Swine-influenza (H1N1 influenza) mimicking a case of high altitude pulmonary oedema (HAPO).

Here we present a case of a 37-year-old soldier of Indian Army, posted in high altitude area of Ladakh region (>4200 m), who after rejoining after a month leave, presented with dry cough, low-grade fever and dyspnoea on exertion while undergoing acclimatisation, and on examination, was detected to have hypoxaemia, fever and bilateral fine crepitations on chest auscultation. He was started on treatment for high altitude pulmonary oedema at a medical aid post, and later referred to General Hospital at Leh. The course of the illness was complicated by worsening hypoxaemia, continuous high-grade fever, leucopenia and hypotension. Focused medical history revealed that he had travelled to the state of Gujarat during his leave, where high incidence of H1N1 influenza was being reported during the ongoing pandemic. Oseltamivir was empirically started, in addition to parenteral antibiotics and he was started on inotropic support. In view of severe hypoxaemia, not responding to non-invasive ventilation, he was intubated and placed on mechanical ventilation. The patient turned out to be H1N1 positive and succumbed to his illness 3 days later.

Unusual case of chylothorax with unilateral limb swelling.

Here, we present an unusual case of 26-month male toddler who presented with swelling of right lower limb with painless hyperpigmented patch over right groin of 18 months duration associated with recent onset respiratory distress. Evaluation revealed right chylothorax and MRI revealed altered signal intensity in bones and muscles of right lower limb. Lymphoscintigraphy revealed absence of lymphatic channels in right lower limb. Skin biopsy from hyperpigmented patch was suggestive of vasoformative lesion favouring lymphangiomatosis. A diagnosis of Gorham's syndrome was made, and our patient was managed with drainage of chylothorax followed by pleurodesis, parenteral nutrition and radiotherapy.