A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India

Purpose: To report the clinico?demographic profile of rhino?orbito?cerebral mucormycosis (ROCM) in patients during the “second wave” of the COVID?19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross?sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID?19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID?19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty?six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID?19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Hepatoprotective effect of obeticholic acid on acetaminophen induced hepatotoxicity in mice

Acetaminophen (APAP) is commonly used as analgesic and antipyretic drug for relieving mild and moderate pain, but at high doses produces hepatic necrosis. Though, Obeticholic acid (OCA) has been tested in range of diseases, its therapeutic potential against APAP-induced hepatic injury remains to be elucidated. Thus, in this study, we investigated the preventive effect of OCA along with N-acetylcysteine (NAC) and Silymarin (SIL) against acetaminophen-induced hepatotoxicity in mice. SIL (100 mg/kg, po) and OCA (30 mg/kg, po) were administered continuously for six days prior to APAP administration. After sixth dose, animas were fasted for 12 h and treated with 300 mg/kg APAP and then received SIL (100 mg/kg, po), NAC (500 mg/kg, ip) and OCA (30 mg/kg, po) at 1 h after APAP. Mice were sacrificed 6 h after APAP injection. Analysis of serum Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), liver glutathione (GSH) and histopathology were employed for assessment of hepatotoxicity. APAP group showed a significant increase in ALT, AST, ALP and centriolobular hepatic necrosis with a significant decrease in glutathione in comparison to control group. All these parameters were significantly improved in all the three treated groups when compared to APAP group. In conclusion, Obeticholic acid (OCA), Silymarin (SIL) and N-acetylcysteine (NAC) are suggested to protect against APAP-induced hepatotoxicity in mice by ameliorating liver enzymes, antioxidant effect and decreasing liver necrosis.

Oral health status and oral health related quality of life in Kodhu tribes – A descriptive cross sectional study

Introduction: In this modern era, a significant group of people is living in isolated hilly areas far away from civilization with their custom and beliefs. They are known as “tribes.” “Kodhu” tribe is one of the major Indian tribes present in the remote areas of Visakhapatnam. The objective is to assess the oral health status and oral health-related quality of life and education level in Kodhu Tribe in residing in Araku and Paderu regions of Visakhapatnam. Material and Methods: A descriptive cross-sectional study was conducted among the Kodhu tribal population situated in the Araku and Paderu areas Visakhapatnam, Andhra Pradesh. The study comprised of 800 participants selected using a simple random sampling technique. Chi-square test was used to assess the oral health status of the tribal population, while, independent t-test was used for multiple comparison of OHIP-14 and oral health status. A p-value ? 0.05 was considered statistically significant. Results: Among 800 participants, 458 were illiterate, and 342 were literate. The prevalence of dental caries was 49% among the illiterates while literates had 50.4% prevalence and the difference was statistically significant (P < 0.03). The periodontal status prevalence was found to be higher in illiterates (56.4%). The domains that are present in OHIP were found to be significantly associated with dental caries, periodontal status, and oral mucosal lesions (P < 0.001). Conclusion: The oral health status of Kodhu tribe was found to have high prevalence of the periodontal disease and dental caries. Regular oral examination by dental professionals, dental health education, and motivation to maintain oral hygiene should be insisted to improve the oral health status of this tribal community

A study of association between thyroid dysfunction and serum anti-mullerian hormone levels in women presenting with infertility

Background: This study was conducted to study the association between thyroid dysfunction and serum AMH levels in women presenting with infertility.Methods: An institution based cross-sectional study including, was conducted at Kamineni hospital fertility clinic among 70 women presenting with infertility during a two year period from May 2016 to April 2018 after fulfilling inclusion criteria.Results: Hypothyroidism was the most common thyroid dysfunction observed in the study participants and subclinical hypothyroidism was seen predominantly. Age of the women did not seem to influence the prevalence of thyroid disease. Low serum AMH indicating poor ovarian reserve was observed in 70% of women over 34yrs suggesting a significant correlation. All the women diagnosed with overt hypothyroidism had low serum AMH levels and half of the women with subclinical hypothyroidism also had low serum AMH levels suggesting a close association between thyroid dysfunction and ovarian reserve. Women with hyperthyroidism had normal AMH levels.Conclusions: Serum AMH levels in infertile patients, were inversely correlated with TSH levels.

Objective structured practical examination as a formative assessment tool compared to traditional method for third year M.B.B.S. community medicine students

Background: Assessment of students in medical colleges was done by traditional practical examination for evaluation of practical or clinical skills, which is subjective in nature and suffer from lack of objectivity. So a uniform system of clinical and practical evaluation of medical students is always desirable. An objective structured practical examination (OSPE) is one such method believed to meet the deficiencies of the conventional system of practical/clinical examination. This study is an attempt to evaluate the effectiveness of OSPE as a formative assessment tool compared to traditional methods for M.B.B.S. students.Methods: A cross sectional comparative study was carried out on 56 MBBS students in KAMSRC, Hyderabad, Telangana. Students of 3rd year M.B.B.S were subjected to traditional practical evaluation followed by OSPE. A eight station OSPE was conducted one week after the TPE. The scores obtained in both were compared. All the data collected was entered and analyzed with MS excel software 2007.Results: Average marks scored by the students in OSPE (17.78±2.69) were higher as compared to traditional practical examination (15.00±3.49) which was statistically significant. 74.4% of the students strongly agreed that OSPE is fairer in comparison to traditional practical examination. 90.5% students strongly agreed that variability of examiner and patient can be removed to a large extent by OSPE.Conclusions: Based on the observation, OSPE was found to be a more effective assessment tool than traditional method.

Prospective study of primary amenorrhoea and its management in a rural tertiary centre

Background: Amenorrhoea (absence of menstruation) is a symptom of varied causes. It results from dysfunction of hypothalamic-pituitary ovarian axis, uterus and vagina. It is a major concern for pubertal girls and their family members. It has a major impact on the physical, mental, psychological and social life of the girl and her family. The objective of the present study was to evaluate the aetiology and management of primary amenorrhoea in young adolescent girls.Methods: It was a prospective study conducted for a period of 2 years from August 2016 to July 2018 at Rajarajeswari medical college and hospital. Patients presenting with history of amenorrhoea that is, absence of menses by the age of 13 years with no visible development of secondary sexual characteristics or by 15 years of age with the presence of normal secondary sexual characteristics were included in our study. Cases of secondary amenorrhoea were excluded. Detailed history, examination, investigations and management was documented and analysed.Results: A total of 25 patients of primary amenorrhea were studied during the study period. In our study outflow tract anomalies were the commonest cause of amenorrhoea accounting for 84%, of which imperforate hymen (32%) and Mayer Rokitansky Küster Hauser syndrome (MRKH) 36% were the two most common Mullerian anomaly causing primary amenorrhoea. Gonadal dysgenesis accounted for 12% of the cases. Amenorrhoea was the commonest complaint patients presented with accounting to 76%, followed by cyclical pain abdomen accounting for 16% of cases.Conclusions: Primary amenorrhoea is multifactorial and is of major concern among adolescent girls. Early diagnosis and intervention has an impact on the physical and psychological wellbeing of the girl.

Cytokines - As A Diagnostic Marker Of Pulpal Inflammation

Considering the management of the decayed teeths’certain clinical signs, sensitivity tests, and radiographic findings do not provide accurate information about pulpal status. There can be a possibility of diagnosing pulpal pathological status using the cytokines that are released during the inflammation process in healthy as well as infected tooth pulp as a marker. This article emphasizes on the importance of cytokines level estimation in puplal blood that may help in the diagnosis of pulpal inflammation

Formulation And Evaluation Of Polyherbal Face Scrubber For Oily Skin In Gel Form

Cosmetics play a vital role for everyone to have a joyful and sanguine life. In present scenario herbal cosmeceuticals have more demand because they have no side effects. People having oily skin suffer from acne, whiteheads and blackheads quite often so scrubbing become more essential. In our present study we formulated 3 different formulations F1, F2, F3 in gel form for oily skin by using turmeric, aloe vera, cinnamon, potato starch, activated charcoal powder, honey, green tea, lemon juice, onion, walnut shell, coconut oil, beet root juice powder, sodium lauryl sulphate, water and evaluated by using various parameters such as physical appearance, viscosity, pH, Spreadability, irritability, washability, stability studies and got fruitful results with all the tests. The scrub F2 was found to show excellent effects on controlling oil secretion, and preventing formation of new pimples. The herbal formulation F2 was having characteristic odour, reddish brown in color having, light, non-irritant to the skin and quite elegant. The powder was smooth to touch and in gel form it spreads satisfactorily. Thus, the formulated scrub F2 can be utilized efficaciously without a side effect which exfoliates and makes glowing skin.

Quality of life among elderly population in an urban slum of Tirupati city

Background: Healthy aging is a process of developing and maintaining the functional ability that enables well- being in older age. Objective of the present study is to assess the quality of life among elderly population using WHOQOL-BREF scale and to determine the association between socio demographic factors and quality of life.Methods: Community based cross- sectional study was conducted in the urban field practice areas of SVIMS-Sri Padmavathi Medical College for women, Tirupati for a period of one month (February 2019 to March 2019). Study population were Elderly of age 60 years and above. Total 60 elderly were included in the study. Quality of life was assessed using WHOQOL-BREF questionnaire.Results: Most of the study population was in the age group of 60-64 years, Most of them were females (71.7%). More than one third were illiterates (36.7%), 30% were studied up to primary school. 93.3% of study population were suffered from some form of illness. Mean total transformed score was high among ?70 years compared to <70 years, Males were showing high mean total transformed score compared to females, literates were showing high score and persons with illness were showing high scores and persons without illness.Conclusions: It is concluded from this study that most of the elderly population are suffered from some form of illness. Overall quality of life is good among elderly within 70 years of age, males, literates and who are in living as married compared to their counter parts.

Mean platelet volume (MPV) as a diagnostic marker in neonatal sepsis

Background: Neonatal sepsis is a frequent and important cause of morbidity and mortality which accounts for one quarter of neonatal deaths. There are very few studies done in India to evaluate the role of MPV as diagnostic marker of neonatal sepsis.Methods: Prospective case control study in a tertiary care hospital. Neonates > 30 weeks gestation admitted to neonatal intensive care unit during the study period of 1 year with clinically suspected were included in the study. Neonates with Septic screen positive and culture positive sepsis were included in group A and normal neonates were included in Group B. MPV was done for all the subjects and values more than 10.2fl was considered positive. Newborns with congenital anomalies and who were already on antibiotics prior to admission were excluded from the study. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 17.0.Results: 106 neonates were included in the study. MPV showed statistically significant difference between the study groups (mean 12.8'1.52, 10.82'1.20 respectively) at a cut of value of 10.2fl and a sensitivity of 93%, specificity of 84 % with a positive predictive value of 83% and negative predictive value of 94%.Conclusions: MPV can be used as an adjuvant marker along with established septic screen to ensure early diagnosis and treatment of neonatal sepsis with no additional expense.

Prevalence of risk factors and 10 year risk estimation of cardiovascular diseases among rural population of Mysuru, Karnataka

Background: Cardiovascular diseases (CVD) are leading cause of death among non-communicable diseases (NCD). Many people in developing countries are detected late and die from NCDs, often in their most productive years. Prevention of CVD is an essential step to control the epidemic of NCDs. Thus, this study was undertaken to assess the prevalence of risk factors and to estimate the risk of CVD in the next 10 years.Methods: A community based cross-sectional study was conducted among 608 individuals aged ≥40 years in rural area of Mysuru. Data was collected using Semi structured questionnaire and 10 year CVD risk was estimated using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts.Results: A total of 608 study participants (mean age 56.76±11.07 years; Male:Female ratio 1.2:1) were included in the study. The prevalence of tobacco (32.9%) and alcohol (20.1%) consumption was significantly higher among males compared with females. Hypertension, diabetes and obesity prevalence was 39.5%, 15.5% and 28.1% respectively. One-fifth of population had moderate (20-39%) estimated risk and 7.4% had very high (≥40%) risk of developing CVD event in next 10 years. The estimated high risk (≥30%) of CVD events was statistically higher among individuals who were non-literates, unemployed, physically inactive, middle and above socioeconomic status.Conclusions: In the present study, CVD risk factors and estimated risk of CVD were significantly prevalent in the rural population. The use of simple tools like WHO/ISH risk prediction charts to estimate CVD risk is recommended in low resource settings at Community level, as the benefit of screening outweighs the risk of missing an opportunity to prevent CVD.

A Hormonal Imbalance- Its Impact On Eruption And Exfoliation: A Case Report

Delayed tooth eruption is the emergence of a tooth into the oral cavity at a time that deviates significantly from norms established for different race, ethnicity, and gender. It may be due to many local and systemic reasons, eruption delay of more than two years should be definitely investigated. Certain endocrinal hormonal imbalances that occur in infancy or early childhood can lead to many clinical manifestations like short stature, delayed tooth eruption and delay in major developmental milestones. The possibility of hormonal disturbances should be suspected when evaluating teenagers and adolescents with the complaint of delayed eruption, both physician and dentist should be aware of this clinical manifestation. This is a case report on delayed eruption of teeth in a teenager with undiagnosed hormonal imbalance who visited our department, a watchful eye and timely investigation led to the diagnosis of underlying organic problem.

Expression of ER, PR and HER 2 Receptor Status in Breast Carcinomas and its Correlation with Histopathological Grading

Introduction: Breast cancer is the most common cancer in women in developed countries. In India; it is second to cancer of cervix among women. Several histopathological features have prognostic significance in breast carcinoma which includes histologic subtype, grade, lymph node status, ER/PR status, Growth factors and its receptors, proliferation activity and DNA content, oncogenes and tumor suppressor genes. The Immunohistochemistry (IHC) classification provides both therapeutic and prognostic information. Aim and objectives: To assesses the ER/PR status and HER -2 status of breast carcinoma, to correlate the ER/PR and HER-2 receptors status with modified Bloom- Richardson histological grading, and clinico pathological parameters. Materials and methods: This study was undertaken over a period of 2 years from August 2013 to July 2015 in the Department of Pathology, Chalmeda Anand Rao Institute of Medical Sciences. Total of 75 cases of carcinoma breast in females diagnosed histopathologically, belonging to age group of 21-85 years were included in the study. Pingle Prathyusha, Radhika Mucharla, V. Srinivas Kumar, Geeta Voolapalli, Thota Ravinder. Expression of ER, PR and HER 2 Receptor Status in Breast Carcinomas and its Correlation with Histopathological Grading. IAIM, 2019; 6(7): 49-58. Page 50 Results: Histopathological grading was done according to Modified Bloom Richardson’s grading. 27(36%) cases were of grade II and 24(32%) cases each were of grade I and grade III. ER and PR were positive in 76% and 58.7% of tumors respectively. HER-2 over expression (score 2+ & 3+) was seen in 44% of tumors and was negative (0 or 1+) in 56% of tumors. Among the most common histologic subtype i.e., IDC (NOS), ER, PR and HER-2 were expressed in 75.36%, 60.86% and 44.92% respectively. Tumors with ER/PR-, HER2+ subtype were larger (>5cms), 1(1.3%) each medullary and apocrine carcinoma were positive for HER-2. None of the lobular, mucinous and papillary carcinoma expressed HER-2. Statistically significant values were noted for histologic grade immunohistochemical sub types, lympho vascular invasion and nuclear pleomorphism. Conclusion: In this study ER, PR and HER-2 receptors status correlates well with histopathological grading and other clinico-pathological parameters. These assays have the advantage of allowing only tumor cells to be assessed for receptor status. They can be conducted relatively inexpensively on routinely processed tissue sections with no need for specialized equipment.

Study of p53 Expression in Carcinoma Cervix and Normal Cervical Epithelium

Introduction: Cervical carcinomas are one of the leading causes of mortality in women worldwide and various screening methods are developed for early detection, which includes clinical, pathological and molecular methods. Biomarker- p53 protein is useful in differentiating neoplastic from non-neoplastic and CIN lesions and the p53 expression is also a prognostic marker for cervical carcinoma as it correlates with other clinico-pathological prognostic parameters. Aim and objectives: To study expression of p53 in cervical carcinomas of various histological types and normal cervical epithelium and Correlation of p53 expression with the histopathological grade of cervical carcinomas. Materials and methods: 40 cases of cervical biopsy/ hysterectomy specimens of carcinoma cervix and 20 cases of hysterectomy specimens for other gynecologic causes received at department of pathology, CAIMS, Karimnagar from January 2014 to October 2015 were examined for gross and microscopic features. Immunohistochemistry was used to study the p53 expression in normal and neoplastic cervical epithelium. The p53 expression was correlated with various clinicopathological prognostic parameters. Results: Of the 40 cases of carcinoma cervix, 80% cases showed p53 positivity. The predominant histological type of carcinoma cervix positive for p53 was moderately differentiated squamous cell carcinoma (SCC). One out of three cases of Adenocarcinoma (ADC) was p53 positive. The single case of CIN III showed p53 positive cells in all the layers of squamous Radhika Mucharla, Pingle Prathyusha, Geeta Voolapalli, T. Ravinder, Vemula Sreenivas. Study of p53 Expression in Carcinoma Cervix and Normal Cervical Epithelium. IAIM, 2019; 6(7): 37-48. Page 38 epithelium. The p53 positivity showed a statistically significant association with the microscopic type of carcinoma cervix (p value=0.019). The p53 positivity increased with the age, parity, clinical stage and grade of the disease. Conclusion: The expression of p53 was high in premalignant cervical lesion in invasive cervical carcinoma compared to normal cervical epithelium. Our study indicates that p53 is a powerful prognostic marker.

Disease Profile And Outcome Of Neonates Admitted To Nicu In Svrrggh, Tirupati - A Teritiary Care Centre

Introduction: Neonatal morbidity and mortality rates reflect a nation’s socioeconomic status as well as the efficiency of their health care services. The objective of this study is to identify the disease spectrum and the commonest causes of morbidity and mortality in this group of babies. Methods: The study was a retrospective study of all the newborns admitted in the neonatal intensive care unit of the Department of Pediatrics, SVRRGGH, Tirupathi. Results:Atotal of 1289 newborns were admitted to NICU during the study period of which 696 (56.5%) were term, 537 (43.5%) were preterm. The most common disease was sepsis (35.5%) followed by birth asphyxia (31.5%), neonatal jaundice (10.2%), hyaline membrane disease (12.6%), meconium aspiration syndrome (11%), congenital malformations (4%) and hypoglycemia (5%). Out of 1233 patients, 276 expired (22.3%). The common causes of mortality were sepsis (35.5%), hyaline membrane disease (27.6%) and hypoxic ischaemic encephalopathy stage 3 (23.1%). Conclusion: Neonatal period is a very vulnerable period with a high risk of morbidity and mortality which is preventable with good obstetric care and subsequent neonatal care.

Study Of Clinicohematological Profile And Neurological Manifestations Of Vitamin B 12 Deficiency In Children

Vitamin B12 deficiency is an important and under recognised cause of anemia and neurological morbidity in children. As per previous studies from India iron deficiency was most common cause for anemia. But from the past two to three decades prevalence of cobalamin deficiency is increasing. This study aims to study the various clinical, neurological manifestations and hematologic profile of Vitamin B12 deficiency anemia in children aged 6 months to 12 years. A total of 58 children with Vitamin B12 deficiency were studied of which the most common age group affected were 1 to 4 years. Pallor, Anorexia, generalised weakness (100%), hyper pigmented knuckles (94%) and Hyper pigmented distal phalanges (90%), Glossitis (68%) were the most common presentations. The neurological features were seen in all the cases in 6 – 12 month age group. Leucopenia was seen in 74% and Thrombocytopenia in 49% cases. Early identification and treatment can prevent irreversible ain injury and its profound impact on neurological outcome of child.

A study on therapeutic plasma exchange using apheresis in treatment of Guillain-Barré syndrome in a tertiary care teaching hospital

Background: Therapeutic plasma exchange (TPE) is the separation and removal of plasma from whole blood with replacement by a crystalloid/colloid solution (typically albumin or plasma). The DGHS has established guidelines and recommendations for application of therapeutic apheresis in clinical practice. Guillain-Barré syndrome (GBS) is considered category I indications for TPE. This study was undertaken to establish the effectiveness and safety of therapeutic plasma exchange in GBS which is one of the common indication for TPE at our tertiary care teaching hospital.Methods: A retrospective study of 30 patients admitted to a tertiary care teaching hospital, from January 2014 to December 2016 with clinical signs of Guillain-Barre syndrome (GBS) and/or GBS variants were evaluated for performing TPE. A total of 104 procedures were performed for 30 patients. Replacement of crystalloids and plasma was used. Medical Research Council scale was used to assess the clinical improvement by measuring the grade of muscle power. Information was collected in a structured proforma and statistical analysis was performed using SPSS software (version 20). P value less than 0.05 was considered statistically significant.Results: During the study period, 104 procedures were performed on 30 patients on an average of three procedures per patient. The average age of the patients was 41.4±10.4 years. The mean period of illness at admission was 14.5±5.4 (range 4-32) days. In 23 out of 30 patients, more than three TPE procedures were done, out of which 21 patients clinically improved. The common complications during the procedure were chills (16%), hypotension (10%) and non-hemolytic febrile transfusion reaction (10%) and they were managed accordingly. Two (6.7%) patients who were not ambulatory at discharge had significantly (p <0.05) lower grade of power in lower limbs at admission and all patients recovered fully on follow up.Conclusions: GBS is one of the most commonly occurring clinical paralytic disorders. 76.7% of patients underwent three or more cycles of TPE with 70% had excellent clinical improvement which was comparable with various other studies. Based on results published by various other studies, therapeutic plasma exchange is a comparatively safe and effective procedure

Effectiveness of non-invasive positive pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease

Background:In patients with acute exacerbations of COPD, endotracheal intubation and complications associated with mechanical ventilation may be evaded using non-invasive ventilation.The aim of the study was to analyse the effectiveness of NPPV for hypercapnic respiratory failure secondary to acute exacerbation of COPD in India.Methods:In this prospective study, 63 cases of hypercapnic respiratory failure secondary to acute exacerbation of COPD admitted in the intensive care unitduring 2011-13 formed the study population. Standard therapy was initiated in all the patients. Patients who failed to improve with standard therapy alone were given a trial of non invasive ventilation. Non invasively ventilated patients, showing significantly improvement in their clinical status and arterial blood gas parameters were discharged. Patients who failed to show significant improvement with NPPV were given invasive ventilation.Results:Standard therapy was initiated in 63 patients on admission but 25 patients failed to improve with standard therapy alone. Out of the total 25 patients non invasively ventilated, 22 patients showed significantly improvement. Significant improvement in the Mean pH, Mean paCO2 and Mean paHCO3 in both standard therapy and non invasive ventilation group. Success rate was found to be highest (88%) in standard therapy + noninvasive ventilation treatment modality group. Conclusions: NIV is an effective tool in hypercapnic respiratory failure secondary to acute exacerbation of COPD and its early initiation would improve the clinical status and respiratory acidosis

Intraoral plasmablastic non-hodgkin’s lymphoma associated with human immunodeficiency virus.

Plasmablastic Lymphoma of oral cavity is an aggressive rare form of Non Hodgkin’s Lymphoma which is an Acquired Immuno Deficiency Syndrome defining condition. Head and neck region is the second most common area for extranodal NHL’s primarily involving gingiva and palate, which often presents as a diagnostic problem. We report a case of PBL in a 19 year old female patient later diagnosed as Human Immunodeficiency Virus (HIV) positive. She presented with expanding painful ulceroproliferative lesion involving left mandible and gingiva of 20 days duration. Histopathological examination and immunohistochemical analysis confirmed the diagnosis. Uncommon discovery of multiple bony lesions in whole body CT and hypercalcemia raise a question about Multiple Myeloma (MM). Literature showed very few cases with osteolytic lesions and none of the cases reported multiple bone lesions in skull. Our case report stresses the importance of differentiating this extremely rare case of PBL with skull lesions from MM.