Stuck with pancytopenia in dengue fever: Evoke for hemophagocytic syndrome.

The hemophagocytic syndrome is an atypical and rare manifestation of dengue fever (DF). We describe a 15-year-old girl developing DF associated hemophagocytic syndrome who responded with supportive treatment.

Adrenal hematoma and right hemothorax after echis carinatus bite: an unusual manifestation.

Common bleeding manifestations after viperine bite include bleeding from site of bite, bleeding gums, epistaxis, hemoptysis, hematuria, hematemesis, and intracranial bleed. Bleeding in the adrenal gland is a rare manifestation. We report here a patient of viperine bite who developed right adrenal hematoma and right hemothorax after 3 days of bite. To the best of our knowledge this is the first case report of adrenal hematoma and right hemothorax after Echis carinatus bite.

Dapsone Hypersensitivity Syndrome With Leukemoid Reaction and Severe Thrombocytosis.

Hypersensitivity reactions to dapsone are common and potentially fatal adverse drug reactions. Herein, we report a case of a 45-year-old female who presented with fever, generalized desquamating rashes, and icterus three weeks after initiation of dapsone therapy for leprosy neuritis. She was diagnosed to have dapsone hypersensitivity syndrome (DHS) with leukemoid reaction and thrombocytosis. Dapsone was immediately discontinued, and she has treated with prednisolone 50 mg daily for a month and tapered over the next month. She has improved completely. DHS, leukemoid reaction, and severe thrombocytosis, or these adverse drug reactions to dapsone have rarely been reported.

IL-5 in the plasma-cell-dominant Castleman disease: a nosological entity.

A 40-year-old male presented with a history of low-grade fever, weight loss, night sweats and breathlessness of 3 months duration. On examination, the patient had freely mobile lump in left lumbar region. The lump was surgically excised. Histological examination and immunohistochemistry of the specimen were consistent with the diagnosis of plasma cell variant of the Castleman disease. The patient had polyclonal hypergammaglobulinemia, anemia, eosinophilia and elevated interleukin (IL)-6 level. The level of IL-5 was not measured; however, the presence of eosinophilia indirectly suggests an increased IL-5 level. He obtained complete remission after resection of lump and 20 months of surgery had no signs and symptoms of diseases recurrence with normal hematological parameters. We discuss the role of IL-5 in the pathophysiology of the Castleman disease along with dysregulated overproduction of IL-6.

Multiple intracranial hemorrhages in pregnancy: A common autoimmune etiology.

Systemic lupus erythematosus (SLE) is an autoimmune disorder, primarily affect female in fertile age. Pregnancy in SLE female is a high-risk situation which can adversely affect maternal-fetal dyad. SLE can flare during pregnancy or in postpartum period. We describe a case of a young pregnant female who presented because of right hemiparesis due multiple hemorrhages in the brain. The first presentation of the SLE with multiple intracranial hemorrhages in pregnancy, preceding the other characteristic clinical symptoms is rare. Here, we high lighten the major neurological issues and maternal-fetal dyad issues in SLE pregnancy and treatment strategies for management of SLE in pregnancy.

Reversible ecchymosis and hyperpigmented lesions: A rare presentation of dietary Vitamin B12 deficiency.

A 40-year-old male presented because of generalized weakness, fatigability, and hyperpigmentation with ecchymosis, he was diagnosed to have dietary Vitamin B12 deficiency anemia. The hyperpigmentation and ecchymosis lesions resolved after Vitamin B12 supplementation. Beside hyperpigmented lesion on the skin, the presence of ecchymosis is a very rare manifestation of the disease. Thrombocytopenia in Vitamin B12 deficiency anemia rarely leads to ecchymosis.

The QT dispersion and QTc dispersion in patients presenting with acute neurological events and its impact on early prognosis.

AIMS: To find out and investigate whether the QT dispersion and QTc dispersion is related to type and prognosis of the acute stroke in patients presenting within 24 h of the onset of stroke. SETTINGS AND DESIGN: This was a observational study conducted at Mahatma Gandhi Hospital, Dr. SN. Medical College, Jodhpur, during January 2014 to January 2015. SUBJECTS AND METHODS: The patients presented within 24 h of onset of acute stroke (hemorrhagic, infarction, or transient ischemic event) were included in the study. The stroke was confirmed by computed tomography scan and magnetic resonance imaging. Patients with (i) altered sensorium because of metabolic, infective, seizures, trauma, or tumor; (ii) prior history of cardiovascular disease, electrocardiographic abnormalities' because of dyselectrolytemia; and (iii) and patients who were on drugs (antiarrhythmic drugs, antipsychotic drugs, erythromycin, theophylline, etc.,) which known to cause electrocardiogram changes, were excluded from the study. National Institute of Health Stroke Score (NIHSS) was calculated at the time of admission and Modified Rankin Scale (MRS) at the time of discharge. Fifty age- and sex-matched healthy controls included. STATISTICAL ANALYSIS USED: Student's t-test, ANOVA, and area under curve for sensitivity and specificity for the test. RESULTS: We included 52 patients (male/female: 27/25) and 50 controls (26/24). The mean age of patients was 63.17 ± 08.90 years. Of total patients, infarct was found in 32 (61.53%), hemorrhage in 18 (34.61%), transient ischemic attack (TIA) in 1 (1.9%), and subarachnoid hemorrhage in 1 (1.9%) patient. The QT dispersion and QTc dispersion were significantly higher in cases as compare to controls. (87.30 ± 24.42 vs. 49.60 ± 08.79 ms; P < 0.001) and (97.53 ± 27.36 vs. 56.28 ± 09.86 ms; P < 0.001). Among various types of stroke, the mean QT dispersion and QTc dispersion were maximum and significantly higher in hemorrhagic stroke as compared to infarct and TIA (P < 0.001). The mean QT dispersion and QTc dispersion was found significantly high in nonsurvivors (n = 16) as compared to survivors group (n = 36) (P < 0.05). The mean QT dispersion was directly correlated with the NIHSS and functional outcome score MRS. Patients with greater QT and QTc dispersion having high NIHSS had poor prognosis. CONCLUSION: We concluded that patients presenting with acute neurological events having increased QT dispersion and QTc dispersion is related to high mortality and poor functional outcomes on hospital discharge and if the values of dispersion score are very high we can predict for hemorrhagic stroke.

Acute pancreatitis, ascites, and acute renal failure in Plasmodium vivax malaria infection, a rare complication.

A 22-year-old male presented with 6 days history of intermittent fever with chills, 2 days history of upper abdomen pain, distension of abdomen, and decreased urine output. He was diagnosed to have Plasmodium vivax malaria, acute pancreatitis, ascites, and acute renal failure. These constellations of complications in P. vivax infection have never been reported in the past. The patient responded to intravenous chloroquine and supportive treatment. For renal failure, he required hemodialysis. Acute pancreatitis, ascites, and acute renal failure form an unusual combination in P. vivax infection.

Spontaneous Soft Tissue Haematomas- A Rare Presentation of Chronic Myeloid Leukemic (CML).

Spontaneous soft tissue haematomas are rarely found in haematological malignancies. Chronic myeloid leukemia (CML) is a myeloproliferative disorder which rarely present with thrombo-haemorrhagic phenomenon. It is a malignant clonal disorder of pleuripotent stem cells that results in increase in myeloid, erythroid and platelets cells in peripheral blood and marked myeloid hyperplasia in bone marrow. It is characterized by the presence of Philadelphia chromosome (Ph) with BCR - ABL 1 fusion gene. This gene is responsible for the formation of 210 KDa chimeric proteins with enhanced tyrosine kinase activity which leads to the abnormal bone marrow cell proliferation and to the clinical and morphologic manifestations of leukemia. Cutaneous and mucous membrane bleeding is common in CML whereas bleeding in deep soft tissue is rarely found because of qualitative and quantitative platelet abnormalities. Here, we report a case of CML (BCR-ABL rearrangement positive) who presented with large haematoma in the anterior as well as posterior compartment of left thigh and treated successfully with hydroxyurea and imatinib.

Retinal Hemorrhages in Severe Non-cerebral Plasmodium vivax Malaria in an Adult.

Malaria is the most important parasitic diseases of humans and one of the leading causes of morbidity and mortality in tropical countries. Earlier Plasmodium vivax was considered as a benign infection, but now it is recognized as a cause of severe malarial disease. It causes severe malarial disease similar to those as Plasmodium falciparum including cerebral malaria, severe anaemia, severe thrombocytopenia, hepatic dysfunction, shock, acute respiratory distress syndrome (ARDS), acute renal failure, and pulmonary oedema. Malarial retinopathy includes retinal whitening, vessel changes, retinal hemorrhages and papilledema. However, retinal hemorrhages are very rare in Plasmodium vivax infestation. Hereby, we report a case of 30-year-old man, who presented with fever with chills and diminution of vision. He was found to have Plasmodium vivax infection with retinal hemorrhages. He was treated successfully with artisunate, primaquine and doxycycline, completely recovered after one month.