Category: Case Study & Report

Understanding and Evaluating a Normal Metopic Ridge and Pathological Metopic Craniosynostosis in an Infant

Authors: Valliammai Valliyappan, Ashok Veerappan, Nishkkriyaa Gopal

ABSTRACT

A palpable ridge along the metopic suture is a common finding in infants and may cause concern for metopic craniosynostosis. However, a benign metopic ridge represents a normal variant that does not require imaging or surgical intervention. After obtaining verbal parental consent, we report the case of an 11-month-old infant who presented with a prominent midline forehead ridge. Detailed clinical evaluation revealed normal cranial shape, growth parameters, and neurodevelopment, supporting the diagnosis of a benign metopic ridge. This case highlights the importance of careful clinical assessment to differentiate normal variants from pathological craniosynostosis, thereby avoiding unnecessary investigations and parental anxiety.

Keywords: Cranial suture, Metopic ridge, Metopic, craniosynostosis, Trigonocephaly

Citations: IeJSME 2026 Vol 20 (1): 55-56

Interaction Between a Macrolide Antibiotic and a Second-Generation Antihistamine: A Case Report

Authors: Valliammai Valliyappan, Ashok Veerappan, Nishkkriyaa Gopal

ABSTRACT

Drug–drug interactions are a common yet often overlooked cause of adverse drug reactions. We report a case of a 30-year-old man who developed QT interval prolongation after receiving erythromycin and loratadine concurrently for an upper respiratory tract infection. The event was attributed to the additive QT-prolonging effect of erythromycin at therapeutic dose and reduced hepatic metabolism of loratadine due to CYP3A4 inhibition by erythromycin, further increasing QT prolongation risk. Discontinuation of erythromycin and loratadine led to rapid clinical improvement and normalisation of electrocardiographic findings. This case underscores the importance of careful prescribing, medication review, and awareness of pharmacokinetic interactions.

Keywords: CYP3A4, Drug interaction, Erythromycin, Loratadine, QT prolongation

Citations: IeJSME 2026 Vol 20 (1): 57-59

An Interactive Digital Quiz to Support Active Learning in Hypertension Education for Medical Undergraduates

Author: Valliammai Valliyappan

ABSTRACT

Hypertension is a major global health concern and a core topic in undergraduate medical education. This paper describes the development of an interactive digital quiz designed to support active learning in hypertension education. The quiz was aligned with the Malaysian Clinical Practice Guidelines and incorporates structured questions with immediate feedback to reinforce key concepts. Grounded in retrieval practice, formative feedback, self-directed learning and technology-enhanced learning principles, the resource was designed as a lowstakes learning tool without cumulative scoring or performance tracking. The innovation provides a practical and accessible adjunct to conventional teaching and may enhance learner engagement and knowledge consolidation.

Keywords: Hypertension, Medical Education, Interactive Digital Quiz

Citations: IeJSME 2026 Vol 20 (1): 60-62

Endodontic Management of Talon Cusp in Permanent Maxillary Lateral Incisors – A Case Series

Authors: Kai Xin Chong, Galvinderjeet Kaur Grewal, Benjamin Syek Hur Lim

ABSTRACT

Talon cusp is a developmental anomaly which predisposes the affected tooth to pulpal and periodontal complications. This case series describes two cases of talon cusp which are complicated by pulp necrosis and periapical pathoses, requiring endodontic intervention. In the first case, severe periodontal destruction surrounding the affected tooth was noted as the patient had underlying periodontal disease, resulting in an endo-periodontal lesion (EPL) that requires both endodontic and periodontal management. The case series highlights the importance of thorough clinical and radiographic assessment, as well as individualised multi-disciplinary treatment planning to achieve favourable clinical outcomes in treating such dental anomaly.

Keywords: Dens evaginatus, endodontic microsurgery, endo-periodontal lesions, palatogingival groove, talon cusp

Citations: IeJSME 2026 Vol 20 (1): 63-71

Diagnostic & Therapeutic Challenges of Actinomycosis: A Benign Speck Masquerading as a Soft Tissue Malignancy

Auhors: Abdul Kadir Amirul Ashraf, Boay Heong Eyrique Goh, Kok Keat Tee, Joon Hi Tham, Gerrarde Paul Aaron.

ABSTRACT

Actinomycosis is a chronic infection caused by filamentous gram-positive anaerobes, typically presenting in cervicofacial regions. We report a rare case involving the lower limb of an immunocompetent male, initially suspected to have soft tissue sarcoma based on imaging. The diagnosis was confirmed histologically with characteristic sulfur granules and the Splendore-Hoeppli phenomenon. Despite antibiotic therapy, non-compliancy led to disease progression and necessitated a below-knee amputation. This case emphasises the importance of early diagnosis, patient compliance, and a multidisciplinary approach in managing rare infections mimicking malignancies.

Citations: IeJSME 2025 Vol 19 (2): 37-42

Early Recognition of Tuberous Sclerosis Complex in Primary Care: A Case Report

Authors: Valliammai Valliyappan, Ashok Veerappan, Nishkkriyaa Gopal.

ABSTRACT

Tuberous sclerosis complex (TSC) is a rare, multisystem genetic condition marked by the development of benign tumours in multiple organs. TSC is the second most common neurocutaneous disorder and is inherited in an autosomal dominant pattern, although the rate of spontaneous mutation is high. Although the condition is often identified in paediatric neurology settings, the first clues can emerge in primary care. This case report describes the presentation, diagnosis, and initial management of a child with TSC in a general practice, highlighting the pivotal role of primary care in recognising early signs and initiating multi-disciplinary care.

Keywords: Genetic disorder, hypopigmented macules, paediatric epilepsy, primary care, seizures, tuberous sclerosis.

Citations: IeJSME 2025 Vol 19 (2): 43-46

Modulation of Tooth Eruption – An Understanding at the Molecular and Biochemical Level

Authors: Sivakumar Arunachalam, Indumathi Sivakumar, Jitendra Sharan, Sabarinath Prasad

ABSTRACT

Tooth eruption is a localised event whereby the signals for eruption for a given tooth are synthesised in the dental follicle of that tooth with a possible cross talk of signals coming from the adjacent stellate reticulum. The eruption process requires alveolar bone resorption that is primarily regulated by the dental follicle. This is reflected by the fact that failures of eruption often can be traced to either osteoclast deficiencies or to dental follicle abnormalities. Recent advances in application of molecular techniques to animal models allowed for better understanding of gene regulatory events involved in the physiology of tooth eruption. This article attempts to consolidate and organise the facts that offshoot from animal studies.

Keywords: Tooth Eruption, Dental Follicle, Molecular Biology, Eruption Mechanism

Citations: IeJSME 2025 Vol 19 (1): 54-62

DOI: https://doi.org/10.56026/imu.19.1.54

A Rare Case of Neuroendocrine Tumour of Gallbladder – Case Report

Authors: Kok Jen Yong, Keat How Teoh

ABSTRACT

Introduction
A neuroendocrine neoplasm (NEN) is a type of heterogenous tumour originating and spreading from neuroendocrine cells and peptidergic neural crest Kulchitsky cells (silver-addicted cells). The occurrence of gallbladder NEN (GB-NEN) is extremely rare and accounting for only 0.5% of all neuroendocrine tumours and 2.1% of all gallbladder tumours.

Case Presentation
A 60-year-old female with chronic cholecystitis and cholelithiasis, presented with septic shock and clinical condition suspicious of perforated viscus. The CT examination and laparotomy findings were suggestive of gallbladder carcinoma. The diagnosis of GB-NEN was later confirmed by histopathological examination and immunohistochemical studies. Following laparotomy, the patient’s condition deteriorated and succumbed to death.

Discussion
The diagnosis of GB-NEN is challenging due to ambiguous clinical manifestation and existing limitations of diagnostic techniques. Immunohistochemical staining is effective in diagnosing GB-NEN and highly specific markers have been identified. Surgery remains the mainstay of treatment for GB-NEN and following adjuvant therapy may prolong survival.

Conclusion
Current literature on GB-NEN is scarce and the standard treatment plan is under exploration. Early detection of GB-NEN improves prognosis and is encouraged for patients with chronic cholecystitis
and cholelithiasis. Individualised treatment plan should be emphasised to maximise patients’ benefits
in clinical practice.

Citations: IeJSME 2025 Vol 19 (1): 63-66

DOI: https://doi.org/10.56026/imu.19.1.63

 

Isolated Bone Marrow Involvement of Lepromatous Leprosy in an HIV-infected Patient with No Apparent Skin Lesions: A Case Report

Authors: Joshua Shadrach Daniel, Kwee Choy Koh, Thin Thin Win

ABSTRACT

Leprosy caused by Mycobacterium leprae, primarily manifests with cutaneous and neurological symptoms. Bone marrow (BM) involvement without skin lesions is exceedingly rare, particularly in immunocompromised patients. Here is a case of a 40-year-old HIV-infected man with a nadir CD4 count of 29 cells/mm³ who presented with recurrent anaemia, massive hepatosplenomegaly, and no apparent skin lesions. BM analysis revealed epithelioid granulomas with foamy histiocytes containing acid-fast bacilli, confirmed by Wade-Fite staining. This case highlights the rare presentation of lepromatous leprosy, emphasising the diagnostic challenges posed by the absence of typical cutaneous features.

Keywords: Leprosy, HIV, Bone marrow involvement

Citations: IeJSME 2025 Vol 19 (1): 67-70

DOI: https://doi.org/10.56026/imu.19.1.67

Vascular Anomaly in an Orthodontic Patient – A Case Report

Author: Sivakumar Arunachalam

ABSTRACT

Separation of vascular lesions into one of the two groups, namely, hemangioma and vascular malformations can be of considerable significance relative to the treatment of patients. They pose serious bleeding risks. A case report is presented here where a patient with a vascular malformation is treated with fixed orthodontic appliances. A coordinated, interdisciplinary approach can result in enhanced patient satisfaction and successful treatment outcomes.

Keywords: Vascular anomaly, Hemangioma, Nevus flammeus.

Citations: IeJSME 2025 Vol 19 (1): 71-74

DOI: https://doi.org/10.56026/imu.19.1.71

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