Background: Stroke is a rare but serious complication of malaria, especially with Plasmodium falciparum infection as a result of cerebral vessels obstruction by the parasitized red blood cells. Prompt recognition in malaria patients presenting with neurological symptoms is essential for effective management. Case Presentation: A 32-year-old male with no prior cardiovascular risk factors developed acute neurological symptoms after treatment for confirmed malaria. Brain imaging showed multifocal ischemic infarcts. Comprehensive investigations excluded common causes of stroke, including hypertension, diabetes, coagulopathies, and cardiac sources of embolism as well as vasculitis. The close timing between malaria infection and strokes, along with the absence of alternative explanations, supported a diagnosis of malaria-associated ischemic stroke. The patient continued antimalarial therapy and received supportive care including physiotherapy. Over subsequent day, neurological deficits gradually improved with rehabilitation. Conclusion: Malaria-induced stroke, though uncommon, should be considered in young patients presenting with acute neurological deficits in endemic areas. Early diagnosis and... Continue Reading

Background: Bladder leiomyoma is an uncommon, benign, smooth-muscle neoplasm that can closely resemble a urachal remnant when located at the anterior bladder or dome. Imaging findings may overlap substantially with urachal remnants or other lesions and definitive diagnosis often requires surgical excision, especially in symptomatic patients or when malignancy cannot be excluded. Bladder leiomyoma arising at the bladder dome is particularly uncommon and may radiographically mimic urachal pathology, creating diagnostic uncertainty and affecting preoperative decision-making. Case Presentation: A 45-year-old woman presented with approximately six months of suprapubic discomfort and progressive stress-predominant urinary incontinence. Pelvic MRI demonstrated a 3 cm anterior/dome lesion favored to represent a urachal remnant. Cystoscopy showed an invaginating dome mass with intact mucosa, limiting the utility of transurethral biopsy. Given persistent symptoms, non-diagnostic imaging, and the inability to exclude a urachal remnant, the patient underwent robotic-assisted partial cystectomy with en bloc excision of the dome lesion and a... Continue Reading

Background Amoxicillin, a commonly used broad-spectrum antibiotic, can crystallize in renal tubules when administered at high doses, causing acute amoxicillin-induced crystal nephropathy (AICN). This condition typically presents with acute kidney injury (AKI) and macroscopic hematuria. Risk factors include high dosage, rapid infusion, dehydration, and low urinary pH. Although urine microscopy can confirm amoxicillin crystals, it is underutilized, contributing to underrecognition of AICN.   Case Report We present the case of a 75-year-old woman with fever and cellulitis, diagnosed with native aortic valve endocarditis due to Streptococcus dysgalactiae. She was treated with high-dose intravenous amoxicillin (6 × 2 g/day). On day two, she developed macroscopic hematuria and progressive AKI, eventually requiring temporary hemodialysis. Urine microscopy revealed elongated amoxicillin crystals, confirming the diagnosis of AICN. Amoxicillin was discontinued and replaced with continuous penicillin G infusion. Renal function recovered markedly within one week, allowing discontinuation of dialysis.   Discussion This case highlights the... Continue Reading

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Recurrent Hypocalcemic Tetany in children is an important clinical feature of pseudohypoparathyroidism encompassing a spectrum of rare endocrine disorders characterised by end-organ resistance to parathyroid hormone (PTH). We report a case of a 10-year-old girl with genetically confirmed PHP Type 1a and 1c, presenting with classical features including recurrent hypocalcemic tetany, short stature, and mild intellectual delay. Notably, the child exhibited additional findings of primary hypothyroidism, celiac disease, positive autoimmune markers (ANA, SSA/Ro, Ro-52), congenital heart disease (ventricular septal defect), and Müllerian duct anomalies — features rarely reported in conjunction with pseudohypoparathyroidism. The whole spectrum of these findings cant be explained by GNAS mutation hence underscoring the importance of a multidisciplinary approach and highlights the possibility of blended or complex syndromes when atypical features co-occur in rare monogenic conditions. Continue Reading

Background: Croup is a common pediatric respiratory illness characterized by a barking cough, inspiratory stridor, and hoarseness resulting from upper airway narrowing. While most cases are of viral etiology, spasmodic croup can be triggered by non-infectious factors such as allergy, gastroesophageal reflux disease, or psychological stress.Case Presentation: We describe a previously healthy with no significant past medical history 10-year-old girl, with multiple presentations to the emergency department with persistent hiccups accompanied by inspiratory stridor with the classic “steeple sign”. Her clinical course suggested overlapping mechanisms, including reflux-related and stress-related functional triggers, as her symptoms improved with proton-pump inhibition and corticosteroids. Conclusion: This case illustrates an unusual presentation of recurrent spasmodic croup with persistent hiccups, likely multifactorial in origin. Awareness of atypical features may help in early identification and improve patient outcomes. Continue Reading

Antecedentes: La enfermedad de Kikuchi-Fujimoto (EKF) se ha reportado con mayor frecuencia en países asiáticos. Su curso clínico suele ser transitorio, con resolución espontánea en 1 a 4 meses; sin embargo, algunos pacientes pueden experimentar recurrencias. Presentación del caso: Un varón de 18 años con antecedentes de convulsiones febriles en la infancia presentó un mes de fiebre persistente, malestar general, exantema y linfadenopatía dolorosa generalizada. Al ingreso, estaba taquicárdico, febril y exhibía pancitopenia significativa. Los estudios infecciosos y el panel de sepsis fueron negativos, mientras que los reactantes de fase aguda estaban elevados. La TC reveló linfadenopatía sistémica y hepatoesplenomegalia. Dada la sospecha de linfoma o linfadenitis tuberculosa, se realizó una biopsia de ganglio linfático, que demostró linfadenitis necrosante compatible con la enfermedad de Kikuchi-Fujimoto. Debido a la asociación conocida con lupus eritematoso sistémico, se ampliaron las pruebas inmunológicas, revelando anticuerpos anti-ADN bicatenario elevados y criterios EULAR/ACR positivos, confirmando KFD... Continue Reading

Background: Poorly controlled type 2 diabetes mellitus (T2DM) increases the risk of severe respiratory infections and pulmonary complications, including lung abscesses and cavitary lesions. In tuberculosis-endemic regions, these findings are often initially attributed to tuberculosis, which may delay the diagnosis and management of other relevant infectious etiologies. Case Presentation: We report a case series of two patients with poorly controlled T2DM who developed pulmonary cavitations in the right upper lung lobe following non-tuberculous infectious processes. The first case involved a 22-year-old woman with a recent dengue infection who developed a cavitary pneumonia without signs of sepsis and showed a favorable clinical course with conservative management using intravenous antibiotics. The second case was a 68-year-old man with T2DM and chronic obstructive pulmonary disease, initially treated for community-acquired pneumonia, who subsequently developed severe diabetic ketoacidosis, septic shock, and extensive pulmonary cavitation, requiring intensive care unit admission, broad-spectrum intravenous antibiotics, and surgical lobectomy.... Continue Reading

Background: Schwannomas are benign peripheral nerve sheath tumours arising from Schwann cells and are uncommon in the upper limb. Median nerve schwannomas constitute approximately 0.1–0.3% of all hand tumours, and extensive involvement of the median nerve by multiple schwannomas across multiple joints is exceptionally rare. Differentiating schwannoma from neurofibroma on imaging can be challenging. Case Presentation: A patient presented with a painful palpable mass along the flexor aspect of the right forearm extending from the elbow to the distal interphalangeal joint. Clinical examination demonstrated a mobile mass with a positive Tinel’s sign along the median nerve distribution. Magnetic resonance imaging revealed a longitudinally extensive lesion along the median nerve but could not reliably differentiate schwannoma from neurofibroma. A core needle biopsy confirmed schwannoma with Antoni A and Antoni B areas and strong S-100 positivity. Complete surgical excision with preservation of the median nerve was performed, resulting in excellent functional recovery.... Continue Reading

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis frequently associated with systemic inflammatory diseases. We aimed to describe systemic disease associations, management strategies and outcomes of PG managed in internal medicine. We retrospectively reviewed all patients treated for PG in our department between January 2021 and December 2025 and extracted demographic, clinical, histologic, treatment and outcome data from medical records. Ten patients (5 women; mean age 38.2 years) were included. Ulcerative PG predominated (6/10) and 4 patients had pustular PG; lesions mainly involved the lower limbs and pathergy was observed in 5 patients. An associated systemic disease was identified in 8 patients, including Behçet disease, inflammatory bowel disease, systemic sclerosis, ANCA-associated vasculitis, systemic lupus erythematosus and Takayasu arteritis. All patients received systemic corticosteroids; additional immunosuppressants or anti-TNFα therapy were used as steroid-sparing treatments and/or to control the underlying systemic disease. Six patients achieved complete healing without relapse, whereas four experienced... Continue Reading

Objective: Reconstruction of large-segment tibial bone defects caused by osteomyelitis or fracture nonunion remains a major clinical challenge in orthopedic surgery, with the core demand of balancing mechanical stability and biological osseointegration. 3D-printed porous tantalum prostheses have emerged as a novel biomaterial for bone defect repair due to their bionic mechanical properties and excellent biocompatibility, and their combination with the Masquelet induced membrane technique (IMT) is expected to improve the therapeutic effect of large bone defects. However, clinical evidence of this combined strategy for tibial defect reconstruction is still insufficient. Methods: A series of six patients with large tibial bone defects treated in our hospital from December 2021 to December 2023 were retrospectively analyzed, including 1 case of osteomyelitis-induced defect and 5 cases of nonunion-induced defect. All patients received two-stage surgical treatment based on CARE guidelines: Stage I was debridement + vancomycin-loaded PMMA spacer implantation to induce membrane formation; Stage... Continue Reading

Academic publishing is meant to reward scientific merit, methodological rigor, and originality. Yet in closely connected academic communities, professional hierarchies and name recognition can influence how research is received. In parts of Indian psychiatric publishing, there is a growing perception that manuscripts linked to well-known senior academicians or prominent institutions are more likely to be accepted. Whether fully accurate or not, this belief itself reflects a trust deficit within the system. Such dynamics rarely involve overt rule-breaking. Instead, they may arise from informal networks, editorial familiarity, and limited transparency in decision-making. The consequences can discourage early-career researchers and restrict the diversity of ideas entering the literature. Strengthening double-blind review, improving transparency around editorial decisions, and broadening conflict-of-interest disclosures may help restore confidence. A publication system that is visibly fair is essential for maintaining credibility and fostering genuine academic growth. Continue Reading

Background: Isolated cerebral mucormycosis is a rare, life-threatening infection, usually occurring in immunocompromised hosts but also reported in people with intravenous drug use, with a predilection for the basal ganglia. Case Presentation: A 30-year-old previously healthy man with a history of intravenous drug use presented with new-onset generalized seizures, altered mental status, and left-sided hemiplegia. Magnetic resonance imaging showed a 4.4 × 4.3 × 5.1 cm ring-enhancing mass in the right basal ganglia with extension into the thalamus and temporal lobe and mild midline shift. Stereotactic biopsy with conservative debulking revealed a fungal abscess; Gomori methenamine silver staining demonstrated broad pauci-septate hyphae with irregular right-angle branching, supporting a diagnosis of cerebral mucormycosis. He was treated with liposomal amphotericin B and isavuconazole, followed by prolonged oral isavuconazole. Complete excision was not feasible because of the deep lesion location. Conclusion: Follow-up magnetic resonance imaging at 16 weeks showed reduction in lesion size... Continue Reading