International Medical Case Reports Journal最新文献

{"title":"Unexpected Right-Sided Nerve Root Variant During L4-L5 Microdiscectomy and Decompression: A Case Report Highlighting Diagnostic and Intraoperative Challenges.","authors":"Abukar Abdi Nor, Abdiweli Mohamed Abdi, Nur Abdullahi Karshe, Dayib Hussein Mohamed, Ayub Omar Adam, Mohamed Ismael Iman, Nor Haji Osman, Osman Mohamed Mohamud, Abdirahman Mohamed Jimale","doi":"10.2147/IMCRJ.S640726","DOIUrl":"https://doi.org/10.2147/IMCRJ.S640726","url":null,"abstract":"<p><p>Lumbosacral nerve root variants may complicate anatomical identification and decompression during lumbar spine surgery. We report a 45-year-old woman with progressive lower limb numbness and paresthesia predominantly affecting the right leg, intermittent low back pain, and right-sided radiating pain aggravated by standing and walking. Examination showed preserved motor strength and sensory impairment in a predominantly right L4 distribution. Preoperative magnetic resonance imaging (MRI) demonstrated an L4-L5 disc bulge with thecal sac indentation, bilateral L5 nerve root abutment, and mild bilateral foraminal narrowing; no nerve root anomaly was reported. During L4-L5 microdiscectomy and decompression, two distinct right-sided neural structures were unexpectedly identified under microscopic visualization and interpreted as suspected duplication of the exiting L4 root. Both structures were preserved during decompression. Retrospective MRI review did not confirm the variant, and intraoperative electrophysiological identification was not feasible. During five months of monthly telephone follow-up, the patient reported improvement in radicular pain, walking tolerance, and sensory symptoms, without reported neurological deterioration. Follow-up neurological examinations and standardized outcome measures were unavailable. This case highlights the importance of recognizing and characterizing unexpected neural anatomy when clinical, imaging, and operative findings do not fully correlate. Definitive anatomical classification and objective postoperative recovery remain uncertain.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"640726"},"PeriodicalIF":0.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding Diagnostic Overshadowing: A Case Series on Cervical Myelopathy in Patients with Fibromyalgia.","authors":"Paddison R Lowe, Brandon B Carlson, Andrea L Chadwick","doi":"10.2147/IMCRJ.S583085","DOIUrl":"https://doi.org/10.2147/IMCRJ.S583085","url":null,"abstract":"<p><p>Cervical myelopathy is a condition that presents with variable clinical symptoms including neck, arm, low back, and leg pain, numbness, weakness, difficulty with ambulation, and changes in fine motor skills. Fibromyalgia may also present with similar symptomatology including widespread pain and mild subjective symptoms of paresthesias, numbness, and weakness. Although fibromyalgia may be associated with some neurologic symptoms, it is important to note that fibromyalgia itself is not associated with severe, progressive neurologic symptoms or indications of upper motor neuron involvement (ex. Hoffman's sign). We present three patients who were referred to our multidisciplinary chronic pain clinic specifically for fibromyalgia evaluation and treatment. After thorough clinical and radiographic evaluations, they were discovered to have severe physical and neurological impairments caused by unrecognized cervical myelopathy. Fibromyalgia is no longer considered a diagnosis of exclusion and may coexist with other conditions with overlapping symptomatology. Therefore, atypical clinical features should prompt further evaluation rather than be attributed solely to fibromyalgia. Patients with fibromyalgia who describe significant neurological dysfunction accompanied by severe physical limitations should raise clinical concerns. A thorough musculoskeletal and neurological physical examination should <i>always</i> be performed in any patient presenting for fibromyalgia consultation, particularly if these symptoms are present. Imaging studies should be obtained if there are concerning signs, symptoms, and physical examination findings as prompt recognition of cervical myelopathy can lead to treatment that may improve a patient's quality of life. These cases seek to highlight important clinical implications of diagnostic overshadowing in patients with fibromyalgia.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"583085"},"PeriodicalIF":0.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13701085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional Skull Base Chordoma in a Ugandan Adult Male, Presenting with Prolonged Headache: A Case Report.","authors":"Malcom Mark Okello, Male Mutumba, Sam Kalungi, Sharrif Musoke, Phillip Omega, Esther Fiona Wanyenze, Eunice Chepkurui Byebei, Ivan Asiimwe, Alfed Bulamu, Mark Kirabo Iga, Stella Nabawanga, Gerald Alicwamu, Melisa Nalwanga, Cosmas Jerome Mbogga, Boaz Mwesigwa","doi":"10.2147/IMCRJ.S626932","DOIUrl":"https://doi.org/10.2147/IMCRJ.S626932","url":null,"abstract":"<p><strong>Background: </strong>Chordomas are uncommon malignant neoplasms arising from notochordal remnants, most commonly affecting the axial skeleton, mainly the skull base and sacrococcygeal region. Skull base chordoma may be asymptomatic or cause progressive headache before focal symptoms prompt imaging. In resource-limited settings, diagnostic work-up is often prolonged as the patient is managed with analgesics without prompt and satisfactory investigation. We report a case of conventional Chordoma arising at the skull base, in a patient with long standing headache.</p><p><strong>Case presentation: </strong>A 49-year-old man presenting with a more than one-year history of intermittent and progressive worsening headache. After he reported an episode of facial numbness, examination documented preserved facial sensation. There was no other focal neurological clinical abnormality. Head CT imaging revealed an expansile, destructive midline skull base mass (bone erosion) occupying the region of the skull base, sphenoid paranasal sinus extending into the ethmoid. An invasive biopsy through the sphenoid sinuses was obtained for histopathologic evaluation, which showed morphology consistent with chordoma, supported by IHC showing positivity for EMA, pan-cytokeratin, and S100, with negative CK7, CK20, and CD34. The Ki-67 proliferation index was less than 5%. The integrated findings strongly supported conventional chordoma. Brachyury was unavailable. At last documented review, the patient was clinically stable and surgical management was planned; however the patient was lost to follow-up on subsequent attempts.</p><p><strong>Conclusion: </strong>Progressive headache with a newly reported focal neurological symptom warrants appropriate imaging and specialist assessment. In a destructive midline skull base mass, the combined morphology and immunophenotype strongly support chordoma, while the absence of brachyury confirmation remains a limitation.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"626932"},"PeriodicalIF":0.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Recovery Following Conservative Management of a Large Presumed Brain Abscess with a Concomitant <i>Streptococcus intermedius</i> Lung Abscess in a Severely Malnourished Young Adult in a Resource-Limited Setting: A Case Report.","authors":"Filmon Tesfay Riesehaymanot, Estifanos Habteab Zeray, Lidya Musie Tekeste","doi":"10.2147/IMCRJ.S635618","DOIUrl":"https://doi.org/10.2147/IMCRJ.S635618","url":null,"abstract":"<p><strong>Background: </strong>Brain abscess is a life-threatening condition requiring prompt antimicrobial therapy and, when feasible, neurosurgical drainage. Management can be particularly challenging in resource-limited settings where neurosurgical intervention, microbiological confirmation, and follow-up imaging may be unavailable. We report a case of a large presumed brain abscess occurring concurrently with a <i>Streptococcus intermedius</i> lung abscess in a severely malnourished young adult managed in a resource-limited setting.</p><p><strong>Case presentation: </strong>A 22-year-old Eritrean man presented with one week of progressive left-sided weakness preceded by four weeks of productive cough, fever, and weight loss. He was severely malnourished (BMI 14 kg/m²), febrile, and had impaired consciousness with flaccid left hemiplegia. Non-contrast CT and MRI showed a 4 × 3 cm right parietal intracranial lesion with surrounding edema and moderate midline shift, presumed to represent a brain abscess. Chest imaging revealed a right lower-lobe lung abscess, from which <i>Streptococcus intermedius</i> was isolated; blood cultures were negative and echocardiography was normal. Neurosurgical drainage was unavailable. He was treated with intravenous ceftriaxone and metronidazole with supportive and nutritional care. His GCS improved from 10/15 to 15/15 within three days, and he regained independent ambulation by four weeks. He completed four weeks of intravenous antibiotics and was discharged clinically stable with oral antibiotics to complete seven weeks of antibiotics. No follow-up neuroimaging was available, but he remained clinically well during three years of telephone follow-up.</p><p><strong>Conclusion: </strong>This case illustrates the challenges of managing a large presumed brain abscess when neurosurgical drainage and follow-up neuroimaging are unavailable. Despite the absence of microbiological confirmation from the brain lesion, the patient achieved sustained clinical and neurological recovery following prolonged antimicrobial and supportive treatment. The case emphasizes diagnostic vigilance and resource-adapted care while recognizing that clinical recovery does not establish radiological resolution or replace standard neurosurgical management when feasible.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"635618"},"PeriodicalIF":0.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inferolateral ST-Segment Elevation Myocardial Infarction Secondary to Suspected Coronary Embolism in a Patient with Paroxysmal Atrial Fibrillation: A Case Report.","authors":"Sai Tharun Reddy Gopannagari, Kesava Manikanta Achuta, Ishan Kirti, Abed Dabaja, Sujata Kambhatla","doi":"10.2147/IMCRJ.S656587","DOIUrl":"https://doi.org/10.2147/IMCRJ.S656587","url":null,"abstract":"<p><p>Coronary embolism is an underrecognized nonatherosclerotic cause of ST-segment elevation myocardial infarction (STEMI), most commonly associated with atrial fibrillation. We report a 76-year-old man with paroxysmal atrial fibrillation who presented with acute substernal chest pain and inferolateral STEMI. Coronary angiography demonstrated a 100% thrombotic occlusion of the distal right posterolateral ventricular branch with otherwise nonobstructive coronary artery disease. In the setting of an abrupt distal coronary occlusion, minimal underlying atherosclerotic disease, paroxysmal atrial fibrillation, and fulfillment of the Shibata diagnostic criteria, coronary embolism was considered the most likely mechanism. Long-term anticoagulation was continued, and the patient remained asymptomatic at 1-month follow-up. This case highlights the diagnostic challenge of suspected coronary embolism in patients presenting with STEMI, atrial fibrillation, and minimal underlying coronary artery disease.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"656587"},"PeriodicalIF":0.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Correction of Adult Intestinal Malrotation Using Kareem's Procedure: A Case Report.","authors":"Waheeb Radman Al-Kubati, Mansour Mohammed Al-Hameli, Nardeen Alqousi, Anas Al-Kubati, Abdullah Al-Kubati, Bilal Sleiay","doi":"10.2147/IMCRJ.S644052","DOIUrl":"https://doi.org/10.2147/IMCRJ.S644052","url":null,"abstract":"<p><strong>Background: </strong>Intestinal malrotation (IM) is a congenital defect in midgut rotation or fixation that results in abnormal positioning of the bowel. Although most cases present during infancy, adult presentation is uncommon and may be misdiagnosed. Kareem's procedure is an anatomical corrective approach described for gut malrotation; however, evidence regarding its use remains limited.</p><p><strong>Case presentation: </strong>A 26-year-old female presented with sudden, severe, colicky central abdominal pain associated with non-bilious vomiting and complete constipation for 10 hours. She had experienced a similar self-limited episode one month earlier. Contrast-enhanced abdominal CT revealed inversion of the SMA/SMV relationship, right-sided clustering of small bowel loops, and abnormal position of the duodenojejunal junction, consistent with intestinal malrotation with acute complications. The patient underwent anatomical correction using Kareem's procedure. At follow-up, she reported relief of abdominal pain, and CT confirmed normalization of the SMA/SMV relationship, cecal position in the right iliac fossa, and jejunal loops in the left abdomen.</p><p><strong>Conclusion: </strong>IM should be considered in adults with unexplained abdominal pain or features of intestinal obstruction. Kareem's procedure was feasible in this patient and was associated with a favourable outcome. Further evidence is needed before drawing conclusions about comparative effectiveness.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"644052"},"PeriodicalIF":0.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Cystic Lymphangioma of the Transverse Mesocolon in a 7-Year-Old Child: A Case Report.","authors":"Mohamed Abdullahi Awale, Mariam Hassan Ali, Intisar Ahmed Abdi, Mikail Mohamed Mohamoud, Abdirahman Omar Ahmed, Abdirahman Dahir Hayle, Abdullahi Farah Asseyr","doi":"10.2147/IMCRJ.S627784","DOIUrl":"10.2147/IMCRJ.S627784","url":null,"abstract":"<p><strong>Background: </strong>Cystic lymphangiomas are rare benign lymphatic malformations that are usually diagnosed in early childhood. Intra-abdominal lesions are uncommon, and involvement of the transverse mesocolon is particularly rare.</p><p><strong>Case presentation: </strong>A 7-year-old girl presented with a 3-4 week history of vomiting, abdominal pain, progressive abdominal distension, poor appetite, abdominal fullness, generalized weakness, and irregular bowel movements. Examination revealed a large, well-defined, irregular, non-tender abdominal mass measuring approximately 12 × 10 x 12 cm and extending from the right flank to the pubic region. Laboratory investigations were unremarkable. Preoperative imaging demonstrated a large multiloculated cystic intra-abdominal mass, initially interpreted as an ovarian cyst, but the precise site of origin was not established. Exploratory laparotomy identified a giant multiloculated cystic lesion arising from the transverse mesocolon and extending toward the greater curvature of the stomach. Complete excision was achieved without bowel resection. Histopathological examination confirmed cystic lymphangioma. Recovery was uncomplicated, and no recurrence was observed during 8 months of follow-up.</p><p><strong>Conclusion: </strong>Mesocolonic cystic lymphangioma should be considered in the differential diagnosis of a large multiloculated intra-abdominal cystic mass in a child, including an older child, even when imaging suggests an adnexal lesion. This case highlights the difficulty of determining the site of origin of very large cystic lesions preoperatively and supports complete excision when technically feasible for definitive diagnosis and local disease control.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"627784"},"PeriodicalIF":0.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focal Epithelial Hyperplasia in a Somali Child: A Case Report and Review of Management with Topical Imiquimod.","authors":"Mohamed A Hersi, Mohamud M Abdulkadir, Mohamed Abdulkadir Hassan-Kadle, Mohamed Hassan Mohamud, Abdulkarim Ahmed Mohamud, Mohamed Adam Jama","doi":"10.2147/IMCRJ.S632816","DOIUrl":"10.2147/IMCRJ.S632816","url":null,"abstract":"<p><strong>Background: </strong>Focal epithelial hyperplasia (FEH), also known as Heck's disease, is a rare, benign, contagious condition of the oral mucosa associated primarily with human papillomavirus (HPV) types 13 and 32. It predominantly affects children and adolescents and is often underreported in many regions.</p><p><strong>Case presentation: </strong>We report the case of an 8-year-old Somali girl who presented with a 3.5-year history of asymptomatic, progressively increasing oral mucosal lesions. Clinical examination revealed multiple soft, flat-topped, verrucous papules involving the lower labial, buccal, lingual mucosa, and gingiva. The patient presented with poor oral hygiene; however, feeding difficulties, malnutrition, systemic symptoms, previous treatment, and similar lesions among family members were absent. A clinical diagnosis of focal epithelial hyperplasia was made (Figure 1). The patient was treated with off-label topical imiquimod 5% cream applied three times weekly at bedtime. After two weeks of therapy, the patient developed local adverse reactions, including mucosal erythema, erosion, crusting, and minor focal bleeding (Figure 2). During this phase, she experienced localized burning discomfort, mild pain, and transient feeding difficulty, which necessitated a temporary 1-week treatment holiday and supportive local care. Following seven weeks of resumption, complete clinical resolution (Figure 3) of the lesions was achieved within ten weeks of total management, with no recurrence observed over a 16-month follow-up period.</p><p><strong>Conclusion: </strong>This case represents the first documented report of focal epithelial hyperplasia in Somalia and highlights the utility of off-label and non-invasive topical imiquimod 5% cream. Increased clinical awareness is essential for accurate diagnosis and appropriate management, particularly in underreported settings.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"632816"},"PeriodicalIF":0.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifactorial Contributors to Diagnostic Delay in a High-Risk Patient with Hepatocellular Carcinoma: A Case Report with Clinical Lessons.","authors":"Jiao Hu, Liping Guo, Tongen Chen, Jingfeng Zhang, Qiaoqiao Jiang","doi":"10.2147/IMCRJ.S638448","DOIUrl":"10.2147/IMCRJ.S638448","url":null,"abstract":"<p><strong>Background: </strong>Patients at high risk for primary liver cancer (PLC) are recommended to undergo PLC surveillance at least every six months. Alpha-fetoprotein (AFP) is a commonly used biomarker; however, approximately 15-30% of PLC cases remain AFP-negative throughout their course. Therefore, surveillance in high-risk populations should be based on liver imaging. Any newly detected or progressive lesion should be further characterized by contrast-enhanced computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI), or contrast-enhanced ultrasound, following guideline-based classification and follow-up recommendations.</p><p><strong>Case presentation: </strong>This case details a 45-year-old Chinese male with hepatitis B virus (HBV) infection, type 2 diabetes mellitus, and a family history of PLC. As a high-risk individual for PLC, he did not undergo regular PLC surveillance for three years. During opportunistic encounters for acute myocardial infarction and abdominal pain, the attending specialists failed to appreciate the progression of liver imaging findings. In addition, the COVID-19 pandemic may have further aggravated pre-existing difficulties with follow-up and access to care, contributing to a delayed diagnosis of PLC.</p><p><strong>Conclusion: </strong>This case illustrates how a combination of physician-related, patient-related, and social-environmental factors contributed to surveillance failure and diagnostic delay in a high-risk patient with PLC. It reflects on why guideline-recommended interventions were not implemented at each healthcare encounter, how to correctly interpret AFP, and how to improve adherence to surveillance among high-risk populations for PLC. The insights from this case aim to inform systematic improvements in PLC monitoring for patients with chronic HBV infection.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"638448"},"PeriodicalIF":0.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excessive Yawning During Escitalopram Therapy in a Rwandan Woman with Co-Morbid Depression and Post-Traumatic Stress Disorder: A Case Report.","authors":"Melissa Lowan Gihozo, Jean Pierre Gafaranga","doi":"10.2147/IMCRJ.S651827","DOIUrl":"10.2147/IMCRJ.S651827","url":null,"abstract":"<p><p>Excessive yawning is an uncommon but recognized adverse effect of selective serotonin reuptake inhibitors (SSRIs). Although generally benign, it may cause distress and may be mistaken for a symptom of psychiatric or neurological illness. Case reports and pharmacovigilance data have linked escitalopram to yawning, sometimes in a dose-dependent manner. To our knowledge, this is one of the first reported cases of escitalopram-associated yawning in Rwanda. We describe a 44-year-old woman from rural Rwanda who presented with a severe depressive episode and comorbid post-traumatic stress disorder (PTSD). Three days after starting escitalopram 10 mg daily, she reported markedly increased yawning, approximately six episodes every 15 minutes throughout the day, while her sleep and mood had begun to improve slightly. Medical and neurological causes, sleep-related causes and concurrent short-term diazepam use were considered and judged unlikely. The Naranjo Adverse Drug Reaction Probability Scale score was 5, indicating a probable adverse drug reaction. Escitalopram was continued because of emerging antidepressant benefit, and the yawning had decreased substantially at the two-week follow-up. This case suggests that yawning occurring early in escitalopram treatment should be recognized as a probable adverse drug reaction. Awareness of this under-reported effect may prevent unnecessary investigations and premature discontinuation of an effective antidepressant.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"651827"},"PeriodicalIF":0.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}