Assessment of Atherosclerosis in Sle Patients by Measuring Carotid Intima Media Thickness: A Cross Sectional Study.

SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events.Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid Artery Ultrasound has been recommended by the AHA/ACC to assess and follow progression of subclinical atherosclerosis & correlate with traditional /non traditional CV risk factors in SLE. To study the correlation between Carotid Intima Media Thickness, traditional/non traditional CV risk factors in SLE. MATERIAL: Hospital based descriptive, cross sectional study.Patients with Systemic Lupus Erythematosus, diagnosed by SLICC 2012 criteria, aged > 12 years, irrespective of therapy status, between April 2019 to August 2020, were recruited by consecutive sampling. Non consenting patients, individuals with preexisting cardiovascular disease, history of MACE, hypothyroidism (detected prior to diagnosis of SLE/disease onset), smokers, PLHIV,individuals with neck surgical, radiation, were excluded. OBSERVATION: 55 SLE patients were observed. No individuals were lost to follow up. Subgroup analysis was performed between SLE with Nephritis (36) and those without Nephritis (19) as presenting features. The mean age of the study subjects is 33 years with mean disease duration of 4.6 years.SLE nephritis patients had longer disease duration,younger age of disease onset & longer duration of steroid usage.The mean Systolic BP is 134+/-20mmHg, observed to be significantly higher in SLE nephritis patients. Framingham Risk scores were positively correlated with duration of SLE disease & SLEDAI 2K scores & duration of steroid therapy. The mean CIMT of the study population is 0.91mm with 10.9% plaque prevalence whereas Mean CIMT of Lupus nephritis patients is 1.02+/- 0.27mm; but no statistically significant difference in CIMT was observed between two subgroups. Carotid Intima Media thickness was positively correlated in bivariate analysis with anti DSDNA ab levels, Framingham Risk Scores,anaemia, SLE Disease activity scores, 24hr urine proteinuria,duration of steroid usage, Serum Creatinine & CRP. No correlation between CIMT and age of subjects,FPG,TG,serum homocysteine was observed. CONCLUSION: SLE patients have a high atherosclerosis burden and are at increased risk of adverse cardiovascular events. Carotid intima media thickness measurement by USG doppler is a reliable, non invasive, inexpensive tool which helps to detect subclinical atherosclerosis and plaques in SLE patients. In this study,Lupus Nephritis patients, Neuropsychiatric SLE and SLE with secondary APS, early age of lupus onset, longer disease duration with prolonged steroid therapy,significant proteinuria, higher antiDSDNA ab levels and hypocomplementemia are observed to have higher mean CIMT and plaque formation.

Renal cell carcinoma with paraneoplastic leucocytosis.

Paraneoplstic leukocytosis, seen in some solid tumors, is due to increased production of granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interleukin 6 and other cytokines by tumor cells. Though its association with malignancy of lung, ovary and bladder is not uncommon, but it is rarely seen with renal cell carcinoma. We are presenting such an association with papillary cell carcinoma of the kidney.

An unusual association of autosomal polycystic kidney disease and multiple myeloma.

Autosomal dominant polycystic kidney disease (ADPKD) is well known for its different renal and extrarenal complications. Chronic renal failure (CRF) from ADPKD is also reported in older patients. On the other hand, multiple myeloma (MM) can also cause renal damage by different mechanisms. A 38-year-old man presented with dull aching abdominal pain, recent onset respiratory distress along with bilateral pedal swelling. Initial investigations revealed polycystic kidney disease but subsequently it was found that the patient was also suffering from MM. This rare association of ADPKD and MM was responsible for aggravating the renal damage and perhaps resulted in early age of presentation with CRF. The patient was managed symptomatically but unfortunately succumbed before starting specific treatment for MM.

Diagnostic dilemma in a case of osteolytic lesions.

A middle-aged male patient presented with fever, polyarthralgia, polyuria, easy fatigability and weight loss for 1 month. Clinically, there was only significant pallor and a swelling over the right sternoclavicular joint. On investigation, there was anaemia, raised urea, creatinine and pus cells in urine with growth of Escherichia coli. There were also hypercalcaemia and osteolytic lesions over the ribs, scapula, clavicle and skull along with distorted renal corticomedullary differentiation. Although the initial diagnosis was likely to be a case of multiple myeloma, serum protein electrophoresis was negative for the monoclonal band and no Bence-Jones protein was detected in urine. Bone marrow plasma cells were less than 10%, but the serum-free light chain assay revealed altered κ:λ ratio. Later in the course of the disease, a cervical lymph node appeared. The biopsy and immunohistochemistry of this lymph node revealed a CD5 positive diffuse large B-cell lymphoma, but unfortunately the patient succumbed to his illness after receiving the first cycle of Rituximab-Cyclophosphamide-Hydroxydoxorubicin-Oncovin-Prednisolone.

Coexistence of pulmonary tuberculosis and sarcoidosis: a diagnostic dilemma.

Tuberculosis and sarcoidosis are multisystem diseases having different aetiology and management; however, they have similar clinical and histological characteristics. Very rarely they may coexist. We report a rare case of a 38-year-old woman who presented with chronic cough, low-grade fever and respiratory distress that was initially diagnosed as miliary tuberculosis. Diagnosis was supported by positive mycobacterial culture and initially responded to antitubercular treatment, but later recurrences led to further investigations and the diagnosis of coexisting sarcoidosis.

Spondyloepiphyseal dysplasia tarda with progressive arthropathy associated with subcapsular cataract.

Spondyloepiphyseal dysplasia tarda with progressive arthropathy is a form of inherited skeletal dysplasia involving the axial skeleton along with swelling and deformities of the peripheral joints that mimics juvenile rheumatoid arthritis. We report a case of a 14-year-old school boy who presented with dwarfism, spine deformity, ocular anomaly and peripheral arthropathy with characteristic radiological changes in the vertebrae and multiple other joints.

Acute disseminated encephalomyelitis after mixed malaria infection (Plasmodium falciparum and Plasmodium vivax) with MRI closely simulating multiple sclerosis.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is a monophasic, inflammatory, immune-mediated disorder of the central nervous system. It is particularly difficult to distinguish between ADEM and an initial attack of multiple sclerosis (MS) clinically and based on magnetic resonance imaging (MRI) or cerebrospinal fluid. ADEM is quite rare after malaria infection. Our patient, although diagnosed provisionally of ADEM after mixed malaria infection, had neuroimaging closely simulating MS. CASE REPORT: We report a case of a woman with an adult type 2 diabetes presenting with fever and diagnosed by antigen assay to be suffering from mixed malaria infection (Plasmodium falciparum, Plasmodium vivax). While recovering with artesunate and doxycycline therapy, she developed acute onset bladder retention followed by paraparesis. On examination she had evidence of Upper Motor Neuron (UMN) signs in all the 4 limbs along with truncal sensory loss. DISCUSSION: Her MRI of spine showed T2 hyperintensities suggestive of resolving myelitis. MRI of the brain showed multifocal and confluent areas of demyelination mostly involving the corpus callosum and periventricular region. Lesions, particularly the callosal ones, closely simulated MS. In accordance with the McDonald Criteria and Barkhof's MRI Criteria, this patient did not fit into the diagnosis of MS. Our provisional diagnosis was ADEM.