International Journal of Medical and Pharmaceutical Case Reports

Ulcerated Infantile Hemangioma of the Upper Lip Mimicking a Cleft Lip: A Diagnostic Dilemma

Sonu Antony — 2026-03-31

Introduction: Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy, typically emerging in the early postnatal period. While most IH follow a self-limiting course, ulceration is a frequent complication, particularly in high-risk anatomical sites such as the perioral region. Ulcerated IH can pose diagnostic challenges by mimicking other ulcerative conditions, including pyoderma gangrenosum and invasive fungal infections.

Case Report: We describe a 30-day-old male infant presenting with a rapidly progressive ulcerative lesion of the upper lip, resulting in a cleft lip–like deformity. The lesion originated as an erythematous patch over the philtrum during the second week of life and subsequently evolved into a deep ulcer. Initial differential diagnoses included pyoderma gangrenosum and fungal infection. However, retrospective evaluation of serial neonatal photographs revealed a precursor lesion consistent with IH, enabling a clinical diagnosis. The infant was managed with systemic antibiotics for secondary infection, along with oral propranolol and topical timolol, leading to marked clinical improvement.

Conclusion: This case underscores the importance of recognizing early precursor lesions and maintaining a high index of suspicion for IH in atypical ulcerative presentations. Detailed clinical chronology and photographic documentation can be invaluable in establishing the diagnosis. Early identification and prompt treatment are crucial to prevent functional impairment and long-term cosmetic sequelae.

A Rare Case Report of Budd-Chiari Syndrome

Azeem S. Muhammed — 2026-03-02

Background: Budd-Chiari syndrome is an uncommon condition characterized by thrombotic or non-thrombotic obstruction of hepatic venous outflow. It commonly presents with hepatomegaly, ascites, and abdominal pain. Its incidence is estimated at 1 in 100,000 to 1 in 2.5 million annually and commonly affects individuals aged 20–40.

Case Summary: A 38-year-old male presented with upper abdominal pain, nausea, vomiting, and loss of appetite. Icterus was noted on examination. Laboratory tests showed decreased prothrombin time (PT) and activated partial thromboplastin time (aPTT). Abdominal ultrasonography revealed hepatic vein thrombosis. The patient was treated with heparin, warfarin, and supportive care. PT and aPTT improved to 11 and 25 seconds, respectively.

Discussion: Budd-Chiari syndrome is a rare yet life-threatening hepatic vascular condition that requires a high level of clinical suspicion for early detection. This case highlights the importance of correlating clinical features such as abdominal pain, jaundice, and gastrointestinal symptoms with laboratory abnormalities and imaging findings to achieve timely diagnosis.

Conclusion: Early diagnosis, appropriate anticoagulant drug use, and regular follow-up can lead to favorable outcomes and prevent relapse.

A Clinical Case Report of Guillain-barre Syndrome in Adult Patient

D Keerthana — 2026-03-06

Introduction: Guillain–Barré syndrome (GBS) is an uncommon, acute autoimmune condition affecting the peripheral nervous system, marked by rapidly progressive, symmetrical muscle weakness and loss of deep tendon reflexes. It frequently occurs following an antecedent infectious episode. Prompt diagnosis and early initiation of immunomodulatory treatment are critical in limiting disease severity and preventing potentially life-threatening complications.

Case Presentation: A 46-year-old male presented with acute onset, gradually progressive weakness beginning in both lower limbs and later involving the upper limbs, accompanied by difficulty in grasping objects and swallowing. The patient also had respiratory symptoms suggestive of a recent infection. Laboratory evaluation revealed leukocytosis with predominant neutrophilia and significantly elevated C-reactive protein levels.

Discussion: The diagnosis of Guillain–Barré syndrome was made based on the characteristic clinical presentation supported by laboratory findings. Management included intravenous immunoglobulin therapy administered for five consecutive days, along with supportive care and antibiotic therapy for suspected aspiration pneumonia. The patient showed progressive neurological improvement during treatment.

Conclusion: This case underscores the significance of early identification and timely intravenous immunoglobulin therapy, along with a multidisciplinary management approach, in achieving favorable outcomes in patients with Guillain–Barré syndrome.

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Presenting with Acute Paraparesis and Neurogenic Bladder: A Diagnostic Challenge in Young Adult

Soma Lakshmikanth — 2026-03-09

Introduction: Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) presents with varied neurological features and may mimic other causes of acute myelopathy, making early diagnosis challenging.

Case Presentation: A 19-year-old male presented with rapidly progressive bilateral lower-limb weakness and acute urinary retention. MRI revealed longitudinally extensive transverse myelitis from the cervical to thoracic cord, with additional thalamic and optic chiasm involvement. CSF studies supported an inflammatory etiology, and markedly positive serum MOG-IgG confirmed MOGAD. High-dose corticosteroids led to significant neurological recovery, and rituximab was initiated for relapse prevention.

Conclusion: This case highlights the diagnostic challenges of atypical MOGAD presentations and emphasizes the need for early serological testing, comprehensive neuroimaging, and prompt immunotherapy to prevent long-term disability.

Multidisciplinary Preoperative Evaluation and Ethical Decision-Making in Thoraco-Omphalopagus Conjoined Twins: A Case Report

Ahmadwirawan — 2026-03-16

Background: Thoraco-omphalopagus conjoined twins present extreme surgical and ethical complexity due to shared thoracoabdominal structures, most notably the liver and chest wall. While hepatic separation has been widely emphasized, the role of chest wall reconstruction as a determinant of postoperative physiological viability remains underreported.

Aim: Thoraco-omphalopagus conjoined twins represent one of the most complex congenital anomalies due to shared thoracoabdominal structures and the need for multidisciplinary decision-making. This report aims to describe the preoperative multidisciplinary evaluation and ethical considerations in the management of thoraco-omphalopagus conjoined twins.

Presentation of Case: We report thoraco-omphalopagus conjoined twins diagnosed antenatally and delivered at a tertiary referral center. Postnatal evaluation revealed a shared sternum, contiguous rib cage, common diaphragm, and extensively fused liver with complex vascular interconnections. Imaging using contrast-enhanced CT and CT angiography was performed to delineate the anatomy and assess feasibility of separation. Multidisciplinary evaluation involving pediatric surgery, hepatobiliary surgery, neonatology, radiology, intensive care, and clinical ethics guided management. Due to neonatal pneumonia and physiological instability, definitive surgical separation had not yet been performed at the time of reporting.

Discussion: This case highlights the importance of comprehensive preoperative evaluation in thoraco-omphalopagus twins, particularly regarding hepatic vascular anatomy, chest wall integrity, and postoperative respiratory mechanics. Multidisciplinary collaboration and ethical deliberation were essential in balancing surgical feasibility with patient safety and anticipated quality of life.

Conclusion: Thoraco-omphalopagus twin management requires careful integration of anatomical evaluation, multidisciplinary planning, and ethical decision-making. Reporting preoperative assessment and planning may contribute valuable insights for future surgical management of similar cases.

Perifoveal Exudative Vascular Anomalous Complex (PEVAC) in High Myopia: Avoiding the Diagnostic Pitfall of Myopic Choroidal Neovascularization

El Houssaine Ait Lhaj — 2026-03-26

Background: Perifoveal Exudative Vascular Anomalous Complex (PEVAC) is a rare retinal disorder characterized by an isolated perifoveal aneurysmal lesion that closely mimics the presentation of exudative choroidal neovascularization (CNV), requiring accurate diagnosis via multimodal imaging for proper therapeutic management.

Purpose: To report a rare case of Perifoveal Exudative Vascular Anomalous Complex (PEVAC) in a highly myopic patient and to highlight the role of multimodal imaging in avoiding the diagnostic pitfall of myopic choroidal neovascularization (mCNV).

Case Presentation: A 59-year-old male with anisometropic high myopia (LE spherical equivalent: -9.75 D, axial length: 26.96 mm) presented with a three-month history of progressive metamorphopsia and vision loss in the left eye. Fundus examination revealed a juxtafoveal yellowish punctiform lesion, microhemorrhages, and a superior circinate pattern of lipid exudates. While initial clinical suspicion leaned toward mCNV, multimodal imaging provided a definitive correction. Structural OCT identified a 196 µm intraretinal aneurysmal dilation within the outer plexiform layer. OCT-Angiography (OCT-A) localized a prominent high-flow signal within the deep capillary plexus (DCP), confirming the diagnosis of PEVAC. Due to the foveal proximity (569 µm) and the characteristic resistance of PEVAC to anti-VEGF (vascular endothelial growth factor) therapy, image-guided focal laser photocoagulation (Navilas®) was performed.

Results: At the 6-month follow-up, best-corrected visual acuity improved from 20/40 to 20/25 (16/20). Imaging confirmed the complete resorption of circinate exudates, resolution of intraretinal cystic spaces, and visible collapse of the aneurysmal complex.

Conclusion: PEVAC is a critical differential diagnosis for exudative maculopathy in high myopes. Distinguishing it from mCNV through multimodal imaging is essential to prevent unnecessary anti-VEGF injections. Image-guided laser photocoagulation remains a highly effective and precise treatment for lesions near the fovea.

Preventable Pulmonary Embolism Post-TKR: A Case Study Highlighting the Need for Pharmacist-Led Discharge Counseling on NSAID-Anticoagulant Interactions

K. Siri — 2026-03-27

Background and Aim: VTE is a serious risk after knee replacement surgery. Poor pain management and unsupervised NSAID use may lead patients to skip anticoagulants, increasing clot risk. This case study explores the consequences of unsupervised consumption of over-the-counter (OTC) medications in a patient following total knee replacement (TKR). It specifically focuses on how interruption of prescribed thromboprophylaxis contributed to the development of venous thromboembolism (VTE).

Presentation of Case: A 67-year-old woman with a history of type 2 diabetes mellitus and hypertension underwent an elective right total knee replacement procedure. After discharge, she was prescribed oral apixaban (2.5 mg twice daily) as part of her thromboprophylaxis regimen. To manage postoperative pain, the patient independently consumed multiple doses of diclofenac obtained over the counter. She experienced epigastric discomfort, dizziness, and mild bleeding from the surgical site. Concerned about these symptoms, she missed scheduled doses of apixaban and significantly reduced her level of physical activity. Within three days, she was presented with calf swelling, tachycardia, and decreased oxygen saturation, with diagnostics confirming right popliteal deep vein thrombosis (DVT) and segmental pulmonary embolism (PE).

Discussion: This case highlights the risks associated with unsupervised OTC medication use. Diclofenac, when taken together with anticoagulant therapy, can increase the possibility of bleeding complications. The patient’s fear of bleeding led to non-adherence to anticoagulant therapy, while reduced mobility further increased the likelihood of thrombus formation. Together, these factors created a clinical situation that facilitated the development of VTE.

Conclusion: This case emphasizes that uncontrolled use of OTC analgesics may lead to significant drug interactions. Effective patient education at discharge, proper medication review, and the involvement of clinical pharmacists are important measures to reduce the risk of such complications.

Flow Cytometric Detection of CK19-Positive Circulating Tumor Cells in Bone Marrow and Peripheral Blood in Metastatic Breast Cancer: A Case Report

Maria Eduarda Cunha-Silva — 2026-04-01

Metastatic breast cancer represents the most advanced stage, where the accurate and rapid identification of neoplastic cells is essential for clinical management and prognostic assessment. Although immunohistochemistry is the gold standard, flow cytometry emerges as a robust and sensitive complementary diagnostic method for detecting circulating tumor cells. We report a breast cancer patient with bone marrow metastasis and demonstrate the utility of a novel flow cytometry protocol for tumor cell detection. A 39-year-old woman, with no family history of cancer, identified a right breast nodule in January 2025. Imaging studies and biopsy with immunohistochemistry confirmed invasive lobular carcinoma (ER+, PR+, HER2−). Bone scintigraphy revealed multiple metastatic lesions. Bone marrow aspiration showed infiltration by tumor cells, with flow cytometry identifying 4.0% of non-hematologic (CD45−) large cells expressing epithelial markers (Ber-EP4+, Pan-CK+++) and breast tumor markers (GCDFP-15+, CK-19+++). Peripheral blood analysis using the Bulk Lysis protocol detected 2.5% circulating tumor cells. This case highlights that standardized flow cytometry protocols provide a rapid and, reliable and non-invasive approach for detecting tumor cells in different samples. The integration of this technique into clinical practice can significantly enhance disease monitoring and early detection of metastasis in breast cancer patients.