Medical Case Report Library

5 CARE-guideline compliant case reports · International journal publishing standard

  • General MedicineRare Disease
    BMJ Case Reports

    Catastrophic Antiphospholipid Syndrome Precipitated by SARS-CoV-2 Infection in a Young Indian Female: A Diagnostic and Therapeutic Challenge

    Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome characterised by simultaneous multi-organ thrombosis within a short period. COVID-19 has been reported as a precipitating trigger, but cases from Indian populations remain extremely scarce.

    Learning points

    • –CAPS should be suspected in any patient with simultaneous multi-organ thrombosis occurring within one week, particularly post-COVID-19
    • –Triple-positive antiphospholipid antibodies (LA + aCL + anti-β2GPI) identify the highest-risk aPL profile
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  • General SurgeryRare Anatomy
    Journal of Medical Case Reports

    Meckel's Diverticulitis Mimicking Acute Appendicitis with Concurrent Ectopic Pancreatic Tissue: An Intraoperative Surprise and Review of Surgical Approach

    Meckel's diverticulitis is the most common complication of Meckel's diverticulum, affecting approximately 4–6% of individuals. It can mimic acute appendicitis clinically and radiologically, and diagnosis is rarely established preoperatively. The coexistence of ectopic pancreatic tissue within a Meckel's diverticulum is an exceptionally rare pathological finding with fewer than 50 cases reported in world literature.

    Learning points

    • –Always explore 60–90 cm of terminal ileum when a normal appendix is found intraoperatively — Meckel's diverticulitis is the most common alternate diagnosis
    • –CT findings of RIF inflammation without a separately visible normal appendix should raise suspicion for Meckel's pathology
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  • PaediatricsRare Paediatric
    Indian Pediatrics

    Neonatal Marfan Syndrome Presenting as Severe Aortic Regurgitation and Mitral Valve Prolapse in a Term Neonate: A Diagnostic and Cardiothoracic Surgical Challenge

    Neonatal Marfan syndrome (nMFS) is an exceptionally severe, early-onset phenotype of FBN1-related disorders presenting in the first month of life with cardiovascular, skeletal, and ocular manifestations. Unlike classic Marfan syndrome, nMFS carries a very poor prognosis with most deaths occurring within the first year of life due to rapidly progressive cardiac failure. We report a rare case of nMFS in an Indian neonate with severe aortic regurgitation requiring urgent valvular intervention.

    Learning points

    • –A dysmorphic neonate with refractory cardiac failure, aortic root dilatation (Z-score >3), and arachnodactyly should prompt urgent FBN1 gene testing for neonatal Marfan syndrome
    • –nMFS mutations are predominantly in exons 24–32 but exon 47 cysteine-altering variants can also produce the neonatal phenotype
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  • Obstetrics & GynaecologyRare Obstetric
    Journal of Obstetrics and Gynaecology Research

    Spontaneous Heterotopic Pregnancy with Simultaneous Intrauterine and Interstitial Ectopic Gestation in a Woman Without Assisted Reproduction: Successful Laparoscopic Management and Intrauterine Pregnancy Salvage

    Heterotopic pregnancy — the simultaneous occurrence of intrauterine and ectopic pregnancy — has an estimated incidence of 1 in 30,000 in spontaneous conceptions, rising to 1 in 100–500 with assisted reproductive technologies. Interstitial (cornual) ectopic pregnancy is particularly dangerous, accounting for 2–4% of all ectopics, with rupture causing massive haemorrhage and a mortality rate up to 2.5%. We report a rare case of spontaneous heterotopic interstitial ectopic pregnancy managed laparoscopically with successful preservation of the intrauterine pregnancy.

    Learning points

    • –Always systematically examine bilateral adnexa on TVUS even after identifying an intrauterine pregnancy — heterotopic pregnancy can be missed
    • –The 'interstitial line sign' on TVUS has 98% specificity for interstitial ectopic pregnancy and should be specifically sought
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  • CardiologyRare Cardiac
    European Heart Journal – Case Reports

    Kounis Syndrome Type II Triggered by Fluoroquinolone Antibiotic in a Patient with Pre-Existing Coronary Artery Disease: Anaphylaxis-Induced Acute Stent Thrombosis

    Kounis syndrome (KS) is the concurrence of acute coronary syndrome with allergic or hypersensitivity reactions. Type II KS occurs in patients with pre-existing coronary artery disease in whom allergen exposure causes coronary vasospasm superimposed on pre-existing atherosclerotic plaque, or in-stent thrombosis. Fluoroquinolones are recognised triggers but published cases of fluoroquinolone-induced Kounis Type II with stent thrombosis are extremely rare.

    Learning points

    • –Simultaneous urticaria/angioedema with chest pain or ST-elevation in a cardiac patient should immediately trigger consideration of Kounis syndrome
    • –Elevated serum tryptase (>11.4 ng/mL) within 1–3 hours is diagnostic of mast-cell degranulation and supports Kounis syndrome diagnosis
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