Vision Crisis-Bilateral Outer Retinitis Due to Mumps Virus.

PURPOSE: To report a case of mumps-associated outer retinitis, diagnostic, and therapeutic challenges associated with the disease. METHOD: Retrospective observational case report. RESULTS: An 8-year-old male child on presentation had a history of mumps infection following which he developed outer retinitis. Upon evaluation, he had bilateral multifocal perivascular cerebriform retinitis. MRI revealed increased uptake of contrast by bilateral parotid gland and with serum mumps IgM and IgG antibodies being raised, a diagnosis of mumps associated outer retinitis was made. In terms of treatment post-systemic steroid therapy, hyperbaric oxygen therapy was tried as a rescue therapy in this patient. Improvement in vision was noted in the left eye more than the right eye. CONCLUSION: Hyperbaric oxygen therapy can be considered as an additional therapy to systemic steroid therapy in mumps associated retinitis. In such a situation, since there is no specific antiviral drug available for mumps infection, the most effective treatment is prevention by vaccination.

Moyamoya Disease: A Rare Presentation and Literature Review.

Moyamoya disease is a rare vasculopathy involving the vessels of the central nervous system, predominantly the internal carotid arteries. A 21-year-old female patient from the Murshidabad district of West Bengal presented to us with an altered sensorium. She was referred to us from another hospital in Kolkata, where she was diagnosed and being treated as a case of ischemic stroke 2 weeks prior to the presentation. There was a significant past history of excruciating headaches, which would be more at night, and did not have any other obvious aggravating or relieving factors. On examination, the plantar was bilaterally extensor, and the patient was afebrile with no signs of meningeal irritation. Neuroimaging with noncontrast computed tomography (CT) head revealed a large right-sided middle cerebral artery (MCA) territory infarct along with acute hemorrhage in the left basal ganglia region. Upon a thorough perusal of the course of treatment at the previous hospital, it was ascertained that there was no usage of antiplatelet or anticoagulant agents there. A magnetic resonance (MR) angiogram of the intracranial blood vessels was therefore ordered, which was suggestive of moyamoya disease. Therefore, it was concluded that the spontaneous and near-simultaneous occurrence of infarct and hemorrhage was due to the vascular anomalies induced by moyamoya disease, making this case an uncommon presentation of a very rare disease.

A Curious Case of Autoimmunity, Pancytopenia, and Disseminated Intravascular Coagulation.

HISTORY AND EXAMINATION: A 21-year-old female patient presented to us with severe low back pain for 4 months. On examination, patient was afebrile, with severe pallor, and tenderness in both sacroiliac (SI) joints. Patient was being admitted and evaluated, and during the course of evaluation, developed severe headache, which was severe in intensity and associated with nausea and projectile vomiting. Initial investigations: An X-ray of the bilateral SI joints revealed inflammation, and the antinuclear antibody (ANA) turned out to be 4+ with pancytopenia and raised lactate dehydrogenase (LDH), but the liver function tests were normal. Rest of the rheumatological profile was unremarkable. During the course of the evaluation, she developed a severe headache, which, on imaging, showed presence of cerebral edema with chronic subdural hematoma, and a concomitant coagulopathy workup revealed evidence of disseminated intravascular coagulation (DIC). DISCUSSION: Taking the whole picture into consideration, a malignant process in the body was suspected, and serum tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA-125) were sent, all of which were raised. Validating the clinical clue was the bone marrow biopsy done for pancytopenia, which revealed malignant epithelial infiltration. A contrast-enhanced computed tomography (CECT) thorax and whole abdomen were done to find out the primary, which showed a neoplastic mass at the gastroesophageal junction along with bony metastases in the vertebrae and left adrenal. Tissue from the primary lesion was taken for histopathological examination (HPE) through upper gastrointestinal endoscopy. Although HPE revealed grade III poorly differentiated stomach adenocarcinoma, the patient had succumbed to the disease process by the time the diagnosis came to light. CONCLUSION: In short, this case perfectly illustrates how solid organ malignancies might be a mimicker of multisystem disorders, thereby delaying diagnosis and worsening the prognosis even further.