International Journal of Medical and Pharmaceutical Case Reports

Cervicothoracic Mass Revealing a Non-Hodgkin's Lymphoma (NHL) and Its Unusual Localization: A Case Report

EL KHAOUA Sakina — 2025-10-18

Aims: We aimed to report a rare case of a cervicothoracic mass revealing Non-Hodgkin's Lymphoma (NHL), highlighting its unusual localization.

Non-Hodgkin's Lymphoma (NHL) is a rare condition, primarily affecting lymph nodes but can involve any organ. Extra-nodal NHL occurs in 25% of cases, with 60% located in the head and neck region. NHL in this area presents diverse clinical, morphological, and biological features, reflecting the complexity of histopathological classifications. Diagnosis relies on histology, which guides therapeutic management. This case report describes a cervicothoracic mass revealing laryngeal NHL.

A 70-year-old man with a history of diabetes and hypertension, was admitted to the ENT department with a 10-month history of a painless left laterocervical swelling, dysphonia, and deteriorating general condition, without signs of tuberculosis, dyspnea, or initial dysphagia. ENT examination revealed a large, adherent, painless left laterocervical mass extending intrathoracically, associated with left upper limb lymphedema. Nasofibroscopy showed left laryngeal paralysis and deviation of the left hemi-laryngeal structures. Blood tests indicated bicytopenia.

A CT scan identified a lesion in the left hemi-larynx with thyroid cartilage lysis and a cervical tumor extending into the cervico-thoracic area, displacing the trachea and esophagus. No lung nodules or mediastinal lymphadenopathy were observed. MRI confirmed a cervico-thoracic tumor with diffusion hypersignal, low ADC, and homogeneous enhancement, closely associated with the left thyroid lobe.

Direct laryngoscopy and biopsy revealed diffuse large B-cell lymphoma (non-germinal type). Immunohistochemistry showed tumor cells positive for CD20, Bc16, and Mum1, negative for CD3, CD5, CD20, AE1/AE3, and Cyclin D1, with a high Ki67 proliferation index of 90%.

Kikuchi-Fujimoto Disease Revealing Lupus Nephritis: A Case Report in Sub-Saharan Africa

SOW M — 2025-08-30

Introduction: Kikuchi-Fujimoto disease is a rare and benign condition. It most frequently affects young women. It manifests as predominantly cervical lymphadenopathy. Its diagnosis relies on lymph node histology, which reveals acidophilic necrosis, CD68+ histiocyte infiltration, the presence of plasmacytoid monocytes, numerous apoptotic cells (CD8+ T lymphocytes) with nuclear debris, an immunoblastic reaction, and the absence of neutrophils or eosinophils. Spontaneous recovery within a few weeks is the norm. The disease can be associated with systemic lupus erythematosus.

Aim: We aimed to report a rare case lupus nephritis revealed by Kikuchi-Fujimoto disease

Case Presentation: We reported here an observation of Kikuchi-Fujimoto disease associated with lupus nephritis. It involved a young African black woman who presented cervical lymphadenopathy associated with hepatosplenomegaly and fever. Infectious investigations were negative. Lymph node biopsy concluded Kikuchi-Fujimoto disease. The course was towards spontaneous recovery. Systematic screening showed positivity for antinuclear antibodies, and significant proteinuria. Renal biopsy confirmed lupus nephritis.

Conclusion: Lupus with cutaneous manifestations is the most often pathology associated with Kikuchi-Fujimoto disease; lupus glomerulonephritis is rarely described.

Cervicothoracic Cellulitis Complicated by Descending Mediastinitis in a Diabetic Patient: Multidisciplinary Management and Reconstructive Surgery Using a Pedicled Pectoralis Major Muscle Flap from the Military Hospital Mohammed V, Rabat

Oumaima Mansoum — 2025-09-20

Introduction: Cervical cellulitis or necrotizing cervical fasciitis are soft tissue infections that develop from dental or pharyngeal sites and, if not recognized early, can spread to the mediastinum. The initial clinical signs are sometimes vague and can lead to a delay in diagnosis. The key examination is cervical and thoracic computed tomography. Treatment consists of extensive and repeated tissue excisions combined with antibiotic therapy targeting aerobic and anaerobic bacteria.

We report the case of a patient with known diabetes presenting with cervico-thoracic cellulitis of cutaneous origin complicated by descending mediastinitis. highlighting the importance of early diagnosis, surgical treatment, and reconstructive surgery.

Aims: We aimed to report a rare case of cervicothoracic cellulitis complicated by descending mediastinitis in a diabetic patient.

Presentation of Case: We report here an observation of cervicothoracic cellulitis complicated by mediastinitis in a 66-year-old man who presented with anterior cervicothoracic swelling accompanied by oozing skin ulceration with pus discharge in the context of fever and general asthenia. Blood tests revealed an inflammatory and infectious syndrome and ketoacidosis. A cervical-thoracic CT scan confirmed the diagnosis of cervicothoracic cellulitis complicated by descending mediastinitis. An emergency cervicotomy with extensive debridement and drainage was performed. Bacteriological testing identified multisensitive Staphylococcus aureus, which led to targeted antibiotic treatment. Due to significant tissue loss, reconstructive surgery was performed. The postoperative course was that of a full recovery.

Conclusion: Cervicothoracic cellulitis is a serious condition requiring urgent treatment and multidisciplinary medical and surgical care. CT imaging guides surgical planning, while surgical debridement of necrotic tissue, targeted antibiotics, and reconstruction techniques are essential for achieving favorable outcomes.

Secondary Hyperparathyroidism in CKD: Comparative Case Series of Medical Management and Parathyroidectomy

Bayana H — 2025-09-22

In chronic kidney disease (CKD), disturbances in phosphate, calcium, and vitamin D balance often lead to secondary hyperparathyroidism (SHPT), which can progress to tertiary hyperparathyroidism if left untreated.

We present three cases illustrating different management approaches: a 36-year-old male with refractory SHPT successfully treated with total parathyroidectomy, thymectomy, and forearm auto transplantation; a 63-year-old female on long-term dialysis who developed a spinal brown tumor from tertiary hyperparathyroidism, managed with parathyroidectomy and spinal decompression; and a 43-year-old male with stage V CKD whose SHPT was effectively controlled medically with Sevelamer, Alfacalcidol, and Cinacalcet.

These cases emphasize that while medical therapy is effective in early, responsive SHPT, advanced or refractory disease often requires surgical intervention, highlighting the importance of timely diagnosis, individualized treatment, and multidisciplinary follow-up for optimal outcomes.

Safe and Effective Management of Tinea Cruris with Rhinacanthus nasutus Root Extract Gel (0.2% Rhinacanthin C): A Case Report on Clinical and Mycological Outcomes

Patamaporn Pruksakorn — 2025-10-06

Tinea cruris is a dermatophyte infection affecting the genital area, groin, buttocks, and inner thighs, commonly presenting with erythema, desquamation, pruritus, and a burning sensation. While antifungal medications are standard treatments, resistance and recurrence are increasing concerns. In Thai traditional medicine, herbal remedies are also considered for the treatment of fungal skin diseases. This case report described the management of tinea cruris in a 23-year-old male patient who had been suffering from the condition for one year. The patient had previously been treated with ketoconazole cream for 5-6 months, followed by a topical steroid with anti-inflammatory, antibacterial, and antifungal properties for one month. Although itching improved, the lesions persisted and worsened after treatment stopped. Microscopic examination using KOH preparation revealed septate hyphae with arthroconidia from the skin lesion. The patient was then treated with Rhinacanthus nasutus root extract gel (0.2% rhinacanthin C), applied to the affected areas twice daily for eight weeks. Clinical improvement was observed within two weeks of treatment initiation, and KOH preparations remained negative from the second week through the end of the treatment period. The patient tolerated the herbal gel well, with no adverse effects reported. There was no recurrence of tinea cruris during one year of follow-up. This case report suggests that R. nasutus root extract gel, containing 0.2% rhinacanthin C, was effective in relieving both the clinical symptoms and mycological aspects of dermatophytosis. The gel formulation may be a safe and effective topical alternative for the management of tinea cruris.

A Rare Case of Acute on Chronic Liver Failure Triggered by Chikungunya Virus

Mamun Al Mahtab — 2025-10-14

Chikungunya is generally considered as a benign, self-limiting viral infection, which rarely involves liver, kidney, heart and nervous system. Hepatic involvement is usually in the form of mild, self-limiting asymptomatic acute hepatitis with minimal derangement of liver function. However, in uncommon circumstances the disease can lead to acute liver failure. Here we present a rare case of Chikungunya-induced acute on chronic liver failure from Bangladesh.

Leptomeningeal Salmonella Paratyphi B: An Atypical Viral-Mimicking Encephalitis in Geriatrics

Aleena Muhammed Sadi — 2025-10-22

Salmonella meningitis is a rare but severe central nervous system (CNS) infection with high mortality, especially in adults. While Salmonella typhi is the predominant cause, Salmonella Paratyphi B is an uncommon but important pathogen in pediatric meningoencephalitis. Early diagnosis and treatment are critical.

A 71-year-old male presented with a high-grade fever associated with projectile vomiting, severe headache and photophobia. The patient was drowsy, exhibited an altered sensorium. Neurological examination revealed neck rigidity, brisk reflexes and positive Kernig’s and Brudzinski’s signs. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis with elevated protein levels. The Widal test was positive for Salmonella Paratyphi B, and brain MRI with contrast revealed leptomeningeal enhancement. The patient was treated with intravenous ceftriaxone resulting in significant clinical improvement and complete neurological recovery at discharge.

This case underscores Salmonella Paratyphi B as a critical, albeit rare, consideration in geriatric meningoencephalitis. It highlights the diagnostic utility of neuroimaging in atypical presentations and demonstrates that even without culture confirmation, a combination of serology, imaging, and clinical context can guide effective management. The report emphasizes the importance of considering uncommon pathogens in elderly patients with CNS infections to ensure timely, targeted antimicrobial therapy and prevent severe neurological sequelae.

A Rare Case of Pediatric Chronic Mastoiditis Presenting with Subtotal Perforation

P. RajaVarma — 2025-10-25

Chronic mastoiditis is rare in children due to early treatment of otitis media. We report a 13-year-old female with chronic suppurative otitis media, mastoid sclerosis, and subtotal tympanic membrane perforation presenting with persistent mucoid otorrhoea. Audiometry showed mild hearing loss, and CT revealed mastoid sclerosis. Preoperative findings of hypokalemia and ECG changes posed anesthetic challenges. She underwent right cortical mastoidectomy with tympanoplasty. This case underscores the importance of timely diagnosis in pediatric otitis media, the role of multidisciplinary care, and the contributions of clinical pharmacists in perioperative management.

Mixed Connective Tissue Disorder with Pulmonary Hypertension: A Case Report

Praveen Kumar K — 2025-11-08

Background: First identified by Sharp et al. in 1972, Mixed Connective Tissue Disease (MCTD) is an autoimmune overlap syndrome that is typified by anti-U1RNP antibody positivity and symptoms of polymyositis, systemic lupus erythematosus, and systemic sclerosis.

Case Presentation: A 39-year-old female presented with fever, limb and small joint pain, exertional dyspnea, bluish discoloration of fingers on cold exposure (Raynaud’s phenomenon), and dysphagia. Examination was unremarkable. Investigations revealed anemia (Hb 8.4 g/dL), thrombocytopenia (0.80 lakhs/cumm), elevated troponin-T (29.11 pg/mL), and CPK (255 IU/L). ECG showed poor R-wave progression with T-wave inversion (V1–V4), and echocardiography revealed dilated right chambers with severe tricuspid regurgitation and pulmonary hypertension. ANA and anti-U1RNP were positive, along with anti-Scl-70; skin biopsy showed sclerosis.

Discussion: The patient fulfilled both Alarcón-Segovia and Kasukawa diagnostic criteria for MCTD based on serology and clinical findings. Cardiac and pulmonary involvement underscored the disease’s systemic nature.

Conclusion: Early recognition of overlapping autoimmune features and serological markers is vital for timely diagnosis and management of MCTD to prevent life-threatening complications.

A Clinical Comprehensive Analysis of the Correlation between Decompensated Chronic Liver Disease in Portal Hypertensive Gastropathy and Diabetic Nephropathy

Amandeep Kaur — 2025-11-17

This is a case report of a 48-year-old male who presented with decompensated chronic liver disease, complicated by portal hypertensive gastropathy, diabetic nephropathy, and chronic kidney disease. He presented with symptoms of vomiting, fever, low urine output, and impairment of the liver and kidneys. Ultrasound showed liver congestion with ascites; endoscopy revealed Grade II oesophageal varices and portal gastropathy. Thereafter, he tested positive for Hepatitis C infection and therefore had a viral aetiology for liver disease. He was treated with antibiotics, insulin, pantoprazole, and medications for liver protection. Propranolol and midodrine are used to manage portal pressure and blood pressure, respectively. Drotaverine is used to alleviate abdominal pain. This case represents the interaction of liver, kidney, and metabolic disorders. It requires using appropriate drugs with cautious dosage to avoid toxicity. In such complex cases, the role of a pharmacist is crucial for safe and effective therapy.

A Case Report on Thyroid Nodule

Ganeshakumara M — 2025-11-17

Background: Thyroid nodules are commonly encountered in clinical practice, especially in women, and require a structured evaluation to differentiate between cancerous and benign lesions. The diagnostic algorithm relies heavily on fine-needle aspiration cytology (FNAC) and ultrasound-based TI-RADS scoring.

Case Presentation: We describe the case of a 27-year-old female South Indian patient from Ballari, Karnataka, who had a two-month-old, painless swelling on the left side of her neck that was gradually getting worse. A heterogeneous, single thyroid nodule measuring 3.5 × 1.5 cm was found in the left lobe during clinical examination and ultrasound. A benign cystic lesion was suggested by FNAC, which was conducted based on TI-RADS scoring (TR3). Surgery was planned, though, because of the size of the lesion and its unclear cytological characteristics. Hemi-thyroidectomy was done after the lesion was discovered.

Conclusion: This case emphasizes the importance of integrating clinical, radiological, and cytological findings in managing thyroid nodules. While imaging and FNAC may suggest benignity, surgical excision may still be indicated in uncertain or large lesions. Histopathological confirmation remains the gold standard for diagnosis and planning definitive treatment.

Dietary Natural Lutein and Its Impact on Hepatic Autoimmunity in Long COVID: A Clinical Case Study

Anthony M Kyriakopoulos — 2025-09-26

Introduction and Aims: Lutein is a nutrient that is found in many foods, particularly green vegetables. It has powerful antioxidant properties potentially to relieve oxidative-nitrosative stress in long COVID. Moreover, lutein is a promising natural agent to be used against liver damage. Our aim is to evaluate whether natural lutein supplementation by organic Extra Virgin Olive Oil (EVOO) can be therapeutic in alleviating liver damage associated with long COVID.

Presentation of Case: We report a retrospective case study of a long COVID patient where autoimmune hepatitis markers were alleviated in a brief time, after consumption of organic EVOO stable in lutein. A 61-year-old Greek (unvaccinated) woman developed long COVID after SARS-CoV-2 infection. Long COVID symptoms included constipation, chronic fatigue, muscle pain, and blood markers that resembled autoimmune hepatitis (AΙH). High anti-spike protein Immunoglobulin G (IgG) antibodies accompanied the symptoms. Magnetic resonance examination (MRI) was not conclusive for autoimmune hepatitis (AIH) diagnosis. The patient was advised to follow a healthy diet and repeat the examinations. As part of the healthy diet, the patient consumed 24 ml of lutein rich (6.5 mg/Kg) stable EVOO (SEVOO) per day. After two six months periods of testing, AΙΗ markers were normal.

Discussion and Conclusion: Natural lutein consumption by means of SEVOO helped to alleviate liver damage as shown by the AIH markers and to ameliorate chronic fatigue and muscle pain in a long COVID patient.

Fatal Systemic Toxicity Following Ingestion of Bryophyllum pinnatum Leaves: A Clinical Case Report

S. Sana Shinine — 2025-11-07

Background: Bryophyllum pinnata is a perennial succulent herb of the family Crassulaceae. It is widely used for traditional purpose because of its pharmacological properties. However, it contains bioactive compounds such as flavonoids, phenols, tannins, saponins, terpenoids, and bufadienolides that can cause systemic toxicity.

Case Summary: A 63-year-old male patient with a known history of cardiac disease consumed approximately three to four leaves of Bryophyllum pinnata for medicinal purpose. Shortly after ingestion, he developed gastrointestinal related symptoms followed by hemodynamic instability. His condition progressed to shock, sepsis, anuria, and metabolic acidosis. Despite intensive medical management, the patient’s condition deteriorated and ultimately resulted in death. The pre-existing cardiac disorder may have been a predisposing factor that heightened the susceptibility to the toxic effects of Bryophyllum pinnata, particularly due to its cardiac glycoside like compounds.

Conclusion: This case highlights the potential toxic and fatal effects of Bryophyllum pinnata consumption, especially in individuals with underlying cardiac disease. Caution is warranted when using Bryophyllum pinnata for medicinal purposes, and awareness regarding its possible adverse effects should be highlighted among healthcare providers and the general public.

Hallux Valgus Bursitis: Clinical Presentation and Management of a Rare Case

Meesa Sai Charan — 2025-11-20

Background: Hallux valgus is a common forefoot deformity characterized by lateral deviation and valgus rotation of the great toe, often associated with bunion formation. The condition usually develops due to medial deviation of the first metatarsal, lateral deviation or rotation of the hallux, and soft tissue hypertrophy over the first metatarsal head. This deformity is frequently seen in young women and can cause severe pain, gait disturbance, and progressive functional disability if left untreated.

Case Presentation: We report the case of a 25-year-old female who presented with severe pain over the right first metatarsophalangeal (MTP) joint for two months, associated with difficulty in walking and intermittent fever. Clinical evaluation confirmed hallux valgus deformity with bunion formation, resulting in significant restriction of daily activities. Considering the severity of deformity, degenerative changes of the MTP joint, and the alignment of the metatarsal and phalanges, corrective osteotomy was performed. The postoperative course was uneventful, with significant improvement in pain and mobility.

Conclusion: This case highlights that hallux valgus is not merely a cosmetic concern but a disabling condition requiring timely management. Surgical correction, particularly osteotomy, provides effective relief in young symptomatic patients when conservative treatment fails. Early recognition, patient education, and appropriate treatment are essential to restore function, prevent disease progression or worsening of the deformity.

Isolated Posterior Atypical Presentation of Vogt-Koyanagi-Harada Syndrome in a Young Girl: A Rare Case Report

L. Sbai — 2025-11-20

Background: Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune disorder affecting melanocyte-rich tissues, including the uvea, meninges, skin, and inner ear. Posterior involvement is typical, yet isolated posterior forms are exceptionally rare and diagnostically challenging.

We present a pediatric case of atypical isolated posterior VKH successfully managed with corticosteroid therapy.

Case Presentation: A 15-year-old girl presented with sudden bilateral visual loss following diffuse headaches. Fundus examination revealed serous retinal detachments in both eyes. Optical coherence tomography (OCT) showed multilobulated subretinal fluid and disruption of outer retinal layers. Fluorescein angiography demonstrated multiple pinpoint hyperfluorescent leaks and dye pooling, while indocyanine green angiography revealed delayed choroidal perfusion. Laboratory and imaging workup excluded other causes such as posterior scleritis, infectious choroiditis, and central serous chorioretinopathy. She was treated with intravenous methylprednisolone followed by oral tapering, leading to marked improvement in vision and anatomical resolution.

Conclusion: Isolated posterior atypical VKH is an uncommon presentation that may mimic several inflammatory or infectious choroidopathies. Early recognition and aggressive corticosteroid therapy are key to achieving favorable visual outcomes and preventing chronic evolution. Follow-up of patients with ocular VKH is long, even lifelong, because relapses and late complications can occur even several years after the onset of the disease.

Post-Stroke Psychosis Presenting with Auditory Hallucinations: A Case Report in an Elderly Patient

Ioannis Zerefos DO — 2025-11-26

Background: Auditory hallucinations are typically associated with schizophrenia spectrum disorders but can occur secondary to cerebrovascular events, sensory deprivation, or neurodegenerative processes. Post-stroke psychosis (PSP) is an underrecognized neuropsychiatric complication, affecting approximately 5% of stroke survivors. Lesions involving temporoparietal or subcortical structures, in conjunction with dopaminergic dysregulation and sensory impairment, may precipitate hallucinations and delusions, particularly in older adults.

Aims: To report a case of late-onset auditory hallucinations following stroke in an elderly patient, and to underscore the diagnostic challenges and therapeutic considerations when psychosis arises in the context of cerebrovascular disease.

Case Description: An 83-year-old female with a history of cerebrovascular accident, seizure disorder, hearing loss, multiple medical comorbidities and no prior psychiatric history presented with new-onset auditory hallucinations and persecutory delusions. She reported hearing threatening voices and believed her neighbors conspired against her. Neuroimaging revealed acute lacunar infarcts in the bilateral centrum semiovale and left parietal cortex with chronic microvascular ischemic changes. Laboratory findings and cognitive testing were within normal limits. She was initiated on low-dose olanzapine with symptomatic improvement and later readmitted for recurrence following medication discontinuation. Repeat MRI was unchanged. Given the temporal association with cerebrovascular injury and the absence of prior psychiatric history, a diagnosis of post-stroke psychosis was made. Reintroduction of olanzapine resulted in stabilization, and the patient returned to baseline functioning.

Conclusion: This case emphasizes the importance of considering cerebrovascular etiologies in late-onset psychosis, particularly in elderly patients with vascular risk factors and sensory impairment. Early recognition, integrated neuropsychiatric evaluation, and judicious low-dose antipsychotic therapy can lead to favorable outcomes while minimizing treatment-related risk. Future research should further delineate biological mechanisms, looking at vascular injury, sensory loss, and its association with late-life psychosis and/or auditory hallucinations.