Burkholderia sepsis mimicking flare of ANCA-associated vasculitis: A rare presentation

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is an autoimmune condition that primarily targets smallto medium sized vessels in multiple organ systems, with sinonasal, pulmonary and renal involvement being common.The present case study discusses a known case of ANCA associated vasculitis, type 2 diabetes and hypertension, whopresented with altered sensorium and weakness of the left side of the body. Few months before the onset of symptoms,the patient received rituximab injection for treating cutaneous panniculitis and high pANCA titers. MRI of brain and CECTof chest were suggestive of vasculitis and blood culture showed the growth of Burkholderia cepacia. She was treated withbroad spectrum antibiotics and other supportive treatment. Despite all the efforts including ionotropic and ventilatorsupports, the patient succumbed to the infection.

Immune reconstitution inflammatory syndrome in acquired immunodeficiency syndrome.

A 33-year-old male presented with a history of fever and cough and was diagnosed to have pulmonary tuberculosis and acquired immunodeficiency syndrome (AIDS). He was started on antituberculosis therapy (ATT) followed by highly active anti-retroviral treatment (HAART) after one week. He developed an immune reconstitution inflammatory syndrome (IRIS) leading to an exacerbation of the tuberculosis disease. After HAART was stopped his condition improved dramatically.

Treatment of idiopathic hypereosinophilic syndrome with imatinib mesylate.

Patients with idiopathic hypereosinophilic syndrome (HES) show persistent hypereosinophilia of unknown etiology that is associated with end-organ damage. Different treatments, including the use of corticosteroids and cytotoxics, have been investigated for HES with modest success. We report a young patient with HES who developed stroke and remained refractory to conventional therapy. Therapy with imatinib mesylate, a selective tyrosine kinase inhibitor that is highly effective in treating patients with BCR-ABL-positive chronic myeloid leukemia, was tried with the patient. The result was impressive, with hematologic remission achieved rapidly. Our finding concurs with recent reports that imatinib mesylate may be a promising agent in the treatment of some cases of HES.

Non-specific interstitial pneumonia in an HIV positive patient.

A 56 year old male presented with features of interstitial lung disease and was detected HIV positive. Histopathology of the lung suggested non-specific interstitial pneumonia with no evidence of tumour or Pneumocystis carinii. The patient responded to steroids and was started on anti-retroviral treatment.

Cutaneous cryptococcosis.

We report a case of an apparently immunocompetent male, who presented with a painless nodule over the upper abdominal wall. He gave a history of exposure to pigeon droppings. Cryptococcus neoformans was isolated from the lesion and no underlying disorder could be detected. He improved on treatment with oral Fluoconazole.

Connective tissue lipoatrophic panniculitis.

A 23 years old girl with a past history of sero-positive oligoarticular juvenile idiopathic arthritis developed nodules and depressed scars over face and limbs. Biopsy from the lesion revealed mixed panniculitis. She responded to steroids and hydroxychloroquine but has residual lipoatrophic scars needing reconstructive surgery.

Hodgkin's disease and scleroderma.

We report here the uncommon association between scleroderma and Hodgkin's disease in a 42 years male.

Demographic features of sporadic acute hepatitis as determined by viral hepatitis markers.

The demographic features of acute x sporadic viral hepatitis as diagnosed by specific markers of viral infection in four different cities in north and north-east India, were examined. Of 405 patients examined, 26 per cent had HB,Ag, 5.9 per cent IgM-anti-HAV antibody, and 8.4 per cent IgM-anti-HBc antibody. Hepatitis B occurred more frequently in male patients (76 per cent) compared to hepatitis A (54 per cent), and in the young adult age group (21-30 years), compared to the latter, which occurred predominantly in children (0-10 years). By using tests to detect HbsAg and IgM-anti-HBc antibody, this study found that hepatitis B accounted for 3 per cent and 8.8 per cent of clinically detected acute sporadic hepatitis in patients less than and older than 10 years of age respectively, which is in contrast with previously-reported rates from India. This study also suggests that many of the infections thought to have been due to HBV, may be due to NANB hepatitis virus. This study emphasizes the importance of specific laboratory tests to draw epidemiologic conclusions regarding hepatitis.