Salmonella paratyphi-induced splenic vein thrombosis: A case report on infrequent cause of acute abdomen.

Splenic vein thrombosis and splenic infarction are complications beyond the usual clinical spectrum of paratyphoid fever, and the presentation is rarely described. We report the case of a young female, who presented with high-grade fever and severe left upper quadrant pain. Her blood culture was positive for Salmonella paratyphi A, with Widal test suggesting 4-fold rise in titers. Computed tomography revealed splenic vein thrombosis and multiple splenic infarcts, for which antibiotic and anticoagulation were instituted simultaneously. She had a complete resolution with this management, and anticoagulation was tapered off on subsequent visits.

Diabetes Ketoacidosis Complicating as Wrist Drop: A Case Report on Acute Motor Neuropathy.

Diabetic ketoacidosis (DKA) is an acute and major complication of diabetes mellitus. Neurological complications can be seen at any time during the course of illness and range from decreased consciousness to ischemic or hemorrhagic stroke. Acute neuropathy is very rare in this milieu. Here, we report a case of a 40-year-old patient, who developed a left-sided wrist drop after being treated for DKA. The nerve conduction velocity studies demonstrated decreased action potential amplitude in only the motor component of the left radial nerve. Other possible causes of the complaint were ruled out and the patient was managed with cock-up splint, vitamin B1 and B6 supplementation, and physiotherapy. Despite all these measures, the patient had minimal improvement. Thus, close monitoring of patients is crucial to identify these infirmities, even after the acute condition has resolved.

Atypical mucormycosis masquerading as non-resolving cavitatory pneumonia: A frequently misdiagnosed entity.

We are reporting an unusual case of cavitatory pulmonary mucormycosis in a patient with uncontrolled type 2 diabetes mellitus who was treated successfully. This is a unique case of pulmonary mucormycosis masquerading as cavitatory pulmonary disease. A 45-year-old female presented with fever, chest pain, cough and breathlessness. She was also found to have very high blood glucose due to previously undiagnosed diabetes. Diabetic ketoacidosis is the most common predisposing factor for mucormycosis. Our patient had uncontrolled diabetes and presented with bilateral cavitatory pulmonary lesions even in the absence of diabetic ketoacidosis. Appropriate investigations were ordered, and alternate causes of lung cavitation were diligently excluded. She was treated with amphotericin-B for three weeks followed by oral posaconazole for eight weeks with excellent outcome. A low threshold for detection as well as a differential of mucormycosis must be kept in immunocompromised patients presenting with cavitatory lung disease.

Hepato-Duodenal Fistula Complicating a Pyogenic Liver Abscess: An Unusual Presentation.

An elderly male with type 2 diabetes mellitus was admitted to the emergency ward with fever and pain over the right hypochondrium since one month. An abdominal ultrasound revealed an ill-defined hypoechoic lesion with multiple air foci measuring 8 x 6 x 4 cm within the left lobe of the liver implicating segments III b and IV. A contrast-enhanced computed tomography (CECT) scan of the abdomen showed a similar lesion with leakage of oral contrast into the dependent areas of the collection from a rent in the antero-inferior aspect of the first part of the duodenum. Hepato-duodenal fistula or entero-hepatic fistula secondary to pyogenic liver abscess is an atypical and unusual complication requiring a high degree of suspicion for its diagnosis. Though optimal therapy for its management is still not known, early diagnosis with prompt initiation of therapy is imperative to reduce mortality.