Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Neurocognitive and psychiatric sequelae following traumatic brain injury in an Iranian forensic cohort: A longitudinal analysis of lesion localization and clinical outcomes 1 14 118634 10.30483/rjm.2026.254740.1497 EN Morteza Talebi Doluee Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Maliheh Dadgar Moghaddam Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Arya Hedjazi Legal Medicine Research center, Legal Medicine Organization, Tehran, Iran. Maryam Moaddab Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahdi Talebi Department of community and family medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 0000-0002-2328-2536 Journal Article 2026 04 08 Background: Traumatic brain injury (TBI) is a well-established risk factor for neuropsychiatric disorders. However, the relationship between lesion localization and psychiatric phenotypes remains incompletely characterized, particularly in forensic contexts. Objectives: This longitudinal study of an Iranian forensic cohort retrospective analysis of prospectively collected data aimed to investigate the frequency and pattern of psychiatric sequelae following TBI and explore associations between neuroanatomical injury sites and specific psychopathological outcomes. Methods: A total of 113 patients with documented TBI (GCS ≤14, hospitalization ≥24 hours) were consecutively recruited from the Forensic Medicine Organization of Khorasan Razavi, Iran (2020–2022). Patients underwent psychiatric evaluation over a median follow-up of 13 months (IQR: 6–18 months). DSM-5 diagnoses were established using structured clinical interviews. CT scans were reviewed for lesion localization. Multivariate logistic regression and effect sizes (Cramér's V, Cohen's h, risk ratios) were employed. Results: The cohort comprised 92 males (81.4%) and 21 females (18.6%), with a mean age of 36.5 ± 18.4 years. Traffic accidents predominated (84.1%). Notably, 41.6% of patients exhibited no focal parenchymal lesions on initial CT. The most prevalent diagnoses were neurocognitive Disorder (23.0%), major depressive Disorder (19.5%), personality change (13.3%), and post-concussion syndrome (13.3%). In this forensic cohort, 100% of participants received at least one psychiatric diagnosis, which reflects the medicolegal referral context and does not generalize to non-forensic TBI populations. Frontal lobe involvement showed a numerically higher frequency of personality change (29.4% vs. 10.5%; risk ratio = 2.80, 95% CI: 0.98–7.99; p = 0.078). Gender was not an independent predictor (adjusted OR = 1.24, 95% CI: 0.48–3.21, p = 0.66). Conclusion: Neurocognitive Disorder and major depression are the predominant psychiatric sequelae in this Iranian forensic TBI cohort. A substantial proportion of patients developed significant psychopathology despite normal CT imaging—the "normal CT paradox"—underscoring the need for psychiatric surveillance regardless of neuroimaging findings. Findings are limited to forensic medicolegal populations and do not generalize to the general TBI population.

https://journal.razavihospital.ir/article_118634_e827f6de0f97a905af2759e248ac95a4.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Molecular Effects of Curcumin Nanomicelles on Wharton's Jelly-Derived Mesenchymal Stem Cells: Integrated Analysis of Inflammatory Genes, Regulatory MicroRNAs, and DNA Methylation 15 29 118635 10.30483/rjm.2026.254766.1519 EN Hossein Malekan Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Ramin Raoufinia Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran. Workplace Health Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran. Ghazal Alyari Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Department of Medical Genetics, School of Advanced Technologies in Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Amir Reza Bagheri Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Reza Mousavi Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran. Ayda Yavari Kondori Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Hamid Reza Rahimi Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Metabolic Syndrome Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran. 0000-0002-2269-4109 Journal Article 2026 04 30 Background: Mesenchymal stem/stromal cells (MSCs) exert therapeutic effects largely through immunomodulatory and paracrine mechanisms. Pharmacological preconditioning strategies have been proposed to enhance MSC functionality and therapeutic efficacy. Curcumin possesses anti-inflammatory and epigenetic regulatory properties; however, the effects of curcumin nanomicelles on inflammation-associated genes, regulatory microRNAs, and DNA methylation patterns in Wharton's jelly-derived MSCs (WJ-MSCs) remain incompletely understood. Objectives: This study investigated the molecular effects of curcumin nanomicelles on inflammatory regulatory pathways in WJ-MSCs. Methods: WJ-MSCs were isolated from human umbilical cords and characterized by flow cytometry and multilineage differentiation assays. Cell viability following exposure to curcumin nanomicelles was assessed using the MTT assay. Cells were treated with 20 μM and 70 μM curcumin nanomicelles for 24 h. Expression levels of IκBα, TGF-β1, miR-21, and miR-146a were evaluated by quantitative real-time PCR. Promoter methylation status of IκBα and TGF-β1 was analyzed using methylation-sensitive high-resolution melting (MS-HRM). Results: Curcumin nanomicelles induced dose-dependent molecular alterations in WJ-MSCs. Treatment with 70 μM significantly increased IκBα expression and reduced miR-21 expression compared with untreated controls (P < 0.05). TGF-β1 expression was significantly increased following treatment with 20 μM curcumin nanomicelles, whereas no significant change was observed at 70 μM. miR-146a expression was significantly decreased at both tested concentrations. Despite these transcriptional and post-transcriptional changes, no significant alterations in promoter methylation patterns of either IκBα or TGF-β1 were detected after 24 h of treatment. Conclusion: Curcumin nanomicelles modulated inflammation-associated gene expression and regulatory microRNAs in WJ-MSCs without inducing detectable promoter methylation changes in IκBα or TGF-β1. These findings suggest that the early molecular effects of curcumin nanomicelles are predominantly mediated by transcriptional and post-transcriptional mechanisms. The observed modulation of inflammatory regulatory pathways supports further investigation of curcumin nanomicelles as a potential MSC preconditioning strategy; however, additional protein-level, functional, and disease-model studies are required to determine their translational relevance.

https://journal.razavihospital.ir/article_118635_18ef97b44e26908443839317f815266e.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Prevalence of Adenomyosis in Hysterectomy Specimens from Patients with Benign Gynecological Conditions 30 38 118630 10.30483/rjm.2026.254664.1436 EN Taraneh Mohajeri Department of Gynecology, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran. 0000-0002-9301-5492 Sajad Moosavi . Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran. 0009-0002-8053-5445 Zahra Mostafavian Department of Community Medicine, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran. 0000-0002-5738-5605 Journal Article 2026 01 30 Background: Adenomyosis is defined by the ectopic presence of endometrial tissue within the myometrium. The reported histopathological prevalence in hysterectomy specimens varies substantially (8.8–61.5%), and associated risk factors remain a subject of debate. Objectives: This study aimed to determine the prevalence of adenomyosis in hysterectomy specimens obtained for benign gynecological indications and to evaluate its association with key demographic and clinical variables. Methods: This cross-sectional investigation (2023–2025) consecutively enrolled 99 women who underwent hysterectomy for benign conditions at hospitals affiliated with Mashhad Medical Sciences, Islamic Azad University. Patients with gynecological malignancies or incomplete medical records were excluded. Demographic and obstetric data, including age, body mass index (BMI), educational attainment, gravidity, parity, mode of delivery, and history of abortion, were systematically recorded. Adenomyosis was diagnosed through histopathological examination. Following assessment of normality using the Shapiro–Wilk test, continuous variables were compared using the independent-samples t-test, and categorical variables were analyzed using the chi-square test (statistical significance set at p < 0.05). Results: Adenomyosis was histologically confirmed in 36 women (36.4%). The mean age of the cohort was 55.3 ± 10.4 years, and the mean BMI was 27.7 ± 3.7 kg/m². Women diagnosed with adenomyosis exhibited a significantly higher mean BMI compared to those without the condition (30.1 ± 3.0 vs. 26.3 ± 3.4 kg/m²; p < 0.001). In the categorical analysis, adenomyosis was absent in all participants with a normal BMI (<25 kg/m²) but was identified in 38.3% of overweight women and 58.1% of obese women (p < 0.001). No statistically significant associations were observed between adenomyosis and age, gravidity, parity, mode of delivery, history of abortion, or educational level. Conclusion: Adenomyosis was present in over one-third of hysterectomy specimens obtained for benign indications. Elevated BMI emerged as the sole significant risk factor associated with the condition, highlighting overweight and obesity as potentially modifiable contributors to adenomyosis pathogenesis.

https://journal.razavihospital.ir/article_118630_347853b8760e4f93406f069b548a1096.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Infraspinatus muscle diameter following posterior surgical approach for scapular fractures: A descriptive observational study of muscle changes and their relationship with shoulder pain and function 39 48 118636 10.30483/rjm.2026.254670.1440 EN Meisam Jafari Kafiabadi Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0003-4869-0998 Farsad Biglari Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohsen Asadi Shahmirzadi Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mehrdad Sadighi Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Sabaghzadeh Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Saber Barazandeh Rad Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Adel Ebrahimpour Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Babak Toloue Ghamari Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Farzaneh Ghazy Department of Radiology, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran. Journal Article 2026 03 08 Background: Scapular fractures are relatively uncommon but can result in significant morbidity. Understanding their demographic characteristics, fracture mechanisms, associated injuries, radiological dimensions, and functional outcomes is crucial for effective management. This study describes postoperative changes in infraspinatus muscle diameter following the posterior (Judet) surgical approach. It explores their relationship with shoulder pain and its impact on function. Methods: Nineteen participants meeting the inclusion criteria were enrolled in the study. Demographic data, fracture characteristics, associated injuries, and radiological findings were collected. Ultrasound measurements of the infraspinatus and supraspinatus muscle diameters were performed bilaterally at six-month follow-up, with the radiologist blinded to clinical data. Fatty degeneration was graded using the Goutallier classification on postoperative CT. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) performance and pain scores. Statistical analysis was performed to explore relationships between variables. Results: Most participants were male, with a mean age of 35.95 years. Motorcycle accidents were the leading cause of fractures. Associated injuries were present in 21.1% of participants, with concurrent fractures in the lower extremities being the most common. Radiological evaluation revealed a statistically significant reduction in infraspinatus muscle diameter between healthy and fractured shoulders, but no significant difference for supraspinatus (p=0.233). No significant association was found between muscle diameter reduction and functional outcomes or pain scores. Functional outcomes were generally favorable, with most participants reporting high ASES scores. Conclusion: This descriptive study provides valuable insights into scapular fractures by examining key factors, including demographic characteristics, fracture mechanisms, associated injuries, radiological dimensions, and functional outcomes. The primary finding is a significant reduction in infraspinatus muscle diameter following the posterior (Judet) surgical approach for scapular fractures. However, this reduction was not significantly associated with shoulder pain (p=0.45) or functional outcomes (p=0.38) at six-month follow-up. These findings suggest that while measurable muscle atrophy occurs, it may not directly translate to short-term clinical impairment. Longer-term follow-up and studies with preoperative measurements are needed to determine the clinical significance of these morphologic changes.

https://journal.razavihospital.ir/article_118636_cb2e31e6543c1a8e4c33636b666e5b1d.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Effect of a Four-Week Nurse-Led Home-Based Self-Care Program on Quality of Life and Physiological Outcomes in Patients with Heart Failure: A Randomized Controlled Trial 49 63 118639 10.30483/rjm.2026.254786.1533 EN Maryam Marhounkar MSN, Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran Marzieh Jahani Sayad Noveiri Assistant Professor, Department of Medical Surgery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. 0000-0002-2864-3003 Saman Maroufizadeh Assistant Professor, Department of Biostatistics and Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran. Zeinab Borhani Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. Mohammad Taghi Moghadamnia Associate Professor, Department of Medical-Surgical Nursing, School of Nursing, Guilan University of Medical Sciences, Rasht, Iran. Journal Article 2026 05 02 Background: Heart failure (HF) management necessitates effective post-discharge transition. Despite the importance of transitional care, there is limited evidence on the effectiveness of nurse-led home-based self-care programs for patients with heart failure in Iranian post-discharge settings. Objectives: This study evaluated the impact of a nurse-led home self-care program on the quality of life (QoL) and physiological indicators of patients with HF. Methods: This randomized controlled trial included 50 patients hospitalized at Dr. Heshmat Educational and Medical Center (Rasht, Iran), who were allocated to intervention and control groups using permuted-block randomization with allocation concealment via sealed opaque envelopes (SNOSE). The intervention group received a bedside educational program comprising seven modules, each lasting 5–15 minutes, followed by four weeks of post-discharge tele-nursing delivered through weekly 15-minute calls. The control group received standard hospital care. Of the 58 patients initially assessed, 50 were included in the final analysis. Outcomes were measured using the SF-12, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and physiological parameters. Data were analyzed using paired t-tests and ANCOVA. Results: The participants had a mean age of 60.00 ± 8.87 years (mostly male). After adjusting for baseline values, there were no significant between-group differences in heart failure-specific QoL (MLHFQ: adjusted mean difference -6.7, 95% CI -15.9 to 2.6, P=0.154) or general QoL (adjusted mean difference 0.1, 95% CI -1.4 to 1.6, P=0.891). However, pulse rate was significantly lower in the intervention group (adjusted mean difference: -9.8 bpm; 95% CI: -16.8 to -2.8; P=0.007). No significant adjusted differences were observed in systolic/diastolic blood pressure, respiratory rate, or oxygen saturation Conclusion: While the four-week nurse-led self-care program did not significantly improve QoL scores, it was associated with a significant reduction in resting pulse rate. This structured tele-nursing model provides a feasible framework for post-discharge management. Future studies with longer follow-up periods are recommended to evaluate potential long-term effects on quality of life and clinical outcomes.

https://journal.razavihospital.ir/article_118639_9abf214910c5c4ed8ac014f14d5026e9.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Efficacy and Safety of a Standardized Herbal Topical Formulation Containing Dorema ammoniacum for Mild to Moderate Plaque Psoriasis: A Randomized Double-Blind Placebo-Controlled Trial 64 75 118637 10.30483/rjm.2026.254762.1516 EN Zahra Naseri-Pouryazdi Student Research Committee, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Javad Yazdanpanah Department of Dermatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Roshanak Salari Department of Pharmaceutical Sciences in Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences. Mashhad, Iran 0000-0003-4690-7823 Hamid Heidarian Miri School of Food and Nutritional Sciences, University College Cork, Cork, Ireland Alireza Derakhshan Department of Persian Medicine, School of Persian and Complementary Medicine Mashhad University of Medical Sciences 0000-0002-3597-1312 Journal Article 2026 03 24 Background: Psoriasis is a chronic inflammatory skin disease for which topical corticosteroids remain the most commonly used treatment; however, their long-term use may be limited by adverse effects and tachyphylaxis. In Persian medicine, Dorema ammoniacum (Oshaq) has been used for inflammatory skin conditions, suggesting a potential complementary therapeutic approach. Objective :This study aimed to evaluate the efficacy and safety of a standardized topical formulation containing Dorema ammoniacum resin, vinegar, and wheat germ oil in patients with mild-to-moderate plaque psoriasis. Methods: As the first double-blind, placebo-controlled randomized trial of this formulation, the study sought to provide high-quality clinical evidence using the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) as validated outcome measures. Results: For the intervention group, mean PASI score decreased significantly (P = 0.007) from 6.03 to 4.18 by week 8. The placebo group showed no significant change. At week 4 (P = 0.003) and week 8 (P < 0.001), between-group differences were significant. The intervention group's DLQI score decreased significantly (P ≤ 0.001) from 20.43 to 15.18 by week 8, and significant between-group differences were noted (P ≤ 0.001) favoring the intervention. No serious adverse events were noted. Conclusion: The Oshaq-based topical formulation is significantly better than placebo. It improves the severity of mild-to-moderate plaque psoriasis and the quality of life of affected patients. Larger studies with extended follow-up and active comparators are needed to assess its therapeutic role further.

https://journal.razavihospital.ir/article_118637_2bf1564153a0ab14e52c587da9c8a8c3.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 The effect of Curcumin Supplementation on Mortality Rate and Clinical Status of Traumatic ICU-Admitted Patients: A Study Protocol for a Randomized, Triple-Blind, Placebo-Controlled Clinical Trial 76 87 118638 10.30483/rjm.2026.254765.1518 EN Narges Ashraf Ganjooei Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Safarian Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Maryam Emadzadeh Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Tannaz Jamialahmadi Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran Amirhossein Sahebkar Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab 140401, India Center for Innovation and Inclusive Research, Sharda University, Greater Noida, Uttar Pradesh, India. Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Journal Article 2026 04 28 Background: Traumatic injuries significantly contribute to worldwide death and disability rates, often necessitating patient admission to the intensive care unit (ICU), and there is an increased risk of disabilities, poor clinical outcomes, and mortality. Suppressing inflammatory processes in these cases is associated with reduced mortality. Objectives: This research aims to evaluate the effectiveness of curcumin, a polyphenolic phytochemical known for its anti-inflammatory and various health benefits, in improving clinical outcomes and reducing mortality among ICU patients. Methods: The current study is a randomized, triple-blind, placebo-controlled trial in patients with traumatic injuries. This study will enroll 327 patients admitted to the ICU for traumatic injury at Bahonar Hospital in Kerman, Iran. Participants will be randomly assigned in a 1:1:1 ratio to one of three groups: (1) high-dose curcumin, (2) low-dose curcumin, and (3) placebo. The first intervention group will receive two tablets, each containing 500 mg of Curcumin and 5 mg of Piperine. The second intervention group will receive one tablet with 500 mg of Curcumin and 5 mg of Piperine, along with one placebo tablet. The control group will receive two placebo tablets. All patients will receive their tablets once a day for 7 days. The primary outcomes will be the 8-day ICU mortality, 30 days and 60 days mortality rates, while secondary outcomes will include the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Modified Nutrition Risk in Critically Ill (mNUTRIC) score, Glasgow Coma Scale (GCS), mortality rates at 120- and 180-days, duration of hospital/ICU stay, and laboratory results. All factors will be evaluated before and after interventions. Result: This article presents the protocol for an ongoing randomized controlled trial; therefore, no results are available yet. Conlusion: If this study's results indicate that curcumin supplementation effectively improves the outcomes of ICU patients with traumatic injuries, it could offer a cost-effective and readily available treatment to improve patient outcomes and reduce the burden of traumatic injuries on healthcare systems.

https://journal.razavihospital.ir/article_118638_51ea0fee1202f5aed11be11b85db8254.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 14 4 2026 10 01 Esophageal Xanthogranulomatous Inflammation with Peripheral Eosinophilia in an Immunosuppressed Patient with Rheumatoid Arthritis: A Rare Case Report and Focused Literature Review 88 102 118641 10.30483/rjm.2026.254775.1524 EN Sepehr Sadrizadeh Department of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Sadrizadeh Cardiothoracic Surgery and Transplant Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 0000-0003-2808-7868 Mohammad Hassan Jokar Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Alireza Bary Department of Hematology and Oncology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Reza Sahabi Department of Pathology, Razavi Hospital, Mashhad, Iran 0000-0001-8702-0992 Alireza Sharifian-Attar Department of Anesthesia, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-9259-4859 Journal Article 2026 05 09 Background: Xanthogranulomatous inflammation of the esophagus is an exceedingly rare lesion characterized by extensive xanthogranulomatous tissue infiltration, often mimicking neoplasms. The association of esophageal xanthogranuloma with peripheral eosinophilia in immunosuppressed patients remains poorly understood, posing diagnostic challenges. Objectives: This study aimed to present a rare case of esophageal xanthogranuloma with tissue eosinophilia in a patient with rheumatoid arthritis on multiple immunosuppressive agents. In addition, this study examined clinicopathological features, assessed potential pathogenic linkages, and revealed diagnostic considerations. Methods: A 52-year-old man with a 17-year history of rheumatoid arthritis on immunosuppressants presented with progressive dysphagia and gastrointestinal bleeding. The diagnostic workup included contrast-enhanced CT, upper endoscopy, endoscopic ultrasound (EUS), and additional biopsies, all of which were inconclusive. Due to persistent symptoms and nondiagnostic minimally invasive procedures, a transhiatal esophagectomy was performed. Histopathological examination of the resected specimen was conducted, including routine hematoxylin and eosin (H&E) staining. Immunohistochemistry (IHC) was not performed owing to institutional limitations. Laboratory data included peripheral eosinophil counts, with emphasis on absolute eosinophil count. The literature review also included published cases of esophageal xanthogranulomas and eosinophil-associated esophageal lesions. Results: Histology revealed a well-defined intramural esophageal mass demonstrating extensive xanthogranulomatous inflammation, rich in lipid-laden macrophages, multinucleated giant cells, and eosinophils, confirmed qualitatively. No evidence of malignancy or infectious granulomatous disease was identified. The patient recovered uneventfully post-surgery, with symptomatic improvement. Moreover, literature review demonstrated that esophageal xanthogranulomas are rare, with few cases reported, and their pathogenesis remains speculative, particularly regarding eosinophil involvement and immunosuppression. Conclusion: This case revealed the importance of considering xanthogranulomatous inflammation in the differential diagnosis of esophageal intramural lesions in immunosuppressed patients with peripheral eosinophilia. Definitive diagnosis relies on histopathology, with surgical excision often necessary when less invasive methods are inconclusive. Further studies are warranted to elucidate the potential pathogenic links and the role of eosinophils in such lesions.

https://journal.razavihospital.ir/article_118641_37b6f03f4e2cfc8d52b9c6ffd0f6f447.pdf