chronic myeloid leukemia (CML) is a clonal bone marrow stem cell disorder with proliferation of granulocytes and their precursors. Gastrointestinal (GI) involvement is uncommon across all types of leukemia. It typically occurs during the blast phase or in cases of acute leukemia. However, advancements in treatment have significantly reduced the incidence of such complications. We present a unique case of a small bowel bleed in a 68-year-old patient of CML who presented with recurrent massive lower GI bleed.Item Psychogenic polydipsia: A case of water intoxication(Mansa STM Publishers, 2025-06) Rao, TR; Sravya, G; Kaushik, T; Akshaya, D.Psychogenic polydipsia (PPD), a clinical disorder characterized by polyuria and polydipsia, is a common occurrence in inpatients with psychiatric disorders. Primary polydipsia (PP) is a disorder that is clinically characterized by excessive thirst accompanied by increased fluid intake and subsequent excessive excretion of urine without an obvious cause. PP in adults is due to psychogenic causes, is a rare condition and may be more prevalent than thought. There is some evidence for pharmacological management of this condition, but nonpharmacological management, starting from psycho-education to behavioural modification therapy involving family members, can be a very effective strategy. This case report describes a 35-year-old male with schizophrenia who presented with confusion, seizures, and severe hyponatremia due to compulsive water consumption. Prompt diagnosis and management, including fluid restriction, careful sodium correction, and psychiatric intervention, led to symptom resolution. This case highlights the importance of early recognition and a multidisciplinary approach in preventing life-threatening complications associated with PPD. Further research is needed to establish standardized treatment guidelines.Item Partially thrombosed internal carotid artery: A diagnostic dilemma(Mansa STM Publishers, 2025-06) Khanduri, S; Kanojia, A; Habib, A; Ahmad, M; Agrawal, A; Patel, N.Acute or chronic thrombosis of the internal carotid artery (ICA) is a rare but life-threatening condition that can result in ischemic stroke, transient ischemic attacks (TIAs), or significant neurological deficits. The ICA is a major blood vessel supplying oxygenated blood to the brain, and its occlusion can lead to devastating consequences, including cerebral infarction, hemodynamic insufficiency, and embolic complications. Acute thrombosis occurs suddenly, often due to embolism, arterial dissection, or hypercoagulable states, leading to abrupt-onset neurological symptoms such as hemiparesis, hemianesthesia, aphasia, or visual disturbances. It requires urgent intervention, including thrombolysis or mechanical thrombectomy. Chronic thrombosis develops over time, typically secondary to atherosclerosis or vessel narrowing, allowing collateral circulation to compensate. Patients may remain asymptomatic or experience gradual cognitive decline, TIAs, or progressive stroke-like symptoms.Item Septicemic melioidosis in a comorbid patient with familial history of tuberculosis: A case report with special reference to microbiological profile(Mansa STM Publishers, 2025-06) Vijay, SR; Aishwarya, R; Leela, KV.Burkholderia pseudomallei is a Gram-negative, facultative intracellular bacterium commonly found in the rhizosphere of tropical soils. It causes melioidosis, a disease that spreads through skin contact, ingestion, or inhalation of contaminated soil or water. This emerging pathogen is often misdiagnosed, as it mimics various clinical conditions, including pulmonary tuberculosis, and frequently presents as community-acquired pneumonia. Key risk factors for infection include underlying conditions such as diabetes mellitus, chronic lung disease, liver and kidney disorders, alcohol abuse, chronic skin ulcers, and occupational exposure. This report discusses a case of septicemic melioidosis in a farmer with a family history of tuberculosis, who was promptly diagnosed and successfully treated with appropriate antibiotics, leading to full recovery.Item Esophageal intramural hematoma: An unusual cause of acute onset chest pain(Mansa STM Publishers, 2025-06) Umapathy, V; Kulandaivelu, A.An elderly lady in her mid-70 s who is known to have coronary artery disease for which she was on dual antiplatelet therapy, presented with acute onset chest pain and dysphagia. The cardiac evaluation was unremarkable. Esophagogastroduodenoscopy (EGD) showed a large intramural hematoma in the esophagus, causing luminal narrowing. A diagnosis of esophageal intramural hematoma secondary to antiplatelets was made based on the findings of Gastrografin swallow, EGD, and contrast-enhanced computed tomography of the thorax along with the history of taking dual antiplatelets. Antiplatelets were subsequently stopped. She was managed in the critical care unit with intravenous fluids, pantoprazole infusion, empirical antibiotics, fentanyl infusion, and total parenteral nutrition. The relook EGD showed a resolving hematoma. She was maintained on intravenous pantoprazole, allowed to take oral feeds gradually, and was subsequently discharged. To conclude, intramural hematoma of the esophagus can present with acute chest pain and dysphagia. Careful history taking, especially the drug history and appropriate investigations, are pivotal as there are high chances of misdiagnosis and unwanted anticoagulant therapy.Item Digital health intervention in an innovative and personalized approach to the management of irritable bowel syndrome in Indian patients: A case series(Mansa STM Publishers, 2025-06) Garg, R; Charugulla, SN; Agarwal, S; Chan, NVNPSS; Khan, A; Dharurkar, S.Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder marked by abdominal discomfort and altered bowel habits. Despite its prevalence, managing IBS remains challenging due to its complex nature. Digital health interventions have emerged as innovative solutions, combining dietary changes, psychological support, and wellness strategies. This case series of seven IBS patients explores the effectiveness of the DailyBloom IBS App in managing IBS through a 14-week program incorporating a low-FODMAP diet, cognitive behavioral therapy, and physical wellness. Patients experienced reduced abdominal pain, bloating, and diarrhea frequency, alongside the improved quality of life, including less anxiety and stress. This case series highlights the potential of digital therapeutics as a complement to conventional care in India. The DailyBloom™ IBS App adopts a structured four-phase approach: discovery (weeks 1–2), elimination (weeks 3–5), reintroduction (weeks 6–11), and sustenance (weeks 12–14). Patients, categorized into IBS subtypes (IBS-constipation, IBS-diarrhea, IBS-mixed, IBS-undefined), were evaluated for symptom progression, management, and outcomes. Findings emphasize the role of digital therapeutics in providing personalized, evidence-based care, marking a significant advancement in IBS management within the digital health landscape promising both symptom relief and lifestyle improvements for patients.Item Leptomeningeal metastases in a case of squamous cell carcinoma of the uterine cervix : A case report along with review of literature(Mansa STM Publishers, 2025-06) Datta, A; Majumdar, S; Dutta, A; Sen, P.Leptomeningeal metastases (LM) is an extremely rare complication in solid malignancies and an indicator of poor prognosis. Our case is of a 54-year-old lady who was diagnosed with squamous cell carcinoma of the uterine cervix (FIGO Stage IVA). She received 6 cycles of systemic chemotherapy with paclitaxel, carboplatin, and bevacizumab and showed near complete metabolic response in the post 6th cycle response evaluation PET CT scan. After 3 more cycles of maintenance bevacizumab, she developed disease progression. She further developed drowsiness and disorientation. Gadolinium-enhanced MRI and cerebrospinal fluid cytology confirmed the presence of LM. She was treated with craniospinal irradiation along with pembrolizumab. To date, 28 cases of LM in cervical cancer have been reported worldwide, and here we report the 29th case. There is no established treatment protocol for LM yet, and an individualized multimodality approach is commonly used based on retrospective data and patient-specific characteristics.Item Non-syndromic bilateral lower lip pits: A case report and literature review(Mansa STM Publishers, 2025-06) Ulaganathan, P; Balasubramanian, S.This case report describes a rare occurrence of non-syndromic lower lip pits. The 16-year-old female patient had bilateral pits on the lower lip vermilion, without any other associated abnormalities, which sets this case apart from the syndromic lip pits seen in Van der Woude syndrome. The report outlines the clinical features, diagnostic evaluation, and chosen treatment approach, emphasizing the importance of recognizing and distinguishing isolated lip pits from syndromic presentations.Item Elderly rural female with giant neglected subcutaneous lipoma of forearm: A case report(Mansa STM Publishers, 2025-06) Khan, S; Chaturvedi, S; Sharma, D; Parveen, S; Arora, S; Raghava, V.Lipomas of the upper limb more than 5 cm are defined as “giant lipomas.” Patients with huge mass on the forearms and hands rarely neglect the problem and seek medical attention because of difficulty in performing day-to-day activities and cosmetic reasons. Here, we present a case of “giant lipoma” of the forearm measuring 10 cm, which was neglected for over 15 years in an 82-year-old female from a rural background. Although extremely rare, “subcutaneous giant lipomas” of the forearm should be considered in the differential diagnosis of painless, slowly growing, neglected swellings. Optimal management requires histopathology to rule out “well-differentiated liposarcomas”. The case highlights the fact that even though lipomas of the upper limb are limited to 2 cm in size, however, if neglected, they may grow enormously and become “giant lipomas” over many years. The case also highlights the uncared chronic medical ailments of elderly rural females in developing countries.Item Battle on two fronts: Fournier’s gangrene as a devastating complication of targeted radiotherapy for advanced adenocarcinoma rectum(Mansa STM Publishers, 2025-06) Athiyaman, A; Kumar, SS; Victor, VP.Fournier’s gangrene (FG), as a complication of rectal carcinoma, is exceptionally rare and life-threatening. This case reports an unusual presentation of radiotherapy-induced FG in a 75-year-old male patient with advanced rectal adenocarcinoma. Multiple surgical debridements provided temporary stabilization, supported by targeted antibiotics and airway management. However, progressive polymicrobial sepsis necessitated a multidisciplinary approach, which was unsuccessful due to underlying poor prognostic factors. This case underscores the need for standardized clinical guidelines and management protocols to improve patient outcomes and reduce mortality in similar cases.Item Atypical magnetic resonance imaging findings in hypoxic brain injury(Mansa STM Publishers, 2025-01) Maryam, T; Gupta, A.Here, we present the case of hypoxic brain injury in a 50-year-old male patient who was found unconscious by his colleagues in the bathroom when he didn’t return for some time. On magnetic resonance imaging (MRI), there were symmetrical T2/fluid-attenuated inversion recovery hyperintensities seen involving the cortical gray matter of bilateral temporal, parietal, and occipital lobes with thickening of the cortex and effacement of overlying sulci. These areas showed acute restriction of diffusion. The findings on MRI were suggestive of hypoxic brain injury. Hypoxic brain injury in adults can be due to drowning, asphyxiation, carbon monoxide poisoning, or cardiac arrest. The gas geyser syndrome causing hypoxic brain injury due to carbon monoxide poisoning is not a very uncommon occurrence in India as the use of gas geysers with poor ventilation in bathrooms is quite common.Item Laurence-Moon-Bardet-Biedl syndrome- A Case report with review of literature(Mansa STM Publishers, 2025-01) Marathe, NK; Bhat, PM.Laurence-Moon-Bardet-Biedl syndrome (LMBBS) is a rare autosomal recessive (AR) disorder. It has many clinical features out of which ocular manifestations will be discussed in this article along with its ayurvedic correlation. Acharya Sushruta have mentioned Adhyatmika Vyadhis in Sutrasthana which are Aadibala Pravrutta (heridiatory) Janmabala Pravrutta (congenital) and Doshabala Pravrutta. Acharya also elaborates clinical features of Dauhrudavimaanan (not fulfilling desires of pregnant women) in her antenatal phase in Sharirsthana which has resemblance to clinical features of Laurence-Moon-Bardet-Biedl syndrome. This article furthermore mentions a case report of male patient aged 20 years who visited Ophthalmic OPD of Shalakyatantra department in Sane guruji hospital with complaints of diminished vision since childhood, diminished night vision, inability to open right eye completely, lagging of right upper eyelid, delayed developmental milestones.Item Langerhans’ cell histiocytosis presenting as chronic otitis media a diagnostic dilemma(Mansa STM Publishers, 2025-01) George, C; Satish, D; Balasubramanya, AM; Ross, A.Langerhans’ cell histiocytosis (LCH) is a rare condition that can sometimes affect the temporal bone. When it involves the temporal bone, LCH may present with non-specific symptoms such as middle ear inflammation, ear pain, hard of hearing, external auditory canal polyps, or mastoid mucosal inflammation. In cases where patients show signs of chronic otitis media, LCH should be considered a possible differential diagnosis. This case report highlights a 38-year-old male patient who initially presented with features suggestive of chronic otitis media, was diagnosed to have LCH through histopathological analysis, and was treated according to medical oncology protocols.Item Non-implant associated primary breast anaplastic large cell lymphoma in a postpartum female(Mansa STM Publishers, 2025-04) Banka, S; Dhakate, N; Rajput, M.Anaplastic large cell lymphoma (ALCL) is an aggressive peripheral T-cell non-Hodgkin lymphoma. Breast implant-associated ALCL is a rare subtype of ALCL, now designated as a separate entity under the latest 5th edition of the World Health Organization classification of hematolymphoid tumors. ALCL of the breast in a patient without a breast implant is an even rarer subtype. We here report a case of pathologically proven primary ALCL of the breast diagnosed during the postpartum period. The patient achieved a complete metabolic response after six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone. It is essential to recognize this entity because the management is completely different from the more common adenocarcinoma, which is treated with surgery and radiation, unlike lymphoma, which is treated with chemotherapy alone. We reviewed the literature and identified 30 cases of non-implant-associated Primary Breast ALCL. Our case was unique in being postpartum in presentation and involving bilateral breasts.Item Giant fibroadenoma in the left breast: Report of a case(Mansa STM Publishers, 2025-01) Shil, R; Chandra, G; Das, S.Fibroadenoma is a generally common benign, non-cancerous lump that appears suddenly and can be very difficult to distinguish from cancer. The exact cause of fibroadenomas is unknown. About 10% of women worldwide are estimated to experience it once in their lifetime. It can affect a female at any age, even though it is more common in the age group of 20–30. In this case report, we presented a 29-year-old female patient who had a huge fibroadenoma in her left breast, measuring 10 × 8 cm. The patient underwent a lumpectomy and was recovering well. In general, the prognosis is good, but it is important to have multidisciplinary team members to properly manage the patient.