Introduction and importance: Mad honey contains grayanotoxin, which is commonly derived from the nectar of a few Rhododendron species. It is commonly used by natives of the Himalayas in the belief of its medicinal use. Case presentation: The authors report a case of 62 years old male with mad honey poisoning who was presented to the emergency department with loss of consciousness and had bradycardia and hypotension on arrival. The patient received intravenous fluids, atropine, and vasopressor support and was closely monitored in the coronary care unit for 48 h. Discussion: Grayanotoxin I and II are believed to be primarily responsible for mad honey intoxication and act by persistent activation of voltage-gated sodium channels. Hypotension, dizziness, nausea, vomiting, and impaired consciousness are the common presentation of mad honey intoxication. Toxic effects are usually mild and close monitoring for 24–48 h is sufficient but life-threatening complications like cardiac asystole, convulsions, and myocardial infarction have also been reported. Conclusion: Most cases of mad honey intoxication only need symptomatic treatment and close observation but the potential for deterioration and life-threatening complications must also be considered.

Introduction and importance: Bladder paraganglioma is a rare neuroendocrine tumor, accounting for less than 0.06% of all bladder tumors. Due to its nonspecific symptoms, it is frequently misdiagnosed, leading to delays in appropriate management. Case presentation: We report a case of a 45-year-old female who presented with post-micturition palpitations, diaphoresis, hypertensive episodes, and chronic lacunar infarcts for several years. Initially misdiagnosed with an anxiety disorder and later migraine with generalized anxiety disorder, her symptoms persisted despite psychiatric and neurological treatments. Further evaluation with ultrasonography and CT-intravenous urography revealed a bladder mass, prompting surgical intervention. Histopathology confirmed bladder paraganglioma with classic Zellballen architecture, and immunohistochemistry showed positivity for chromogranin A, synaptophysin, and CD56. Clinical discussion: Bladder paragangliomas are frequently mistaken for other bladder neoplasms or functional disorders due to their variable presentation. Imaging plays a crucial role in diagnosis, but definitive confirmation relies on histopathology and immunohistochemistry. Surgical excision remains the gold standard for treatment, with long-term follow-up necessary due to the potential for recurrence. Conclusion: This case highlights the diagnostic challenges of bladder paraganglioma, emphasizing the need for a high index of suspicion in patients presenting with unexplained hypertensive crises or post-micturition symptoms. Early recognition and appropriate management are essential for optimal patient outcomes.

Introduction: Right-sided infective endocarditis (IE) in non-intravenous drug users is a rare finding. IE of the tricuspid valve is considered an important but uncommon complication in patients with a recent history of obstetric and gynecological procedures. Case presentation: We report a case of a 28-year-old female with IE of the tricuspid valve with a prior history of dilatation and curettage. The echocardiography revealed two mobile vegetation in the septal leaflet of the tricuspid valve with severe eccentric tricuspid regurgitation. Blood culture was positive for Staphylococcus aureus. The patient was started on intravenous (i.v.) antibiotics with supportive treatments and improved over the days. Clinical discussion: Infection can get access to the venous system via pelvic veins after the septic obstetric and gynecological procedure and subsequently to the right side of the heart. Different studies have highlighted the role of prophylactic antibiotics in significantly reducing post-abortal infections. In our patient, the disease was diagnosed on the basis of clinical, echocardiographic, and blood culture findings, and the patient responded well to i.v. antibiotics and supportive care under close monitoring in the coronary care unit. Conclusion: It is important for healthcare providers to be aware of the risk factors and symptoms associated with right-sided IE for early diagnosis and treatment. Appropriate antibiotic prophylaxis and adherence to sterile techniques can help to prevent IE.

Drug‐induced pancreatitis (DIP) is a rare but important cause of acute abdominal pain, and ciprofloxacin‐associated cases are exceptionally uncommon. We report a 35‐year‐old woman with no significant medical history who developed severe epigastric pain radiating to the back, accompanied by nausea and vomiting, 3 days after initiating self‐prescribed ciprofloxacin for diarrhea. Laboratory tests revealed markedly elevated serum amylase and lipase, and contrast‐enhanced CT confirmed acute interstitial pancreatitis. Common causes including gallstones, alcohol use, hypertriglyceridemia, hypercalcemia, and viral hepatitis were excluded. Ciprofloxacin was discontinued, and the patient was managed with intravenous fluids, bowel rest, and analgesia, leading to rapid clinical and biochemical improvement within 4 days. Given the temporal relationship, exclusion of alternative etiologies, and supportive causality assessments (Naranjo Adverse Drug Reaction Probability Scale & Badalov Classification), ciprofloxacin was considered the probable cause. This case underscores the importance of considering DIP in patients presenting with new‐onset abdominal pain during fluoroquinolone therapy, as prompt drug withdrawal and supportive care can result in swift recovery and prevent complications.

Bronchopulmonary sequestration is an uncommon abnormality of the respiratory system that often manifests as recurrent pneumonia in childhood or as an incidental discovery on thoracic imaging in adults. The sequestration receives its blood supply from anomalous systemic circulation in contrast to pulmonary circulation and can manifest in either intrapulmonary or extrapulmonary forms. We discuss the instance of a young asymptomatic man who visited us seeking for medical clearance to travel abroad. An opacity was discovered on the chest X-ray, which was followed by a contrast-enhanced CT scan that revealed a well-defined, lobulated soft tissue attenuating lesion in the left lower hemithorax suggesting pulmonary sequestration.