International Medical Case Reports Journal最新文献

{"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}

{"title":"Density Spectral Array Patterns During Total Intravenous Anesthesia with Intravenous Lidocaine for Craniotomy: An Illustrative Two-Case Series.","authors":"Riyadh Firdaus, Jonathan Wiradinata, Lara Aristya, Bintang Pramodana, Arila Atalia","doi":"10.2147/IMCRJ.S645855","DOIUrl":"10.2147/IMCRJ.S645855","url":null,"abstract":"<p><strong>Purpose: </strong>Intravenous lidocaine is used as an adjuvant to total intravenous anesthesia (TIVA). To our knowledge, density spectral array (DSA) patterns during intravenous lidocaine administration in propofol-remifentanil TIVA for craniotomy have rarely been described. We present two illustrative cases for educational and hypothesis-generating purposes.</p><p><strong>Patients and methods: </strong>Two adults underwent craniotomy for tumor resection (left cerebellopontine angle, Case 1; suprasellar, Case 2) with effect-site target-controlled infusion of propofol (Schnider model) and remifentanil (Minto model) and a bilateral scalp block. After a 1.5 mg/kg bolus, lidocaine was infused at 1.5 mg/kg/hour (Case 1) or 2 mg/kg/hour (Case 2) and stopped 30 minutes before the end of surgery. Frontal bispectral index (BIS) and DSA were recorded throughout and interpreted qualitatively at the bedside and offline.</p><p><strong>Results: </strong>In Case 1, an alpha-delta pattern persisted during maintenance, including at the lowest targets used (propofol 1.8 mcg/mL, remifentanil 2.5 ng/mL; BIS 39-45). In Case 2, the DSA showed more pronounced delta dominance, attenuated alpha and beta activity, and intermittent burst suppression, which persisted when propofol was reduced to 1.5 mcg/mL. In both patients, transient beta-power increases were temporally associated with surgical stimulation; electromyographic contribution could not be excluded. No hemodynamic instability or adverse effect attributable to lidocaine was observed.</p><p><strong>Conclusion: </strong>This two-patient illustrative case series demonstrates differing DSA patterns during propofol-remifentanil TIVA with two intravenous lidocaine infusion regimens. Because the observations come from different patients with multiple clinical and anesthetic confounders, no dose-response relationship or causal effect of lidocaine can be established. These hypothesis-generating observations require evaluation in controlled studies.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"645855"},"PeriodicalIF":0.7,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216293","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":"Fibrolipomatous Hamartoma of the Median Nerve Misdiagnosed as a Palmar Space Abscess: A Case Report.","authors":"Ranjan Kumar Jha Snr, Gaurab Acharya, Arun Kumar Chaurasiya, Mohammed Ali Saghir","doi":"10.2147/IMCRJ.S634210","DOIUrl":"10.2147/IMCRJ.S634210","url":null,"abstract":"<p><strong>Background: </strong>Fibrolipomatous hamartoma (FLH), also categorized under lipomatosis of nerve, is a rare, is an uncommon benign fibrofatty lesion of the peripheral nerves that most commonly affects the median nerve. Its slow progression and atypical presentation often lead to misdiagnoses and improper surgical management.</p><p><strong>Case presentation: </strong>A 17-year-old female presented with a 5-year history of progressive left-hand swelling and paraesthesia and a 2-year history of pain and secondary reduction in grip strength. The mass was previously misdiagnosed as an acute mid-palmar space abscess, which resulted in an ineffective incision and drainage. Magnetic Resonance Imaging (MRI) revealed severe median nerve enlargement with pathognomonic \"coaxial cable\" (axial) and \"spaghetti-like\" (coronal) patterns. To prevent neurological deficits, a biopsy was avoided, and the patient underwent open carpal tunnel decompression. At 6-month postoperative follow-up, she demonstrated substantial symptomatic relief, restoration of pain-free grip and pinch strength, and no signs of neurological deterioration.</p><p><strong>Conclusion: </strong>FLH can mimic common inflammatory or infectious hand masses. Magnetic resonance imaging (MRI) provides highly characteristic features that allow a clinicoradiological diagnosis, generally obviating the need for an invasive biopsy. Carpal tunnel decompression may provide symptomatic relief in patients with compressive neuropathy while avoiding potentially injurious intraneural resection.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"634210"},"PeriodicalIF":0.7,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216305","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":"Extracorporeal Cardiopulmonary Resuscitation as a Bridge to Cardiac Transplantation in Refractory Cardiac Arrest Due to Fulminant Myocarditis: A Case Report.","authors":"Lajos Szentgyorgyi, Laura Roberts, Wesley Cheung, Jacquelyn Hooper, Flora Anne Jayne-Coupe, Hind Elmahdi, Vipin Mehta","doi":"10.2147/IMCRJ.S625131","DOIUrl":"10.2147/IMCRJ.S625131","url":null,"abstract":"<p><p>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory cardiac arrest, although evidence for a survival benefit remains heterogeneous and appears highly dependent on patient selection and systems of care. We report the case of a previously healthy 36-year-old woman who presented with acute fulminant myocarditis and cardiogenic shock. Following an in-hospital cardiac arrest unresponsive to conventional cardiopulmonary resuscitation, bedside ECPR was initiated using peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to longer-term mechanical circulatory support with a biventricular assist device (BiVAD). After conversion to central BiVAD support, the patient was listed super-urgently and subsequently underwent successful donation-after-circulatory-death heart transplantation. She was discharged home neurologically intact and remains well five months after discharge. This case demonstrates that when deterioration is imminent and standard therapies have failed, ECPR may provide life-saving support while preparing for definitive mechanical circulatory support, even when most members of the clinical team lack ECPR experience. Timely leadership and coordinated multidisciplinary expertise were the key to achieving a successful outcome in this case.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"625131"},"PeriodicalIF":0.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181917","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":"Advanced Rheumatic Heart Disease Complicated by Pregnancy, Mitral Valve Disease, Pulmonary Hypertension, and Left Atrial Thrombus: A Multidisciplinary Case Report from Resource-Limited Settings.","authors":"Nouh Ismail Botan, Sadam Ismail Ahmed, Fatima Hachi Imaan, Kaltun Hassan Madar","doi":"10.2147/IMCRJ.S643597","DOIUrl":"https://doi.org/10.2147/IMCRJ.S643597","url":null,"abstract":"<p><strong>Introduction: </strong>Rheumatic heart disease (RHD) remains a leading cause of cardiovascular morbidity and mortality among pregnant women in resource-limited settings. Pregnancy induces significant hemodynamic changes that can decompensate pre-existing valvular heart disease, leading to life-threatening complications for both mother and fetus.</p><p><strong>Case presentation: </strong>A 27-year-old pregnant woman (gravida 6, para 5) at approximately 34-38 weeks presented with progressive shortness of breath, palpitations. Based on the modified World Health Organization (mWHO) classification, she was categorized as Class IV (extremely high risk) bilateral lower limb swelling, cough, fatigue, and reduced appetite. Cardiovascular examination revealed a systolic murmur, loud S1 and S2, with bilateral basal crepitations on respiratory examination. Echocardiography demonstrated an enlarged left atrium (5 cm), moderate mitral stenosis, mild mitral regurgitation, with fixed mitral valve leaflets, pulmonary hypertension, poor right ventricular function, a large left atrial thrombus, Labor occurred spontaneously while on low-molecular-weight heparin (LMWH). Mild pericardial effusion, and preserved left ventricular ejection fraction (58%). Laboratory investigations showed elevated CRP (48.8 mg/L), thrombocytopenia (platelets 99 ×10⁹/L), mild coagulation abnormalities (INR 1.5), and urinalysis findings consistent with hematuria and proteinuria. Electrocardiography revealed sinus tachycardia, left atrial enlargement, right ventricular hypertrophy pattern, incomplete right bundle branch block, and prolonged QTc interval. The patient received multidisciplinary care including furosemide, metoprolol, and enoxaparin. She delivered a 2.1 kg neonate with good Apgar scores.</p><p><strong>Discussion: </strong>This case illustrates the severe maternal and fetal risks associated with advanced RHD during pregnancy. The presence of a large left atrial thrombus in a pregnant woman poses significant thromboembolic and hemodynamic risks. Multidisciplinary management involving cardiology, obstetrics, anesthesia, and intensive care is essential for optimizing outcomes.</p><p><strong>Conclusion: </strong>This case highlights the critical importance of early recognition, strict adherence to CARE guidelines and multidisciplinary management, and the need for preventive strategies including primary prevention of rheumatic fever and secondary prophylaxis for RHD in resource-limited settings.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"643597"},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181911","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}