Journal of Rawalpindi Medical College
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Topical Steroid Misuse: An Unrecognized Cause Of Iatrogenic Cushing Syndrome In Infancy
Full text linkCushing’s syndrome represents a condition of excess cortisol activity, arising either from internal overproduction or external administration of glucocorticoids, leading to a wide range of clinical features.1 Cushing’s syndrome in infancy is rare and most often iatrogenic. We report an infant who presented with rapid-onset weight gain and hypertrichosis due to chronic application of an over-the-counter steroid-containing ointment for diaper rash. Recognition of exogenous steroid exposure allowed timely withdrawal and clinical recovery. This case highlights the importance of medication history and the regulation of topical corticosteroid sales in resource-limited developing countries.
Keywords: Cushing Syndrome; Glucocorticoids; Administration, Topical; Infant; Iatrogenic Disease; Adrenal Insufficienc
Postpartum Secondary PPH Leading to Diagnosis of Choriocarcinoma: A Case Report
Full text linkSummary: One uncommon but extremely aggressive kind of gestational trophoblastic neoplasia (GTN) is postpartum choriocarcinoma. Its clinical manifestation frequently resembles typical subsequent postpartum hemorrhage sources, which could impede identification and raise maternal morbidity.
Case Presentation:
A woman with a history of three prior cesarean sections appeared with recurring severe vaginal bleeding. Twelve days after an emergency cesarean delivery, Conservative management was started after an initial examination revealed retained products of conception. However, hypovolemic shock caused the patient's condition to worsen. Suspicion of GTN was raised by significantly high levels of β-human chorionic gonadotropin (β- hCG) in the serum and pelvic magnetic resonance imaging. An urgent surgical procedure was carried out since the bleeding was potentially fatal.
Keywords: Postpartum Hemorrhage, beta-Human Chorionic Gonadotropin, Cesarean Section, Choriocarcinoma, Gestational Trophoblastic Neoplasi
Primary AL Amyloidosis Presenting with Macroglossia and Spontaneous Chest Wall Ecchymosis in a Young Male
Full text linkWe report the case of a 35-year-old male who presented with progressive macroglossia associated with dysarthria and worsening dyspnea with no accompanying stridor, dysphagia, or features suggestive of acromegaly; however, the patient specifically reported difficulty pronouncing words starting with the letter “R.” Clinical examination revealed evidence of both cardiac and pulmonary involvement. Comprehensive investigations were conducted to rule out alternative causes of macroglossia. An abdominal fat pad biopsy demonstrated Congo red positivity with apple-green birefringence under polarized light, confirming the diagnosis of primary AL amyloidosis.⁴ The patient was initiated on chemotherapy, stabilized, and subsequently referred to the oncology department for outpatient follow-up.
Keywords: Immunoglobulin Light-chain Amyloidosis, Macroglossia, Ecchymosis
A Hidden Pigment, A Damaged Joint: The Ochronotic Knee - A Case Report
Full text linkOchronotic arthropathy (alkaptonuria) is a rare hereditary disorder that poses a diagnostic dilemma. It is usually diagnosed perioperatively or by conducting investigations based on perioperative findings in the postoperative period, followed by retrospective analysis. This report discusses a case of a 37-year-old male who presented with bilateral knee pain. Radiological studies were indicative of grade III osteoarthritis but perioperatively black pigmentation was noted. Backtracking revealed it to be a case of alkaptonuria. This typically presents as early-onset osteoarthritis involving major joints like the knee, hip, shoulder, and spine. Orthopedic surgeons should have an inquisitive mind and keep this as their differential diagnosis while dealing with young patients with similar symptoms to avoid surprises during surgery. Our study aims to increase understanding of this condition for effective management and improving functional outcomes.
Keywords: Alkaptonuria, Ochronosis, Osteoarthritis, Rare Diseas
Exploring the Intricacies and Clinical Perspectives of Chronic Diarrhea: A Case Report
Full text linkCrohn’s disease (CD) is a chronic inflammatory disorder that may affect any segment of the gastrointestinal tract, with a predilection for the terminal ileum and colon. It commonly presents chronic diarrhea, abdominal pain, and per rectal (PR) bleeding. We report the case of a gentleman who experienced recurrent diarrhea and PR bleeding, initially managed as infective colitis but subsequently diagnosed with Crohn’s disease following colonoscopy and histopathological confirmation. He was treated successfully with corticosteroids for induction and azathioprine for maintenance therapy. This case emphasizes the need to consider Crohn’s disease as a differential diagnosis in patients with chronic diarrhea and PR bleeding, particularly in regions where infectious causes are more prevalent, and may delay diagnosis.
Keywords: diarrhea, disease, bleeding
Unmasking The Culprit: Recurrent Nosebleeds From Masson’s Tumor
Full text linkMasson’s tumor, also called Intravascular papillary endothelial hyperplasia (IPEH), is a benign condition affecting various parts of the body; nonetheless, sinonasal cavity involvement is uncommon.
We present the case of a 32-year-old male who experienced recurrent epistaxis and frontal headaches for 13 years. Despite multiple nasal surgeries, his symptoms persisted without a confirmed diagnosis. Physical examination revealed numerous adhesions near the middle turbinate, which were more pronounced on the left side. A contrast-enhanced CT scan revealed a heterogeneously enhancing soft-tissue lesion in the left maxillary sinus that extended into the nasal cavity, with erosion of the sinus walls. Histopathology confirmed Masson’s tumor. The patient underwent several surgeries, including lateral rhinotomy and excision of a fleshy mass in the maxillary cavity. One-year post-surgery, there was no recurrence or re-bleeding.
IPEH of the sinonasal region should be part of the differential diagnosis of recurrent epistaxis; otherwise, it can present an ENT surgeon with a diagnostic conundrum.
Keywords: Nasal cavity, Epistaxis, Maxillary sinus, Nasal surgical procedures, Vascular malformation
Budd–Chiari Syndrome Secondary to Burkitt’s Lymphoma in a 5-Year-Old Child
Full text linkWe report a rare case of Budd–Chiari syndrome secondary to Burkitt’s lymphoma in a 5-year-old male presenting with jaundice and abdominal pain. The case highlights the diagnostic challenges in pediatric patients presenting with hepatomegaly and cholestatic jaundice, and emphasizes the importance of considering underlying malignancy in atypical cases of hepatic venous outflow obstruction.
Keywords: Burkitt lymphoma, Budd Chiari syndrome, venous thromboembolism/ etiolog
Otosclerosis: presentation,diagnosis and management
Full text linkHearing loss profoundly affects quality of life, limiting communication, social interaction, and occupational performance. It is also associated with emotional distress, social isolation, and an increased risk of cognitive decline when left untreated. This case report describes a young male presenting to the ENT OPD with progressive hearing loss in bilateral ear. After exclusion of all associated symptoms and previous history, etiology was sought via otoscopy, revealing a perfectly mobile and normal-looking tympanic membrane. PTA and tympanometry revealed bilateral carhart notch and A-type curve on tympanometry, respectively, making the diagnosis of clinical otosclerosis. Patient underwent exploratory tympanotomy and Stapedotomy with a prosthesis. Follow-up PTA showed closure of air bone gap.
Otosclerosis, though benign, is twice as common in females than male. This case illustrates the classical presentation of otosclerosis in a male patient and highlights the role of keen history taking and high clinical suspicion in a male patient where otosclerosis is often missed as a differential diagnosis of progressive hearing loss, resulting in diagnostic delay, making it a clinical rarity, and hence it is selected as a case report.
Keywords: Otosclerosis, Deafness, Quality Of Life, Tympanic Membran
Laparoscopic Management of a Giant Paratubal Cyst: A Case Report
Full text linkLarge paratubal cysts are uncommon benign adnexal lesions that can closely resemble ovarian cysts on both clinical and radiologic assessment. Their laparoscopic excision can be technically demanding, particularly when fertility preservation is desired. We describe a 24-year-old woman who presented with gradually increasing abdominal distension and right lower abdominal pain. Imaging revealed a 25 × 15 × 10 cm right-sided adnexal cyst with the ovary draped over its surface, suggesting a paratubal origin. All tumor markers were within normal limits. Laparoscopic cystectomy with controlled decompression was carried out, and all pelvic organs were preserved. Histopathology confirmed a benign paratubal cyst. The postoperative course was smooth, and the patient was discharged the next day. This case demonstrates that, with careful preoperative evaluation and meticulous surgical technique, laparoscopy can be safely and effectively used even for very large paratubal cysts.
Keywords: Paratubal cyst, Broad ligament cyst, Laparoscopic cystectomy, Giant adnexal mass, Fertility preservation
Post-abortion septic pelvic thrombophlebitis with right ovarian vein thrombosis complicated by septic pulmonary emboli
Full text linkSeptic pelvic thrombophlebitis (SPT) is an uncommon but important cause of persistent fever after delivery or gynaecological procedures1. Anticoagulation and parenteral antibiotics are the main treatment goals for ovarian vein thrombosis.2 Ovarian vein thrombosis (OVT) may complicate and lead to septic pulmonary embolism (SPE).3A woman in her early 20s presented with high-grade fever and right iliac fossa pain seven days after an induced abortion. Her fever persisted despite 72 hours of broad-spectrum intravenous antibiotics. Contrast-enhanced abdominopelvic computed tomography (CT) revealed a right OVT. Subsequent CT pulmonary angiography confirmed multiple peripheral, partly cavitating nodules consistent with SPE. She was successfully treated with optimized antimicrobial therapy and therapeutic anticoagulation. Fever abated, and interval imaging confirmed thrombus regression. She completed a three-month course of anticoagulation and remained well at follow-up with radiological resolution of pulmonary lesions. SPT should be suspected when postpartum or post-abortion fever fails to respond to adequate antibiotics. Prompt diagnosis with cross-sectional imaging and combined antimicrobial-anticoagulant therapy are essential to prevent complications and ensure a good outcome.
Keywords: Ovarian Vein; Thrombophlebitis; Ovarian Venous Thrombosis; Septic Pulmonary Embolism; Puerperal Disorders