Cytological diagnosis of microfilaria coexistent with suspected malignancy of breast and ovary in a young pregnant female.

Filariasis is a major health issue of tropical and subtropical regions and is endemic in India. It is rarely seen in cytological smears, exfoliative scrapings or in effusions. We present the case of a 29-year old female with filaria found on cytological examination of both breast and ovary.

Study of quality of life and depression in people living with HIV/AIDS in India.

The aim of this study was to assess the quality of life (QOL) and the severity of depression in people living with HIV/AIDS (PLWHA) and investigate its correlates. This was a cross-sectional study on 700 PLWHA in India. World Health Organization QOL HIV (WHOQOL HIV-BREF) and Patient Health Questionnaire-9 (PHQ-9) were used to assess QOL and depression in PLWHA, respectively. The study population was divided into five groups on the basis of Cluster of Differentiation 4 (CD4) count as follows: Group A [< 50 cells/µL], Group B [50-199 cells/µL], Group C [200-349 cells/µL], Group D [350-499 cells/µL], and Group E [>500 cells/µL]. The lowest mean scores were noted under Group A [< 50 cells/µL] in physical and psychological domains and the highest mean scores were noted under Group E [> 500 cells/µL] in physical and environment domains. PHQ9 scores negatively correlated with QOL domains and the correlation was statistically significant (p < 0.001) with the highest negative correlation was found in relation to the psychological domain (r = -0.739). The PHQ9 score in those who do not have opportunistic illnesses (7.23 ± 6.14) was lower in comparison to those who had opportunistic illnesses (9.81 ± 6.40) and the difference was statistically significant (p < 0.001). We observed that there was almost a chronological increase in the individual QOL domain score and a decrease in the PHQ9 score with an increase in CD4 count. Our result supports the implementation of routine screening for depression in antiretroviral therapy centers and multidisciplinary interventions to improve outcomes among depressed PLWHA.

DIFFERENT SCORING SYSTEMS IN ACUTE ALCOHOLIC PANCREATITIS: WHICH ONE TO FOLLOW? AN ONGOING DILEMA.

BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle's tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.

Diferentes sistemas de pontuação na pancreatite alcoólica aguda: qual a seguir? Um dilema em curso / Different scoring systems in acute alcoholic pancreatitis: which one to follow? an ongoing dilema

ABSTRACT BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle's tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.

RESUMO CONTEXTO: A pancreatite aguda é uma desordem comum na prática médica. Nos últimos tempos, sua gestão mudou drasticamente com a maioria das decisões tomadas baseadas na gravidade da doença, como administração de antibióticos intravenosos, sucção negativa com o tubo de Ryle ou intervenções cirúrgicas como necrosectomia, etc. Há diferentes escores em uso para avaliar a gravidade da doença, mas a eficácia relativa manteve-se um assunto discutível. OBJETIVO: O presente estudo foi assim realizado para investigar a acurácia preditiva de diferentes sistemas de pontuação na pancreatite aguda. MÉTODOS: Foram selecionados 50 pacientes com pancreatite aguda admitidos na enfermaria de medicina de Pt. B.D. Sharma PGIMS, Rohtak, Índia, e foram considerados para estudo após o cumprimento dos critérios de elegibilidade. Estes pacientes foram investigados na admissão e seguidos prospectivamente. A severidade da pancreatitie foi classificada para cada um destes pacientes pelo sistema de classificação Atlanta revisado. Os sistemas de pontuação comumente usados pertencentes à pancreatite aguda, ou seja, BISAP, Ranson, APACHE II e CTSI modificado foram calculados. Posteriormente, esses escores foram correlacionados com a severidade, presença de falência de órgãos, ocorrência de complicações locais e desfecho final dos pacientes. RESULTADOS: Dos 50 pacientes, a ingestão crônica de álcool foi a etiologia em todos, exceto em um com pancreatite idiopática. A média de idade da população estudada foi de 42,6±13,27 anos. Destes pacientes, 32% apresentavam necrose pancreática, 40% apresentavam coleções peripancreáticas, 56% apresentavam pancreatite aguda leve, 24% apresentavam pancreatite aguda moderadamente grave, enquanto 20% apresentavam pancreatite aguda grave. O APACHE II teve maior precisão em prever a severidade, a falha do órgão e resultados fatais. No que diz respeito a esses parâmetros, os valores preditivos negativos do escore BISAP também foram consideráveis. A contagem modificada de CTSI foi exata em prever complicações locais, mas teve a exatidão limitada em outras predições. CONCLUSÃO: O APACHE II emergiu como o sistema de pontuação mais confiável seguido por BISAP e Ranson na gestão dos pacientes com pancreatite aguda. Mas em condicionantes do tempo e dos recursos, mesmo a Pontuação do BISAP com seus valores preditivos negativos significativos, serviu como uma ferramenta valiosa para avaliar e administrar esses pacientes.

Autoimmune pancreatitis masquerading as carcinoma head of pancreas: A case report and review of literature.

INTRODUCTION: Autoimmune pancreatitis (AIP) is a rare form of chronic inflammatory pancreatic disease secondary to an underlying autoimmune mechanism. It is now considered as pancreatic manifestation of IgG4 related disease, which is a multisystem disease. CASE REPORT: We are reporting a patient who presented with obstructive jaundice and mass head of pancreas on Computed Tomography (CT) scan. Considering a strong clinical suspicion of pancreatic cancer, Whipple procedure was done. Histopathological report revealed intense lymphoplasmacytic infiltrate and fibrosis with collagenisation, so possibility of AIP was suggested. Serum IgG4 levels were advised and found to be increased. Diagnosis of AIP was made and patient responded to steroids. DISCUSSION: Pre-operative core biopsy of the pancreas and Serum IgG4 levels are sufficient to make the diagnosis and resection is usually not recommended in AIP. CONCLUSION: Awareness of the entity and use of ancillary techniques in making the pre-operative diagnosis could have saved the patient from an extensive surgical procedure.

Evaluation of thyroid dysfunction in patients with nephrotic syndrome.

BACKGROUND: Thyroid and kidney are interdependent on each other in many ways for optimal functioning of either organs. Proteinuria causes urinary loss of thyroid hormones and thyroid binding globulins in substantial amount resulting in subclinical/overt hypothyroidism. Autoimmunity, which can attack both the organs simultaneously, may also contribute considerably to the abnormal functioning of both organs. AIMS AND OBJECTIVES: To study the effect of proteinuria on the thyroid function and its association with autoimmunity. METHODS: The study was carried out on a total number of 60 patients with nephrotic range proteinuria attending the kidney and dialysis clinic PGIMS, Rohtak, India. Thyroid profile and baseline investigations along with Anti-TPO antibodies and renal biopsy were carried out on each patient. Patients were allocated to 2 groups based on Anti TPO antibody results: group A comprising 25 Anti-TPO Ab positive patients and group B comprising 35 Anti-TPO Ab negative patients. RESULTS: Group A patients with Anti TPO antibody positivity had more elevated TSH levels (p<0.0001), proteinuria (p=0.0011) and serum creatinine (p=0.0137) as compared to group B patients. Group A patients had more diminished eGFR (p=0.0127) and serum albumin (p=0.0056) than patients in group B. TSH levels were positively correlated with proteinuria r=0.55 (p<0.0001, 95% CI 0.35 to 0.70) and serum creatinine levels r=0.56 (p<0.0001, 95% CI 0.36 to 0.71). TSH levels were negatively correlated with serum albumin levels r=-0.52 (p<0.0001, CI -0.68 to -0.31) and glomerular filtration rate r=-0.54 (p<0.0001, CI -0.69 to -0.33). On histopathology, membranous nephropathy - 29 out of 60 patients, 48% - was the most common finding in both the groups. CONCLUSIONS: Nephrotic range proteinuria leading to thyroid dysfunction is a common entity but the association with autoimmunity causes an exaggerated effect on both these organs. Our study established a significant correlation between thyroid autoimmunity and nephrotic syndrome. Thus, a high index of suspicion should be kept in all patients with nephrotic syndrome to look for any associated antibodies against thyroid antigens. Autoimmunity causes more proteinuria and more elevations of thyrotropin leading to clinical hypothyroidism; however, the occurrence of overt hypothyroidism necessitating treatment needs further study.

Comparative Analysis of Liquid based and Conventional Cytology Smears in Fine Needle Aspirates from Breast Lesions.

CONTEXT: Liquid-based cytology (LBC) is being extensively used for the evaluation of both gynecological and non-gynecological specimens. Suspension of cells in monolayer makes better morphological assessment possible. Along with this, inherent morphological changes such as altered, reduced, or lost background material, fragmented cell clusters, smaller cell size, nucleolar prominence, etc., need to be considered. AIM: Present study was aimed at comparative evaluation of utility of LBC versus conventional smear (CS) in assessing breast lesions and whether it can be used as an alternative to conventional preparation. SETTINGS AND DESIGN: Present study was a prospective study in which 75 cases of breast fine-needle aspiration cytology from patients with palpable breast lumps constituted the study group. MATERIAL AND METHODS: The first pass was used for CS and LBC; a second pass was given. The representative CS and LBC smears were compared using several criteria. STATISTICS: Each feature was scored individually and evaluated statistically using Wilcoxon's signed rank test on the SPSS program. RESULTS: A statistically significant difference was found in informative background and background blood-debris, whereas the difference was not statistically significant in other features such as cellularity, cytoarchitectural pattern, presence of monolayer, and nuclear and cytoplasmic details. CONCLUSION: LBC is a promising technique in the field of cytology. It has the potential to decrease the number of slides screened per case and decrease the turn-around-time.

'Pleomorphic adenoma of the tongue: A common entity at the uncommon location'.

The salivary gland tumors comprise of 3% of head and neck tumors. Pleomorphic adenoma, also known as mixed tumor, is the most common benign neoplasm of the major and minor salivary glands. The occurrence of pleomorphic adenoma of the tongue is very rare, and very few cases have been reported in the literature. A 41-year-old male presented with swelling on tongue. Cytological and histological examination revealed pleomorphic adenoma. Complete excision of the mass was done transorally under general anaesthesia. High index of suspicion and an adequate clearance of the tumor with a cuff of surrounding dispensable normal tissues is the key to successful treatment of such tumors. The authors consider the rarity of this case and present a rare case of pleomorphic adenoma of the tongue.

Underlying coeliac disease in a case of cerebellar ataxia with unknown etiology.

Celiac disease is an immune mediated enteropathy in susceptible individuals as a response to gluten containing diets based on wheat, oat, rye and maize. It clinically presents with malabsorption syndrome along with a myriad of extraintestinal manifestations such as anemia, osteoporosis, dermatitis herpetiformis, peripheral neuropathies, ataxia and cognitive impairment. Although the prevalence of these extraintestinal features range from 1 to 15% in these patients, their presence in the absence of intestinal manifestations is very rare. Here we report the case of a middle aged female diagnosed with celiac disease with coexisting gluten sensitive ataxia in the absence of gastrointestinal symptoms.

Prevalence and Clinical Correlates of Microalbuminuria in Patients with Essential Hypertension - A Tertiary Care Center Cross Sectional Study.

Introduction: Albuminuria is predictor of target organ damage and worse cardiovascular outcomes. Microalbuminuria has been found in a large number of patients with essential hypertension. Aim of our study was to evaluate the frequency of microalbuminuria in essential hypertension and to study its correlation with severity of hypertension and target organ damage. Materials and Methods: This cross-sectional study was conducted at the outpatient clinic of General Medicine department of Pt. B D Sharma PGIMS, Rohtak. Hundred patients of essential hypertension (group A) in the age group of 18-65 years were included in the study. A control group (group B) consisting of hundred healthy normotensive, age and sex matched volunteers were also entered into the study. Arterial blood pressure was measured by digital sphygmomanometer after five minutes of rest; the values reported represented the average of three consecutive measurements taken over a 15-minute period. Urine albumin excretion (UAE) was estimated by an immunoturbidometry method. Microalbuminuria was defined as UAE between 30 and 300 mg/24 hours. Statistical analysis was performed by standard methods to measure rates and proportions; chi square test was used for analyzing the associations between the variables. Results: In this study it was observed that prevalence of microalbuminuria in essential hypertension was 47%. Risk factors for microalbuminuria included higher age, SBP and MAP. Microalbuminuria was associated with dyslipidemia, deranged renal parameters and end organ damage in form of LVH, ischemic changes, hypertensive retinopathy and renal dysfunction. In conclusion, this study confirmed that increased urinary albumin excretion is associated with a worse pattern of cardiovascular risk factors and is a marker of concomitant cardiovascular damage in essential hypertension. Conclusion: Microalbuminuria can therefore be regarded as a useful, relatively inexpensive, integrated marker to help identify patients at higher cardiovascular risk for whom more aggressive preventive strategies and additional treatment measures may be advisable.

Thyroid Association Ophthalmopathy in Hashimoto's Thyroiditis: a Case Report.

Thyroid associated ophthalmopathy is a constellation of symptoms caused by an autoimmune process involving the orbital tissue. It is common in hyperthyroid patients due to Graves' disease and also reported in euthyroid and hypothyroid Graves' patients with positive thyroid receptor antibodies. But in Hashimoto's thyroiditis, thyroid associated ophthalmopathy is a rarely reported and poorly understood entity. Here we report thyroid associated ophthalmopathy in a patient with hypothyroidism and negative thyroid receptor antibodies who showed heterogeneously hypoechoic thyroid gland on ultrasonography, diffuse lymphocytic infiltrate on fine needle aspiration citology and reduced 99m Tc radioisotope uptake, supporting the diagnosis of Hashimoto's thyroiditis. The patient was treated with levothyroxine and artificial tear drops.

Corpus callosum dermoid cyst: A rare entity.

Dermoid cyst is a congenital lesion that arises due to embryogenic impairment. It accounts for less than 0.3% of all intracranial masses. Herein we report a 30-year-old male who presented with a short history of headache and behavioral disorder. Physical and radiological examination diagnosed it to be a lipoma/epidermoid arising from corpus callosum. The lesion was removed endoscopically and histopathologic examination was performed which confirmed it to be a dermoid cyst. Rarity of the lesion and difficulty in pre-operative diagnosis prompted us to bring forward this case report.

Tumefactive Fibroinflammatory Lesion: A Diagnostic Dilemma.

Tumefactive fibroinflammatory lesions (TFLs) are rare idiopathic benign fibrosclerosing lesions that clinically simulate a malignancy. TFLs are seen more frequently in males between 10 and 74 years of age. The usual site of involvement is the head and neck region, but rarely the extremities may be involved. Coexisting fibrosclerotic processes have been reported including retroperitoneal fibrosis, sclerosing cholangitis, sclerosing mediastinal fibrosis, and orbital pseudotumors. The etiology of this poorly understood entity remains unknown. Possible suggestions include exaggerated responses or autoimmune reactions to any chronic infection. The clinical and radiological appearance of TFLs is that of malignancy, but histopathology reveals them to be a benign process broadly classified under non-neoplastic, fibroinflammatory proliferations. The treatment strategies for these lesions are not well defined and variable and include steroids, surgery, and radiotherapy either alone or in combination. TFLs, albeit not fatal, have a high recurrence rate; patients should, therefore, be kept on long-term follow-up. We describe a young female patient presenting with a rapidly developing cheek swelling, which was diagnosed histopathologically as a TFLs.

Macrophage activation syndrome in a patient with systemic onset of the juvenile idiopathic arthritis.

Systemic onset juvenile idiopathic arthritis (sJIA) is defined as arthritis affecting one or more joint usually in the juvenile age group (< 16 years of age) with or preceded by fever of at least 2 weeks duration that is documented to be daily ("quotidian") for at least 3 days which may be associated with evanescent (non-fixed) erythematous rash or generalized lymph node enlargement or hepatomegaly/splenomegaly/both or serositis. Macrophage activation syndrome (MAS) is a life-threatening complication of sJIA marked by sudden onset of non-remitting high fever, profound depression in all three blood cell lines (i.e. leukopenia, anemia, and thrombocytopenia), hepatosplenomegaly, lymphadenopathy, and elevated serum liver enzyme levels. In children with systemic juvenile idiopathic arthritis, the clinical picture may mimic sepsis or an exacerbation of the underlying disease. We report a case of a 16-year-old female patient presenting with high grade fever with joint pains and generalized weakness which proved to be systemic onset juvenile idiopathic arthritis with macrophage activation syndrome after ruling out all other differential diagnoses and responded well to intravenous steroids.

Autoimmune Hepatitis with Autoimmune Haemolytic Anemia Triggered by Varicella - a Rare Presentation.

Varicella is a common infectious exanthematous disease of children. Infection manifests as polymorphic maculopapulovesicular along with low grade fever, malaise and headache. Adults are less likely to be infected with varicella infection but once infected suffer disproportionately from serious complications like pneumonia, encephalitis, hepatitis and thrombocytopenia. Varicella hepatitis is generally a self-limiting disease with only a temporary subclinical rise in hepatic enzymes and are usually encountered however autoimmune hepatitis (AIH) which is an autoimmune disorder of unknown etiology affecting the liver is a very rare association of Varicella infection .similarly autoimmune haemolytic anaemia (AIHA) affecting the erythrocytes which is also rarely associated with varicella infection limited to few case reports. We report a rare triplex of acute varicella infection with AIHA and AIH in a young female patient.

Comparison of Prostatic Tissue Processed by Microwave and Conventional Technique Using Morphometry.

BACKGROUND AND OBJECTIVES: Rapid processing of histopathological specimens and decreased turnaround time is important to fulfill the needs of clinicians treating sick patients, so the present study was conducted to compare the time taken and quality of sections in processing of prostatic tissue by rapid microwave and conventional techniques using morphometry. METHODS: Four to five mm thick paired prostate tissue pieces of fifty cases of prostatectomy specimens were taken. One tissue piece of the pair was processed routinely overnight by conventional tissue processing and the other by microwave processing. Time taken for processing by both conventional technique and microwave technique was noted and compared. Then, both were stained with conventional method of hematoxylin and eosin staining and examined for histological typing and grading. Morphometric study was done on slides of prostatic tissue processed by both conventional and microwave technique. RESULT: The prostatectomy specimens included both benign (86%) and malignant (14%) prostatic lesions in the age range of 46-85 years. The time taken for steps of dehydration, clearing and impregnation in microwave technique was significantly less as compared to histoprocessing done by conventional technique. Morphology, staining patterns of prostatic tissue processed within minutes by microwave technique, whether benign or malignant, were comparable to those sections which were processed in days using standard technique. CONCLUSION: Domestic microwave oven can be used for histoprocessing to accelerate the processing with preservation of morphology and is cheaper than commercially available microwave ovens and processing time was considerably reduced from days to minutes.

Correlation of Hormone Receptor Expression with Histologic Parameters in Benign and Malignant Breast Tumors.

BACKGROUND AND OBJECTIVE: Breast cancer is the commonest cancer of Indian women. Estrogen and Progesterone expression is seen in benign breast lesions and in breast carcinoma associated with good prognostic parameters and it correlates well with response to hormone therapy. Although a lot of studies have been conducted in the past on hormone receptor expression in breast cancer and few have correlated them with other prognostic parameters of breast cancer, the present study was intended to document the prevalence of hormone receptor positive breast carcinomas in our population; their importance in benign breast diseases; to document a reliable scoring system of hormone receptors expression by Quick scoring; to correlate them with most of the proven prognostic parameters of breast carcinoma. METHODS: Tissue specimens from 25 patients with benign breast disease and 50 patients with breast carcinoma were assayed for estrogen (ER) and progesterone (PR) receptors using Quick scoring. ER/PR expression in breast carcinomas was correlated with various prognostic parameters including patients' age, menopausal status, tumor size, type, MBR grade, NPI, lymphatic vessel invasion, lymph node stage, lymphomononuclear invasion, elastosis and HER2/neu status. RESULT: Scoring of steroid receptors paralleled intensity of hyperplasia in benign breast diseases but in breast carcinoma, it was inversely correlated with grade of tumor, NPI, HER2/neu status, tumor necrosis, lymphomononuclear infiltrate and elastosis. We found no relationship with tumor size, lymph node status or age. CONCLUSION: Assessment of hormone receptors for clinical management of breast cancer patients is strongly advocated to provide prognostic information and best therapeutic options.

Assessment of renal functions in patients of chronic liver disease.

AIMS AND OBJECTIVES: Renal involvement in patients of chronic liver disease (CLD) is one of the dreaded complications associated with a steep rise in mortality and morbidity. Derangements in various homeostatic mechanisms in CLD leading to direct renal injury or circulatory compromise have been associated with renal impairment. METHOD: Consecutive cirrhotic patients (n = 100) were included in the study. Structural and functional renal failure was identified and patients were classified into various renal syndromes pre renal, intra-renal and hepatorenal syndrome (HRS). RESULTS: At the time of presentation, 37 patients had renal dysfunction. Thirty patients had pre-renal type of renal failure, six patients had intrinsic renal disease and one patient had structural renal disease. Patients with pre-renal type were further classified into volume responsive pre-renal failure and volume non responsive HRS. Five patients had features suggestive of HRS. Patients with decompensation such as portal hypertension (PHTN), jaundice, upper gastro-intestinal bleed and hepatic encephalopathy had significantly higher incidence of renal derangements as compared to their counterparts. Infection in the form of SBP and/or sepsis predisposed patients to develop renal dysfunction. CONCLUSION: Renal impairment in patients with advanced liver disease is not an uncommon phenomenon and is more commonly associated with a more advanced disease. Presence of PHTN and various signs of decompensation increase the chances of renal derangements in these patients. In view of rising incidence of CLD and higher survival (due to better treatment options available), one should be vigilant for the renal derangements in these patients.

Disseminated tuberculosis causing isolated splenic vein thrombosis and multiple splenic abscesses.

Tuberculosis is a common infectious cause of splenic enlargement in developing countries, but tubercular splenic abscesses are a rare presentation, found predominantly in immunocompromised populations. We report a case of tubercular splenic abscesses with isolated splenic vein thrombosis in an immunocompetent person.