Journal of Case Reports in Medical Science

Resolution of Neck Pain and Recovery of Drug-associated Erectile Dysfunction Following Conservative Management in Cervical Spondylosis: A Case Report

2026-02-27T10:38:28+00:00

Cervical spondylosis is a degenerative disorder of the cervical spine that commonly causes chronic neck pain and functional limitations in older adults. Although pharmacologic therapy, including neuropathic pain agents, is usually the first line of management, it can cause adverse effects such as erectile dysfunction, which may limit its usefulness and necessitate conservative management like physiotherapy.

A 67-year-old male civil servant presented with a six-month history of right-sided neck pain and a burning sensation that began after abrupt neck rotation during exercise. Radiographs showed osteophyte formation and straightening of the cervical lordosis. Medical management included Amlodipine, Neurovite, and the neuropathic pain agent Gabapentin, which provided minimal relief but triggered erectile dysfunction shortly after initiation, prompting discontinuation and referral for physiotherapy.

The patient underwent eight physiotherapy sessions over four weeks, consisting of cervical mobilization (Grades II and III), soft-tissue mobilization, cryotherapy, progressive neck stabilization exercises, strengthening exercises, and ergonomic counseling.

Following treatment, pain reduced (NPRS: 8/10 to 2/10), disability decreased (NDI: 27% to 8%), and the drug-induced erectile dysfunction completely resolved (IIEF-5: 10/25 to 25/25). Cervical range of motion improved across all planes, and no radicular signs were observed.

This case highlights the role of structured physiotherapy in improving pain and function in cervical spondylosis and was associated with recovery of drug-related erectile dysfunction after medication cessation, although causality cannot be definitively established.

Venous Malformation of the Buccal Mucosa in a 65-Year-Old Female: A Case Report

2026-03-12T05:42:16+00:00

Aim: To present a case of venous malformation of the buccal mucosa in an elderly patient and to emphasize the role of clinical and radiologic evaluation in establishing an accurate diagnosis.

Case Presentation: A 65-year-old female reported a painless swelling on the left buccal mucosa that had been present for three months. Clinical examination revealed a localized, soft, bluish lesion that was compressible and demonstrated blanching on diascopy, indicating a vascular origin. Based on initial findings, hemangioma was considered provisionally. To further assess the lesion, Doppler ultrasonography was performed, which revealed a low-flow vascular pattern consistent with a venous malformation.

Discussion: Accurate distinction between vascular tumors and vascular malformations is essential, as their biological behavior and treatment approaches differ. Sole reliance on clinical appearance may lead to misdiagnosis, particularly in older patients. Doppler imaging provides valuable information regarding flow characteristics, enabling precise classification and appropriate treatment planning.

Conclusion: Comprehensive evaluation combining clinical examination and imaging is crucial for correct diagnosis and rational management of oral vascular lesions.

Black Hairy Tongue in an Elderly Patient: A Case Report

2026-06-23T10:33:12+00:00

Aims: Black hairy tongue is a benign acquired disorder characterised by elongation, defective desquamation, and discolouration of the filiform papillae on the dorsal surface of the tongue. Although it is commonly associated with poor oral hygiene, tobacco use, staining beverages, xerostomia, and selected medications, it may also occur without these factors. This case report presents an elderly patient with black hairy tongue and highlights the value of clinical recognition and conservative management.

Case Presentation: A 72-year-old male patient presented with persistent dark discolouration of the tongue for the previous 2–3 years. He had no pain, burning sensation, altered taste, or halitosis, and his main concern was the aesthetic appearance. His medical and drug history was non-contributory, and he reported no tobacco use, alcohol consumption, or deleterious oral habits. He had used complete dentures for 7 years. Intraoral examination showed diffuse blackish-brown discolouration over the posterior two-thirds of the dorsal tongue, with a hairy, carpet-like appearance and elongated filiform papillae. The lateral borders and tip of the tongue were relatively normal. The diagnosis of black hairy tongue was made clinically, and no additional laboratory investigations were performed.

Management and Outcome: The patient was managed conservatively with gentle brushing of the dorsal tongue, use of a tongue cleaner, reinforcement of oral hygiene, once-daily antiseptic mouthwash, adequate hydration, denture cleaning, night-time denture removal, and reassurance. Follow-up showed a marked reduction in pigmentation and improvement in tongue texture, with gradual resolution of the hairy appearance.

Conclusion: Black hairy tongue is a benign and reversible condition. Careful clinical assessment, patient education, oral and denture hygiene, and mechanical debridement can support favourable outcomes while avoiding unnecessary interventions.

Giant High-Risk Cutaneous Squamous Cell Carcinoma of the Lower Abdominal Wall with Lymphovascular Invasion Managed by Wide Excision and Modified Abdominoplasty-like Reconstruction: A Case Report

2026-07-07T08:14:59+00:00

Cutaneous squamous cell carcinoma (cSCC) is a common non-melanoma skin cancer that usually develops in chronically sun-exposed areas. Giant cSCC of the lower abdominal wall is rare and presents distinct oncological and reconstructive challenges, particularly when high-risk pathological features are present. This case report describes a 67-year-old man with a progressively enlarging ulcerated suprapubic mass measuring approximately 6.5×6 cm. Preoperative contrast-enhanced abdominopelvic computed tomography and inguinal ultrasonography showed no muscular or fascial invasion, regional lymph node involvement, or distant metastasis. The patient underwent wide local excision with oncological margins, resulting in a 14 × 9 cm soft tissue defect with preservation of the abdominal fascia. Reconstruction was performed using a modified abdominoplasty-like advancement and translation plasty, allowing primary closure without mesh reinforcement. Histopathological examination confirmed a moderately differentiated non-keratinising invasive cSCC with multiple vascular tumour emboli, consistent with lymphovascular invasion, and negative lateral and deep surgical margins. Adjuvant volumetric modulated arc therapy was delivered to the tumour bed at a total dose of 60 Gy in 30 fractions. At 18 months of follow-up, there was no evidence of local recurrence, regional nodal disease, distant metastasis, abdominal wall weakness, or incisional hernia, and the cosmetic outcome was satisfactory. This case supports careful multidisciplinary management of selected giant high-risk abdominal wall cSCC.

Scalpel or Steroid? A Descriptive Comparison of Two Cases of Oral Mucocele Managed with Surgical Excision and Intralesional Triamcinolone Acetonide

2026-07-22T13:04:57+00:00

Aim: The present study describes two cases of lower-lip oral mucocele managed by conventional surgical excision and intralesional triamcinolone acetonide and to compare their clinical courses descriptively.

Case presentation: A 35-year-old male presented with a 1.8 × 1.2 cm bluish, fluctuant lesion of two months’ duration. The lesion and adjacent minor salivary glands were excised under local anaesthesia, and histopathological examination confirmed a mucus extravasation phenomenon. A 23-year-old male presented with a 1.0 × 0.8 cm recurrently rupturing and refilling lesion of four months’ duration. In accordance with the patient’s preference for minimally invasive treatment, 0.3 mL of triamcinolone acetonide (10 mg/mL) was injected intralesionally.

Results: The surgical site healed uneventfully after suture removal, while the injected lesion regressed progressively and showed complete clinical resolution at four weeks. Neither lesion recurred during six months of follow-up, and no treatment-related complication was observed in the corticosteroid-treated patient.

Discussion: Surgical excision provided tissue for definitive histopathological confirmation but required suturing, analgesics, and postoperative wound care. Intralesional triamcinolone acetonide avoided surgery and was well tolerated, but histopathological confirmation was unavailable.

Conclusion: Both approaches were followed by complete clinical resolution in these individual cases. Because only one patient received each intervention and spontaneous regression cannot be excluded, the findings do not establish comparative effectiveness. Treatment should be individualised according to lesion characteristics, diagnostic certainty, patient preference, and follow-up requirements.

Bleomycin-Induced Flagellate Erythema in a Patient with Classic Kaposi’s Sarcoma: Report of a Rare Adverse Effect

2026-08-03T12:14:46+00:00

Aims: To report a rare, bleomycin-specific cutaneous adverse effect — flagellate erythema — occurring early in a patient treated for classic Kaposi’s sarcoma, and to review its clinical features, pathogenesis and management.

Presentation of a Case: A 61-year-old HIV-negative man with no relevant history presented with one year of slowly enlarging angiomatous nodules and infiltrated erythemato-violaceous plaques on the lower limbs and right wrist, without mucosal or nodal involvement. Skin biopsy showed irregular vascular slits dissecting collagen with a perivascular mononuclear infiltrate, and immunohistochemistry was positive for HHV-8, confirming Kaposi’s sarcoma. An extensive work-up, including HIV serology, thoraco-abdomino-pelvic computed tomography, and lymph-node ultrasonography, excluded visceral involvement. Intramuscular bleomycin monochemotherapy was initiated. Four days after the first 5-mg injection, the patient developed a pruritic maculopapular eruption on the trunk, back and proximal limbs, with linear “whip-like” streaks on the back and buttocks, typical of flagellate erythema. Pharmacovigilance causality assessment strongly implicated bleomycin (I4B4). The rash resolved completely within one week of antihistamine therapy, without residual hyperpigmentation.

Discussion: Flagellate erythema, first described in 1970, is an uncommon but characteristic reaction attributed to the low cutaneous activity of bleomycin hydrolase, with microtrauma and a heat-recall phenomenon proposed as triggers. It arises independently of dose and route, with a latency ranging from a few hours to six months, and is diagnosed clinically. Management relies on antihistamines and corticosteroids, usually without discontinuing bleomycin.

Conclusion: Flagellate erythema is a specific and potentially early complication of bleomycin that warrants close monitoring throughout treatment.

A Case of Truncal Lichen Striatus in a 30-Year-Old Man

2026-08-08T11:24:14+00:00

Aims: Lichen striatus (LS) is an uncommon, benign, acquired inflammatory dermatosis that follows the lines of Blaschko and predominantly affects children; its occurrence in adults is exceptional. We report a case of truncal LS in a 30-year-old man and discuss its distinction from other adult-acquired blaschkolinear dermatoses.

Presentation of Case: A 30-year-old man with a family history of atopy presented with a non-pruritic papular eruption on the right side of the trunk, with no antecedent trauma, infection, drug intake or vaccination. Examination revealed numerous erythematous-violaceous papules distributed unilaterally along the lines of Blaschko in an inverted-U configuration without crossing the anterior midline. Dermoscopy showed an erythematous background with pigmentary incontinence. The remaining skin, mucous membranes and appendages were normal. Laboratory investigations were unremarkable, and histopathology demonstrated a lichenoid infiltrate consistent with LS.

Discussion: In adults, LS must be distinguished primarily from adult blaschkitis, linear lichen planus and linear psoriasis. Adult blaschkitis typically presents with pruritic papulovesicles and a spongiotic histological pattern, whereas LS presents with flat lichenoid papules without spongiosis, as observed in our patient. The considerable clinicopathological overlap has led some authors to regard these conditions as part of a single continuum described by the term blaschkolinear acquired inflammatory skin eruption (BLAISE).

Conclusion: Although rare in adults, LS should be considered in the differential diagnosis of any acute, acquired, blaschkolinear eruption in this age group. It generally resolves spontaneously, and treatment is usually unnecessary except for the symptomatic management of pruritus.

Late-Onset Vulvar Steatocystoma Multiplex: A Rare and Challenging Localization

2026-08-11T11:05:16+00:00

Aims: To report an exceptionally rare case of vulvar steatocystoma multiplex with late onset and sporadic presentation, and to highlight the role of histopathology in the differential diagnosis of chronic vulvar nodules.

Presentation of Case: A 43-year-old woman with no personal or family history presented with asymptomatic, slowly progressive bilateral nodules on the labia majora that had evolved over one year. Clinical examination revealed multiple well-circumscribed, mobile subcutaneous nodules covered by normal-appearing skin. Histopathological examination showed dermal cystic structures lined by stratified squamous epithelium lacking a granular layer, with sebaceous glands within the cyst wall, confirming steatocystoma multiplex. Surgical excision was performed with a satisfactory outcome.

Discussion: Vulvar steatocystoma multiplex is exceptionally rare; most reported cases occur in familial forms or in older patients. This case is distinguished by its late onset, sporadic nature, and strictly localised vulvar involvement. The differential diagnosis of chronic asymptomatic vulvar nodules is broad, and histopathological confirmation remains essential.

Conclusion: Steatocystoma multiplex should be included in the differential diagnosis of chronic, asymptomatic vulvar nodules. Histopathological examination is the cornerstone of diagnosis, and reporting rare localisations contributes to better recognition of this uncommon condition.

Ear and Eye Involvement in Lichen Planus: An Underrecognized Association

2026-08-14T13:24:38+00:00

Aims: To describe a case of generalised lichen planus with concomitant auricular and ocular involvement and to emphasise the importance of recognising atypical extra-cutaneous manifestations.

Presentation of Case: A 50-year-old woman with no significant medical history presented with generalised lichen planus of six months’ duration, progressive hearing loss, and increased tearing. Examination demonstrated diffuse pruritic violaceous papules and plaques, a whitish reticular network on the buccal mucosa, and Wickham’s striae on dermoscopy. Audiometric testing confirmed bilateral hearing loss, more pronounced on the right side. Ophthalmological assessment identified moderate ocular dryness with decreased visual acuity in the left eye. No alternative cause of the auditory or ocular findings was identified during the reported work-up. The patient received systemic corticosteroid therapy at 1 mg/kg/day together with dexamethasone-tobramycin eye drops. After two months, cutaneous disease activity and pruritus decreased, with concurrent improvement in auditory and ocular symptoms.

Discussion: Auricular and ocular involvement in lichen planus is uncommon and may be overlooked because symptoms can be insidious. External auditory canal disease may progress to stenosis and hearing impairment, whereas ocular involvement may affect the ocular surface and lacrimal pathways.

Conclusion: Targeted enquiry about hearing and ocular symptoms, with appropriate multidisciplinary assessment, may facilitate earlier recognition of these uncommon manifestations and reduce the risk of persistent functional impairment.

Delayed Diagnosis of Advanced CYLD Cutaneous Syndrome with Extensive Multifocal Scalp Cylindromas and Spiradenomas: A Case Report

2026-08-21T11:53:52+00:00

Background: CYLD cutaneous syndrome (CCS), formerly known as Brooke–Spiegler syndrome, is a rare autosomal dominant genodermatosis caused by pathogenic variants in the CYLD gene. It is characterized by the development of multiple skin adnexal tumours, including cylindromas, spiradenomas, and trichoepitheliomas, which may progressively coalesce into a scalp "turban tumour."

Aims: To report a rare case of advanced CYLD cutaneous syndrome with multifocal cylindromas and spiradenomas culminating in a giant turban tumour, and to highlight the clinical, dermoscopic, histopathological, and management features that facilitate diagnosis.

Case Presentation: An 81-year-old woman presented with multiple cutaneous tumours affecting the scalp, face, trunk, and extremities since the age of 19. The scalp lesions progressively coalesced into a classical turban tumour. Two distinct tumour morphologies were identified clinically: painless skin-coloured cylindromas and tender violaceous spiradenomas. A positive family history involving two affected children suggested autosomal dominant inheritance. Histopathological examination of the excised dominant scalp lesion, reviewed by the CARADERM national rare skin tumour network, confirmed a benign hybrid cylindrospiradenoma without malignant transformation. Immunohistochemistry demonstrated diffuse SOX10 positivity, focal EMA expression, negative BerEP4, androgen receptor and CD45, with a Ki-67 proliferation index below 5%. Germline CYLD genetic testing was initiated.

Discussion: This case illustrates the diagnostic value of combining clinical examination, dermoscopy, histopathology, immunohistochemistry, and expert multidisciplinary review in recognizing CYLD cutaneous syndrome. It also highlights the importance of early diagnosis, genetic counselling, and lifelong surveillance because of the risk of malignant transformation.

Conclusion: Advanced CYLD cutaneous syndrome should be suspected in patients presenting with multiple familial adnexal tumours, particularly when cylindromas and spiradenomas coexist. Referral to specialized rare-tumour networks facilitates accurate diagnosis and appropriate management, while long-term follow-up and genetic counselling remain essential components of care.

Comparative Analysis of Scalpel and Diode Laser Surgical Methods in Management of Traumatic Fibroma

2026-01-06T11:54:16+00:00

Aims: To compare the clinical outcomes of conventional scalpel excision and diode laser ablation in the management of traumatic fibroma.

Presentation of Case: This report presents two cases of traumatic fibroma treated using different surgical modalities. In Case 1, a traumatic fibroma was excised using a conventional scalpel technique, resulting in complete lesion removal with satisfactory healing at 15 days and no recurrence at one-month follow-up. In Case 2, excision was performed using an 880-nm diode laser, which provided excellent intraoperative haemostasis, minimal patient discomfort, and rapid postoperative healing without scarring within eight days. Histopathological examination in both cases confirmed the diagnosis of traumatic fibroma.

Discussion: Both treatment modalities were effective in achieving complete lesion removal. However, diode laser excision demonstrated superior clinical advantages, including better haemostasis, reduced postoperative discomfort, and faster wound healing compared to conventional scalpel excision.

Conclusion: While both scalpel and diode laser techniques are effective for the management of traumatic fibroma, diode laser excision offers enhanced clinical efficiency and patient comfort, making it a valuable alternative for soft-tissue lesion management.