A rare case of scrub typhus vasculitis presenting as acute coronary syndrome diagnosed by skin manifestations.

A 48-year-old diabetic man presented with complaints of acute onset chest heaviness with palpitations, anxiety and headache. He had raised troponin-T level and electrocardiogram showed ST elevation myocardial infarction. There was a prior history of fever of 4 days duration with associated abdominal pain. He later developed skin rash and neurological symptoms following admission to the hospital. Dermatological examination revealed purpura and a livedo-like rash. Investigations revealed deranged liver and renal function tests and positive serological tests for scrub typhus. Coronary angiography revealed no evidence of atherosclerosis or any other pathology. He was therefore diagnosed as a case of scrub typhus-induced vasculitis with coronary manifestations and was managed with oral doxycycline. Scrub typhus presenting like an acute coronary syndrome has been reported very rarely previously. In addition, patient had gastrointestinal, central nervous system and hematological involvement which added to the rarity of the case.

A 36-year-old man with vomiting, pain abdomen, significant weight loss, hyponatremia, and hypoglycemia.

Diagnosis of Strongyloides stercoralis hyperinfection can be a challenge. The key to a timely diagnosis is to have a high index of suspicion. We present a rare case of a 36-year-old human immunodeficiency virus negative male patient, who was on multidrug therapy for lepromatous leprosy and was treated for type 2 lepra reactions with steroids in the past. The patient presented with vomiting and pain abdomen, persistent hyponatremia, and terminal hypoglycemia. He had features of malnutrition and had a rapid downhill course following admission. A diagnosis of S. stercoralis hyperinfection with sepsis and multiorgan failure, adrenal hemorrhage, and syndrome of inappropriate antidiuretic hormone secretion was established on a postmortem examination.

Trabajos Cientificos y Colaboraciones. Hanseniasis en la infancia- Relatode un Caso de la forma Borderine- Virchwiana en Niño con menos de 2 años de edad / No disponible

Se relata un caso de hanseniasis borderline-virchowiana en un nio de 1 ao y 11 meses de edad, residente en Manaus-Amzonas, donde la enfermedad es hiperendémica. Se analiza las implicaciones de la detección de hanseniasis en este grupo etario como la intensificación de la transmisión, la posibilidad del contagio no interhumano y vertical de la enfermedad y la necesidad de la búsqueda activa de esos casos. Se procura todavía llamar la atención de los profesionales de salud para el diagnóstico de la hanseniasis en niños, que a pesar de ser un evento raro necesita ser hecho precozmente a fin de iniciare un tratamiento adecuado y efectivo (AU)

Report of a Leprosy case (Borderline-Lepromatous) in a child aged one year and eleven months, resident in Manaus-Amazonas, where the disease is still hyperendemic. Analysis on implications of leprosy detection at this age group such as intense transmission, possibility of not inter-human and vertical disease trnasmission and aso the need of active case-finding. The authors try to draw health professionals attention to leprosy diagnosis in children, wich despite being a rare event, it needs to be identified earlier, in order to provide adequate and effective treatment (AU)

Does Entamoeba histolytica cause irritable bowel syndrome?

BACKGROUND: Symptoms of patients with irritable bowel syndrome (IBS) closely mimic those of patients with non-dysenteric amebic colitis. AIM: To examine the clinical relevance of presence and types of Entamoeba histolytica in stools of patients with IBS. METHODS: IBS was diagnosed by Manning's criteria. Stool examination was done 4-weekly for 48 weeks to detect E. histolytica cysts or trophozoites. Patients underwent initial sigmoidoscopy. Sera of 22 IBS patients, 23 asymptomatic cyst passers and 36 healthy volunteers whose stools were also examined were tested for presence of antiamebic antibodies. Stools were cultured for amebae; positive cultures were subjected to polyacrylamide-gel electrophoresis (PAGE) using hexokinase (HK) isoenzyme to distinguish between pathogenic (fast-moving band) E. histolytica infection and nonpathogenic (slow band) species of Entamoeba dispar. RESULTS: E. histolytica cultured from stool samples of four IBS patients had slow-moving band of HK on PAGE. All patients spontaneously eradicated the infection during the next eight to 24 weeks; all had negative serology for antiamebic antibodies, and normal rectal mucosa on sigmoidoscopy. No change in symptom score occurred on follow up in IBS patients, although all of them cleared the infection. Three additional E. histolytica isolates from IBS patients obtained from another laboratory also showed nonpathogenic isoenzyme pattern. CONCLUSION: Bowel symptoms in IBS patients were not related to E. histolytica infection. The term non-dysenteric amebic colitis thus appears to be inappropriate, since it may be used erroneously for patients with IBS with nonpathogenic ameba, leading to injudicious treatment with antiamebic drugs.

Severe abdominal pain in low dosage clofazimine.

We describe a 41 yr old leprosy patient treated for 10 yrs with clofazimine who underwent laparotomy for severe abdominal pain. At surgery, the only significant findings were that the coeliac lymph nodes were enlarged and stained purplish black as were the omentum and the intraperitoneal fat. No other cause of abdominal pain was identified. On histological examination, reddish-purple crystals were identified at frozen section but not in the paraffin sections.