International Journal of Medical and Pharmaceutical Case Reports

Cerebral Venous Sinus Thrombosis (CVST) Correlation to Oral Contraceptive Pills (OCP) Use: A Case Report

Naseerah Maryam — 2026-05-16

Cerebral venous sinus thrombosis (CVST) is an uncommon form of intracranial thrombosis characterised by the formation of a blood clot within the cerebral venous drainage system, including the dural venous sinuses, cortical veins, and the deep venous structures such as the vein of Galen system. Which is considered a subtype of venous thromboembolism. Common presenting features of CVST are symptoms of raised intracranial pressure, headaches, seizures, focal neurological deficits and altered sensorium. Seventy percent of CVST cases result from a hypercoagulable state.It also refers to acute Thrombosis or blood clots that can lead to strokes.

Oral contraceptive pills (OCPs) are extensively utilised both for contraception and for the treatment of various gynaecological disorders, providing substantial benefits to women’s health. Nevertheless, their administration is also linked to a spectrum of potential adverse health effects.

We report a case of female patient presented with intermittent fever, headache, dizziness, generalized weakness, and gastrointestinal symptoms. She had a history of hypothyroidism and was recently diagnosed with PCOS, for which she was on combined oral contraceptives. Initial evaluation indicated anemia and minor metabolic abnormalities. Persistent neurological symptoms followed by seizures prompted further evaluation with contrast-enhanced CT (Computed Tomography) of the brain, which showed haemorrhagic venous infarcts in the left temporo-occipital region with surrounding edema, leading to the diagnosis of Cerebral Venous Sinus Thrombosis likely associated with oral contraceptive use. The suspected drug was discontinued, and treatment with low-molecular-weight heparin was initiated. The patient improved clinically and was discharged in stable condition.

This case highlights the risk of oral contraceptive-associated CVST and the importance of early diagnosis and prompt anticoagulation.

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.

Posterior Circulation Stroke with Neck Neoplasia in A Hypertensive Patient

Aneena Sabu — 2026-04-04

Posterior circulation strokes account for 20-25% of ischemic events, frequently presenting with altered sensorium, dysphagia, and limb weakness that challenge early recognition. Coexisting spinal pathology further complicates diagnosis, mandating comprehensive neuroimaging. A 68-year-old female with hypertension (amlodipine 5 mg daily) presented with a 15-day history of progressive altered sensorium, drowsiness, anorexia, dysphagia, and bilateral lower limb weakness. Initial vitals showed BP 130/80 mmHg, PR 74 bpm, SpO₂ 98% on room air. Serial assessments revealed evolving tachycardia (PR 106-116 bpm), desaturation (SpO₂ 90-98%), and hypertension (up to 160/100 mmHg). Laboratory findings included leukocytosis (WBC 17,450/mm³, neutrophils 90%), elevated CRP (13.4 mg/L), and mild hypokalemia (K⁺ 3.3 mEq/L). CSF analysis demonstrated elevated protein (157.4 mg/dL) with lymphocytic pleocytosis (40 cells/mm³). MRI brain confirmed acute posterior circulation infarction with DWI hyperintensities, while cervical spine imaging revealed a neoplastic lesion causing neural compression. Provisional diagnoses included posterior circulation stroke, neoplasia-related cervical dystonia, systemic infection, and hypertension. Management comprised intravenous antibiotics (ceftriaxone 1 g BD, piperacillin-tazobactam 4.5 g TDS, metronidazole), methylprednisolone 1 g daily, aspirin 75 mg, atorvastatin 40 mg, amlodipine 2.5 mg, and supportive therapy (pantoprazole, ondansetron, IV fluids, lactulose). Clinical improvement ensued with vital sign stabilization and resolving neurological deficits. Timely MRI-guided diagnosis and aggressive multimodal therapy yielded favorable short-term outcomes, underscoring integrated neurological care for elderly patients with multifocal crises.

PCR-Confirmed Herpetic Anterior Scleritis in an Adolescent: A Case Report

H. Okieh — 2026-04-15

Background: Scleritis is a severe and potentially sight-threatening inflammatory disease of the sclera, most frequently associated with systemic autoimmune disorders. Infectious etiologies are less common but remain clinically significant, particularly those caused by herpes viruses. Early recognition is essential, as inappropriate management,especially isolated corticosteroid therapy,may worsen the disease course.

Case Report: We report the case of a 15-year-old female presenting with a unilateral painful red eye associated with cutaneous herpetic lesions. Best-corrected visual acuity was 20/20 in both eyes. Ocular examination revealed localized nasal conjunctival hyperemia in the left eye without scleral nodules or necrosis. The cornea was clear with preserved corneal sensitivity, and no signs of anterior uveitis were observed. The phenylephrine test demonstrated persistence of redness with partial blanching, suggesting deep vascular involvement. Polymerase chain reaction (PCR) testing for herpes virus was positive, confirming the viral etiology. The patient was treated with systemic antiviral therapy followed by cautious introduction of corticosteroids, with a favorable clinical outcome.

Conclusion: Herpetic anterior scleritis may mimic superficial inflammatory conditions such as episcleritis, particularly in early stages. PCR plays a pivotal role in confirming the diagnosis and guiding appropriate management. Prompt antiviral therapy is essential to prevent complications and ensure favorable outcomes.

Carbamazepine-Induced DRESS Syndrome with Severe Hepatic Involvement: A Case Report and Clinical Insights

H. Bheemesh — 2026-04-21

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome represents an uncommon yet potentially fatal clinical condition. Drug-induced hypersensitivity reaction is characterised by fever, rash, haematological abnormalities and multi-organ involvement particularly the liver. Carbamazepine is a well-known trigger.

Aim: The study presents a rare but serious adverse drug reaction, carbamazepine-induced DRESS syndrome with hepatic involvement.

Case Presentation: A 29-year-old male with a seizure disorder on long term carbamazepine therapy presented with high grade fever, generalized erythematous rash, abdominal pain and jaundice. Laboratory findings showed leukocytosis, eosinophilia, elevated liver enzymes and hyperbilirubinemia.

Methodology: Clinical evaluation, laboratory monitoring and causality assessment using the Naranjo scale (score 7) were performed. Carbamazepine was discontinued and replaced with levetiracetam along with supportive therapy.

Discussion: Temporal association, clinical features and improvement after drug withdrawal confirmed carbamazepine induced DRESS with hepatic involvement.

Conclusion: The study concludes that early recognition and discontinuation of the offending drug are crucial to prevent serious complications and ensure a favourable recovery.

Regenerative Endodontic Treatment of an Immature Permanent Tooth with Trauma-Induced Arrested Root Development: A Case Report

Hazal Faiz Arslanparcasi — 2026-04-25

Pulpal necrosis in permanent teeth with trauma-induced incomplete root development complicates treatment planning because of the presence of an open apex and thin dentinal walls. This case report aimed to evaluate the clinical and radiographic outcomes of regenerative endodontic treatment performed in a maxillary left central incisor with trauma-induced incomplete root development. In a 16-year-old female patient, an open apex, arrested root development, and periapical pathology were identified in tooth #21. Regenerative endodontic treatment, including canal disinfection, calcium hydroxide medication, induction of apical bleeding, and placement of a coronal barrier with MTA NeoPUTTY, was performed. At the 6- and 9-month follow-ups, the patient remained asymptomatic, and radiographic findings indicated continued root development. Regenerative endodontic treatment may be considered an effective approach for managing permanent teeth with trauma-induced incomplete root development.

Induction of Prolonged Cushing’s Syndrome Due to Prolonged Therapeutic Use of Corticosteroids

Aneena Sabu — 2026-04-28

Background: The long-term ingestion of external corticosteroids can lead to iatrogenic Cushing’s syndrome and are known to be adverse drug reactions that are prevented. There are many nonspecific symptoms associated with iatrogenic Cushing’s syndrome that often mimic other dermatologic or systemic conditions and may therefore go undetected. If there has been long-term use of an external corticosteroid, there are also considerations if the external corticosteroid is withdrawn suddenly. It can lead to a delayed crisis.

Case Report: 53-year-old hypertensive female patient presented with skin thickening and hyperpigmentation over the abdomen and the lower extremities; generalized pruritus; exertional dyspnea; weakness; recent history of a chest pain; and fall. The patient reported medical history of taking chronic non-steroidal anti-inflammatory medication and external corticosteroids for joint pain. Clinical examination showed pallor, mild pedal edema, hypertension, skin atrophy, and scaliness. When laboratory tests were performed, low serum cortisol levels, concentric left ventricular hypertrophy with diastolic dysfunction Grade I, mild anemia, thrombocytopenia, hyperbilirubinemia, and mild renal impairment were obtained.

Treatment/ Results: The patient was treated with antihypertensives, supportive care, gradual tapering of steroids and dermatology consult.

Conclusion: This case demonstrates that there is chronic adrenal suppression from due to long-term exposure of corticosteroids. Low cortisol level confirms the diagnosis of Cushing’s syndrome due to exogenous steroid use as compared to endogenous causes. In the evaluation of abnormal skin or systemic changes, always ask the patient about use of corticosteroids; it is important to taper corticosteroids appropriately so sudden withdrawal does not result in a crisis

Atypical Presentation of Metformin- induced Lactic Acidosis in a Patient with Normal Renal Function: A Case Report

S. Vidya — 2026-05-12

Elevated lactate levels and high anion gap metabolic acidosis are hallmarks of Metformin-associated lactic acidosis, a rare but potentially fatal complication of Metformin therapy. Although the incidence of MALA is low, it carries a significantly high mortality rate, particularly in cases where diagnosis and treatment are delayed. Early recognition is therefore essential to improve clinical outcomes and reduce the risk of fatality.

MALA is most commonly associated with underlying conditions such as sepsis, hypoxia, or renal impairment, all of which can impair lactate clearance and exacerbate metabolic disturbances. However, it is important to note that MALA can also occur in the absence of these traditional risk factors, making diagnosis more challenging. This highlights the need for clinicians to maintain a high index of suspicion even in atypical presentations.

In this case, a patient with type 2 diabetes mellitus who had been receiving long-term metformin therapy presented with symptoms including nausea, vomiting, and altered mental status following a short episode of fever. Despite having normal renal function, laboratory investigations revealed severe metabolic acidosis, with a blood pH of less than 7.2 and markedly elevated lactate levels. These findings are consistent with a diagnosis of MALA, suggesting that metformin accumulation or altered metabolism may have contributed to the condition.

The probable cause of the patient’s metabolic disturbance was attributed to metformin, despite the absence of common predisposing factors such as renal dysfunction. This case underscores the importance of recognising that MALA can develop even in patients who appear clinically stable and do not exhibit typical risk factors. Timely identification and intervention are therefore critical in preventing severe complications and improving patient outcome.

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.