Anjum R, Abdulsalam R, Francis S
… +1 more, Mbaideen S
BMJ Case Rep
· 2026 Jun · PMID 42285591
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Hidradenoma papilliferum (HP) is a rare benign adnexal tumour arising from apocrine or mammary-like glands, most commonly in the vulvar region. We report a case of a woman in her early 30s who presented with sudden left-...Hidradenoma papilliferum (HP) is a rare benign adnexal tumour arising from apocrine or mammary-like glands, most commonly in the vulvar region. We report a case of a woman in her early 30s who presented with sudden left-sided vulvar pain and postcoital bleeding secondary to a long-standing nodule that had remained asymptomatic for 3 years. Examination revealed a firm mobile mass on the left labia minora. The lesion was excised under local anaesthesia, and histopathology confirmed HP with characteristic papillary and glandular features. Postoperative recovery was uneventful with no recurrence at 6 months. This case highlights the diagnostic challenge of HP, which may mimic more common vulvar cysts, and underscores the importance of histopathological evaluation to ensure accurate diagnosis and appropriate management.
Wiltshire S, Shrestha A, Timma Subramanian K
… +1 more, Boland G
BMJ Case Rep
· 2026 Jun · PMID 42285590
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Breast abscesses are localised infections that can be lactational or non-lactational. Non-lactational abscesses are more often associated with less common bacteria. We describe a case of as the causative bacteria of a n...Breast abscesses are localised infections that can be lactational or non-lactational. Non-lactational abscesses are more often associated with less common bacteria. We describe a case of as the causative bacteria of a non-lactational breast abscess. Resistance to amoxicillin was noted, and recurrence occurred despite multiple treatments with appropriate antibiotics. Definitive management required incision and drainage of the abscess. Our literature review shows 22 total cases of being isolated from breast abscesses, with only 9.1% of cases confirming full susceptibility to all tested antibiotics. Resistance to at least one antibiotic was seen in 45.5% of cases. The literature shows that rates of antibiotic resistance in are rising, and therefore, monitoring of antibiotic resistance in these patients may be indicated. Culture and sensitivity should be encouraged as this may guide management options for recurrent breast abscesses.
Kovacevic M, Bešenji I, Jarakovic M
… +7 more, Radonjic J, Stefanovic M, Crnomarkovic B, Keca S, Dimic S, Bjelica S, Srdanovic I
BMJ Case Rep
· 2026 Jun · PMID 42285589
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We describe the case of a previously healthy adolescent female who presented with chest discomfort and near-syncope, accompanied by trifascicular block and hypotension. Her clinical condition rapidly progressed to cardio...We describe the case of a previously healthy adolescent female who presented with chest discomfort and near-syncope, accompanied by trifascicular block and hypotension. Her clinical condition rapidly progressed to cardiogenic shock with neurological impairment. Despite multiple attempts, transvenous pacing failed to achieve consistent ventricular capture. Flecainide intoxication was subsequently confirmed through toxicological analysis. The patient was managed with invasive ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), sodium bicarbonate and intravenous lipid emulsion therapy, resulting in full neurological and cardiac recovery following a prolonged intensive care unit stay. Flecainide overdose is rare but associated with high mortality due to profound conduction abnormalities and shock. Early recognition and timely escalation to advanced mechanical circulatory support, including VA-ECMO, are critical for survival.Learning points. Prompt identification and advanced haemodynamic support are lifesaving in severe flecainide intoxication, clinicians should consider VA-ECMO early in refractory cases.
Stephen M, Kaliaperumal S, Temkar S
… +1 more, Sahi A
BMJ Case Rep
· 2026 Jun · PMID 42285588
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Treatment of glaucoma is directed towards controlling intraocular pressure (IOP) and the options are many, starting from medical therapy to cyclodestructive surgeries. Drainage devices are a treatment option for glaucoma...Treatment of glaucoma is directed towards controlling intraocular pressure (IOP) and the options are many, starting from medical therapy to cyclodestructive surgeries. Drainage devices are a treatment option for glaucoma with a visual prognosis and have a major advantage of long-term success in controlling IOP and better tolerability. The Aurolab Aqueous Drainage Implant (AADI) is devised from a prototype Baerveldt implant. Numerous complications have been reported with the AADI; however, chronic inflammation so far is very rare. In our report, significant uveitis was noted in a patient with primary open-angle glaucoma post failed trabeculectomy after implantation of the AADI, resulting in the formation of annular synechiae and neovascularisation of the iris. There was poor compliance with medications and loss to follow-up owing to COVID-19 restrictions for more than a year. The patient was meticulously managed by intracameral anti-VEGF and synechiae release coupled with cataract extraction and intraocular lens implantation under the cover of steroids.Through this case, we want to emphasise the need for patient compliance towards postoperative medications and, to our knowledge, such dense inflammation following implantation of the AADI has not been reported.
BMJ Case Rep
· 2026 Jun · PMID 42270149
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A unique case of chromoblastomycosis, a chronic subcutaneous fungal infection, involving the maxillary sinus-a site rarely affected by this organism. The case highlights the diagnostic challenge posed by its non-specific...A unique case of chromoblastomycosis, a chronic subcutaneous fungal infection, involving the maxillary sinus-a site rarely affected by this organism. The case highlights the diagnostic challenge posed by its non-specific clinical features, often mimicking chronic rhinosinusitis or neoplastic lesions. Histopathological examination revealed characteristic sclerotic (Medlar) bodies, confirming the diagnosis. Surgical debridement combined with prolonged antifungal therapy led to successful resolution. This report emphasises the importance of considering rare fungal aetiologies like chromoblastomycosis in atypical presentations of fungal sinusitis, especially in immunocompetent individuals.
BMJ Case Rep
· 2026 Jun · PMID 42270148
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Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder characterised by pulmonary cysts, recurrent spontaneous pneumothorax, cutaneous lesions and an increased risk of renal tumours. Pulmonary manifestations...Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder characterised by pulmonary cysts, recurrent spontaneous pneumothorax, cutaneous lesions and an increased risk of renal tumours. Pulmonary manifestations often precede other features, leading to delayed recognition. We report the case of a non-smoking male in his early 60s who presented with recurrent left-sided spontaneous pneumothorax and exertional dyspnoea. Cutaneous examination revealed multiple acrochordons over the neck. Chest imaging demonstrated pneumothorax, and high-resolution CT of the thorax showed a left upper lobe bulla with multiple bilateral thin-walled pulmonary cysts with basal predominance. The patient underwent bullectomy and surgical pleurodesis. Histopathology revealed thin-walled cysts lined by normal respiratory epithelium without smooth muscle proliferation, and HMB-45 immunostaining was negative, excluding lymphangioleiomyomatosis. Serum alpha-1 antitrypsin levels were normal. Genetic analysis identified a heterozygous pathogenic frameshift variant (c.1285delC) in the FLCN gene, confirming the diagnosis of BHD syndrome. The postoperative course was uneventful, and renal surveillance and family counselling were initiated. This case underscores the importance of considering BHD syndrome in non-smokers presenting with recurrent pneumothorax and cystic lung disease, as early diagnosis facilitates appropriate surveillance and genetic evaluation.
Edwards N, McBride D, Castonguay M
… +1 more, Wallace A
BMJ Case Rep
· 2026 Jun · PMID 42270147
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Mucoid impaction of the bronchi is an uncommon benign condition that can closely mimic pulmonary malignancy on imaging. A woman in her 50s with a remote history of chest wall chondrosarcoma presented with chest pain and...Mucoid impaction of the bronchi is an uncommon benign condition that can closely mimic pulmonary malignancy on imaging. A woman in her 50s with a remote history of chest wall chondrosarcoma presented with chest pain and was found to have a new pulmonary mass with satellite nodules. Computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) findings raised concern for metastatic disease or primary lung cancer. Given the radiological suspicion and the patient's oncological history, surgical resection was undertaken. Intraoperative lymph node sampling was negative for malignancy. Histopathological examination of the lung specimen demonstrated dense mucoid impaction with eosinophils and Charcot-Leyden crystals, with no evidence of neoplasia. This case highlights the limitations of imaging alone in differentiating benign from malignant pulmonary lesions and reinforces the importance of histopathological confirmation before definitive oncological management.
Restrepo M, Weltz C, Green S
… +2 more, Lamb A, Fasano J
BMJ Case Rep
· 2026 Jun · PMID 42270146
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We present the case of radiation recall dermatitis (RRD) induced by ibrutinib therapy in a patient with a history of breast cancer and non-Hodgkin lymphoma. There is currently only one other reported case of Bruton's tyr...We present the case of radiation recall dermatitis (RRD) induced by ibrutinib therapy in a patient with a history of breast cancer and non-Hodgkin lymphoma. There is currently only one other reported case of Bruton's tyrosine kinase (BTK) inhibitor therapy-induced RRD in a patient with breast cancer and chronic lymphocytic leukaemia. This case highlights a potentially under-recognised risk of RRD associated with BTK inhibitors, emphasising the need for further research to clarify its pathophysiology and incidence in this treatment context. A deeper understanding of the dermatological side effects of BTK inhibitors can help providers better anticipate, recognise and manage patient symptoms.
BMJ Case Rep
· 2026 Jun · PMID 42270145
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Otalgia in adults is often secondary to non-otologic pathology, particularly with normal otoscopic examination. Auriculotemporal neuralgia (ATN) is a rare and overlooked cause of secondary otalgia. We present a case of a...Otalgia in adults is often secondary to non-otologic pathology, particularly with normal otoscopic examination. Auriculotemporal neuralgia (ATN) is a rare and overlooked cause of secondary otalgia. We present a case of an Army veteran with chronic right otalgia and dizziness following blast-related mild traumatic brain injury who was initially diagnosed with vestibular migraine. Despite significant improvement in headache symptoms with migraine-directed preventive and abortive treatments, otalgia persisted. Auriculotemporal nerve block produced complete but short-lived pain relief, confirming ATN. Cryoneurolysis of the auriculotemporal nerve resulted in complete resolution of otalgia for 2-3 months after first and second treatments. However, transient worsening of tinnitus, ear pressure and dizziness also occurred but eventually returned to baseline. This case highlights cryoneurolysis as a potential therapeutic option for refractory ATN-related otalgia.
Aljunied I, Malima T, Waters C
… +3 more, Richards K, Abd Elwahab SM, Barry K
BMJ Case Rep
· 2026 Jun · PMID 42270144
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Invasive ductal carcinoma of the breast is known to typically metastasise to the lungs, liver, bone and brain, with subcutaneous soft tissue involvement being rare, with only eight cases reported internationally. We repo...Invasive ductal carcinoma of the breast is known to typically metastasise to the lungs, liver, bone and brain, with subcutaneous soft tissue involvement being rare, with only eight cases reported internationally. We report the case of a woman with a history of left-sided invasive ductal carcinoma treated with a mastectomy and adjuvant therapy, who presented 7 years later with a 2.8 cm subcutaneous lesion over the contralateral shoulder. Histopathological examination and immunohistochemistry confirmed metastatic invasive ductal carcinoma, displaying a morphological and receptor profile congruent with her primary tumour. This case highlights the potential for late and atypical metastatic presentations of breast cancer and underlines the importance of maintaining diagnostic vigilance in long-term survivors.
Yousuf MS, Samad K, Gazdar MH
… +2 more, Mohsin M, Islam S
BMJ Case Rep
· 2026 Jun · PMID 42264940
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Left cardiac sympathetic denervation (LCSD) via video-assisted thoracoscopy (VATS) is an effective therapy for drug-refractory malignant arrhythmias in congenital long QT syndromes and requires meticulous perioperative p...Left cardiac sympathetic denervation (LCSD) via video-assisted thoracoscopy (VATS) is an effective therapy for drug-refractory malignant arrhythmias in congenital long QT syndromes and requires meticulous perioperative planning in children with automatic implantable cardioverter-defibrillators (AICDs). We describe what is likely the first paediatric VATS-LCSD performed in Pakistan. A boy in early childhood with Jervell and Lange-Nielsen syndrome, severe QT prolongation and recurrent ventricular arrhythmias despite beta-blockade and mexiletine had received multiple AICD shocks. Intraoperative management focused on preventing electrocautery-induced AICD activation by applying a magnet to suspend antitachycardia therapies, using external defibrillation pads and ensuring continuous electrophysiology support. Anaesthesia incorporated sevoflurane, dexmedetomidine, cisatracurium and lidocaine, with one-lung ventilation achieved by intentional endobronchial tracheal tube placement. Thoracoscopic excision of the left sympathetic chain (T5-T1), including the lower stellate, was completed uneventfully. The child was extubated in the operating room and discharged the next day without complications.
BMJ Case Rep
· 2026 Jun · PMID 42264548
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Giant cell arteritis (GCA) is a medical emergency due to the high risk of permanent vision loss. It occurs most often in people of northern European ancestry, with a global prevalence of approximately 50-52 cases per 100...Giant cell arteritis (GCA) is a medical emergency due to the high risk of permanent vision loss. It occurs most often in people of northern European ancestry, with a global prevalence of approximately 50-52 cases per 100 000 individuals aged 50 years and older. Distinguishing GCA from infectious processes can be challenging as both may produce constitutional symptoms and elevated acute-phase reactants. Septic emboli mimic GCA by causing transient or permanent visual disturbances and retinal lesions. This case report underscores the importance of ophthalmological evaluation to differentiate GCA from its mimics and ensure appropriate, safe management.
BMJ Case Rep
· 2026 Jun · PMID 42264547
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A male in his late teens presented with acute respiratory distress, subcutaneous emphysema and a pneumothorax in the setting of necrotising pulmonary tuberculosis. Imaging demonstrated a thick-walled cavitary lesion in t...A male in his late teens presented with acute respiratory distress, subcutaneous emphysema and a pneumothorax in the setting of necrotising pulmonary tuberculosis. Imaging demonstrated a thick-walled cavitary lesion in the right upper lung with direct communication to the pleural space, consistent with a severe bronchopleural fistula (BPF) causing continuous air leak and loss of effective ventilation. Despite intercostal drainage, antimicrobial therapy and lung-protective ventilation, the patient's condition deteriorated due to persistent ventilatory compromise. Bronchoscopic evaluation identified a mural defect in the right main bronchus. A silicone endobronchial spigot was deployed as an endoluminal patch, resulting in immediate cessation of the air leak, improved respiratory mechanics and clinical improvement. The patient remained stable on antitubercular therapy with no recurrence of the leak at follow-up. This case highlights the value of bronchoscopic spigot occlusion as a practical and minimally invasive solution for central BPF in critically ill patients.
Bouhamdi C, Baybay H, Hammas N
… +4 more, Douhi Z, Soughi M, Elloudi S, Mernissi FZ
BMJ Case Rep
· 2026 Jun · PMID 42259574
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Dermal sinus tracts (DST) are rare epithelial-lined anomalies, typically located along the midline and diagnosed in early life. Cutaneous leishmaniasis (CL), although endemic in many regions, rarely involves non-exposed...Dermal sinus tracts (DST) are rare epithelial-lined anomalies, typically located along the midline and diagnosed in early life. Cutaneous leishmaniasis (CL), although endemic in many regions, rarely involves non-exposed sites or congenital structural anomalies. To our knowledge, no prior report has described CL occurring within a latent lateral DST.We present the case of a woman in her mid-50s with a chronic draining gluteal lesion whose induration and dermoscopic features mimicked a keratinising tumour. Her history revealed a previous lesion 20 years earlier, adjacent to the current lesion site and likewise characterised by chronic discharge; it had spontaneously resolved, leaving an atrophic scar. Clinical and parasitological evaluations confirmed CL, while histological examination of the excised specimen demonstrated a chronic fistulous tract, consistent with a dermal sinus tract in the appropriate clinical and surgical context, without granulomas or malignancy. Dermoscopic findings included central erosion, starburst-like structures, polymorphous vessels and white halos, evolving over time despite parasitological cure. Surgical excision revealed a blind-ended, non-communicating sinus tract with chronic inflammatory remodelling.This case illustrates how a dormant congenital anomaly may function as a localised immunocompromised cutaneous district, creating a permissive microenvironment for parasitic colonisation. It also highlights the diagnostic complexity generated by overlapping dermoscopic features. Awareness of such rare presentations is crucial in endemic areas to ensure accurate diagnosis and prompt management.
BMJ Case Rep
· 2026 Jun · PMID 42259573
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We report an adolescent girl with genetically confirmed Bardet-Biedl syndrome complicated by end-stage renal disease, epilepsy, psychomotor delay and cardiac anomalies. During intensive care for postictal coma and presum...We report an adolescent girl with genetically confirmed Bardet-Biedl syndrome complicated by end-stage renal disease, epilepsy, psychomotor delay and cardiac anomalies. During intensive care for postictal coma and presumed sepsis, she received phenobarbital, amoxicillin-clavulanic acid and ceftriaxone. Four days after admission, she developed acute generalised exanthematous pustulosis, marked by febrile erythroderma with numerous sterile, non-follicular pustules predominantly involving major flexural areas. Laboratory findings showed neutrophilic leucocytosis, eosinophilia and profound thrombocytopenia, precluding skin biopsy. The clinical chronology, morphology and biological features supported a definite diagnosis, with a EuroSCAR score of 9. Suspected medications were withdrawn, pharmacovigilance reporting was performed and supportive dermatological care was initiated. The cutaneous eruption improved, with regression of pustules and residual desquamation; however, the patient deteriorated and died of refractory septic shock.
Yanai AI, Horiuchi M, Kaiwa Y
… +2 more, Shibuya R, Fukuda K
BMJ Case Rep
· 2026 Jun · PMID 42259572
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Riedel's thyroiditis is an extremely rare fibrosing inflammatory disorder that extends beyond the thyroid capsule into surrounding structures. The disease usually progresses slowly; however, we report an unusual case wit...Riedel's thyroiditis is an extremely rare fibrosing inflammatory disorder that extends beyond the thyroid capsule into surrounding structures. The disease usually progresses slowly; however, we report an unusual case with rapid progression that closely mimicked malignancy.An Asian woman in her 50s developed throat discomfort, hoarseness and a neck mass within 1 month. Laryngoscopy revealed left vocal cord paresis. Ultrasonography demonstrated a rapidly enlarging hypoechoic mass and fine-needle aspiration cytology suggested possible malignancy. Total thyroidectomy with lymph node dissection was, therefore, performed. Histopathological examination revealed dense fibrosis and obliterative phlebitis, consistent with Riedel's thyroiditis. The patient's hoarseness improved postoperatively, and she remains well 2.5 years later on levothyroxine monotherapy.This case illustrates that Riedel's thyroiditis can rarely present with acute progression and recurrent laryngeal nerve palsy, closely mimicking thyroid cancer. Early surgical intervention provided both a definitive diagnosis and effective treatment.
Khurana S, Kumar V, Adil M
… +2 more, Raj N, Dubey VR
BMJ Case Rep
· 2026 Jun · PMID 42259571
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A woman in her 30s presented with acute flaccid paraparesis secondary to severe hypokalaemia. She had a known history of hypertension controlled on amlodipine and bisoprolol. Biochemical workup revealed metabolic alkalos...A woman in her 30s presented with acute flaccid paraparesis secondary to severe hypokalaemia. She had a known history of hypertension controlled on amlodipine and bisoprolol. Biochemical workup revealed metabolic alkalosis, renal potassium loss, suppressed plasma renin activity and markedly elevated aldosterone levels. CT imaging identified a left adrenal adenoma consistent with an aldosterone-producing adenoma. The patient underwent laparoscopic adrenalectomy, after which she no longer required antihypertensive medication and maintained normal serum potassium. This case highlights a reversible but often under-recognised cause of secondary hypertension presenting with hypokalaemic paraparesis.
Rajbhar S, Kodumuri L, Thakur P
… +1 more, Verma AK
BMJ Case Rep
· 2026 Jun · PMID 42248602
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Takayasu arteritis, which is also known as aortic arch syndrome, non-specific aortoarteritis and pulseless disease, is a rare chronic inflammatory progressive large vessel vasculitis of likely autoimmune aetiology causin...Takayasu arteritis, which is also known as aortic arch syndrome, non-specific aortoarteritis and pulseless disease, is a rare chronic inflammatory progressive large vessel vasculitis of likely autoimmune aetiology causing narrowing, occlusion and aneurysms of systemic and pulmonary arteries, especially the aorta and its branches, afflicting women of childbearing age. It is an uncommon disease with an estimated annual incidence rate of 1.2-2.6 per million. Hypertension is the the most common mode of presentation. Based on site and extent, it is divided into five types as type I (branches of aortic arch), type II (aortic arch, its branches and descending thoracic aorta), type III (descending thoracic aorta and abdominal aorta), type IV (abdominal aorta only) and type V (aortic arch, descending thoracic aorta and abdominal aorta). Therapeutic modalities include medical (antihypertensive, steroids, cyclophosphamide, etc) as well as surgical interventions.