An interesting case of melioidosis: a mimicry of pulmonary tuberculosis

Melioidosis is caused by Burkholderia pseudomalleiwhich is a soil-dwelling aerobic bacterium reported mostly in tropical and subtropical areas, especiallyinAsia (Southeast) andAustralia (Northern part). Melioidosis is a severe infection that can manifest as chronic debilitating pneumonia mimics pulmonary tuberculosis. Here, we reporteda case of melioidosis, in 51-year-old menwith poorly controlled type 2 diabetes mellitus. The patient recovered with appropriate intravenous antibiotics and supportive medications.

A rare young case of Foix Chavany Marie syndrome

Foix Chavany Marie syndrome, also called as bilateral opercular syndrome (OPS) was first described in 1837 by Magnus and further defined by Foix, Chavany and Marie in 1926 after whom it was named so. Here, we present a case of 37-year-old female, with known recurrent CVA who presented with sudden onset aphasia, dysphagia and difficulty in opening and closing her mouth and drooling of saliva. On imaging, patient was found to have ischemia of bilateral operculum.

A case of long-term hypothyroidism converted to hyperthyroidism secondary to an autoimmune trigger

Primary hypothyroidism is a common endocrine condition that is encountered. Graves disease and Hashimoto抯 thyroiditis are the most common autoimmune conditions in which conversion of hyperthyroidism to hypothyroidism is seen. Chances of conversion of hypothyroidism to hyperthyroidism is extremely rare. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism. The etiology being an autoimmune switch by an external stimulus in genetically susceptible individuals. Hereby, presenting a case of 53-years female, who is a known case of type II diabetes mellitus, chronic kidney disease, nephrotic syndrome diagnosed with minimal change disease who presented with a hormonal profile showing hyperthyroidism. She had a history of hypothyroidism in the past for 12-years and was treated with levothyroxine and was off treatment for the past 2 years. Further evaluation showed presence of primary Sjogren抯 syndrome which has let to this conversion.

Scorpion sting bite with intracerebral bleed:a case report

Scorpion sting can present with multiple clinical presentations ranging from local swelling to cardiogenic shock. Scorpion sting affects many organ which can cause myocarditis, cardiogenic shock, acute renal dysfunction and respiratory collapse. Central nervous system involvement can cause encephalopathy, seizures, subarachnoid haemorrhage, and ischemic stroke. Cerebral bleed is a rare presentation of scorpion sting.Here we present a case of scorpion sting with unusual central nervous system (CNS) presentation of gangliocapsular bleed.

Male Sjogren抯 syndrome presenting with respiratory paralysis due to hypokalemia

Respiratory paralysis due to hypokalemia is a rare entity in Sjogren抯syndrome. Apart from distal renal tubular acidosis (RTA) and hypokalemia the clinical symptoms like dryness of eye, mouth and parotid swelling were absent in our case. Due to this rarity in this pattern of presenting the symptoms, the differential diagnosis of autoimmune disease is often missed and it will eventually end up in a fatal condition. Hypokalemia causes muscle weakness gradually and there will be sudden onset of respiratory paralysis which could be dangerous to the individual. Although there is the presence of rare combination of symptoms clinical history, blood gas analysis, urine analysis and ANA profile will help in the appropriate diagnosis. Herewe report a rare case of male Sjogren抯 syndrome presenting with respiratory paralysis due to hypokalemia.

A study on clinical profile of acute undifferentiated febrile illness in a tertiary care hospital

Background: Acute febrile illness is very common among patients seeking hospital care in tropical country like India. This study was conducted to evaluate etiology and clinical profile of Acute Undifferentiated Febrile Illness (AUFI) in a tertiary care hospital.Methods: This study was conducted in 175 patients with acute febrile illness who were admitted in the medical wards and ICU from January 2018 to June 2019 in a tertiary care hospital. Clinical examination and investigations like complete hemogram, liver function test, renal function test, smear for malarial parasite, widal test, urine analysis blood and urine culture, antibody titters for dengue, Leptospirosis and imaging were done.Results: Out of 175, 94 (54%) were males and 81 (46%) were females. The commonest etiology was dengue (19%) followed by enteric fever (18%), scrub typhus (16%), malaria (14%), tuberculosis (6%) and leptospirosis (5%). 138 (79%) patients had less than 14 days of fever of which dengue was the most common and 37 (21%) patients had more than 14 days of fever with tuberculosis being predominate. Other common symptoms were chills/rigors, headache and myalgia seen in 77%, 71% and 42% respectively. Icterus was seen in malaria (42%) and leptospirosis (38%). Elevated transaminases levels were observed with dengue, leptospirosis, scrub typhus, enteric fever and malaria. ARDS was most common in scrub typhus.Conclusions: Among acute febrile illness, dengue and enteric fever were the most common in this study. A thorough and probing search for an eschar is very important in scrub typhus. The treating physician has to keep in mind the comprehensive list of differential diagnosis for patients with febrile illness and anticipating the complications.

An interesting presentation of pituitary adenoma

Pitutary adenomas are one of the commonest tumors of seller region of which prolactinomas and non- functioning adenomas predominate. The usual presentation are symptoms of endocrine dysfunction and mass effects. We present a case report of 37 year old male presenting with frontal headache and vomiting. Clinical observations revealed frontal bossing with enlarged hands and feet which arose a suspicion of Acromegaly. Investigations revealed elevated IGF 1 (insulin like growth factor) and growth hormone levels. Magnetic resonance image of the brain were done which showed pituitary adenoma. This case highlights the importance of clinical examination and the treating physician must have high clinical index of suspicion to detect endocrine dysfunction and use the modern techniques like stereotactic radio surgery (SRS).

Purple Urinary Bag Syndrome

Purple Urinary Bag Syndrome occurs due to the precipitation and reaction of indigo and indirubin pigments with the synthetic materials in the catheter and urinary bag which gives the characteristic purple color. We report a case of a 59 years old woman with this rare entity.

A study of clinicopathological profile and treatment outcomes in patients with autoimmune hemolytic anaemia

Background: Autoimmune haemolytic anaemia (AIHA) is relatively uncommon condition with grave consequences, if not diagnosed and treated early. The literature on the clinical outcome and response to treatment is relatively scarce. Aim was to study the clinic-pathological profile and the treatment outcomes in patients with AIHA.Methods: Around 25 patients with AIHA attending a tertiary care hospital over a period of one year were included in the study. The patients were divided based on severity of anaemia and etiology. All the patients data were analysed for the demographic data, clinico -pathological findings and the response to treatment. All the patients data were analysed using SPSS software (version 22).Results: Out of 25 patients, 76% were females and 24% were males. Based on severity of anaemia, 60%, 28% and 8% had severe, moderate and mild anaemia. Around 48% of the patients had thrombocytopenia along with anaemia. 8 (32%) and 17 (68%) patients have primary and secondary AIHAs respectively. In our study the commonest cause for the secondary AIHA was Systemic Lupus Erythematosus (SLE) followed by haematological malignancy, primary Sjogrens, Anti-phospholipid antibody (APLA) syndrome, carcinoma colon and Wilsons disease. Hepatosplenomegaly and lymphadenopathy were present in 36% and 4% respectively. Out of 22 (88%) patients on corticosteroid therapy, 15 (60%) patients responded to corticosteroids alone and 6(24%) patients required corticosteroid plus immunosuppressive therapy.Conclusions: AIHA has to be ruled out in all anaemia patients with indirect hyperbilirubinemia and abnormal peripheral smear. Secondary AIHA is more common than primary. Corticosteroids and immunosuppressive agents are the mainstay of treatment of AIHA.