Middle-aged Male Patients Research Articles

Immune checkpoint inhibitor therapy for primary neuroendocrine carcinoma of the gallbladder: A case report and literature review.

Gallbladder neuroendocrine carcinoma (GNEC) is indeed a relatively rare malignant tumor of the gallbladder with neuroendocrine differentiation and the ability to produce and secrete a number of neurotransmitters and hormones, characteristics that make its clinical presentation and biological behavior likely to be different from those of other types of gallbladder cancer. Current treatment mostly relies on surgery and adjuvant chemotherapy and radiotherapy. We report a 53-year-old middle-aged male patient who underwent radical surgery for gallbladder malignancy after a diagnosis of neuroendocrine carcinoma of the gallbladder. Diagnosis of neuroendocrine carcinoma of the gallbladder based on the return of pathologic findings. After local progression of postoperative chemotherapy with the first-line regimen of etoposide + cisplatin, an immune checkpoint inhibitor (traplizumab) + FOLIFIRI (fluorouracil + calcium folinate + irinotecan) regimen was used. The patient achieved 20 months of clinical survival and ultimately died of myelosuppression. The use of immune checkpoint inhibitors may become an effective tool in the treatment of neuroendocrine carcinoma of the gallbladder.

A rare case of Pancreatic lesion: Pancreatic mass and chronic pancreatitis caused by parasitic infection

A middle-age male patient was hospitalized for six-months upper abdominal pain. The patient had experienced 3 episodes of acute pancreatitis in the past 6 years. All the examination pointed to chronic pancreatitis and tumor, which, however, covering up the truth that the patient was in infection with Clonorchis sinensis in his pancreas. As the condition met the surgical indications, we performed pancreaticoduodenectomy and found the infection of Clonorchis sinensis in the postoperative pathological report. The patient maintain healthy during subsequent follow-up. Pancreatic mass with Clonorchis sinensis infected were rarely seen clinically, here we report the case which indicate us that further study on parasite and pancreatic lesion should be implemented. This case report is in accordance with Strengthening the reporting of Clinical Case Report and Helsinki Declaration.

EP553 - Omental Infarction mimicking acute cholecystitis - A Case Report

Abstract Introduction Spontaneous torsion and infarction of the omentum is a rare presentation with a variety of clinical presentations. We report a middle-aged male patient who presented with signs and symptoms mimicking acute cholecystitis. Case Presentation A 47-year-old man presented with an 18-hour history of right upper quadrant (RUQ) pain. Pain was constant, worse on movement and inspiration. On examination, he was exceptionally tender in the RUQ with positive Murphy’s sign. Initial investigations showed a mild inflammatory response, and the working diagnosis was acute cholecystitis. An abdominal ultrasound scan demonstrated a thin-walled gallbladder, free from gallstones and no evidence of acute cholecystitis. Given the patients ongoing severe pain and examination findings, a CT scan of abdomen and pelvis with contrast was performed. This demonstrated an oval shaped area of localized omental fat stranding in the RUQ, suggestive of omental infarction. The patient was managed conservatively with analgesia and discharged once symptoms were adequately controlled. Discussion Torted, infarcted omentum is a rare cause of acute abdominal pain. It is more frequently observed in 40–50-year-olds with male predominance. Most commonly it mimics symptoms and signs of acute appendicitis. However, this is a rare case mimicking acute cholecystitis. In this case, the necrotic segment was adherent with the anterior abdominal wall, causing significant pain and tenderness. When the clinically presentation of acute cholecystitis is not reflected by abdominal ultrasound, cross sectional imaging should be obtained to ensure definitive diagnosis is established in timely manner.

Surgical Technique for Complementing Robotic-Assisted Total Knee Arthroplasty in Middle-Aged Patients with Rigid Knee Bones.

This study reports 12 cases of inaccurate bone cutting from a single-surgeon series of 509 consecutively performed robotic-assisted total knee arthroplasty (TKA) for 1 year. In addition, a complementary technique with the combined benefits of robotic-assisted and manual techniques that address this issue is described. From June 2020 to May 2021, a consecutive series of 509 TKAs was performed on 338 patients using a posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital. The surgical records were reviewed to identify the causative bone locations and bone re-cutting events correlated with improper trial instrument positioning. The re-cutting rate was 2.4% (12/509). All re-cutting attempts occurred because of improper cutting of the femoral posterior chamfer. Re-cutting was attempted mostly on middle-aged male patients. This complementary technique can facilitate manual bone cutting while retaining the advantages of robotic surgery during robotic-assisted TKA. Additionally, the combined technique of manual bone cutting and robotic-assisted surgery can be a useful alternative for middle-aged male patients with rigid knee bones.

Vertebral artery pseudoaneurysm: a rare cause of posterior circulation infarction in a middle-aged man.

Pseudoaneurysm of the vertebral artery is a rare cause of posterior circulation stroke. Treatment for this condition can be achieved through microscopic surgery or endovascular therapy. We report a case of a 36-year-old middle-aged male patient who presented with left limb numbness as the sole complaint. On a magnetic resonance imaging examination, multiple infarcts were observed in the left cerebellar tonsil. A subsequent head and neck computed tomography angiography examination led to the diagnosis of a pseudoaneurysm in the left vertebral artery. Following standard antiplatelet therapy, the patient underwent endovascular intervention. The patient's left limb numbness gradually subsided after surgery. A follow-up angiography performed 1 week after discharge showed no recurrence. These findings suggest that covered stent placement is an effective method of treating pseudoaneurysm of the vertebral artery.

627. LEFT THORACOSCOPIC PRIMARY REPAIR OF ESOPHAGEAL PERFORATION SECONDARY TO BOERHAAVE SYNDROME

Abstract Background With the advancement of the minimally invasive surgical techniques, more and more acute surgical conditions including esophageal perforations can be performed safely using minimally invasive surgical approach. Methods A middle aged male patient presented to our department with 3 days history of epigastric pain and vomiting. He was febrile on admission and investigation revealed the left sided esophageal perforation due to Boerhaave Syndrome with left sided pleural effusion. He underwent left thoracoscopic primary repair of esophageal perforation and wash out successfully. This is the video of the thoracoscopic primary repair of the perforation. Patient was put in the right lateral semi prone position, the area of perforation was identified by careful dissection of the pleura and repaired was performed in 2 layers. The pleura cavity was washed out with warm saline and underwater sealed chest tube drain was inserted. Results Post operatively patient was transferred to surgical intensive care unit for 1 day. Patient was kept nil by mouth with parenteral nutrition for 7 days. Contrast study was performed on post operative day 7 and started oral feeding when there was no evidence of leakage. Patient recovered and discharged well. Conclusion Thoracoscopic primary repair with wash out of spontaneous esophageal perforation secondary to Boerrhave Syndrome is challenging however it is safe and can be performed successfully. https://drive.google.com/file/d/1JTfJLV-ngUBwzMybGV4FL8EEQB-ysj9O/view

Efficacy of GnRH Pulses in Hypogonadism Secondary to Primary Empty Sella: Case Report.

This study aims to assess the effectiveness of pulsed gonadotropin-releasing hormone (GnRH) micropump replacement therapy in the treatment of hypogonadotropic hypogonadism (HH) caused by primary empty sella (PES).The efficacy of pulsed GnRH replacement therapy using the micropump was evaluated in a middle-aged male patient with HH who had experienced the loss of his only child. Relevant literature was also consulted to compare the differences between pulse GnRH treatment and conventional treatment in terms of the development of secondary sexual characteristics, sex hormone levels, sperm production rate, and sperm activity rate in male patient with HH.In this report, a 45-year-old male diagnosed with HH and PES presented with fatigue and decreased libido. The main characteristics included decreased follicle stimulating hormone (FSH) levels of 0.03 mIU/mL, luteinizing hormone (LH) levels of 0.02 mIU/mL, and testosterone (T) levels of 0.72 nmol/L. Magnetic resonance imaging (MRI) revealed an empty sella. Semen analysis showed a small number of normal sperm with reduced motility. During treatment with the micropump pulse GnRH, the patient experienced no side effects and showed improvements in fatigue, reduced libido, sexual urge, anxiety, and feelings of inferiority. LH, FSH, and T levels returned to normal, while sperm activity rate increased to 79.9%. Ultimately, the patient's spouse achieved a natural pregnancy.Pulsed gonadotropin delivery using the micropump demonstrates good efficacy and tolerability, and aligns more closely with the physiological rhythm of GnRH secretion in the human body.

Clinical, Laboratory, and Imaging Characteristics of Tropheryma Whipplei Detection in Bronchoalveolar Lavage Fluid Using Next-Generation Sequencing: A Case-Control Study.

The aim of this study was to assess the prevalence of Tropheryma whipplei (TW) infection in the population and to investigate the clinical symptoms, as well as the laboratory and imaging characteristics of patients testing positive for TW using next-generation sequencing (NGS). A retrospective review was conducted on 1346 bronchoalveolar lavage fluid (BALF) samples collected between January 2021 and September 2023. The case group comprised patients with TW detected using NGS while the control group included 65 randomly chosen Gram-positive bacterial infection patients without TW. Comparative analyses were carried out on the basic demographics, laboratory parameters, and imaging findings between the two groups. Additionally, the case group underwent an in-depth examination of underlying diseases, pathogens, final diagnoses, treatment strategies. The case group comprised of 51 patients with TW, constituting 3.8% of the total. There was no significant difference in gender and age between the case and control groups (P = 0.84, P = 0.07). Symptoms such as coughing, expectoration, wheezing, fever, and hemoptysis are less commonly detected in the case group with a higher incidence of chest pain when compared to the control group (P >0.05). The case group exhibited decreased albumin levels and increased C-reactive protein and D-dimer levels compared to normal levels. Imaging findings in the case group commonly included nodules, patchy images, and interstitial changes, the most common underlying disease is cardiovascular disease, and the most frequently co-occurring pathogen is the human herpesvirus. Among the case group, 27 patients received a final diagnosis of pneumonia, and 3 patients clinically diagnosed with Whipple's disease demonstrated improvement in both symptoms and imaging after treatment. NGS revealed a relatively low overall detection rate of TW-positive patients using BALF. TW was more prevalent in middle-aged and elderly male patients characterized by symptoms such as cough, expectoration, shortness of breath, and fever. Chest imaging in these cases typically showed nodules and interstitial changes.

Yokenella regensburgei-Past, Present and Future.

Yokenella regensburgei is a Gram-negative rod part of the Enterobacteriaceae family (order Enterobacterales) and a rare cause of human infections. Although improved diagnostic methods have led to an increase in reports of this elusive pathogen, information remains limited. In order to provide a better understanding of this bacterium, we developed the first comprehensive review of its biology, biochemical profile, antimicrobial resistance pattern, virulence factors, natural reservoir and involvement in various veterinary and human infections. Human infections with this bacterium are scarcely reported, most probably due to constraints regarding its identification and biochemical similarities to Hafnia alvei. Multiple systematic searches revealed 23 cases of human infection, with a seemingly worldwide distribution, mostly in middle-aged or elderly male patients, often associated with immunosuppression. To date, Y. regensburgei has been reported in skin and soft tissue infections, bacteremia and sepsis, osteoarticular infections and in others such as urinary tract and digestive infections. The unique ability of Y. regensburgei to degrade polystyrene presents a novel and promising avenue for addressing plastic pollution in the near future. However, large-scale applications of this bacterium will undoubtedly increase human exposure, highlighting the necessity for comprehensive research into its role in human and veterinary infections, pathogenicity and antibiotic resistance.

Navigating Complex Cardiovascular Pathologies: A Case Report on Aortic Arch Replacement in a Middle-Aged Male with Stanford A De Bakery I Aortic Dissection

Background: Aorta dissection is characterized by the presence of an intimal tear, which permits the passage of blood through the tear and into the aorta media. This process leads to the separation of the intimal and the formation of a dissection flap, representing the true lumen and a newly formed false lumens. The incidence of aortic dissection varies between 0.2% and 0.8%. Management of acute aortic standford A aortic dissection primarily involves invasive surgical procedures. Case presentation: A middle-aged male patient, aged 40, who possesses risk factors including uncontrolled hypertension and obesity, arrived to the emergency room with symptoms of chest pain. He described the pain as tearing in nature and said that it radiated towards the abdominal. The examination findings included a blood pressure reading of 255/143, a widened mediastinum and cardiomegaly observed on the chest X-ray, a slight elevation in Hs-Troponin levels, and the presence of sinus rhythm with left ventricular hypertrophy. He underwent CT scan, which demonstrated the presence of an aortic dissection extending from the ascending to descending aorta, with no associated damage to the aortic valve from echocardiography. He was diagnosed with Standford A DeBakey I Aortic dissection and underwent preference replacement of the aortic arch and elephant trunk implantation instead of Bentall procedure. Conclusion: The surgical and perioperative methods employed may differ based on the specific clinical presentation and the nature of the aortic disease. Because there was no involvement of the aortic valve, we performed total aortic arch replacement and elephant trunk procedure over the Bentall procedure. Keyword: Aortic Dissection, Dissection Flap, Total Aortic Arch Replacement.

Management of Tinea incognito with Unani medicine: A case report

Tinea infections are one of the most commonly occurring skin infections creating a threat to the public health scenario in India. With the excessive and unsupervised use of over-the-counter steroid formulations, the condition is becoming more severe, leading to chronic relapse of the disease with modified skin lesions, termed as tinea incognito. This condition is usually difficult to treat, but Unani medicines can provide satisfactory results in such cases. Here is a case report of a middle-aged male patient suffering from tinea incognito. On treating the patient with Unani medicines for 30 days, there was a significant reduction in the subjective symptoms, i.e. erythema, pruritus, and scaling, along with a reduction in the Physician’s Global Assessment Score. The microscopic examination of the lesions on the potassium hydroxide mount was found to be negative for fungal hyphae after the treatment. Through this case report, it can be inferred that tinea incognito can be effectively managed with the administration of Unani medicines.

Obesity and septic patient outcomes: Shaping the puzzle through age and sex perspectives

While obesity has been reported as a protective factor in septic patients, little is known about the potential modifying effects of age and sex. The objective of this study is to investigate age and sex-specific associations between obesity and the prognosis of septic patients. A retrospective analysis was conducted on a cohort of 15,464 septic patients, categorized by body mass index (BMI) into four groups: underweight (<18.5kg/m2, n=483), normal (18.5-24.9kg/m2, n=4344), overweight (25-29.9kg/m2, n=4949) and obese (≥30kg/m2, n=5688). Multivariable logistic regression and inverse probability weighting were employed to robustly confirm the protective effect of a higher BMI on 28-day mortality, with normal weight serving as the reference category. Subgroup analyses based on age (young: 18-39, middle-aged: 40-64 and elderly: ≥65) and sex were performed. The findings demonstrate that high BMI independently confers a protective effect against 28-day mortality in septic patients. However, the relationship between BMI and 28-day mortality exhibits a non-linear trend, with a BMI of 34.5kg/m2 displaying the lowest odds ratio. Notably, the survival benefits associated with a high BMI were not observed in the young group. Moreover, being underweight emerges as an independent risk factor for middle-aged and elderly female patients, while in males it is only a risk factor in the elderly group. Interestingly, being overweight and obese were identified as independent protective factors in middle-aged and elderly male patients, but not in females. The effect of BMI on mortality in septic patients varies according to age and sex. Elderly individuals with sepsis may derive more prognostic benefits from obesity.

Exploring the Link between Head and Neck Cancer and Elevated Risk of Rheumatoid Arthritis: A National Population-Based Cohort Study.

An increased risk of cancer among patients with rheumatoid arthritis (RA) has been reported. However, the risk of RA events among patients with head and neck cancer (HNC) is unknown. Therefore, we investigated the incidence and risk of RA among patients with HNC. This study was based on a cohort dataset. Overall, 2824 individuals without HNC and 706 patients with HNC were selected using propensity score matching. The overall RA event rate was 12.19 for patients with HNC and 7.60 for those without HNC. A significantly increased risk of developing RA was also observed among patients with HNC. The risk of developing RA over time was relatively high within the first year after HNC diagnosis; further, it increased significantly during the follow-up period. Moreover, middle-aged male patients with HNC exhibited an increased risk of developing RA compared with the controls; however, no significant difference was noted among female patients or other age groups. Notably, subgroup analysis according to cancer subtype revealed that only oral cancer survivors had an increased risk of developing RA. These results underscore the importance of vigilant monitoring by clinicians to promptly identify the onset of RA in patients with HNC.

Seizures as the Cardinal Manifestation of Idiopathic Intracranial Hypertension: A Case Report

Idiopathic intracranial hypertension (IIH) conventionally presents with features like headache, visual obscuration, diplopia and tinnitus. We present a case of a middle-aged male patient with headache and visual complaints and concurrent drug-resistant right focal seizures. Imaging revealed the presence of a left petrous bone defect with temporal lobe encephalocele with other features suggestive of IIH. Resolution of the symptoms was obtained after placement of theco-peritoneal shunt. Focal seizures in IIH are a rare phenomenon, precipitated by parenchymal herniation through eroded bony defects producing encephaloceles leading to tissue traction and ictal focus formation. In evaluation for drug-resistant temporal lobe epilepsy, IIH-induced encephalocele formation should be carefully considered.

An unusual anterior mitral leaflet perforation in a patient with no infective endocarditis: a case report

Abstract Background Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve, allowing blood to escape through these gaps. Typically, this is caused by infective endocarditis and the most common site is the anterior leaflet. However, it is crucial to explore other potential causes of valve damage, particularly when conventional risk factors are not apparent. Case presentation We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis. Conclusion Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.

A case of spontaneous brain arteriovenous malformation occlusion: Imaging analysis and clinical debate.

The spontaneous occlusion of brain arteriovenous malformations (bAVMs) is a rare event, particularly for unruptured ones. Associated factors include single-venous drainage and small nidus size. Most of the previously reported cases were ruptured bAVMs. We report the case of a middle-aged male patient with an unruptured, rolandic, left-sided bAVM associated with a 30-year history of refractory epilepsy. We documented the spontaneous thrombosis of the venous drainage of the AVM without any sign of bleeding. Finally, we underline the difference between ruptured-induced occlusion and truly spontaneous thrombosis of the bAVMs.

Schmidt's Syndrome: An Uncommon Cause of Spontaneous Hypoglycemia

AbstractSchmidt's syndrome, or autoimmune polyendocrine syndrome type 2 (APS-2), is an uncommon disorder characterized by the co-occurrence of autoimmune thyroiditis and adrenalitis. APS-2 is defined as a combination of Addison's disease, autoimmune thyroid disease, and/or type 1 diabetes mellitus. It is an autosomal dominantly inherited polygenic disorder with incomplete penetrance; the candidate genes include but are not limited to HLA-DR3, HLA-DR4, CTLA-4, PTPN22, and CD25-IL-2. Autoimmune thyroiditis, often Hashimoto's disease, results in hypothyroidism. Primary adrenal failure results in enhanced secretion of adrenocorticotrophic hormone melanocyte and co-secretion of melanocyte-stimulating hormone, contributing to hyperpigmentation. Mineralocorticoid deficiency results in salt wasting, fatigue and cramps, postural hypotension, and hyperkalemia. Cortisol, an insulin counter-regulatory hormone, plays a pivotal role in maintaining euglycemia; deficiency predisposes to the development of hypoglycemia. We here report a rare presentation of Schmidt's syndrome as hypoinsulinemic hypoglycemia in a middle-aged male patient. Management includes treatment of acute hypoglycemic episodes with glucose or glucagon, long-term glucocorticoids and mineralocorticoids for adrenal insufficiency, and thyroid hormone supplements for hypothyroidism. This case report and brief overview aim to contribute to the scientific understanding of Schmidt's syndrome/APS-2. Additionally, here we briefly outline the diagnostic challenges in hypoglycemia evaluation, including the utilization of Whipple's triad and the gold standard supervised 72-hour fast and evaluation for primary adrenal and thyroid insufficiencies.

Comparison of the Effect of Eight Weeks Aerobic and Combined Exercise on Some Hemodynamic Indicators in Middle-Aged Male Patients Undergoing Coronary Artery Bypass Graft Surgery

Introduction: Exercise training by modulating blood pressure and heart rate have a protective role for middle-aged cardiac patients. Aim of this study was to compare the effect of eight weeks of aerobic and combined exercise on some hemodynamic indicators in middle-aged male patients undergoing coronary artery bypass graft surgery.&#x0D; Methods: In this clinical trial, a sample of 30 middle-aged men who underwent coronary artery surgery in 2023 were enrolled after meeting predetermined eligibility criteria and randomized for participation. They were divided into three aerobic (n=10), combined (n=10) and control (n=10) groups. The individuals of the 2 intervention groups performed selected aerobic and combined exercises (with an intensity of 55 - 75% of the maximum heart rate, for 60 minutes) for 8 weeks, 3 sessions per week. Blood pressure, heart rate and peripheral oxygen saturation (SpO2) were measured before and after the intervention. The parametric paired sample t-test, one-way ANOVA test and Tukey's Test were used to examine differences at a significance level of P ≤ 0.05.&#x0D; Results: The effect of aerobic exercises on systolic blood pressure (P=0.036), diastolic blood pressure (P=0.040) and heart rate (P=0.013) was significant and caused a decrease in these indicators, but the decrease in the combined group was not significant (P&gt;0.05). The intergroup effect difference was not significant (P&gt;0.05). In both aerobic (P=0.000) and combined (P=0.007) groups, the peripheral oxygen saturation has increased significantly and intergroup mean difference was significant (P=0.004).&#x0D; Conclusion: It seems that aerobic and combined exercises as a helpful intervention strategy to improve hemodynamic indicators, make the patient more adaptable to the conditions after coronary artery bypass graft surgery.

Comparing the Effect of Eight Weeks of Aerobic and Combined Exercise on Some Hemorheological Indicators in Middle-Aged Male Patients Undergoing Coronary Artery Bypass Graft Surgery

Background: Hemorhological disorders are one of the primary causes of cardiovascular diseases. Accordingly, aerobic and combined exercises can improve hemorhological indicators and reduce cardiovascular complications in high-risk people. Objectives: This study aimed to compare the effects of eight weeks of aerobic and combined exercise on some hemorheological indicators in middle-aged male patients undergoing Coronary Artery Bypass Graft Surgery. Methods: This experimental study was conducted in 2023 on 30 middle-aged men (Age, 57.63 ± 6.38, BMI, 26.61 ± 3.60) undergoing Coronary Artery Bypass Graft Surgery in Kermanshah, Iran, who were divided into aerobic (10 people), combined (10 people), and control (10 people) groups. The intervention groups received selected exercises for eight weeks (24 sessions). Serum hemoglobin, hematocrit, fibrinogen, and erythrocyte sedimentation rate (ESR) were measured before and after the intervention. The parametric paired sample t-test and one-way ANOVA test were used to examine differences at a significance level of P ≤ 0.05. Results: The effect of combined exercises on hemoglobin and hematocrit was significant (P ≤ 0.05), but the amount of reduction in the aerobic group was not significant (P &gt; 0.05). Findings in the fibrinogen and ESR variables showed a significant decrease in both aerobic and combined groups (P ≤ 0.05). There was no significant difference between the effect of eight weeks of aerobic and combined training on the variables of hemoglobin, hematocrit, fibrinogen, and ESR (P &gt; 0.05). Conclusions: Based on the results, aerobic and combined exercises effectively improved the hemorheological indicators and overall conditions of patients who underwent Coronary Artery Bypass Graft Surgery. Therefore, these exercises should be included in the cardiac rehabilitation program as an effective treatment method.

Thyrotoxicosis Masquerading as Late Onset Mania: A Case Report on Treatment of Mania in Thyroid Storm

Manic episodes, typically associated with Bipolar Affective Disorder (BPAD), can also arise from medical conditions such as thyrotoxicosis, leading to “secondary” or “organic” mania. Thyrotoxicosis, characterised by excessive thyroid hormone levels, can cause neuropsychiatric symptoms and, in severe cases, result in a thyroid storm. Present case is of a middle-aged male patient without a prior psychiatric history who presented with manic symptoms such as overspending, over familiarity, and agitation, alongside physical signs of thyrotoxicosis, including weight loss and tachycardia. He was diagnosed with a thyroid storm secondary to Graves’ disease. Despite the rarity of the condition and the absence of established guidelines, management prioritised controlling sympathetic overactivity and restoring euthyroid status. Lithium, along with antipsychotics were chosen for their minimal impact on the QTc interval, was utilised to effectively address the manic symptoms. Aggressive medical management targeting both thyroid function and manic symptoms led to significant improvement. This case highlights the critical need to consider medical aetiologies in psychiatric presentations and underscores the importance of early diagnosis and multidisciplinary management to reduce morbidity. Collaborative efforts among medical specialties are essential to address the complexities of such cases.