Lipoid Pneumonia After Prolonged Inhalation of Clarified Butter Made from the Milk of a Buffalo or Cow (Ghee).

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances. It can present acutely or more commonly presents as an insidious onset chronic respiratory illness. It requires a high degree of suspicion with great emphasis on history. It can mimic tuberculosis, malignancy or interstitial lung disease. We report the case of a 31-year-old male with a history of sniffing hydrogenated oil, presenting with a non-resolving pneumonia.

Skull base chondrosarcoma presenting with parenchymal hemorrhage: A case report.

Chondrosarcoma (CS) is a locally invasive, slow growing malignant neoplasm. Intracranial chondrosarcoma are extradural osseous lesions and intradural location with intratumoral hemorrhage is very rare. We report a rare case of 65-year-old male presenting with a small mass in left posterior skull base and later, suddenly deteriorating due to large cerebellar hemorrhage. A brief review of literature of such cases is also presented.

Diagnosis and Management of Osteoarticular Tuberculosis: A Drastic Change in Mind Set Needed-It is Not Enough to Simply Diagnose TB.

BACKGROUND: In the era of increasing drug resistance in pulmonary tuberculosis (TB), it is prudent to assess causes of poor response to anti tubercular therapy (ATT) and drug sensitivity pattern (DSP) in osteoarticular TB. MATERIALS AND METHODS: As a part of Bombay Orthopaedic society's research project, members were asked to refer non responders to ATT to our institute. Cases were enrolled from October 2010 to March 2014. Deep tissue samples were obtained in all but five cases and subjected to a battery of tests including histopathology (HPE) and TB culture and sensitivity. The DSP was compared with the study performed by the principle author from 2004 to 2007 and published in 2009. RESULTS: 39 male and 50 female patients with a mean age of 24.85 years (2-66) were included and classified in four groups after results. (1) Culture and HPE positive-36. 24 had MDR and three XDR TB. Primary resistance to even second line drugs and deterioration of DSP since last study was noted, (2) culture negative and HPE positive-21. The cause of poor response was surgical in more than half cases, (3) non representative samples or lost to follow-up-15, (4) TB mimics-16. CONCLUSION: There is increasing incidence of primary resistance to second line drugs, primary resistance in children and worsening of resistance patterns as compared to older studies. ATT initiation is a fateful decision and every attempt should be made to rule out TB mimics and establish DSP before initiation.

A patient with hypercoagulable state due to tuberculosis.

A 55-year-old male patient presented with status epilepticus following prolonged fever. Investigations revealed miliary opacities in lungs that were diagnosed as tubercular after thoracoscopic lung biopsy. Wide derangement of coagulation parameters was found, indicating a pro-coagulent state. There was evidence of widespread thrombosis.

Lymphorrhea: An Unusual Complication of Jugular Venous Catheterization for Hemodialysis.

A considerable number of end-stage renal disease patients undergo tunneled cuffed catheter insertion for hemodialysis under ultrasonographic guidance while awaiting arteriovenous fistula creation. We report a case of a 62-year-old female who underwent tunneled catheter insertion in the left internal jugular vein under ultrasound and fluoroscopic guidance, which was followed by pericatheter serous discharge. Fluid examination confirmed the diagnosis of lymphorrhea, and lymphoscintigraphy facilitated its localization. This case is reported for its rarity and with a discussion on literature review, complications of lymphorrhea, and their management.

Tumour induced osteomalacia: a report of two cases. A disease of defective matrix synthesis?

Tumour induced hypophosphataemic osteomalacia or rickets is a well delineated clinical entity. There is confusion, however, about the nomenclature and classification of the associated tumours. The tumour factor responsible for the biochemical abnormalities has also not been identified. We report here two cases: one, a 43 year old male with a soft tissue tumour in the left vastus medialis, and the other, a 25 year old female with a soft tissue tumour in the right anterior axillary fold. Reversal of biochemical abnormalities and clinical improvement occurred after removal of the tumour in both cases. Both tumours showed unusual morphology characterised by spindle cell component, large vascular spaces, osteoclast-like giant cells, calcification and ossification. The tumour in the second patient was benign, while the nature of the tumour in the first patient was debated. We speculate that defective matrix may be the cause of unusual histology of the tumours, and also the source of the phosphaturic factor.

Allergic fungal sinusitis: incidence and clinical and pathological features of seven cases.

Allergic fungal sinusitis, like allergic bronchopulmonary fungal disease, is a noninvasive inflammatory process. It manifests as recurrent nasal polyposis. Histologically the characteristic feature is the presence of thick mucin with dense collections of degenerating eosinophils and Charcot-Leyden crystals (allergic mucin). Demonstration of fungal hyphae in allergic mucin is diagnostic of the disease. We reviewed 85 cases of nasal polyposis operated upon during a period of four years. Allergic fungal sinusitis was diagnosed in seven (8.2%) cases on the basis of presence of allergic mucin and fungal hyphae. History of previous nasal polypectomy was present in four of the seven cases, and in six of the remaining 78. There were no clinical or radiological features that could distinguish the cases of allergic fungal sinusitis from the rest. Aspergillus fumigatus, Mucor and Cladosporium were cultured from one case each.

Cytomegalovirus nasal polyp after renal transplant.

Infection is a major problem after transplantation. Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients. We describe a case of CMV infection with rare clinical manifestation in the form of nasal polyp. Patient presented 6 weeks following renal transplantation with history of fever and stuffy nose. On evaluation he was found to have nasal polyp which was excised. Histopathology revealed characteristic CMV inclusion bodies. Patient responded to ganciclovir therapy and is presently doing well eighteen months after transplantation.

The spectrum of chronic autoimmune hepatitis.

Autoimmune hepatitis (AIH) is characterised by the presence of periportal hepatitis coupled with the presence of autoantibodies in the serum. We report our experience with 10 cases (females--8, males--2) who presented to the rheumatology clinic with either articular or extra-articular manifestations. Three patients (1 SLE, 1 Sjogren's and 1 RA), satisfied the criteria for an underlying rheumatic disease (secondary AIH) while, others had primary AIH. Median duration of hepatic involvement was 6 months and the varied presentations were noted. Articular disease ranged from arthralgias, palindromic arthritis to persistent non-erosive/non-deforming arthritis (Jaccoud's arthritis). Autoimmune thrombocytopenia was seen in 2 and autoimmune hypo and hyperthyroidism were seen in 3 patients each. Anti-nuclear antibody was positive in 9/10 (6 with speckled pattern and 3 with homogenous pattern) and anti-mitochondrial antibodies were positive in three. Hepatitis C virus (HCV) markers were positive in 1, who probably had viral hepatitis with dominant autoimmune features. All have been started on steroids (5 patients--1 mg/kg dose, 1 patient--0.5 mg/kg dose and 3 patients--0.25 mg/kg dose). The HCV positive patient was on a low dose steroid (0.25 mg/kg) and interferron treatment was contemplated before she was lost to follow up. Four patients are also on azathioprine in the dose of 2 mg/kg/day. Of the 6 patients who are under regular follow up, the liver parameters have normalised in 5 and one showed hypoalbuminaemia with normal enzyme levels at the last follow up.

Treatment of AA amyloidosis in rheumatoid arthritis.

Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were treated with chlorambucil. All had established but uncontrolled RA with a persistently raised ESR. Moderate (> 1 gm, < 3.5 gm/d) to nephrotic range (> 3.5 gm/d) proteinuria and a relatively well preserved renal function was noted in three patients. One patient had deranged renal function and required dialysis. On chlorambucil, there was complete recovery, partial improvement and no improvement in one patient each. The fourth patient required haemodialysis, did not tolerate chlorambucil and succumbed to the illness. Therapy with chlorambucil can benefit some patients of RA with AA amyloidosis. Leucopenia is the most important dose limiting side effect.

Evaluation of the knee pathology by ultrasonography.

Fourteen patients undergoing total knee replacement for the arthritic conditions of the knee were evaluated by ultrasonography (USG) prior to surgery. USG findings (synovium, fluid, femoral cartilage, cyst and loose bodies) were compared with surgical findings. USG and surgical findings matched for synovial pathology in 57%, for presence fluid in 71% and for cartilage damage in 45%. Loose bodies and cyst present in one patient was not picked up by USG. Baker's cyst was detected in one patient.