Disseminated Cryptococcosis in Idiopathic CD4+ Lymphocytopenia.

INTRODUCTION: Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non- HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3 with ambiguous natural history and prognosis. In addition, cryptococcal and nontuberculous mycobacterial infections are reported as known opportunistic infections. Therefore, management turns around vigilant follow-up and treatment of the current clinical scenario of these patients. CASE PRESENTATION: Here, a 55-year-old lady was referred with a history of diffuse headache and intermittent fever for two months, projectile vomiting, and altered mental status for five days. Nonpruritic maculopapular rashes and diffuse desquamation of the skin were noted. She had no significant previous medical history. Based on clinical findings and investigations, she was diagnosed with ICL having disseminated cryptococcosis. Unfortunately, the patient did not undergo specific treatment as she was recognized late, and unfortunately, she died. CONCLUSION: It is of paramount importance to recognize the clinical entity as early as possible to start appropriate treatment, which may positively impact the outcome. Therefore, the clinician must be aware of disseminated cryptococcosis associated with non-HIV states.

Disseminated Tuberculosis in an Immunocompetent State: A Case Report.

BACKGROUND: Tuberculosis is one of the major infectious diseases of mankind and remains a significant health concern, especially in developing countries. Clinical manifestations of TB are broad and sometimes very challenging for clinicians to diagnose early. Tuberculous psoas abscess was generally secondary to spinal tuberculosis or direct extension from adjacent structures in immunocompromised individuals, but tuberculous psoas abscess in the immunocompetent state is very infrequent. In addition, pancytopenia and new onset neck swelling simultaneously make this presentation a very unusual clinical entity in tuberculosis. CASE PRESENTATION: We now present a case of a 21-years-old, unmarried, otherwise healthy girl presented with fever, lower abdominal pain and weight loss for two months. She also noticed painless neck swelling for 15 days. She later had a tuberculous left sided psoas abscess with pancytopenia and a cold abscess on the left side of the neck with no sign of any other apparent focus, according to the evidence. Diagnosis of disseminated TB without lung involvement was established and ATT was started. The outcome was successful on follow up. CONCLUSION: Among the broad spectrum of atypical manifestations of TB, this case report draws attention to its rarity, diagnostic challenge and awareness of the clinical spectrum, especially in developing countries.

Parotid gland swelling as an initial presentation of Multiple Myeloma: a case report.

INTRODUCTION: Parotid swellings are commonly encountered in ENT Clinics, the cause of which could range from neural conditions, endocrine problems, vitamin deficiencies, and sialadenitis, which may even be a manifestation of an underlying systemic disease. Multiple myeloma represents a clonal proliferation of plasma cells and is a condition in which a parotid swelling might be present, although very uncommon. CASE PRESENTATION: We report a case of 60-year-old female presented with unilateral parotid swelling, which led to a diagnosis of multiple myeloma based on the investigations. CONCLUSION: Various imaging modalities are currently available to assess the extent of the swelling and evaluate the soft tissue and osseous involvement. The clinician must have a rigorous insight into the several clinical manifestations and the sites of involvement of the different conditions to make a proper diagnosis.