The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: A prospective cohort study.

Introduction: Ureteral stone is a worldwide disease and accounts for 20% of all urolithiasis. There is a widespread discussion on the preferred initial treatment method, whether medical or surgical, and each has its pros and cons. In this study, we aimed to assess the role of both ureteral wall thickness around the stone and inflammatory markers in guiding the decision-making process. Methods: In this prospective study, 161 patients who presented with ureteric colic and were diagnosed with ureteral stone with NCCT were included. UWT around the stone was measured, and the NLR and PLR were calculated. The patients were given a single daily dose of tamsulosin 0.4 mg for 4 weeks with weekly follow-up to determine SSP or failure. Results: Of the 161 patients with a mean age 40.12 ± 12.36 SD, 55.9% had a spontaneous stone passage. Receiver operating characteristics showed a cut off value of 2.45 mm UWT of non SSP patients with an 83% sensitivity and 86% specificity. Moreover, there was a significant correlation between higher NLR, PLR and increased UWT (Pearson correlation of 0.314 and 0.426 respectively). The combined higher NLR, PLR and increased UWT were associated with failure of SSP (p-value <0.001). Conclusion: Many factors play a role in decision making for management of ureteral stones. Our study concludes that patients with high NLR, PLR, and UWT around the stone have lesser chance of SSP using MET. Their rise can be used as predictors to decide early intervention.

Evaluation of mini-PCNL and RIRS for renal stones 1-2 cm in an economically challenged setting: A prospective cohort study.

Introduction: Retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mPCNL) are viable options for the treatment of renal calculi 1-2 cm. Both have their pros and cons, but also vary in costs. We aimed to evaluate them in an economically challenged setting. Methods: Two-hundred-seventy-one patients who underwent mPCNL (120) or RIRS (151) for renal calculi 1-2 cm were recruited in the study. Cases were comparatively statistically analyzed for differences in patient and stone parameters, duration of operation and hospital stay, and clinical outcomes such as stone free rate and complications. Local costs were calculated compared. Results: Patient and stone parameters did not differ for both procedures. Stone free rate was slightly higher for mPCNL, and significantly higher in the lower pole. Hospitalization was shorter for RIRS, but operation times did not differ significantly. Neither did the complication rates. There was a significantly higher Hb drop for mPCNL, but that did not translate in a significantly higher transfusion rate. Conclusion: Given the fact that all parameters were very similar or not statistically significant, choosing and the option comes down to other factors, such as availability of methodology and infrastructure, availability of surgical competence, surgeon's preference, and patient's preference. Both mPCNL and RIRS, are viable, safe, and efficient options for the treatment of renal stones 1-2 cm in size. mPCNL is the more cost-effective option and therefore should be considered if minimally invasive treatment is endeavored in economically challenged countries.

Resistance to thyroid hormone in a child with thyroid agenesis: A case report with review of the literature.

Introduction: The coexistence of thyroid dysgenesis and resistance to thyroid hormone (RTH) is a very rare occurrence. The current study aims to report a unique case of thyroid agenesis with RTH in a pediatric patient. Case report: A 5-year-old male patient presented with poor feeding, excessive somnolence, and a noticeable umbilical hernia since the age of 2 months. He was initially diagnosed as a case of congenital hypothyroidism, and since then, he had been placed on thyroid replacement therapy. No further investigations were conducted until the age of 5 years. Recent laboratory findings revealed an elevated TSH level (42.41 µIU/mL). X-ray examination showed delayed bone age (30 months). Ultrasound (US) examination demonstrated the complete absence of thyroid lobes, isthmus, and ectopic thyroid tissue, but small 2.7 x 2.5-mm non-echoic, cystic, and hypo-vascular nodules were seen in the bed of the right thyroid lobe. The patient was kept on thyroid replacement therapy (levothyroxine) and under close follow-up. On follow-up, the patient's thyroid function status revealed resistance to exogenous thyroid hormone. Discussion: Thyroid agenesis is the complete absence of the thyroid gland. Meanwhile, RTH is a hereditary disease characterized by decreased sensitivity of body tissues to thyroid hormone. Most cases of RTH are due to mutations in the gene encoding for THRß. However, recently RTH due to THRα mutations has also been reported. The presentations of RTH cases in general and with thyroid dysgenesis are quite heterogenous. Conclusion: Although the combination is exceedingly rare, thyroid agenesis can coexist with RTH.

Osteoclast-like giant cell tumor of the parotid gland; a case report with literature review.

Introduction: The osteoclast-like giant cell is a benign tumor that presents as either an isolated benign tumor or one with a carcinomatous component. This study aims to report a rare case of osteoclast-like giant cell tumor (GCT) of the parotid gland. Case report: A 67-year-old female presented with a painless left pre-auricular swelling of 2-month duration which increased in size gradually over that period. On examination, there was a firm, mobile mass with well-defined borders in the left parotid gland. Fine needle aspiration cytology showed a giant cell-rich lesion that was highly cellular and contained a large number of osteoclast-like multinucleated giant cells, with clusters of spindle and epithelioid cells. Total parotidectomy was performed. After the operation, the patient was sent for radiotherapy. Discussion: The histogenesis and exact nature of this tumor are unknown although numerous ideas have been put forward. The most common clinical manifestation is a painless slow-growing tumor in the parotid area. Primary osteoclast-like GCT of the salivary gland might show concomitant benign or malignant neoplasms. There is also a "pure form" of the tumor that has no accompanying neoplasm. Conclusion: GCT of the parotid gland is a rare tumor. The histogenesis and nature of parotid gland GCT are not completely understood. The treatment of choice is total excision followed by radiotherapy.

Post COVID - 19 neurological disorders; a single center experience; a case series.

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, is a newly conducted respiratory disease caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The current study aims to estimate the neurological diseases which develop after COVID-19 infection. Method: This is a single center retrospective case series conducted in seven months. the patients were collected in an out-patient clinic. Diagnosis of COVID-19 and the way of diagnosis is confirmed through either polymerase chain reaction (PCR) test for COVID-19 and/or typical findings on chest computed tomography scan (CT scan). Patients developed neurological symptoms after being infected with COVID-19. Symptoms have to be developed within less than 6 months of recovery, or developed during illness and persisted after recovery. Result: A total number of 59 patients infected with SARS-CoV2 were included. The majority of the patients had mild symptoms 32 (54%), 12 (20%) patients developed severe symptoms. Headache was the most common presenting symptom 27(46%) followed by fatigue in 8 (13.5%). The majority of the patients 55 (91.6%) presented with no focal signs. MRI was done for 27 (46%) patients without abnormal finding in 22 cases. Nearly 22 (37.3%) cases were diagnosed as recurrent episodes of migraine or new onset of migraine. All patients were managed according to the underlying pathology, only (28, 47.5%) patients were known to be completely recovered. Conclusion: SARS-CoV2 can invade and cause inflammation in the central and peripheral nervous systems. It is responsible for many neurological problems. More studies are necessary to analyze the long term effect of the virus on the nervous system.

Recurrent seasonal severe hypertriglyceridemia-induced acute pancreatitis; a case report.

Introduction: Acute pancreatitis (AP) is a serious inflammatory condition of the pancreas. Hypertriglyceridemia (HTG) is considered an uncommon cause of AP. The current study aims to present a unique case of recurrent seasonal severe HTG-induced AP (HTG-AP); treated with insulin and heparin. Case report: A 36-year-old male presented with recurrent attacks of severe upper abdominal pain that was radiating to the back and associated with repeated vomiting. The condition has being occurring every autumn-winter for the last three years. He had thalassemia minor and had a history of HTG-AP. His TG levels were relatively normal from February to August; however, from September to February, his TG levels highly elevated which has resulted in HTG-AP every year for the past three years. The condition was confirmed via a contrast-enhanced computerized tomography scan of the abdomen. To prevent the next HTG-AP, his TG level was monitored monthly. When TG levels spiked again, the patient was put on an insulin infusion with heparin, glucose, and potassium to rapidly reduce TG level. After two days, serum TG was dramatically reduced (<500 mg/dL). Discussion: Despite multiple theories being proposed, the pathogenesis of HTG-AP is yet to be understood. Usually, HTG-AP is a single episodic, and recurrent HTG-AP is considered uncommon finding. Previous reports are contradictory regarding TG level and seasonal variation. There is currently no standard management approach to treat HTG-AP cases. Conclusion: HTG-AP rarely reoccurs on an annual basis, and seasonal variation seems to play a major role in its onset. The condition can be managed with insulin, heparin, and glucose infusions.

Ductal carcinoma in situ arising from fibroadenoma; a rare case with review of literature.

Introduction: ibroadenoma (FA) is a common benign breast mass representing a group of hyperplastic breast lobules due to the deviation of normal development. This study aims to present a rare case of ductal carcinoma in situ (DCIS) associated with fibroadenoma. Case report: A 49-year-old married female presents with a right breast mass for five years. Core needle biopsy diagnosed the specimen as cellular complex fibroadenoma. A breast-lumpectomy and the histopathological examination of the surgical specimen confirmed ductal carcinoma in-situ. Discussion: Malignant changes within fibroadenomas typically happen at an older age, with the age of detection in the fifth decade. Complex fibroadenomas are more related to malignant transformation. Old age and strong family history are risk factors for malignant transformation of fibroadenomas. Conclusion: Fibroadenomas are common benign tumors. They can rarely be associated with DCIS. Therefore, the risk of malignancy should always be kept in mind.

Post COVID-19 pulmonary fibrosis; a meta-analysis study.

Introduction; Pulmonary fibrosis is a frequently reported COVID-19 sequela in which the exact prevalence and risk factors are yet to be established. This meta-analysis aims to investigate the prevalence of post-COVID-19 pulmonary fibrosis (PCPF) and the potential risk factors. Methods; CINAHL, PubMed/MEDLINE, Cochrane Library, Web of Science, and EMBASE databases were searched to identify English language studies published up to December 3, 2021. Results; The systematic search initially revealed a total of 618 articles - of which only 13 studies reporting 2018 patients were included in this study. Among the patients, 1047 (51.9%) were male and 971 (48.1%) were female. The mean age was 54.5 years (15-94). The prevalence of PCPF was 44.9%. The mean age was 59 years in fibrotic patients and 48.5 years in non-fibrotic patients. Chronic obstructive pulmonary disease was the only comorbidity associated with PCPF. Fibrotic patients more commonly suffered from persistent symptoms of dyspnea, cough, chest pain, fatigue, and myalgia (p-value < 0.05). Factors related to COVID-19 severity that were associated with PCPF development included computed tomography score of ≥18, ICU admission, invasive/non-invasive mechanical ventilation, longer hospitalization period, and steroid, antibiotic and immunoglobulin treatments (p-value < 0.05). Parenchymal bands (284/341), ground-glass opacities (552/753), interlobular septal thickening (220/381), and consolidation (197/319) were the most common lung abnormalities found in fibrotic patients. Conclusion, About 44.9% of COVID-19 survivors appear to have developed pulmonary fibrosis. Factors related to COVID-19 severity were significantly associated with PCPF development.

Breast cancer recurrence 27 years after full recovery; A case report with literature review.

INTRODUCTION: Breast cancer can recur after a decade of healthy life. The purpose of this study is to describe a rare case of breast cancer recurrence after 27 years of full recovery. CASE REPORT: A 67-year-old married nulliparous (G1P0A1) female presented with a few weeks of left axillary swelling. She is a known case of left breast cancer that was identified and treated in 1994 with a standard mastectomy without axillary intervention. An ultrasound and mammography imaging revealed a normal right breast and a clear left breast bed. Fine needle aspiration cytology (FNAC) revealed metastasized ductal carcinoma of the breast. The patient underwent general anesthesia and axillary dissection for level I and II axillary lymph node groups. DISCUSSION: The incidence of recurrence in axillary lymph nodes following excision of the original tumor in breast cancer patients varies according to the surgical approach, ranging from 0.8% to 8.6%. Patients with breast cancer who have a positive estrogen receptor are at a higher risk of delayed recurrence. CONCLUSION: Breast cancer can recur even 27 years after being diagnosed and treated. This demonstrates the significance of continuing follow-up in patients diagnosed with breast cancer throughout their lives.

Bilateral brachial plexus block as alternative to general anaesthesia in high-risk patient; a case report and literature review.

INTRODUCTION: Bilateral brachial plexus blocks can be an alternative to general anaesthesia in the surgery of arm, forearm, wrist, or hand. This study aims to report a case in which a risky patient underwent amputation surgery under regional anaesthesia. CASE PRESENTATION: A 64-year-old male was admitted to the hospital for an amputation operation. Ultrasonography revealed normal findings regarding internal organs, aside from grade II increased echogenicity of both kidneys and a small bladder cyst. Echocardiography revealed mildly left ventricular dilation, moderate systolic left ventricular dysfunction, ejection fraction 38%, left ventricular wall hypokinesia with left ventricular dilation. The amputation was performed under a bilateral supraclavicular brachial plexus block with the guidance of ultrasound. DISCUSSION: Theoretically, there are some advantages to regional anaesthesia in comparison to general anaesthesia, such as decreasing the ordinary body response to stress in the presence of low levels of cortisol and catecholamines, increasing blood flow and peripheral vasodilatation, decreasing hypercoagulability, lower risk of arterial and venous thrombosis and it aids to prevent endotracheal intubation and mechanical ventilation. CONCLUSION: Bilateral brachial plexus blocks, as a type of regional anaesthesia under ultrasound guidance, can be depended upon as a reliable substitute for general anaesthesia in perilous conditions.

The relationship between CT severity infections and oxygen saturation in patients infected with COVID-19, a cohort study.

Introduction: Thin-section chest computed tomography is an important diagnostic test and utilized to determine the severity of lung involvement in COVID-19 pneumonia. The goal of this study is to examine the relationship between CT severity and the oxygen saturation level of individuals with COVID-19. Method: This is a single-center retrospective study of COVID-19 patients that were admitted at a COVID-19 hospital. Patients confirming COVID-19 with PCR testing, patients undergoing lung CT-scan and measures of capillary oxygen saturation using pulse oximetry at the time of admission were all included. Result: The total number of the cases were 105. The age was classified into four age groups, with the majority of them falling into the fourth to sixth decade of life (42, 40%). Diabetes was the most common comorbidity disease (29, 27.6%). Pulse oximetry showed hypoxemia in 87 (82.9%) cases. The most common CT finding was ground glass opacities (GGO) (45, 42.9%). The data showed a significant positive correlation between oxygen saturation and CT severity in patients infected with covid-19. Conclusion: These findings support the importance of using pulse oximetry to monitor COVID-19 patients in order to evaluate or even estimate their clinical situations.

Post COVID-19 neurological complications; a meta-analysis.

Introduction: Despite numerous studies regarding neurological manifestations and complications of COVID-19, only a few cases of neurological consequences following complete recovery from SARS-CoV-2 infection have been described. Objectives: The current study aims to present a quantitative meta-analysis of published studies regarding the post-infectious neurological complications of COVID-19. Data sources: The Web of Science, PubMed, MEDLINE on OVID, and Google scholar were searched for English-language researches published after January 1, 2020. Result: The review of the literature revealed 60 cases - of which 40 (66.7%) cases were male, and 18 (30%) were female. The average age was 44.95 years. Overall, 17 (28.3%) patients had comorbid conditions. Twenty-four (40%) patients were hospitalized during an active COVID-19 infection. The average interval from the COVID-19 infection to the onset of neurological sequelae was 33.2 days. Guillain-Barre syndrome was the most commonly reported neurological condition (15, 25%). Conclusion: Despite recovery from acute infection, the pandemic highlights the significance of ongoing, comprehensive follow-up of all COVID-19 patients - even those initially were believed to be asymptomatic.

Recurrent spontaneous subcutaneous emphysema of unknown origin: A case report with literature review.

Introduction: Subcutaneous emphysema caused by a surgical operation is known as surgical emphysema, and if the cause is unknown, it is known as spontaneous subcutaneous emphysema. The current study aims to report a rare case of recurrent spontaneous SE of unknown origin. Case report: A 27-year-old male patient presented with swelling of the chest, neck, and face that had started 20 days prior. There was crepitation on palpation. Pulmonary function tests were normal. Laryngoscopy showed a normal larynx. Bronchoscopy showed a normal bronchial tree except for some redness in the trachea and left main bronchus. Computed tomography of the chest with contrast showed subcutaneous emphysema in the anterior chest and lower neck.The patient reported a similar condition 3 years prior resulting in swelling of the upper left chest with an associated pneumothorax that was treated with tube thoracostomy. Workup including VATS was done to find the underlying cause but no cause was found. Discussion: The pathogenesis is the same as in the most cases. Air that is driven into the interstitial tissues around the pulmonary vasculature gradually moves back toward the lung's hilum, resulting in pneumomediastinum. The air gradually spreads to the soft tissues of the neck, face, chest, and limbs, resulting in widespread subcutaneous emphysema. Conclusion: Spontaneous subcutaneous emphysema without known origin is a rare condition that may resolve by conservative treatment.

Thyroid collision tumors; A case series with literature review.

Background: Collision tumors are two histologically distinct types of malignancies within the same mass and organ. The aim of this study is to present a case series of thyroid collisions. Methods: This was a multicenter retrospective case series study. The participants were consecutive in order. Socio-demographic and clinical data were obtained from hospital records. Results: The study included eight cases comprising six (75%) females and two (25%) males. The patients had different presentations, including neck swelling, dyspnea, and dizziness. The pathology was successfully determined through fine-needle aspiration. Four patients (50%) underwent lobectomy, whereas the other half (four patients) underwent total thyroidectomy. Conclusion: Collision tumors of papillary thyroid cancer (PTC) and follicular thyroid carcinoma (FTA) or medullary thyroid carcinoma (MTC) and FTA are exceedingly rare phenomena that most commonly affect females. Complete or partial thyroidectomy is the ideal management of choice for these cases and is associated with good survival.

Hobnail variant of papillary thyroid carcinoma with anaplastic dedifferentiation co-existent with tuberculosis lymphadenitis.

INTRODUCTION: The current study aims to report a rare case of metastatic papillary thyroid carcinoma (PTC) of the cervical lymph nodes with hobnail variant and anaplastic de-differentiation. In addition to the primary disease, there was a second pathology which was caseating granulomatous lymph adenitis suggestive of tuberculosis. CASE REPORT: A 91-year-old female presented with a painful right sided neck swelling for two weeks, increased in size suddenly. On clinical examination, there was a well-defined firm painful right sided neck mass. On ultrasound examination, there was multiple well defined solid hypoechoic, hypervascular nodules. These resembled lymph nodes of variable size and shape, mostly in the right side. The patient underwent right lateral cervical lymph node dissection. After the operation, she was sent for radiotherapy. DISCUSSION: The hobnail variant of PTC is genetically identical to poorly differentiated thyroid carcinoma in that its mutations are in the p53 and TERT promoters are more common in this variant than in conventional PTCs. The proportion of hobnail features have no effect on the outcome. Additionally, 10% of tumor cells with hobnail features were previously linked to a more aggressive clinicopathological aspect. CONCLUSION: Although it is rare, metastatic PTC with hobnail variant could undergo anaplastic dedifferentiation.

Pilonidal sinus of breast, a case report with literature review.

INTRODUCTION: Pilonidal sinus (PNS) is an acquired inflammatory infection that mostly occurs in the sacrococcygeal region. This study aims to present a case of breast pilonidal sinus with a brief literature review. CASE PRESENTATION: A 31-year-old female presented with two painful right breast lumps for about one-month duration. Ultrasound (US) examination revealed heterogeneous areas with minimal inflammation at the right breast. There was also a nipple inversion, retro areolar duct dilatation, skin fistula, and reactive inflammatory level I axillary lymph nodes, suggesting inflammation/infection. Wide local excision was done. Histopathological examination revealed duct ectasia with a focus of sclerosing adenosis and a single hair shaft located in the breast tissue. DISCUSSION: Authors encourage surgical treatment (excision and primary closure) due to high recurrence risk after aspiration, medical treatment, and slow response of the abscess to antibiotic administration. Gender, family history, smoking, overweight, sinus size, poor hygiene, and surgical technique are among the risk factors that play a role in recurrence. CONCLUSION: Breast PNS is a very rare and atypical variant of PNS that may occur due to nipple inversion, hormonal effect, poor hygiene, tight brassieres. Surgical treatment is the best option to reduce recurrence risk.

Fibrolipoma of the tongue; a case report with literature review.

INTRODUCTION: Fibrolipoma is a less frequent variant of lipoma, it is rarely reported in the oral cavity, especially in the tongue. This study aims to report a very rare case of tongue fibrolipoma. CASE REPORT: A 53-year-old female presented with a painless mass at the anterior part of the tongue. It was soft with a smooth regular border. The patient underwent wide local excision to remove the lesion, and the sample was sent for histopathological examination which confirmed the diagnosis of a single fibrolipoma. DISCUSSION: Fibrolipoma is rare in the oral cavity, however, they have been seen in the buccal mucosa, lips, buccal vestibule, floor of the mouth, and retromolar area. It has been proposed that disturbance in glucose and lipid metabolism, hormone therapy, and trauma can lead to the formation and proliferation of the tumor. CONCLUSION: Fibrolipoma of the tongue is a rare occurrence. Surgical excision is the ideal management strategy. Histopathological examination is the gold standard for definitive diagnosis.

False-positive HIV in a patient with SARS-CoV-2 infection; a case report.

INTRODUCTION: A small portion of Corona Virus disease-2019 (COVID-19) cases associated with co-infections, however occasionally they turn out to be false positive due to possible cross-reactivities. The current report aims to present a rare case of false-positive human immunodeficiency virus (HIV) in a COVID-19 patient. CASE REPORT: A 32-year-old female complaining from thyroid problems referred for thyroid operation. She had mild symptoms of COVID-19. Her preoperative laboratory findings were normal, except for HIV screening test which was repetitively positive. RNA PCR was performed to confirm the diagnosis of HIV, it revealed a negative result. The patient underwent thyroidectomy as planned and was given the required supportive treatment to recover from COVID-19. Two-month follow up revealed that she was negative for COVID-19 on PCR testing, and HIV immunoassay test was no longer positive. DISCUSSION: Due to structural similarities between the spike protein chains of SARS-CoV-2 and some other viruses such as dengue, Zika, and other closely related coronaviruses (SARS-CoV, MERS-CoV), the protein can potentially interfere with the immunoassay tests. Although HIV immunoassay tests have high sensitivity and specificity, false-positive results have been reported, such as in the case of Epstein Barr virus, Influenza vaccination, and the Australian COVID-19 vaccination. CONCLUSION: Similarity between HIV and SARS-CoV-2 spike proteins can lead to antibody cross-reactivities, yielding false-positive results on immunoassay screening tests.

Post COVID-19 cerebral venous sinus thrombosis; a case report.

INTRODUCTION: Cerebral venous sinus thrombosis (CVST) in the setting of coronavirus disease 2019 (COVID-19) is an uncommon phenomenon with increasing incidence. This study aims to present a rare case of post COVID-19 CVST. CASE REPORT: A 58-year-old female presented with headache, nausea, left sided weakness, and slurred speech. She recently recovered from COVID-19 who had severe presentations. On examination, mild left central facial palsy, high grade left sided hemiparesis (Grade 2/5), positive Babinski on left side, left side hypoesthesia, and inability to walk were observed. Laboratory and ultrasound findings were not significant, however magnetic resonance imaging (MRI) revealed CVST. The patient was prescribed Clexane 6000 IU twice daily, and after 14 days, it was changed to warfarin with an INR between 2 and 3. After 3 weeks of treatment, the patient was able to walk, and after 3 months her warfarin medication was discontinued. DISCUSSION: COVID-19 has been reported to be linked with CVST, however there is limited information about it. The exact figures regarding the affected groups and incidence rates are highly controversial. The diagnosis of CVST poses a challenge to physicians as their symptoms are highly unspecific, hence MRI is required for definitive diagnosis. Anticoagulant is commonly used in their treatment; however, the ideal anticoagulant of choice and the management duration are yet to be known. CONCLUSION: Active or recently resolved COVID-19 can be considered as an independent risk factor for developing CVST and it rises the mortality rate of the disease.

Topical corticosteroid-induced iatrogenic cushing syndrome in an infant; a case report with literature review.

INTRODUCTION: Cushing syndrome (CS) is an endocrinological abnormality that results from a high level of glucocorticoids in the blood. Iatrogenic CS due to the overuse of topical corticosteroids is rarely reported. The current study aims to present a rare case of topical corticosteroid induced iatrogenic CS in an infant. CASE PRESENTATION: A 4-month-old female infant presented with an insidious onset of face puffiness that progressed over a 2-month period. The mother reported to have used a cream containing Betamethasone corticosteroid 5-8 times a day for a duration of 3 months to treat diaper dermatitis. Laboratory findings revealed low levels of adrenocorticotrophic hormone (ACTH) and serum. Abdominal ultrasound showed normal adrenal glands. The topical corticosteroid was halted and physiologic topical hydrocortisone doses were administered. CLINICAL DISCUSSION: Infants are more likely to acquire topical corticosteroid induced iatrogenic CS due to their thin and absorptive skin, higher body surface area, and the high prevalence of conditions that necessitates the use of these medications. Most iatrogenic CS cases following topical steroid application have been reported in infants with diaper dermatitis that are most commonly treated with Clobetasol and Bethamethasone. CONCLUSION: Infants are susceptible to develop CS due to topical corticosteroid overuse. Hence, physicians need to consider this in infantile CS cases, and take appropriate measures to avoid their occurrence.