BMJ Case Rep
· 2026 Jun · PMID 42315245
·
Publisher ↗
Percussive massage guns are increasingly available in society, yet the risk of improper use is under-recognised. We report an unusual case of bilateral retinal tears and dialysis in a student who used a high-frequency pe...Percussive massage guns are increasingly available in society, yet the risk of improper use is under-recognised. We report an unusual case of bilateral retinal tears and dialysis in a student who used a high-frequency percussive massage gun directly onto his eyes and around his orbit to relieve tiredness. Despite no ocular history, examination revealed extensive retinal tears and commotio retinae (retinal bruising) in both eyes. The patient was treated successfully with barrier laser therapy. This rare presentation highlights the potential for significant retinal injury. It also underscores the need for cautious massage gun use, careful history taking in unexpected clinical scenarios and clear manufacturer warnings against improper application.
BMJ Case Rep
· 2026 Jun · PMID 42315244
·
Publisher ↗
Subacute thyroiditis is an inflammatory thyroid disorder that typically presents with anterior neck pain, thyroid tenderness and transient thyrotoxicosis. Presentation as pyrexia of unknown origin (PUO) without classical...Subacute thyroiditis is an inflammatory thyroid disorder that typically presents with anterior neck pain, thyroid tenderness and transient thyrotoxicosis. Presentation as pyrexia of unknown origin (PUO) without classical thyroid symptoms is uncommon and may lead to diagnostic delay.We report a case of a patient in their late 50s who presented with persistent evening febrile spikes, weight loss and markedly elevated inflammatory markers, fulfilling the criteria for PUO. Extensive evaluation for infectious, malignant and autoimmune causes was unrevealing. Careful repeat clinical examination revealed mild thyroid enlargement, prompting thyroid function testing, which demonstrated suppressed thyroid-stimulating hormone with elevated thyroid hormone levels. Technetium-99m thyroid scintigraphy showed markedly reduced uptake, consistent with subacute thyroiditis.The patient was treated with corticosteroids, resulting in rapid defervescence of fever within 48 hours. This case highlights that subacute thyroiditis, although uncommon, should be considered in patients presenting with persistent unexplained fever and elevated inflammatory markers, even in the absence of classical thyroid symptoms.
BMJ Case Rep
· 2026 Jun · PMID 42315243
·
Publisher ↗
Autoimmune small-vessel cerebral vasculitis is an uncommon but potentially reversible cause of rapidly progressive cognitive and neurological decline. Its presentation can be heterogeneous, often mimicking vascular, infe...Autoimmune small-vessel cerebral vasculitis is an uncommon but potentially reversible cause of rapidly progressive cognitive and neurological decline. Its presentation can be heterogeneous, often mimicking vascular, infectious or degenerative processes. Hyponatraemia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) may occur as a secondary manifestation of hypothalamic involvement or systemic inflammation, compounding neurological dysfunction and complicating management. We describe a middle-aged woman who developed acute cognitive deterioration, emotional lability and gait disturbance secondary to newly diagnosed autoimmune small-vessel vasculitis with serological evidence of systemic autoimmunity, on a background of prior polyautoimmune diseases (type 1 diabetes mellitus and hypothyroidism). Despite resolution of inflammatory activity following high-dose corticosteroid therapy, profound hyponatraemia (serum sodium 110-120 mmol/L) persisted despite conventional measures (fluid restriction, salt supplementation and urea) and despite improvement in inflammatory activity following immunotherapy, consistent with refractory SIADH. Initiation of tolvaptan, a selective vasopressin V-receptor antagonist, successfully resulted in gradual and sustained correction of serum sodium levels without over-rapid correction, osmotic demyelination or hepatic toxicity. Alongside longer-term immunosuppression with steroids and cyclophosphamide, this led to stabilisation of neurological and cognitive deficits. This case highlights the complexities of managing patients with cognitive and neuropsychiatric sequelae from autoimmune small-vessel central nervous system (CNS) vasculitis and the importance of evaluation and treatment of potential organic causes of cognitive impairment. To our knowledge, there are no prior published reports describing refractory SIADH in autoimmune small-vessel CNS vasculitis requiring V-receptor antagonism. Awareness of this disease association and this effective therapeutic option allows earlier recognition and improved patient outcomes in similar cases.
BMJ Case Rep
· 2026 Jun · PMID 42315242
·
Publisher ↗
Traumatic displacement of the eyeball into the paranasal sinuses is an exceptionally uncommon sequelae following head injury, particularly when the orbit is the site of major impact. We present a case of a ruptured globe...Traumatic displacement of the eyeball into the paranasal sinuses is an exceptionally uncommon sequelae following head injury, particularly when the orbit is the site of major impact. We present a case of a ruptured globe dislocation into the ethmoid sinus with extensive bilateral orbital fractures in a male in his early 20s, following a high-velocity motor vehicle (two-wheeler) road traffic accident 3 weeks ago. He also sustained a right optic canal fracture with encephalocele, which led to traumatic optic neuropathy. The case was managed through a multidisciplinary staged surgical approach. The delayed presentation led to globe devitalisation, necessitating enucleation followed by orbital wall reconstruction and prosthetic rehabilitation. Subsequently, the encephalocele was surgically repaired. This case differs from earlier reports because it involves a unique combination of globe rupture and luxation of the left eye with encephalocele and optic canal fracture, inducing direct traumatic optic neuropathy of the right eye.
Rai DK, Sharma P, Talwar D
… +5 more, Pal S, Sinha S, Swati S, Singh N, Dabral C
BMJ Case Rep
· 2026 Jun · PMID 42309563
·
Publisher ↗
Visceral leishmaniasis (VL) is a systemic parasitic disease that predominantly involves the reticuloendothelial system, with pulmonary involvement being distinctly uncommon, particularly in individuals who are immunocomp...Visceral leishmaniasis (VL) is a systemic parasitic disease that predominantly involves the reticuloendothelial system, with pulmonary involvement being distinctly uncommon, particularly in individuals who are immunocompetent. We report a case of a middle-aged female who was immunocompetent presenting with acute hypoxaemic respiratory failure, characterised by progressive dyspnoea, bilateral lung consolidation and pleural effusion, initially mimicking severe pulmonary infection or haematological malignancy. The presence of pancytopenia, hypergammaglobulinaemia and massive hepatosplenomegaly raised suspicion of an underlying systemic disorder. Definitive diagnosis was established by demonstration of amastigotes in splenic aspirate, with further confirmation of direct pulmonary involvement through identification of intracellular amastigotes within alveolar macrophages on a transbronchial lung biopsy. The patient showed significant clinical and radiological improvement following treatment with liposomal amphotericin B and miltefosine. This case highlights that VL can rarely present with primary pulmonary manifestations even in immunocompetent hosts. It underscores the importance of considering VL in the differential diagnosis of unexplained pulmonary infiltrates with systemic features in endemic regions and demonstrates that histopathological confirmation from lung tissue can be crucial in establishing pulmonary involvement in atypical presentations.
BMJ Case Rep
· 2026 Jun · PMID 42309562
·
Publisher ↗
A man in his mid 60s with a history of resected primary cutaneous melanoma then developed metastatic mutant disease involving lymph nodes, liver and bone. He was unable to tolerate 2 months in total of BRAF/MEK inhibito...A man in his mid 60s with a history of resected primary cutaneous melanoma then developed metastatic mutant disease involving lymph nodes, liver and bone. He was unable to tolerate 2 months in total of BRAF/MEK inhibitor therapy because of multiple toxicities and subsequently developed progression while off therapy. During this time, he underwent surgical aortic valve replacement for severe aortic stenosis with coronary artery bypass grafting. The latter procedure was complicated by an infection. Unexpectedly, post-operative restaging imaging demonstrated complete resolution without further anti-cancer therapy. The patient has remained in complete remission on surveillance alone for more than 6 years. Two years after surgery, he developed a new honeybee venom allergy, suggesting an alteration in immune responsiveness. This case highlights a rare and durable regression of metastatic melanoma temporally associated with major surgery and supports the hypothesis that surgery-associated systemic immune activation may contribute to long-term tumour control.
Burgos Bustamante LG, Bravo Quelle N, Báez Arold C
BMJ Case Rep
· 2026 Jun · PMID 42309561
·
Publisher ↗
We present a case of sleep-related facio-mandibular myoclonus (FMM) in a man in the third decade of life with recurrent tongue-biting episodes during sleep onset. Video-polysomnography and video-electroencephalogram reve...We present a case of sleep-related facio-mandibular myoclonus (FMM) in a man in the third decade of life with recurrent tongue-biting episodes during sleep onset. Video-polysomnography and video-electroencephalogram revealed myoclonic jaw jerks without epileptiform activity. The episodes were associated with stress and improved with clonazepam and non-pharmacological interventions. This case highlights sleep-related FMM as a rare, under-recognised cause of sleep-related tongue biting, distinct from epilepsy and bruxism. Early diagnosis through neurophysiological studies is crucial to prevent misdiagnosis and ensure accurate treatment.
Teixeira MM, Vieira B, Belinha A
… +1 more, Costa É
BMJ Case Rep
· 2026 Jun · PMID 42303440
·
Publisher ↗
Acute hypoxaemic respiratory failure is frequently attributed to primary pulmonary pathology, particularly in the presence of radiographic abnormalities and inflammatory markers. Cardiac conditions, however, may present...Acute hypoxaemic respiratory failure is frequently attributed to primary pulmonary pathology, particularly in the presence of radiographic abnormalities and inflammatory markers. Cardiac conditions, however, may present with similar features and lead to diagnostic error. We report the case of a man in his early 60s admitted with acute hypoxaemic respiratory failure, initially diagnosed with severe community-acquired pneumonia on the basis of unilateral chest opacity and an apparent inflammatory response. Despite empirical antibiotic therapy, his respiratory status deteriorated. Bedside echocardiography identified acute severe mitral regurgitation due to rupture of the posterior mitral leaflet chordae tendineae. Targeted medical management was initiated, followed by definitive surgical repair with full clinical recovery. This case highlights the potential for acute valvular disease to mimic pulmonary infection and the importance of early echocardiographic assessment in patients with unexplained respiratory failure.
Zubair FK, Karthik YS, Gogineni R
… +1 more, Colaco SM
BMJ Case Rep
· 2026 Jun · PMID 42303439
·
Publisher ↗
Pleomorphic adenoma of the lacrimal gland is a benign epithelial neoplasm and can rarely undergo cystic degeneration, mimicking other conditions with similar radiological findings. It commonly presents as a slow growing,...Pleomorphic adenoma of the lacrimal gland is a benign epithelial neoplasm and can rarely undergo cystic degeneration, mimicking other conditions with similar radiological findings. It commonly presents as a slow growing, painless mass in the outer upper eyelid, characterised by exophthalmos, ptosis, diplopia and reduced ocular movements. Here, we present one such case of a male in his mid-30s presenting with a painless, progressive fullness in the left upper eyelid with mild proptosis and restricted ocular movements which was initially suspected to be due to an underlying dermoid cyst owing to the cystic nature of the lesion on imaging. Surgical intervention involving complete excision was preferred, rendering no recurrence on follow-up. Histopathological examination however revealed microscopic features suggestive of a pleomorphic adenoma with cystic changes contrary to the initial diagnosis of a dermoid cyst. This case highlights the challenges faced in arriving at the right diagnosis with successful treatment outcomes.
H H, Mahshook A, Ahmedabadi WM
… +1 more, Jaiprakash P
BMJ Case Rep
· 2026 Jun · PMID 42303438
·
Publisher ↗
Cervical vagal schwannomas are rare benign nerve sheath tumours that present diagnostic and management challenges due to slow growth and proximity to vital neck structures. Fine-needle aspiration cytology (FNAC) may be u...Cervical vagal schwannomas are rare benign nerve sheath tumours that present diagnostic and management challenges due to slow growth and proximity to vital neck structures. Fine-needle aspiration cytology (FNAC) may be unreliable and lead to misdiagnosis, whereas MRI is the preferred modality for accurate evaluation and surgical planning. A woman in her early 50s presented with a painless, slow-growing mass at the right mandibular angle, initially diagnosed as pleomorphic adenoma on FNAC and managed conservatively. Eleven months later, she developed exertional dizziness and sought reassessment. MRI revealed a large right carotid space lesion suggestive of a vagal schwannoma. Surgical excision confirmed the diagnosis. This case highlights the diagnostic limitations of cytology, the importance of MRI and the risk of significant postoperative complications necessitating thorough counselling and multidisciplinary care.
BMJ Case Rep
· 2026 Jun · PMID 42303437
·
Publisher ↗
Craniometaphyseal dysplasia is a rare sclerosing bone disorder that may be difficult to recognise in early childhood. We report a patient initially evaluated in the toddler period for macrocephaly and craniofacial dysmor...Craniometaphyseal dysplasia is a rare sclerosing bone disorder that may be difficult to recognise in early childhood. We report a patient initially evaluated in the toddler period for macrocephaly and craniofacial dysmorphism, in whom early neuroimaging was unremarkable, supporting the diagnosis of macrocephaly of infancy. During early childhood, following head trauma, incidental radiological findings revealed progressive cranial sclerosis. Persistent macrocephaly and craniofacial features prompted further investigation, leading to the diagnosis of craniometaphyseal dysplasia, confirmed by identification of a pathogenic variant. The patient was subsequently enrolled in long-term multidisciplinary follow-up. Into early adulthood, cranial features remained, metabolic parameters remained stable, sensorineural hearing loss did not progress and no neurological or visual complications developed. This case illustrates how the condition may remain unrecognised when early imaging appears reassuring and highlights the importance of revisiting diagnostic impressions when clinical features persist or evolve. Early recognition and coordinated follow-up may help prevent irreversible complications and support favourable long-term outcomes.
BMJ Case Rep
· 2026 Jun · PMID 42303436
·
Publisher ↗
A patient in their early 40s presented with a bilateral gradual painless decrease in vision. Best-corrected visual acuity (BCVA) was 20/40p OD and 20/20 OS. Tomography using Pentacam (OCULUS) demonstrated a bilateral cla...A patient in their early 40s presented with a bilateral gradual painless decrease in vision. Best-corrected visual acuity (BCVA) was 20/40p OD and 20/20 OS. Tomography using Pentacam (OCULUS) demonstrated a bilateral claw-like appearance on keratometry maps with inferior peripheral thinning, suggestive of pellucid marginal corneal degeneration (PMCD). Given the patient's age is more typical for PMCD and the crab-claw pattern, a diagnosis of PMCD was made. Vision and tomography were stable over 2 years. At year 3, OD developed Vogt's striae and Fleischer's ring with tomography showing increased inferior steepening and loss of the characteristic vertical 'flat' band between inferior lobes; BCVA was 20/50 OD and 20/20p in OS. The diagnosis was revised to inferior keratoconus (KC) OD and epithelium-off collagen cross-linking (CXL). Progressive inferior KC can present in the fifth decade of life, and a case of early inferior KC at this age is likely to get misdiagnosed as PMCD due to the crab-claw appearance.
BMJ Case Rep
· 2026 Jun · PMID 42297430
·
Publisher ↗
Painful tonic spasms (PTS) are paroxysmal, stereotyped, painful episodes of involuntary posturing typically associated with demyelinating or structural lesions within the corticospinal tract. We report a case of PTS in t...Painful tonic spasms (PTS) are paroxysmal, stereotyped, painful episodes of involuntary posturing typically associated with demyelinating or structural lesions within the corticospinal tract. We report a case of PTS in temporal association with a COVID-19 infection, most likely attributable to post-infectious neuroinflammation. A woman in her 40s developed frequent, disabling, painful spasms of the left extremities 2 weeks after a COVID-19 infection. An MRI of the brain revealed a solitary contrast-enhancing T2/fluid-attenuated inversion recovery hyperintense ovoid lesion in the right cerebral peduncle. Comprehensive cerebrospinal fluid and serum evaluation, including demyelinating and autoimmune panels, was unremarkable. A 24-hour electroencephalogram capturing three episodes showed no electrographic abnormalities. Symptoms resolved following a short course of high-dose intravenous methylprednisolone and long-term oxcarbazepine. Serial imaging over 2 years demonstrated an interval decrease in lesion size and complete resolution of contrast enhancement, most consistent with a monophasic post-infectious inflammatory aetiology.
Santhanam HS, Shetty S, Shetty S
… +1 more, H B SD
BMJ Case Rep
· 2026 Jun · PMID 42297429
·
Publisher ↗
Acute leukaemia complicates 1 in 75 000 pregnancies and poses therapeutic challenges due to the teratogenic risks of chemotherapy during organogenesis. We report a case of a woman in her early 30s (adolescent/young adult...Acute leukaemia complicates 1 in 75 000 pregnancies and poses therapeutic challenges due to the teratogenic risks of chemotherapy during organogenesis. We report a case of a woman in her early 30s (adolescent/young adult (AYA) population) at 8 weeks of gestation who presented with fatigue. Peripheral blood smear suggested acute lymphoblastic leukaemia (ALL) and diagnostic tests confirmed pro B-cell type ALL. Medical termination of pregnancy was performed as per the International Federation of Gynaecology and Obstetrics guidelines due to first-trimester teratogenicity risks, followed by intrathecal methotrexate for central nervous system prophylaxis and induction as per the modified Berlin-Frankfurt-Münster regimen, a paediatric-inspired protocol selected for AYA efficacy. She achieved complete remission post-induction, with minimal residual disease <0.01% by flow cytometry and remained on maintenance therapy. This highlights the need for multidisciplinary management, psychological support for fertility and grief counselling. While first-trimester termination minimises fetal risks, continuing pregnancy with the incorporation of safer agents, such as vincristine and corticosteroids, post-organogenesis has yielded positive maternal-fetal outcomes in reported cases.
BMJ Case Rep
· 2026 Jun · PMID 42297426
·
Publisher ↗
Contained rupture of a mycotic abdominal aortic aneurysm (AAA) is rare and potentially fatal. While most cases involve or , is an uncommon cause.A man in his early 60s presented with acute prostatitis and a prostatic...Contained rupture of a mycotic abdominal aortic aneurysm (AAA) is rare and potentially fatal. While most cases involve or , is an uncommon cause.A man in his early 60s presented with acute prostatitis and a prostatic abscess. Abdominal ultrasound incidentally revealed a 3.8 cm infrarenal saccular AAA suspicious for contained rupture. Contrast-enhanced CT confirmed focal aortic wall disruption without active extravasation. Intravenous ceftriaxone and vancomycin were initiated, and serial imaging demonstrated stability. After infection control, endovascular aneurysm repair (EVAR) with an Endurant II stent graft was successfully performed. Recovery was uneventful and the patient completed targeted antibiotic therapy.This case illustrates an unusual presentation of -associated mycotic aneurysm detected before frank rupture. Early imaging, infection control and multidisciplinary coordination enabled a staged strategy with a favourable outcome.
BMJ Case Rep
· 2026 Jun · PMID 42297425
·
Publisher ↗
Pancreatic neuroendocrine tumours (pNETs) are rare and can be difficult to manage due to their variable presentations. Surgical resection remains the standard treatment for symptom control and reduced risk of recurrence....Pancreatic neuroendocrine tumours (pNETs) are rare and can be difficult to manage due to their variable presentations. Surgical resection remains the standard treatment for symptom control and reduced risk of recurrence. Minimally invasive robotic surgery has become an alternative to open approaches due to its enhanced three-dimensional visualisation and precision. Most documented cases, however, involve solitary tumours or multifocal disease in patients with genetic syndromes such as MEN-1. We present the case of a woman in her 20s who underwent robotic subtotal pancreatectomy for multifocal pNETs, without evidence of an underlying genetic syndrome. After an uneventful postoperative recovery, the patient was discharged home on day 3. This case contributes to the limited descriptive literature on the presentation and surgical management of sporadic insulinomas.
BMJ Case Rep
· 2026 Jun · PMID 42297424
·
Publisher ↗
A woman aged in her 50s presented with sudden onset of vertigo, headaches and epistaxis, initially attributed to her background of chronic systemic hypertension. Ophthalmological history was significant for bilateral pro...A woman aged in her 50s presented with sudden onset of vertigo, headaches and epistaxis, initially attributed to her background of chronic systemic hypertension. Ophthalmological history was significant for bilateral proliferative diabetic retinopathy and retinal detachment managed with vitrectomy, endolaser and intraocular silicone oil 5 years prior to the current presentation. Review of the initial non-contrast CT by our neuroradiology department identified right subretinal silicone oil, tracking along the subarachnoid space of the right optic sheath, right suprasellar cistern and non-dependent lateral ventricles. Initially interpreted as acute haemorrhage at an external facility, the patient underwent repeat imaging over a period of 6 months that failed to demonstrate expected temporal resolution of blood products. A subsequent unifying diagnosis of disseminated subarachnoid and intraventricular silicone oil was established. The following case highlights the relevant clinical history when requesting imaging and pertinent radiological findings when reporting patients postretinal detachment surgery.