BMJ Case Rep
· 2026 May · PMID 42215065
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Mixed drug overdose presents a complex and potentially unpredictable clinical course, particularly in the presence of comorbidities that may alter drug metabolism, half-life and pharmacodynamic effects. We report a man i...Mixed drug overdose presents a complex and potentially unpredictable clinical course, particularly in the presence of comorbidities that may alter drug metabolism, half-life and pharmacodynamic effects. We report a man in his 50s presenting with reduced consciousness, Glasgow Coma Scale (GCS) 11, requiring oxygen therapy after ingesting 100 mg diazepam, 1200 mg pregabalin and suspected co-ingestion of zopiclone and gabapentin. Flumazenil produced rapid but transient improvement. However, fluctuating consciousness persisted, with further deterioration in GCS on day 8 that again responded to flumazenil. He had liver fibrosis and a raised body mass index (33 kg/m²). Investigations revealed hyperammonaemia, mild diffuse encephalopathy on electroencephalogram (EEG) and faecal retention. CT head was unremarkable.The prolonged clinical course was likely multifactorial, reflecting synergistic central nervous system depressant effects in the context of polypharmacy, hepatic dysfunction, hyperammonaemia and obesity. This case highlights the importance of recognising mixed overdose and comorbid modifiers in prolonged complex toxic presentations.
Sneddon M, Shepherd R, Monaghan A
… +1 more, Little B
BMJ Case Rep
· 2026 May · PMID 42215064
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We describe a case of a gentleman in his late 70s with left ureteric injury secondary to insertion of a urethral catheter into the left ureter. The resulting left ureteric injury required emergency percutaneous nephrosto...We describe a case of a gentleman in his late 70s with left ureteric injury secondary to insertion of a urethral catheter into the left ureter. The resulting left ureteric injury required emergency percutaneous nephrostomy (PCN) insertion.This patient presented acutely to the urology service with haematuria and presumed urinary tract infection owing to a pre-existing bladder cancer diagnosis. A urethral catheter was inserted on admission for monitoring urine output and when his urethral catheter was noted to be blocked with clot overnight it was changed to a larger catheter.An 18Ch catheter was inserted and he experienced pain on balloon inflation. Owing to his background and presentation, a repeat staging CT scan was performed, which identified that the catheter balloon was inflated in the mid left ureter.The catheter was removed and within 4 hours the patient began reporting severe left abdominal pain with localised tenderness on examination. A CT urogram revealed a urine leak secondary to a left mid-ureteric injury. He was transferred the following morning to the regional centre for PCN.
Janani K, Govindhraj S, Premraj K
… +3 more, Sethi P, Agarwal A, Jadhav AS
BMJ Case Rep
· 2026 May · PMID 42215063
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Epidural catheters are commonly used to provide effective postoperative analgesia and are usually removed without difficulty. We report a case of unexpected resistance during removal of an epidural catheter in an obese a...Epidural catheters are commonly used to provide effective postoperative analgesia and are usually removed without difficulty. We report a case of unexpected resistance during removal of an epidural catheter in an obese adolescent patient. After several unsuccessful manoeuvres, including positional changes and saline flushing, further blind traction was avoided to reduce the risk of catheter fracture or neurological injury. Imaging was done to identify the aetiology, which revealed looping of the catheter in the paraspinal muscular plane. After multidisciplinary discussion, the clinical team adopted a carefully planned and minimally invasive approach with surgical backup. The catheter was successfully removed under local infiltration anaesthesia without complications. This case demonstrates the importance of careful evaluation when resistance is encountered and highlights how imaging techniques can assist in clarifying the underlying mechanism. Based on this experience and existing literature, we outline a pragmatic stepwise approach that may assist clinicians when managing similar situations.
Lee C, Schadt J, Leesley H
… +3 more, Ng T, Maslow A, Chen TH
BMJ Case Rep
· 2026 May · PMID 42215062
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Intraoperative tracheobronchial injury is an uncommon but potentially life-threatening complication during thoracic surgery. We present two cases: one female patient in her 70s and another female patient in her 40s sched...Intraoperative tracheobronchial injury is an uncommon but potentially life-threatening complication during thoracic surgery. We present two cases: one female patient in her 70s and another female patient in her 40s scheduled for robotic right upper and lower lobectomy respectively. Both cases were complicated by iatrogenic injuries to the left mainstem bronchus requiring repair. Successful management of the unanticipated iatrogenic injuries required ongoing communication and coordination between the anaesthesiologist and surgeon and a shift in ventilation strategies to adapt to surgical conditions and allow repair while maintaining a closed chest approach.
BMJ Case Rep
· 2026 May · PMID 42215061
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Laryngeal mucormycosis is an uncommon form of fungal laryngitis that typically affects immunocompromised individuals. We report a rare such case in a male in his 40s who had recently recovered from severe acute respirato...Laryngeal mucormycosis is an uncommon form of fungal laryngitis that typically affects immunocompromised individuals. We report a rare such case in a male in his 40s who had recently recovered from severe acute respiratory syndrome-coronavirus disease-19 (SARS CoV-2 infection-COVID 19) and presented with a 1-month history of worsening hoarseness, haemoptysis, and noisy breathing. A chewing gum-like subglottic necrotic mass was biopsied. The rarity of the diagnosis was aided by histopathological and microbial study of the mass, which confirmed mucormycosis. Management included surgical debulking, intravenous liposomal amphotericin B and oral posaconazole followed by staged management of subglottic stenosis.
Bedia Cadelo J, García Feijoo P, Zamorano-Fernandez J
… +1 more, Isla Guerrero A
BMJ Case Rep
· 2026 May · PMID 42215060
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A boy in his early teens presented with transient visual disturbances and headache. Brain imaging revealed bilateral occipital infarctions, while vascular studies demonstrated bilateral V3 vertebral artery wall abnormali...A boy in his early teens presented with transient visual disturbances and headache. Brain imaging revealed bilateral occipital infarctions, while vascular studies demonstrated bilateral V3 vertebral artery wall abnormalities with pseudoaneurysm formation associated with C1-C2 rotatory subluxation. Initial conservative management, including resting and a rigid cervical brace, failed to prevent vascular progression. The patient underwent posterior C1-C2 fixation to address the underlying mechanical cause. Follow-up CT angiography 1 year after surgery demonstrated complete resolution of the pseudoaneurysm and near-normalisation of both vertebral artery walls. At 18 months of follow-up, he remained asymptomatic, with no recurrent ischaemic events and no progression of the pre-existing visual deficit. This case highlights the importance of considering dynamic atlantoaxial instability in children with posterior circulation strokes and supports surgical stabilisation as definitive etiological treatment in selected cases.
Rana B, Bhutani H, Lakhanpal M
… +2 more, Srivastava S, Sharma A
BMJ Case Rep
· 2026 May · PMID 42215059
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Inflammatory myofibroblastic tumour (IMT), also known as Inflammatory Myofibroblastoma, is a rare, benign yet aggressive lesion that often mimics malignancy. Histologically, it is composed of spindle-shaped myofibroblast...Inflammatory myofibroblastic tumour (IMT), also known as Inflammatory Myofibroblastoma, is a rare, benign yet aggressive lesion that often mimics malignancy. Histologically, it is composed of spindle-shaped myofibroblasts and chronic inflammatory infiltrates. Immunohistochemistry shows positive staining for smooth muscle actin and anaplastic lymphoma kinase, aiding in diagnosis.Typically found in the lungs, mesentery, and mammary glands, its occurrence in the oro-maxillofacial region is exceedingly rare. We present a case of an early-adolescent female with mandibular IMT, addressing the diagnostic dilemma posed by its radio-histopathological diagnosis through immunohistochemistry, which was pivotal in confirming the diagnosis, elucidating the challenge in treatment planning, demonstrating wide local excision as the gold standard due to the lesion's aggressive and recurrent character, and the importance of long-term follow-up in deciphering this enigma.
BMJ Case Rep
· 2026 May · PMID 42215058
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Synchronous tumours of the female genital tract need to be distinguished from metastatic s such as primary ovarian or endometrial cancer with metastasis to the other site. This is because the treatment approach differs i...Synchronous tumours of the female genital tract need to be distinguished from metastatic s such as primary ovarian or endometrial cancer with metastasis to the other site. This is because the treatment approach differs in both the cases and the prognosis of synchronous tumours is better. We present three cases with common symptom of lower abdominal pain in the presentation. These three patients had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy and were diagnosed with synchronous primary endometrial and ovarian carcinoma.
Soni AH, Ghewade B, Goswami N
… +3 more, Wadhera VV, Patil PA, Rashmika M
BMJ Case Rep
· 2026 May · PMID 42215057
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This article describes the case of a male patient in his late 40s with a history of pulmonary tuberculosis (TB) 25 years ago who presented with a decade-long recurrent cough, sputum production and frequent pneumonia. His...This article describes the case of a male patient in his late 40s with a history of pulmonary tuberculosis (TB) 25 years ago who presented with a decade-long recurrent cough, sputum production and frequent pneumonia. His symptoms were repeatedly wrongly credited to TB reactivation or reinfection, leading to several unnecessary courses of anti-tubercular therapy. A decisive high-resolution CT thorax revealed the pathognomonic features of Mounier-Kuhn syndrome such as marked tracheobronchomegaly and airway diverticulosis. This provided an appropriate explanation for his clinical course. This case highlights a critical diagnostic pitfall, emphasising the need to consider structural airway diseases in patients with a history of TB whose symptoms follow an atypical or refractory pattern, thereby avoiding unnecessary treatments and guiding appropriate management.
BMJ Case Rep
· 2026 May · PMID 42215056
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Incontinentia pigmenti (IP) is a rare genetic condition which is X-linked and predominantly affects the structures arising from neuroectodermal origin such as the skin, teeth, eyes, hair, nails and central nervous system...Incontinentia pigmenti (IP) is a rare genetic condition which is X-linked and predominantly affects the structures arising from neuroectodermal origin such as the skin, teeth, eyes, hair, nails and central nervous system. The dermatological manifestations are seen as the first developing signs. The dental manifestations are also commonly seen. Here we discuss a case of a girl in her early adolescence who was diagnosed with a case of IP. The dental features present in this case were typical, including missing permanent teeth, retained deciduous teeth, microdontia and delayed eruption.
Cunningham JS, Teoh J, Clottey K
… +1 more, Rajendran S
BMJ Case Rep
· 2026 May · PMID 42215055
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A woman presented 20 days postpartum to a tertiary hospital emergency department with right iliac fossa pain, nausea and anorexia. CT imaging suggested appendicitis and she was scheduled for laparoscopic appendicectomy....A woman presented 20 days postpartum to a tertiary hospital emergency department with right iliac fossa pain, nausea and anorexia. CT imaging suggested appendicitis and she was scheduled for laparoscopic appendicectomy. An inflamed right infundibulopelvic ligament was identified intraoperatively instead indicating ovarian vein thrombophlebitis. She was treated with short-term intravenous antibiotics and therapeutic enoxaparin for 3 months.This case highlights the diagnostic challenge of postpartum ovarian vein thrombosis (POVT), a rare but potentially serious condition that can mimic appendicitis. POVT may be difficult to discern on CT scan despite it being the primary diagnostic tool in the acute setting. Clinical suspicion must remain high in postpartum women with abdominal pain, especially in the context of risk factors such as caesarean section, multiple pregnancy, uterine infections, preeclampsia and elevated body mass index. Early recognition may avoid unnecessary surgery, prevent complications such as pulmonary embolism and enable timely initiation of anticoagulation therapy.
BMJ Case Rep
· 2026 May · PMID 42209042
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Fat embolism syndrome (FES) is a rare complication of trauma and orthopaedic procedures involving long bones. Radiographically, the condition typically presents with patchy ground-glass opacities and small centrilobular...Fat embolism syndrome (FES) is a rare complication of trauma and orthopaedic procedures involving long bones. Radiographically, the condition typically presents with patchy ground-glass opacities and small centrilobular nodules. The presence of macroscopic fat emboli is a rare finding. We present an atypical case of macroscopic fat emboli in clinical fat embolism syndrome in the absence of ground glass opacification, highlighting the variability in radiographic presentations of this syndrome.
Omayer A, BaniHani HA, Thobaiti IA
… +1 more, Babalola A
BMJ Case Rep
· 2026 May · PMID 42209041
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Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition classically characterised by seizures with contralateral hemiparesis (often with facial asymmetry and variable cognitive impairment) and unilateral cerebral hemiat...Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition classically characterised by seizures with contralateral hemiparesis (often with facial asymmetry and variable cognitive impairment) and unilateral cerebral hemiatrophy on neuroimaging, frequently accompanied by compensatory calvarial thickening and paranasal sinus hyperpneumatisation. We report a woman in her early 20s with DDMS and medically refractory epilepsy who underwent a combined posterior quadrant disconnection with a selective posterior corpus callosotomy. Postoperatively, she experienced transient transcortical motor aphasia and hemiparesis, both of which resolved with rehabilitation. At 1 year, she remained free of generalised seizures and reported a marked reduction in drop attacks. This case demonstrates the feasibility and favourable outcome of tailored posterior disconnection surgery in adult DDMS, highlighting the importance of individualised presurgical evaluation and multidisciplinary management.
BMJ Case Rep
· 2026 May · PMID 42209040
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Idiopathic ventricular tachycardia arising from right ventricle outflow tract (RVOT-VT) is an uncommon, catecholamine-sensitive form of VT occurring in the absence of structural heart disease and may pose challenges duri...Idiopathic ventricular tachycardia arising from right ventricle outflow tract (RVOT-VT) is an uncommon, catecholamine-sensitive form of VT occurring in the absence of structural heart disease and may pose challenges during pregnancy and delivery due to the risk of sympathetic stimulation. We report a case of a pregnant woman with RVOT-VT who underwent caesarean section. She had a history of dyspnoea and palpitations, was diagnosed and started on calcium channel blocker in the antenatal period. Peripartum management of RVOT-VT can be challenging. A carefully planned spinal anaesthetic using bupivacaine and intrathecal morphine was administered, with specific measures taken to minimise arrhythmogenic triggers. This case highlights the importance of tailored anaesthetic planning in patients with RVOT-VT, focusing on trigger avoidance, choice of anaesthetic technique and appropriate vasopressor use.
Del Rio V, Treihaft A, Weingarten JA
… +4 more, Saleh A, Minkin R, Groner L, Peterson S
BMJ Case Rep
· 2026 May · PMID 42209039
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E-cigarette or vaping-associated lung injury (EVALI) remains an important but often overlooked cause of acute respiratory failure, particularly in the years following the COVID-19 pandemic. We describe a middle-aged woma...E-cigarette or vaping-associated lung injury (EVALI) remains an important but often overlooked cause of acute respiratory failure, particularly in the years following the COVID-19 pandemic. We describe a middle-aged woman with a recent history of nicotine-only vaping who presented with worsening cough, dyspnoea on exertion and progressive hypoxia. Imaging initially suggested multifocal pneumonia, and she was started on broad-spectrum antibiotics and bronchodilator therapy. Despite this, she continued to deteriorate, prompting intensive care unit transfer and initiation of high-dose corticosteroids. Extensive workup including infectious, autoimmune and vasculitis panels was negative. Given her history of recent vaping, EVALI was considered the most likely aetiology. Her clinical course improved significantly after corticosteroid therapy, and she was discharged on a steroid taper. This case highlights the diagnostic challenges posed by EVALI and the ongoing risk associated with vaping, including those containing only nicotine. This case report aims to contribute to the ongoing clinical awareness of EVALI.
BMJ Case Rep
· 2026 May · PMID 42209038
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Fungal infections in immunocompetent patients-even those with intrathecal drug delivery pumps (ITDDPs)-are exceedingly rare. This is the first report of arachnoiditis in a patient with an ITDDP. The patient presented wi...Fungal infections in immunocompetent patients-even those with intrathecal drug delivery pumps (ITDDPs)-are exceedingly rare. This is the first report of arachnoiditis in a patient with an ITDDP. The patient presented with falls and progressive lower extremity weakness. Imaging showed a compressive lesion, for which the patient was taken for exploration and decompression. Cultures grew and pathology showed fungus consistent with The patient's recovery was complicated by respiratory failure requiring re-intubation secondary to an exacerbation of myasthenia gravis. Additionally, the patient developed cholestatic hepatotoxicity from voriconazole requiring biliary sphincterotomy and replacement of voriconazole. ITDDPs pose a significant risk of infection, and although fungal arachnoiditis is rare, it should be considered in the differential diagnosis in this patient population.
BMJ Case Rep
· 2026 May · PMID 42209037
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Collision tumours of the thyroid are rare, accounting for less than 1% of all thyroid malignancies. They represent the coexistence of two histologically distinct but adjacent and morphologically independent tumours, most...Collision tumours of the thyroid are rare, accounting for less than 1% of all thyroid malignancies. They represent the coexistence of two histologically distinct but adjacent and morphologically independent tumours, most commonly papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC). We report a case of a diabetic male in his fourth decade of life who presented with neck swelling. Imaging revealed a bulky left thyroid lobe with lymph node involvement. Fine-needle aspiration cytology suggested PTC with lymph node metastasis. However, histopathology following total thyroidectomy, paratracheal dissection and left functional neck dissection revealed a collision tumour comprising both PTC and MTC. Postoperative management included radioiodine therapy, Ga-68 DOTANOC (1,4,7,10-tetraazacyclododecane-tetraacetic acid 1-Nal3-octreotide) scan and external beam radiotherapy. In such cases, the prognosis largely depends on the more aggressive component, typically MTC. The serial monitoring of serum calcitonin and thyroglobulin levels and appropriate imaging are essential for follow-up. Owing to the rarity and complexity of these tumours, multimodal treatment should be considered.
BMJ Case Rep
· 2026 May · PMID 42209036
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A man in his 60s with insulin-dependent type 2 diabetes mellitus presented with concerns of fever, lower abdominal pain and generalised weakness shortly after returning from Caribbean travel. Imaging demonstrated emphyse...A man in his 60s with insulin-dependent type 2 diabetes mellitus presented with concerns of fever, lower abdominal pain and generalised weakness shortly after returning from Caribbean travel. Imaging demonstrated emphysematous aortitis involving the infrarenal abdominal aorta, with associated penetrating aortic ulcer and pseudoaneurysm. Concurrent blood cultures confirmed an infection with species. The patient's emphysematous aortitis was successfully treated by vascular surgery via an emergent surgical resection of the infected vessel and aorto-biliac reconstruction with a cryopreserved homograft. The patient was hemodynamically stabilised and consequently discharged with continued outpatient pharmacological management of infection with a 6-week course of intravenous ceftriaxone and subsequent lifelong amoxicillin-clavulanate suppression. On 3-month follow-up, imaging demonstrated interval postprocedural changes of prior aorto-biliac endograft placement, with a dissection flap in the infrarenal aorta that resolves just proximal to the aortic bifurcation. Aortic infections are rare and have a high rate of mortality, even with both pharmacologic and non-pharmacologic interventions. This case demonstrates the importance of recognising emphysematous aortitis, an aortic infection, on CT imaging and initiating prompt surgical and antimicrobial management.
Rai DK, Pal S, Talwar D
… +2 more, Singh N, Sharma P
BMJ Case Rep
· 2026 May · PMID 42209035
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Allergic bronchopulmonary aspergillosis (ABPA) is a T helper 2 cell-mediated hypersensitive lung disorder in response to that usually affects asthmatic and cystic fibrosis patients. However, it rarely presents as lung c...Allergic bronchopulmonary aspergillosis (ABPA) is a T helper 2 cell-mediated hypersensitive lung disorder in response to that usually affects asthmatic and cystic fibrosis patients. However, it rarely presents as lung collapse.We report a case of an elderly male who presented in the emergency department with respiratory distress, with oxygen saturation 80% with room air (RA). On evaluation with examination and radiology, the case was revealed as left lung collapse. Fibreoptic bronchoscopy revealed a huge mucus plug (MP) obliterating the left main bronchus, causing collapse of the entire left lung. The MP could not be completely removed by suction and was extracted with a cryoprobe. Post procedure, SpO improved to 99% RA with X-ray showing complete lung aeration restoration. A suspicion of ABPA was made. -specific IgE and IgG came positive, along with raised total IgE and peripheral eosinophilia. The patient was started on itraconazole and oral corticosteroids and discharged in stable condition.This case highlights that it is important to consider an MP with ABPA as a differential in cases of lung collapse after ruling out malignancy.
Fernandes BP, Esteves A, Pimenta AC
… +4 more, Rodrigues L, Oliveira N, Sousa V, Alves R
BMJ Case Rep
· 2026 May · PMID 42209034
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Monoclonal gammopathy of renal significance is characterised by kidney injury caused by nephrotoxic monoclonal immunoglobulins produced by a pathogenic B cell or plasma cell clone. Cryoglobulinaemia in this context may l...Monoclonal gammopathy of renal significance is characterised by kidney injury caused by nephrotoxic monoclonal immunoglobulins produced by a pathogenic B cell or plasma cell clone. Cryoglobulinaemia in this context may lead to severe systemic and renal manifestations. This case report describes a patient who presented with rapidly progressive digital necrosis and acute kidney injury, ultimately diagnosed with severe type II cryoglobulinaemic glomerulonephritis associated with monoclonal gammopathy. Routine immunofluorescence (IF) on frozen tissue failed to demonstrate immunoglobulin deposits; however, IF performed on formalin-fixed paraffin-embedded tissue following pronase digestion revealed masked monotypic lambda light chain deposits. This case highlights the diagnostic challenge posed by masked deposits and underscores the importance of advanced IF techniques in complex cases of cryoglobulinaemia.