Case Reports in Clinical Practice
Volume:5 Issue: 2, Spring 2020

Stromal or mesenchymal neoplasms affecting the gastrointestinal tract are relatively rare lesions. A far less common group of Gastrointestinal (GI) mesenchymal tumors is leiomyoma. Surgery is the mainstay treatment for leiomyoma. Complete endoscopic resection of the tumor could be challenging due to its submucosal origin. In this study, we reported a case of a 48-year-old woman with leiomyoma of the cecum, i.e. treated by endoscopic resection.

Tuberculosis (TB) could be presented with different manifestations. On many occasions, further evaluation in patients with the first diagnosis of the lung, pancreas, ovarian, or bladder cancer leads to the definite diagnosis of TB and the symptoms subside by treatment. Concerning the easy access to diagnostic tests and dramatic treatment responses, it is essential that physicians in endemic areas consider TB in patients with suspicious symptoms and in the differential diagnosis of malignancies, to diagnose the disease sooner and by simple and inexpensive tests; thus, avoiding imposing extra expenses to patients and the health system. We reported a 45 year-old female who was evaluated for abdominal pain, significant weight loss, and ascites for the past 4 months. The mediastinal and abdominopelvic Computed Tomography (CT) scan was performed in the initial evaluations of the patient. Accordingly, massive para-aortic and mediastinal lymphadenopathies and two thyroid nodules were detected. Furthermore, considering peritoneal thickening and moderate ascites, lymphoproliferative disorders were highly suggested as the diagnosis. The laboratory test data revealed bicytopenia, Erythrocyte Sedimentation Rate (ESR:57), and a high Cancer Antigen 125 (CA125). Unfortunately, the results of paracentesis were unavailable, though cytology was negative for malignancy. Due to anemia and weight loss, endoscopy and colonoscopy were performed twice in two different clinics, of which only gastritis was reported. Multiple abdominal and vaginal sonography was performed; these assessments suggested mild splenomegaly, mesenteric engorgement and thickening, multiple para-aortic and iliac adenopathies, as well as healthy uterus and ovaries. At the beginning of admission in Imam Khomeini Hospital, the patient denied any relevant medical history or family history. With further detailed questioning, we noticed a positive TB history in the patient’s grandmother, who lived with her. A Purified Protein Derivative (PPD)

Ingested Foreign Bodies (FB) frequently occur in pediatric patients. The most commonly ingested foreign bodies are coins, magnets, batteries, small toys, jewelry, buttons, and bones in decreasing order of frequency. A three-year-old boy referred to the emergency room with incidental ingestion of an ampoule of epinephrine. The radiography data demonstrated the location of the ingested ampoule in the stomach. The upper endoscopy was performed; however, the object had already passed through the pylorus. The following day, he passed the ampoule without complications. Our case was pretty unique because the most commonly ingested FBs in the pediatric population include coins followed by magnets, batteries, and so on. Asymptomatic patients having no dangerous FB could be observed until either presenting something abnormal or uneventfully passing the FB.

Acute Lymphoblastic Leukemia (ALL) is a type of leukemia that generates from white blood cells in the bone marrow. ALL could present with different nonspecific symptoms. Hypercalcemia is a rare presentation in B-cell ALL. We reported a middle-aged man presented with hypercalcemia and osteolytic bone lesions without bone pain and a definitive diagnosis of B-cell ALL.

Pelizaeus-Merzbacher Disease (PMD), as a rare genetically x-linked leukodystrophy, is a disorder of proteolipid protein expression in myelin formation. This disorder is clinically presented by neurodevelopmental delay and abnormal pendular eye movements. The responsible gene for this disorder is the proteolipid protein gene (PLP1). Our case was a oneyear- old boy referred to the radiology department for evaluating the Central Nervous System (CNS) development by brain Magnetic Resonance Imaging (MRI). Clinically, he demonstrated neuro-developmental delay symptoms. The brain MRI results indicated a diffuse lack of normal white matter myelination. This case report should be considered about the possibility of PMD in the brain MRI of patients who present a diffuse arrest of normal white matter myelination.

Multiple Endocrine Neoplasia type 2B (MEN2B) is an autosomal dominant disorder characterized by Medullary Thyroid Carcinoma (MTC) and pheochromocytoma. MTC occurs in almost all MEN2B patients. The tumor develops at an earlier age and is aggressive. Surgery is often not curative for this condition. Death from MTC occurred in 50% of patients with MEN2B. Thus, early diagnosis and prevention are crucial in this regard. Thyroidectomy, as early as the neonatal period, may be indicated in patients with MEN2B identified by genetic screening.

We reported a 24-year-old male presented to the emergency department with dyspnea for the past 3 months. There was a nodule 3*3 cm in the Right Lower Lobe (RLL) of the thyroid gland. Non-contrast Computer Tomography (CT) scan of the lung revealed multiple nodular lesions compatible with metastasis. The Fine Needle Aspiration (FNA) cytology of the thyroid nodule indicated that the features of medullary thyroid carcinoma were positive stains in Immunohistochemistry (IHC) for calcitonin. A diagnosis of pulmonary metastatic medullary thyroid carcinoma, as a presenting feature of MEN2B, was made. The
patient was treated with Vandetanib.

In the reported MEN2B patient, MTC occurred in the early stages of life and was
multifocal. Thus, it is crucial to diagnose medullary thyroid cancer at the early stages of the disease.

Turner Syndrome (TS) is a chromosomal sex disorder, phenotypically characterized by short stature, webbed neck, cubitus valgus, and rarely with slight intellectual disability. A majority of TS patients (95%-98%) have infertility due to ovarian failure. Pregnancy in TS patients is an unusual case; however, pregnancy could rarely occur in mosaicism TS patients without any assistance. Pregnancy in such patients is associated with high risks of maternal mortality, spontaneous abortion, as well as the congenital and karyotype abnormalities of the fetus. A 30-year-old pregnant woman has referred to our genetics lab with a history of polyabortivity. Her menarche occurred at the age of 13 years and her menstruation was claimed to be in a regular cycle. The patient’s two first pregnancies resulted in stillbirth, whereas the third one was delivered through caesarian surgery, but spoiled after 8 days. Our case was characterized by mosaicism 45, X/45, XX, after referring as a multi-abortion case. The fourth pregnancy has happened at the age of 31 years and a healthy embryo with normal heart function was diagnosed by sonography in 17 weeks of gestation. The result of amniocentesis confirmed a healthy female embryo with 46, XX karyotype. Spontaneous pregnancy is regarded as a precarious situation terrifying by abortion or malignancy; also, chromosomal abnormalities, like trisomy 21 and TS, are prevalent in offspring. Therefore, it is strongly recommended to have cohort studies based on karyotype characterization to decrease the patient’s concerns as well as to follow more practical clinical approaches.

Bell`s palsy is a neurological condition manifests with acute unilateral neuropathy of 7th cranial nerve. The cause is not clear. However, some infections, immune system responses and ischemic causes are suggested as etiologies. We report 2 cases with Bell`s palsy while using quetiapine plus sertraline, in the absence of concurrent prescriptions which have been reported Bell’s palsy as an adverse effect.

 First patient was an Iranian 54 years old male with Major Depressive Disorder who has been treated by sertraline 100mg per day for 1 year. His main manifestations was depressed mood, fatigue, insomnia, irritability, suicidal ideas and social isolation. He presented the classical manifestations of peripheral Bell`s palsy only 3 days after initiation of quetiapine 50mg per night. Brain imaging such as Magnetic Resonance Imaging (MRI) and Diffusion Weighted Imaging (DWI) was performed. Also other investigations for infective and immune causes were done. All of them showed normal results. The second case was an Iranian 20 year old female diagnosed as Major Depressive and Body dysmorphic disorder patient. She was being treated by sertraline 100 mg/daily plus quetiapine 25md per night for 15 months. She also presented peripheral type of Bell`s palsy while using this combination therapy. Neurological investigations also performed and all results were normal. She recovered after reduction of quetiapine dosage to 12.5 mg per night and prescription of acyclovir and dexamethasone by our neurologist colleague.

Based on our search there is no reported correlation between psychiatric medications and Bell`s palsy. First explanation about our cases is an accidental correlation but also the short time correlation between initiation of treatment and presenting Bell’s palsy in first case and recovery of second one after reduction of quetiapine dosage are supporting the idea that the combination of sertraline and quetiapine may causes Bell’s palsy. Some articles have mentioned that antipsychotic drugs may have a weak antibiotic agent role and specially may demonstrate an inhibitory effect on neurotropic viruses, such as herpes simplex. Sertraline may also acts as an antibacterial agent. Reduction of protecting human microbiota may explain our observations.

Combination of sertraline and quetiapine may cause Bell`s palsy and clinicians should consider neurological adverse effects of this common combination.