Rheumatoid Arthritis Complicated by Myositis and Vasculitic Neuropathy: A Rare Association.

Rheumatoid arthritis (RA) is a multisystem disease with a variety of manifestations. Vasculitis and myositis are two very rare complications of RA. However, the coexistence of both of these complications in the same patient is extremely rare in medical literature. We here present such a rare association of clinical features in a 36 year old male patient with RA. He had RA for around four years before development of these complications almost simultaneously. The patient was treated with rituximab and oral steroids. The myositis component responded promptly but the vasculitic neuropathy was very slow to respond.

Encephalitis Due to Dengue Virus Infection Mimicking Japanese B Encephalitis: Two Case Reports.

Dengue virus induced encephalitis is a very rare entity and its full clinicoradiological profile is still unknown. We here report two cases of dengue encephalitis from Eastern India. The first one is a 20 year old female and the second one is a 13 year old boy. Both of them presented with altered consciousness and seizures. Blood and CSF study for dengue IgM were positive. MRI of brain showed T2 hyperintensity in the Thalami along with similar changes in other parts of the brain. Both patients responded to conservative therapy but residual neurological deficit were variably present. Relevant literature pertaining to dengue encephalitis have also been discussed.

Sudden Renal Failure in a Scleroderma Patient: A Clinical Dilemma.

Scleroderma is a connective tissue disease which may present with renal crisis. But sometimes, acute renal failure in scleroderma may be due to a second pathology. We here present a case of a 35 year old woman with systemic sclerosis, who presented with acute renal failure. She was started treatment as a case of scleroderma renal crisis. But her condition continued to deteriorate and she also developed some cutaneous vasculitic lesions. Her urine also had active sediments. Finally, serology and kidney biopsy established the renal lesion as stage IV lupus nephritis. She responded to immunosuppressive regimen for lupus with rapid improvement of kidney function. Such overlap of scleroderma with lupus is very rarely reported.

Disease Activity in Spondyloarthropathy: Does it affect Vascular Health?

BACKGROUND: Chronic inflammation in spondyloarthropathy (SpA) is associated with accelerated atherosclerotic cardiovascular disease (CVD). Flow mediated vasodilatation (FMD) and carotid intima-media thickness (cIMT) detects endothelial dysfunction and subclinical atherosclerosis respectively, responsible for atherosclerotic CVD. OBJECTIVE: We aimed to examine the association of disease activity in SpA with surrogate markers of CVD, i.e., FMD and cIMT. METHODS: Fifty patients of Axial SpA (Assessment of SpondyloArthritis Society-ASAS 2009 criteria) (<5 years disease duration) and 50 control subjects, matched for age (33.7±8.8 vs. 33.7±8.4 years) and sex, with no CV risk factors were recruited. Ultrasound assessment of FMD of brachial artery and cIMT of both common carotid arteries were performed. Measurements were compared between patients and controls by Student's t test. Association of disease activity in SpA patients with FMD and cIMT, were evaluated by Pearson/Spearman's correlation. RESULTS: FMD (4.9±1.4 vs. 8.7±1.6 %) and cIMT (0.52±0.04 vs. 0.44±0.11 mm), were impaired in SpA patients than healthy controls (all p<0.05). However, subjects in both the groups had no difference in age and body mass index with similar, within normal range blood pressure and lipid profile. CONCLUSION: We observed that FMD and cIMT were deranged in SpA, and higher disease activity in SpA was associated with impaired FMD and cIMT. However, a larger population with a prospective study-design would further confirm this relationship between SpA disease activity and CVD surrogate markers.

Multiple Cerebral Venous Sinus Thrombosis as Fist Manifestation of Primary Anti-Phospholipid Antibody Syndrome.

Antiphospholipid antibody syndrome (APS) is an autoimmune disorder, mainly found in young females, presenting with vascular thrombosis and/or obstetric complications. Thrombosis at anatomically significant sites may lead to considerable morbidity and/or mortality. We here present a case of primary APS presenting with sudden onset bilateral multiple cerebral venous sinus thrombosis. The patient, a 17 year old female with no prior rheumatological history, presented with sudden onset bilateral painful blindness and massive proptosis. MRI venography was instrumental in diagnosis. She also had significant thrombocytopenia. Except for the visual dimness, the other symptoms responded to therapy. Such massive cerebral venous thrombosis is extremely rare in primary APS.

Gitelman-like Syndrome with Kanamycin Toxicity.

A 22 year-old lady with multi-drug-resistant pulmonary tuberculosis was on Kanamycin, Cycloserine, Ethionamide, Pyrazinamide and Moxifloxacin since more than two months. She presented with muscle cramps and carpopedal spasm. Investigation revealed hypokalemia and metabolic alkalosis. She also had hypomagnesemia, hypochloremia and hypocalciuria. Serum urea and creatinine levels were normal. Patient was treated with intravenous and oral potassium chloride. Kanamycin was stopped. Metabolic alkalosis and hypokalemia improved gradually over one month. Biochemical parameters were like Gitelman's syndrome but it reversed with stoppage of Kanamycin. Gitelman-like syndrome with Kanamycin toxicity has not been reported in literature previously.