Iranian Man Research Articles

SURPASSING THE FIFTH DECADE: EBSTEIN’S ANOMALY CASE REPORT

SESSION TITLE: Cardiovascular Disease 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Ebstein's anomaly (EA) is a rare congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle. Although it accounts for only 0.5% of congenital heart defects, only 5% of patients survive beyond the fifth decade.1,5 We report a newly diagnosed patient with this condition in the seventh decade of life. CASE PRESENTATION: A 72-year-old female with a history of hypertension and prior stroke without residual deficits presented with new-onset seizures. She was hypertensive, tachycardic, and tachypneic, requiring intubation. Physical exam showed jugular venous distention, bilateral crackles, and bilateral pedal edema. X-ray showed cardiomegaly with pulmonary vasculature cephalization. EKG indicated right axis deviation, atrial fibrillation, complete RBBB, and prolonged QTc. 2D-Echo confirmed features of EA including severe tricuspid regurgitation (TR) with tethering of leaflets; right ventricular and atrial dilation; and vena cava dilatation. The displacement index (DI) was recorded at 0.90 mm/m2. Left ventricular EF∼50% with moderate wall thickening. Her hospital course involved resolution of her seizure activity, acute respiratory failure, and acute kidney injury. Her atrial fibrillation and hypertension were treated with AV nodal blocking agents, ARBs, loop diuretics, and oral anticoagulation. Despite her severe TR, she responded well to medical management and continued to improve after the incident. DISCUSSION: EA ranges from minimal to severe TR, consequently affecting the age and degree of clinical presentation.4 Because TR causes right atrial dilatation and reduced right ventricular function, arrhythmias typically occur as well. Other diagnoses we considered based upon echo findings included carcinoid syndrome and Uhl’s anomaly. In carcinoid syndrome, the leaflets are thickened and retracted. In Uhl’s anomaly, the right ventricular myocardium is thin with normal valvular function and preserved left ventricular function.6 The presence of the characteristic displacement of the septal leaflet of the tricuspid valve, in tandem with the abnormal DI and persistent dilated vena cava, supports an Ebstein diagnosis.5 For older patients, medical management and reassessments of functional capacity are indicated.2 Though no formalized guidelines exist, candidacy for tricuspid repair, replacement, or ablation is reserved for those with poor functional reserve or intractable arrhythmias.2,4 Even with this stratification, surgical interventions have remained equivocal and yielded more cardiac re-presentations.3 CONCLUSIONS: Our patient is atypical for being asymptomatic even after surpassing the fifth decade of life with EA, likely attributable to her decreased DI within the spectrum of EA. Our case strengthens the scarce evidence available for the role of conservative management in an asymptomatic elderly. Reference #1: D’ Andrea et al. An atypical assessment of Ebstein’s Anomaly in an elderly patient, report of case. Monaldi Arch Chest Dis. 2011;76:104–1052. Reference #2: Kawase I et al. Repair of Ebstein’s Anomaly in an elderly patient; report of a case. Kyobu Geka. 2008;61:887–890. Reference #3: Kim HYI et al. Natural Course of Adult Ebstein’s Anomaly When Treated according to Current Recommendation. Korean Med Sci. 2016 Nov;31(11):1749-1754.https://doi.org/10.3346/jkms.2016.31.11.1749. Reference #4: Yesin et al. Ebstein’s Anomaly in an asymptomatic nonagenarian: A case report. Curr Res: Cardiol 2015;2(1):40-42. Reference #5: Moradi et al. Complex Ebstein’s Anomaly in an 86-Year-Old Iranian Man: A Case Report. J Tehran Heart Cent. 2017 Jan;12(1):39-41. Reference #6: Ammash et al. Mimics of Ebstein’s Anomaly. Am Heart J. 1997 Sep;134(3):508-13. DISCLOSURES: No relevant relationships by Haleem Abdul, source=Web Response No relevant relationships by Ramsey Ataya, source=Web Response No relevant relationships by Rahul Dasgupta, source=Web Response No relevant relationships by Walter Ramirez, source=Admin input

A case of human acute otoacariasis caused by Rhizoglyphus sp, the first report from Iran

Otoacariasis is the presence of ticks and mites in the auditory canal. A 50-year-old Iranian man was subjected at the an ear, nose, and throat clinic at Rouhani Hospital in Babol with complaint of left ear pain. Otoscopic examination showed mite infestation in the left auditory canal. The infestation was eradicated with the 2% H2O2 solution. Treatment began by applying oral ciprofloxacin (500 mg/day) twice daily for 7 d. We report the rare case of an ear canal infestation with the Rhizoglyphus and their eradication with 2% H2O2 solution.

First case of superficial infection due to Naganishia albida (formerly Cryptococcus albidus) in Iran: A review of the literature

Background and Purpose: Naganishia albida (formerly Cryptococcus albidus) is a non-neoformans cryptococcal species rarely isolated as a human pathogen.Case report:Herein, we present the case of a 26-year-old Iranian man with a superficial cutaneous lesion in the axilla. The initial treatment for pityriasis versicolor by clotrimazole was unsuccessful. We performed skin sampling based on the standard protocol and conducted further investigations by the conventional laboratory tests and molecular analysis of the skin samples. All the mentioned analyses revealed N. albida as the causative agent of infection. The minimum inhibitory concentration (MIC) analysis was carried out for the isolated agent, and the patient was treated using 100 mg daily of oral itraconazole.Conclusion: N. albida can be the causative agent of some superficial infections. This is the first report on the successful detection and treatment of a superficial skin infection due to N. albida by oral itraconazole.

A Rare Large Residual Cyst of the Mandible

Introduction: A residual cyst is a periapical cyst persisted after its associated tooth had been extracted. Case Presentation: A 59-year-old Iranian man complaining of a dull pain in his left side of the mandible after falling down one month ago was referred to the department of oral and maxillofacial pathology, Hamadan University of Medical Sciences, Iran. Panoramic film revealed a radiolucent lesion and fracture of the mandible at the right side. An excisional biopsy was obtained. Based on the histopathologic findings, residual cyst was diagnosed. Conclusions: We reported a rare case of large residual cyst. Dental practitioners should consider this lesion in the differential diagnosis of radiolucent lesions of the jaw bone.

Genetic Investigation of an Iranian Supercentenarian by Whole Exome Sequencing.

The genetic basis of longevity is an important field of study because the majority of supercentenarian cases experience healthy aging and may only show age-related diseases in their last few years of life. It is clear that genetic factors play an important role in survival beyond 90 years of age, but the exact relationship of genetic variants to this phenomenon remains unknown. The aim of this project was to investigate different hypotheses that describe the relationship between genetic variants and human longevity in a living Iranian man by Whole Exome Sequencing. Initially, we conducted high quality DNA extraction on a peripheral blood sample. Then, whole exome sequencing was performed on the DNA and different bioinformatic software packages and databases were used to analyze the data. Tertiary analysis was performed on four genetic hypotheses for longevity. Analysis showed that among 27 metabolic variants which are related to longevity, 18 variants encompassed the exceptional longevity allele. In comparison with the NHGRI GWAS catalog, the case had 58 trait-associated variants of which 11 were homozygous for the risk allele. We also discovered 25 novel variants within candidate genes for aging and longevity and we detected seven longevity-associated variants in the sample. This study was performed on just one sample and so the results cannot be interpreted as a generalized principle for other elderly societies, but this is the first step towards investigation of the genetic basis of longevity in Iran and provides an insight for further studies in the field of longevity.

Ameloblastomatous Calcifying Odontogenic Cyst: A Rare Lesion

Introduction: Calcifying odontogenic cyst (COC) is a unique and uncommon odontogenic cyst classified into four groups of cystic, odontoma producing, ameloblastomatous proliferating and neoplastic ones. Case Presentation: A 34-year-old Iranian man complaining of a painless facial and palatal swelling of the left side of the maxilla persisted for approximately three years was referred to the department of oral and maxillofacial surgery, Hamadan University, Iran. Panoramic film revealed a well-defined multilocular mixed radiolucent and radioopaque lesion of the maxilla at the left side. An incisional biopsy was obtained. Based on the histopathologic findings, ameloblastomatous COC was diagnosed. Discussion: We reported a rare case of COC. According to Praetorius et al. classification, this patient comes under the category of type 1C (ameloblastomatous proliferating). Many patients with ameloblastomatous COC should be reported to understand its biological behavior as possible.

Mycobacterium iranicumInfection in HIV-infected Patient, Iran

To the Editor: The species Mycobacterium iranicum was described in 2013 (1) on the basis of 8 clinical strains isolated in various countries (Iran, Italy, Greece, the Netherlands, Sweden, and the United States). Recently, the isolation of M. iranicum from the sputum of a woman also was reported (2). We report the isolation of this newly recognized species from an HIV-positive patient. A scotochromogenic, rapidly growing strain was isolated in 2012 from respiratory specimens of an HIV-positive 44-year-old Iranian man with chronic pulmonary disease. The patient had been found to be HIV seropositive (viral load >1,000 copies/mL, CD4 lymphocyte count 120/µL) in 2004 when he was hospitalized because of fever, weight loss, and oral candidiasis. Treatment with antiretroviral drugs, including stavudine, lamivudine, and nevirapine, was begun. The patient rapidly improved; the fever disappeared, he gained weight, and he was discharged from the hospital. At a 6-month follow-up visit, viral load was 1,000 copies/mL and CD4 lymphocyte count was 420/µL. He continued to receive antiretroviral treatment until 2010 when treatment was discontinued because of its high cost. The man was hospitalized again in 2012 with mild fever, weight loss, chronic chest pain, and nonproductive cough. At that time, the viral load was >100,000 copies/mL, and CD4 count was 5 lymphocytes/µL. Tuberculin skin test results were negative, radiograph of the chest showed no abnormalities, and routine cultures of sputum and blood were negative for common bacteria. Lactate dehydrogenase level (98 U/L [reference <600 U/L]) was within normal limits, whereas liver function was abnormal (alanine aminotransferase level 95 U/L [reference <36 U/L], L-aspartate aminotransferase level 85 U/L [reference <29 U/L], alkaline phosphatase 180 U/L [reference 44–147 U/L], and total bilirubin 1.4 mg/dL [reference 0.3–1mg/dl]). Antiretroviral therapy was resumed, which led to an increase in CD4 cells (205 lymphocytes/µL after 1 month). The examination by microscopy (Ziehl-Neelsen staining) of 3 sputum samples did not reveal acid-fast bacilli; culture for mycobacteria was not done. Oral treatment with tetracycline was started, but the patient’s fever and chest pain remained unchanged. After bronchoscopy, 2 of 3 bronchial lavage (BAL) samples were found to be positive for acid-fast coccobacilli by microscopy, and rapidly growing, deep orange mycobacteria grew in all 3 cultures. Giemsa stain did not show Pneumocystis jirovecii in BAL samples. A standard antituberculosis regimen was undertaken but did not result in substantial improvement. At 1 month follow-up, 1 sputum sample was negative for acid-fast organisms, and 1 BAL specimen was positive by microscopy and in culture. When the isolate was identified as M. iranicum, therapy was replaced with a combination of amikacin and ciprofloxacin for 3 months (standard treatment used in Iran for infections caused by rapidly growing mycobacteria), and the patient improved rapidly. Mycobacteria were neither observed nor grew in culture in a BAL specimen obtained 1 month after the change in therapeutic regimen. Identification of the isolates was initially attempted with biochemical tests, and they were negative for niacin production, nitrate reduction, Tween 80 hydrolysis, and semiquantitative catalase. The tests were positive for urease activity, iron uptake, tellurite reduction, arylsulfatase (3 days after the start of the test), 5% NaCl tolerance, and heat-stable (68°C) catalase. The genetic sequencing of almost-complete (1,450 bp) 16S rRNA gene (3), a 710-bp fragment of the β-subunit of the RNA polymerase gene (4), and the hypervariable region (402 bp) of the 65-kDa heath-shock protein (5) revealed 99.8%, 99.4%, and 100% identity, respectively, with sequences of the type strain found in GenBank and definitively confirmed the identification. The clinical criteria required by the American Thoracic Society and Infectious Disease Society of America (3) to assess the importance of the isolation of a nontuberculous mycobacterium from pulmonary specimens include, in adjunct to a specific symptomatology, the presence of nodular or cavitary lung lesions and the exclusion of any other possible cause of the disease. The normal thoracic radiograph findings for the case-patient described here cannot, however, be considered a definitive exclusion criterion: in highly immunocompromised patients, a chest radiograph may show no abnormalities, even when substantial pathologic features of infection are present (6). The microbiological criteria were clearly fulfilled by isolating the organism from multiple sputum specimens and the BAL specimens. The patient’s response to the treatment and the disappearance of thoracic symptoms further support the assertion. Our report confirms the potential pathogenicity of M. iranicum. In addition to the case described here, 9 isolations of this species have been reported so far. Among them, the clinical relevance has been demonstrated for 2 strains grown from respiratory specimens of patients with pulmonary disease and for 1 strain isolated from a cutaneous lesion (1,2). The role of an accurate identification, in conjunction with symptoms and radiographic findings, is central to understanding the clinical significance of mycobacteria isolated from pathologic specimens.

Corynebacterium propinquum Associated With Acute, Nongonococcal Urethritis

Corynebacterium propinquum is usually considered part of the normal human oropharyngeal flora and is rarely responsible for clinical infection. We report here what seems to be the first case of acute purulent urethral discharge in a young Iranian man with urethritis acquired after orogenital contact. Attention should be devoted to less common nondiphtheriae Corynebacterium species for differential diagnosis.

Pulmonary Alveolar Microlithiasis

A 28-year-old Iranian man who had lived in the United Kingdom for 3 years came to the outpatient clinic with a 3-year history of frequent cough, which occasionally produced a little sputum. He had never smoked and did not describe any other respiratory symptoms. Examination revealed sparse fine crepitations over all lung zones. Spirometry revealed a forced expiratory volume in 1 second of 2.85 L (73%) and a forced vital capacity of 4.01 L (86%). A roentgenogram of the chest revealed diffuse micronodular opacities resembling miliary tuberculosis (Fig 1A). His tuberculin test gave a Heaf grade I reaction, and his sputum samples were negative for tuberculosis. The results of laboratory tests for blood count, biochemical profile, C-reactive protein, and erythrocyte sedimentation rate were all normal. An autoantibody screen produced negative results. Computed tomography of the thorax revealed extensive fine centrilobular nodularity throughout both lungs (Fig 1B), associated with ground-glass changes and septal thickening. There were small areas of subpleural calcification, particularly at both lung bases. He underwent bronchoscopy with transbronchial biopsy, which demonstrated

Mesenteric Vein Thrombosis Complicating Pneumatosis Intestinalis, A Case Report

Introduction Pneumatosis intestinalis is usually considered as a benign condition. Here we report the association of this condition with mesenteric vein thrombosis leading to gangrenous bowel which, to our best knowledge, is the first reported association. Case Presentation The patient was a 71-year old Iranian smoker man, who was diagnosed with pneumatosis intestinalis for 11 months and then developed the abdominal pain which was confirmed to be due to the mesenteric vein thrombosis complicated by bowel gangrene. Discussion Although pneumatosis intestinalis is not usually threatening in adults, its new onset in the abdomen of these patients should prompt the complications such as mesenteric vein thrombosis.

Microsporum fulvum, an Ignored Pathogenic Dermatophyte: A New Clinical Isolation from Iran

Misidentifying with Microsporum gypseum has for a long time been accounted for less prevalence of the geophilic species, Microsporum fulvum in human dermatophytosis. We describe a new case of infection with the species in an Iranian young man. Direct examination of skin scrapings revealed a tinea corporis, and morphological study of the recovered isolate from the culture resulted in the identification of M. gypseum. However, PCR amplification of ITS1-5.8S rDNA-ITS2 region and subsequent ITS-RFLP and sequencing were indicative of M. fulvum as the true causative agent. To recognize M. fulvum in human infections and to validate the morphologically distinguished isolates of M. gypseum, the genetic-based identification is strongly recommended.

The liver Metastatic Adenocarcinoma of Colorectal Cancer With Synchronous Isolated Hepatic Tuberculosis

Dear Editor, Tuberculosis is a global problem. According to the World Health Organization, more than 2 billion people are currently infected with tuberculosis bacilli and 1.7 million deaths attributed to TB in 2006 (1). TB usually occurs in lung and other form of it like primary abdominal TB is not uncommon and 6-38% of patients with active pulmonary TB have abdominal TB (2). Hepatic tuberculosis is usually associated with military tuberculosis or active pulmonary and isolated liver tuberculosis (ILT) is a rare type of TB (3, 4). Hereby we report a case of isolated hepatic tuberculosis. A 54 year old Iranian man has suffered from gastrointestinal symptoms, changes in bowel habits and rectal bleeding and abdominal pain for 3 month. Laboratory data revealed hematocrit 33%; hemoglobin 10.2 g/dL; white blood cells 9400/mm³ (71% neutrophils). Liver enzymes showed: total bilirubin of 9 mg/L with a direct bilirubin of 4.3 mg/L; SGOT and SGPT were 138 U/L and 192 U/L respectively (normal range for SGOT is 17-59 U/L and for SGPT is 21-72 U/L). Abdominal examination was unremarkable except for mild tenderness in RUQ. Patients had not history of colon cancer or TB in familial history. The patient was undergoing colonoscopy, a lesion measuring 3.0 × 4.1 × 1.5 cm in the sigmoid colon was found. The biopsy of the lesion was referred to the lab. Colon adenocarcinoma diagnosed before surgery. For metastatic work up, the patient undergoing CT and a lesion in the right lobe of the liver was observed which a biopsy was taken from. Our initial diagnosis according to the patient with adenocarcinoma and colonoscopy results, before operation, and the finding of patients CT were metastatic lesion. For the final diagnosis of the lesion we used biopsy and pathologic findings which were positive for tuberculosis and metastatic adenocarcinoma in liver. Lung was cleared for tuberculosis in studies and isolated hepatic tuberculosis diagnosed. However TB can diffuse in other organ like mesenteric lymph nodes, gastrointestinal tract and Urinary tract but isolated hepatic tuberculosis is rare condition. Overall we know 3 forms of hepatic tuberculosis. Diffuse hepatic with pulmonary or miliary tuberculosis, which is the most common form. Diffuse hepatic infiltration without recognizable pulmonary involvement and third form usually presents as a focal – local or abscess. This form is very rare (5, 6). In Kok KY study, Incidence of isolated hepatic tuberculosis estimated as0.3% (7). Many studies confirm that Clinical presentation of isolated hepatic tuberculosis is so atypical and we can`t only use imaging for diagnosing the ILT, because many other of focal lesions in liver, such as metastases, hepatocellular carcinoma are similar to that, so pathology examination is necessary for distinguishing tuberculosis from lymphoproliferative disorder and other granulomatous diseases (7-9). Usually Pathologic finding in tuberculosis liver is a necrotizing and granolomatus. likely gaint cells are found in the granuloma which are surrounded by lymphohistiocytic cells, plasma cells and eosinophils (10). Unfortunately, in most of cases the diagnosis of liver TB is made only after exploratory laboratory or biopsy, as the present case. Therefore the diagnosis of liver TB should be considered in the context of a mass in the right lobe of the liver in patients from endemic TB zone or in the immunocompromised patients. Figure 1. Images of a Necrosis Granulomatous in Biopsy of Liver and Pleomorphic Tumor Cells are Hyperchromatic With Irregular Nuclear Borders (× 400 H&E stain)

461 – Delusional disorder in an iranian man with anorexia nervosa: a case report

Introduction Anorexia Nervosa is a serious mental illness and is frequently seen in young females in childhood and adolescence. The most common ages of onset of anorexia nervosa are the mid teens. Objectives To our knowledge this is singular report of a case of delusional disorder in which Anorexia Nervosa preceded the onset of psychotic symptoms. Age and sex of our case are unusual in Anorexia nervosa. Aim In this report a rare case of Anorexia nervosa is presented in which the patient is a 32 year old male with poor socioeconomic background from a developing country who subsequently experienced a distinct onset of delusional disorder. After four weeks, delusional disorder and Anorexia Nervosa resolved due to treatment by atypical antipsychotics (Risperidone). Results The association between anorexia Nervosa and Delusional Disorder is important. In the case which is reported here delusional thoughts started six month after anorexia nervosa when the patient became extremely thin and cachectic. Conclusion In fact the theory of occurrence of psychotic disorder as a result of severe malnutrition is intensified.

Gaucher disease in a 53-year-old Iranian man

Gaucher disease in a 53-year-old Iranian man

Renal malakoplakia presenting as a renal mass in a 55-year-old man: a case report

IntroductionMalakoplakia is an uncommon chronic inflammatory condition that has a gross and microscopic appearance resembling that of xanthogranulomatous pyelonephritis. It is characterized by distinctive Michaelis-Gutmann bodies. Malakoplakia can affect any organ system but genitourinary tract involvement is the most common, particularly in immunocompromised individuals. Very rare cases have been reported to present as a unifocal lesion mimicking a renal tumor.Case presentationWe report a case of renal malakoplakia in a 55-year-old Iranian man with a past history of recurrent urinary tract infections who presented with left flank pain. An ultrasound study showed a large solid left renal mass, and he underwent a left radical nephrectomy with a clinical diagnosis of a renal tumor. Pathology slides revealed the diffuse infiltration of sheets of Periodic Acid Schiff-positive histiocytes in his renal parenchyma; these cells showed strong immunoreactivity for CD 68. The final diagnosis was renal malakoplakia.ConclusionRenal malakoplakia must be kept in mind for patients presenting with a renal mass and a history of long-term recurrent renal infections or renal failure. The large, rapidly growing nodules of malakoplakia may mimic renal cell carcinoma in imaging studies. In these cases, a true cut needle biopsy may help the correct diagnosis and prevent unnecessary surgery.

Caught between cultures: cultural norms in Jungian psychodynamic process

In our increasingly mobile world, more of us are caught between cultures rather than in one culture. We straddle different ethnic, racial, political, geographical, and religious groups, forced into awareness of the precarious nature of our self-definition, involuntarily gazing at the constructed nature of our cultural norms, unable to avoid reckoning with the choices of which collective to honour. The impossibility of separating individual from collective is foundational to work as Jungian practitioners, but a paradox of individuation is becoming free of the control of collective norms while simultaneously living within those very norms. In such a conflict it becomes easy to overlook the fact that when the norms we have incorporated into ourselves are from cultures vastly different from the one in which we live, the cacophony can be overwhelming. In this paper, I will draw from postmodern theorists such as Derrida, Foucault and Irigaray in an effort to re-imagine the role of culture in psychodynamic process. The case of a Muslim Iranian man working with a Christian American woman analyst will be used to explore the complexity of a multitude of cultural norms present in the consulting room.

An Iranian male with syringoid eccrine carcinoma misdiagnosed as basal cell carcinoma: a case report

Syringoid carcinoma (syringoid eccrine carcinoma, or eccrine epithelioma) is a rare cutaneous tumor with some controversy regarding its correct definition. This tumor shows a slow growth and has often been for many years, some decades before diagnosis. It may also be difficult to differentiate from its benign counterpart (syringoma) or other adnexal carcinoma and cutaneous metastasis. There have been limited case reports of syringoid carcinoma in foreign literatures but none from Iran. Here we report a case of syringoid carcinoma in a 52 year-old Iranian man. Syringoid eccrine carcinoma is a very rare and uncommon diagnosed tumor thought to be derived from eccrine sweat apparatus. It locally invasive, destructive and often shows recurrence. It may also be difficult to differentiate from metastatic adenocarcinoma.

Hemoglobin Q-Iran detected in family members from Northern Iran: a case report

IntroductionHemoglobin Q-Iran (α75Asp→His) is an important member of the hemoglobin Q family, molecularly characterized by the replacement of aspartic acid by histidine. The first report of hemoglobin Q-Iran and the nomenclature of this hemoglobinopathy dates back to 1970. Iran is known as a country with a high prevalence of α- and β-thalassemia and different types of hemoglobinopathy. Many of these variants are yet to be identified as the practice of molecular laboratory techniques is limited in this part of the world. Applying such molecular methods, we report the first hemoglobin Q-Iran cases in Northern Iran.Case presentationAn unusual band was detected in an isoelectric focusing test and cellulose acetate electrophoresis of a sample from a 22-year-old Iranian man from Mazandaran Province. Capillary zone electrophoresis analysis identified this band as hemoglobin Q. A similar band was also detected in his mother's electrophoresis (38 years, Iranian ethnicity). The cases underwent molecular investigation and the presence of a hemoglobin Q-Iran mutation was confirmed by the amplification refractory mutation system polymerase chain reaction method. Direct conventional sequencing revealed a single guanine to cytosine missense mutation (c.226G > C; GAC >CAC) at codon 75 in the α-globin gene in both cases.ConclusionThe wide spectrum and high frequency of nondeletional α-globin mutations in Mazandaran Province is remarkable and seem to differ considerably from what has been found in Mediterranean populations. This short communication reports the first cases of patients with hemoglobin Q found in that region.

Autoimmune pancreatitis mimicking carcinoma of the head of the pancreas: a case report

IntroductionWe report on a case of autoimmune pancreatitis presenting as pancreatic head cancer, which is extremely rare in Iran. Currently, on the PubMed database, no such cases exist.Case presentationA 70-year-old Iranian man presented with recurrent abdominal pain, jaundice and elevated bilirubin and alkaline phosphatase levels. An abdominal computed tomography scan revealed a heterogeneous presence in the pancreatic head as well as dilated intra- and extrahepatic bile ducts. A common bile duct stent had been inserted. Our patient was subsequently diagnosed with pancreatic head cancer.Due to his continued recurrent abdominal pain, our patient returned to the hospital. His levels of bilirubin, alkaline phosphatase and tumor markers were all normal but his immunoglobulin G4 and antinuclear antibodies were extremely high. A biopsy of the pancreatic head heterogeneity by endoscopic ultrasonography was performed.Pathologic samples showed fibrosis associated with lymphoplasmacytic infiltration and no evidence of malignancy. A diagnosis of autoimmune pancreatitis was confirmed, the bile duct stent removed, and an appropriate treatment plan was undertaken.ConclusionAutoimmune pancreatitis should be considered in suspected cases of pancreatic cancer. In these instances, a biopsy of the pancreas will help to differentiate between the two and prevent complications due to disease progression as well as unnecessary surgery.

Extra-hepatic fascioliasis with peritoneal malignancy tumor feature

Fascioliasis is a zoonose parasitic disease caused by Fasciola hepatica and Fasciola gigantica and is widespread in most regions of the world. Ectopic fascioliasis usually caused by juvenile Fasciola spp., but in recent years a few cases of tissue-embedded ova have been reported from different endemic areas. A 79-year-old Iranian man resident in Eird-e-Mousa village from Ardabil Province, north-west of Iran, complained with abdominal pain, nausea, and intestinal obstruction symptoms referred to Ardabil Fatemi hospital. In laparotomy multiple intestinal masses with peritoneal seeding resembling of a malignant lesion were seen. After appendectomy and peritoneal mass biopsy with numerous intraperitoneal adenopathy, paraffin embedded blocks were prepared from each tissues. A blood sample was taken from the patient 5months later for serological diagnosis. Histopathological examination of sections showed fibrofatty stroma with dense mixed inflammatory cells infiltration and fibrosis in peritoneal masses. Large numbers of ova of Fasciola spp. were noted with typical circumscribed granulomas. Despite of anti-fasciola treatment, IHA test for detecting anti F. hepatica antibodies was positive 5months after surgery with a titer of 1/128. Due to multiple clinical manifestation of extra-hepatic fascioliasis, its differential diagnosis from intraperitoneal tumors or other similar diseases should be considered.