Meningitis-Retention Syndrome as an Unrecognized Clinical Condition in Indian Scenario: Fall Through the Cracks.

Meningitis-retention syndrome (MRS) is a recently recognized condition marked by the concurrent occurrence of aseptic meningitis with acute urinary retention. We present the case of a 22-year-old man who presented with an undiagnosed fever with headache and urinary retention. Subsequent urodynamic testing revealed an underactive detrusor, resulting in insufficient contraction of the bladder during voiding despite normal sensation during bladder filling. Normal urinary voiding was successfully restored without the need for treatment within a 30-day timeframe. It is crucial to include MRS in the differential diagnosis of acute urinary retention. It is crucial to include MRS in the differential diagnosis of acute urinary retention. Despite the generally benign and self-remitting nature of MRS, the management of acute urinary retention is necessary.

Hematological characteristics of autochthonous hypermicrofilaremic dirofilariosis in dogs in Kannur District of Kerala.

This study aimed to determine whether autochthonous high-intensity D. repens microfilaremia leads to haematological changes in companion dogs. Dogs with hypermicrofilaremia presented to the District Veterinary Centre, Kannur were selected for the study. A total of 100 dogs were positive for hypermicrofilariaemia with D. repens based on peripheral blood smear examination and Knott's test. Of these, 3 dogs were concurrently positive for sheathed microfilaria (MF) of Brugia spp. Interestingly, an adult live worm of D. repens approximately eight cm in length was detected on a subcutaneous mass on the hind limb of a hypermicrofilaremic dog in the study. We compared the hematological parameters of 100 autochthonous hypermicrofilaremic dogs and 15 uninfected dogs. The hematological findings in the study are mild to moderate anemia, moderate to severe thrombocytopenia, leucocytosis with granulocytosis, lymphocytosis and monocytosis as compared to the uninfected group of dogs. The pathogenicity of naturally occurring hypermicrofilaremia is poorly studied, and knowledge of its epidemiology, host-parasite relationship and impact on various organs is warranted for better prevention and control, especially in hot-spot areas. Supplementary Information: The online version contains supplementary material available at 10.1007/s12639-023-01622-6.

Acute effects of concurrent muscle power and sport-specific endurance exercises on markers of immunological stress response and measures of muscular fitness in highly trained youth male athletes.

PURPOSE: To examine the acute effects of concurrent muscle power and sport-specific endurance exercises order on immunological stress responses, muscular-fitness, and rating-of-perceived-exertion (RPE) in highly trained youth male judo athletes. METHODS: Twenty male participants randomly performed two concurrent training (CT) sessions; power-endurance and endurance-power. Measures of immune response (e.g., white blood cells), muscular-fitness (i.e., counter-movement-jump [CMJ]), RPE, blood-lactate, and -glucose were taken at different time-point (i.e., pre, mid, post, and post6h). RESULTS: There were significant time*order interactions for white blood cells, lymphocytes, granulocytes, granulocyte-lymphocyte-ratio, and systemic-inflammation-index. Power-endurance resulted in significantly larger pre-to-post increases in white blood cells and lymphocytes while endurance-power resulted in significantly larger pre-to-post increases in the granulocyte-lymphocyte-ratio and systemic-inflammation-index. Likewise, significantly larger pre-to-post6h white blood cells and granulocytes increases were observed following power-endurance compared to endurance-power. Moreover, there was a significant time*order interaction for blood-glucose and -lactate. Following endurance-power, blood-lactate and -glucose increased from pre-to-mid but not from pre-to-post. Meanwhile, in power-endurance blood-lactate and -glucose increased from pre-to-post but not from pre-to-mid. A significant time*order interaction was observed for CMJ-force with larger pre-to-post decreases in endurance-power compared to power-endurance. Further, CMJ-power showed larger pre-to-mid performance decreases following power-endurance, compared to endurance-power. Regarding RPE, significant time*order interactions were noted with larger pre-to-mid values following endurance-power and larger pre-to-post values following power-endurance. CONCLUSION: CT induced acute and delayed order-dependent immune cell count alterations in highly trained youth male judo athletes. In general, power-endurance induced higher acute and delayed immunological stress responses compared to endurance-power. CMJ-force and RPE fluctuated during both CT sessions but went back to baseline 6 h post-exercise.

Evaluation of hematological parameters in pulmonary tuberculosis patients.

Introduction: Tuberculosis (TB) is the most common infectious disease caused by mycobacterium tuberculosis. Apart from the lungs, tuberculosis also affects the bone marrow. There are significant hematological abnormalities that occur in association with tuberculosis. So we can use these hematological parameters as a marker for the diagnosis, prognosis, and response to therapy. Aims: To evaluate the hematological parameters in pulmonary tuberculosis patients. Methods and Materials: A total of 70 diagnosed tuberculosis patients and 70 healthy controls were selected by purposive sampling in this study. About 4 ml of venous blood was collected with proper aseptic precaution. 2 ml ethylenediamine tetra acetic acid (EDTA) tube blood was used for hematological analysis by using Siemens Advia 2120i 5-part hematology analyzer. Rest 2 ml blood was used for measurement of erythrocyte sedimentation rate (ESR) by Wintrobe's method. Results: The hemoglobin, packed cell volume (PCV), and blood indices values were significantly lower compared to healthy controls in both sexes. White blood cell (WBC) count, absolute neutrophil count, platelet count, and ESR values were significantly increased in tuberculosis patients as compared to healthy controls and were found to be statistically significant (P-value < 0.05). Conclusions: To measure hematological parameters in tuberculosis is a simple and cost-effective method to predict the course of the disease and monitor complications in developing countries like India.

Hematological findings in adult patients with SARS CoV-2 infection at Tygerberg Hospital Cape Town South Africa.

Background: Coronavirus disease 2019 (COVID-19) is associated with hematological abnormalities of variable severity. The full blood count (FBC) and leukocyte differential count (DIFF) could facilitate the prediction of disease severity and outcome in COVID-19. This study aimed to assess the hematological parameters in early severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their correlation with disease outcome. Methods: A retrospective cross-sectional descriptive study was performed. Adults with a FBC and positive SARS-CoV-2 polymerase chain reaction results between March 1, and June 31, 2020 were reviewed. Basic hematological parameters (FBC, DIFF) and human immunodeficiency virus (HIV) status were recorded. Outcome measures were admission to a general ward or intensive care unit (ICU), recovery or death. Results: Six hundred and eighty-five cases median age 51 years, were analyzed. Forty-four percent were males and fourteen percent were HIV-positive with no association between death and/or ICU admission (p = 0.522 and p = 0.830, respectively). Leucocytosis was predictive of ICU admission (odds ratio [OR]: 2.4, confidence interval [CI]: 1.77-3.8186) and neutrophilia, of both mortality (OR: 1.5, CI: 1.0440-2.0899) and ICU admission (OR: 4, CI: 2.5933-6.475). Median lymphocyte count was decreased and d-dimer raised, showing no significant association with outcome. Raised neutrophil-to-lymphocyte-ratio (NLR) was associated with increased odds of mortality (OR: 2.5, CI: 1.3556-3.2503) and ICU admission (OR: 4.8, CI: 2.4307-9.5430) as was monocyte-to-lymphocyte-ratio (MLR) (OR: 2, CI: 1.3132-2.9064) and (OR: 2.3, CI: 1.0608-1.9935), respectively. Hospital admission and older age were significantly associated with mortality (p = 0.0008 and p < 0.0001), respectively. Conclusion: Evidence-based interpretation of routine laboratory parameters, readily available in resource-constrained settings, may identify patients at increased risk of mortality. The FBC, DIFF, NLR, and MLR should form part of the early COVID-19 investigation.

Hyperleucocytosis as an unusual presentation of hypereosinophilic pneumonitis with acute respiratory distress syndrome.

Idiopathic hypereosinophilic syndrome in children is a rare disease. Even with improved understanding of eosinophilic disorders and recent advances in diagnostic modalities, evaluation of hypereosinophilia remains challenging due to heterogeneous etiologic factors. In acute clinical settings, the management plan is often unclear as the condition is not encountered frequently. It is often associated with leucocytosis, but hyperleucocytosis causing multiorgan dysfunction in the absence of malignancy is rarely seen. A previously well 5-year-old boy presented to our emergency room with a 2-week history of fever, progressive cough and dyspnoea, rapidly progressing to respiratory failure and acute respiratory distress syndrome. Hyperleucocytosis with hypereosinophilia on peripheral blood film, bilateral pulmonary infiltrates on X-ray and ground glass opacities suggested hypereosinophilic syndrome with secondary acute respiratory distress syndrome. Owing to severe and rapidly increasing leucocytosis, malignancy was highly suspected, but it was ruled out along with secondary hypereosinophilic syndrome after extensive investigations, and acute respiratory distress syndrome in this child was attributed to Idiopathic Hypereosinophilic Syndrome. Eosinophilia had a dramatic response to high dose corticosteroid therapy. To conclude, in patients with hypereosinophilic syndrome, possibility of progression to acute respiratory distress syndrome should be anticipated and managed accordingly.

Pharmacological screening of Acalypha indica L.: Possible role in the treatment of asthma.

ETHNOPHARMACOLOGICAL RELEVANCE: Acalypha indica Linn (Euphorbiaceae), a popular traditional medicine, is an erect herb found throughout various parts of India. In Ayurveda, Acalypha indica was commonly used in asthma and allergy. However, no attempts were made in past to validate the antiasthmatic potential of Acalypha indica. AIM OF THE STUDY: The present study was aimed to assess the anti-asthmatic potential of ethanolic extracts of Acalypha indica leaves (EAIL) using various experimental animal models. MATERIALS AND METHODS: EAIL was analyzed using different screening methods such as acetylcholine and histamine-induced contraction of goat tracheal chain, clonidine-induced catalepsy in mice, milk-induced leucocytosis and eosinophilia in mice, clonidine-induced mast cell degranulation in rats, passive paw anaphylaxis in rats, histamine-induced bronchoconstriction in guinea pigs, and ovalbumin (OVA)-induced histopathological alterations in mice. RESULTS: Data received in the present study showed that EAIL drastically antagonized acetylcholine and histamine-induced contraction of goat tracheal chain, suggesting its anticholinergic and antihistaminic activity respectively. The duration of immobility, produced by clonidine, was found to be decreased in mice which showed its H1 receptor blocking activity. In milk-induced leucocytosis and eosinophilia in mice, EAIL significantly reduced the number of leucocytes and eosinophils suggesting its adaptogenic and anti-allergic potential. Inhibition of clonidine-induced mast cell degranulation in rats displayed its mast cell stabilizing potential. Reduction of paw edema in passive paw anaphylaxis exhibited antianaphylactic activity of EAIL. Guinea pigs were protected from histamine-induced bronchoconstriction by EAIL which revealed its bronchodilator potential. Furthermore, the histopathological architecture of lung tissue was near to normal. CONCLUSION: Our results contribute towards validation of the traditional use of Acalypha indica in the treatment of asthma due to the presence of a wide range of phytoconstituents. Hence our investigation revealed that EAIL possessed strong antiasthmatic property by virtue of various mechanisms.

An Unusual Case of High-Grade Non-Hodgkin Lymphoma Masquerading as Acute Pyelonephritis with Acute Kidney Injury.

Renal involvement in non-Hodgkin lymphoma (NHL) has myriad of morphological features. We discuss an unusual case who presented as acute pyelonephritis (leucocytosis and acute kidney injury), ovarian mass and compressive myelopathy finally diagnosed as Non Hodgkins Lymphoma.

Evaluation of inflammatory and liver injury biomarkers among drug-naive viral hepatitis B patients: A study in a referral laboratory, Ghana

Background and Aim: Globally, hepatitis B virus (HBV) infection is among the commonest chronic infections and the leading cause of liver cancer. This study evaluated inflammatory and liver injury biomarkers among newlydiagnosed HBV-infected patients to reveal inflammation and liver injury levels. Patients and Methods: This case-control study was conducted among 146 newly diagnosed drug-naive patients and 64 blood donors. Questionnaires were administered to obtain demographic data. Blood samples were collected to assess viral serological markers, inflammatory markers, liver function, and hematological indices. Also, noninvasive markers of liver fibrosis (APRI: aspartate transaminase - platelet ratio index, FIB-4: fibrosis 4 index, and AAR: aspartate - alanine transaminase ratio) were mathematically derived. The patients were categorized into acute and chronic infections based on their viral serological markers. Results: Overall, 81.5% of the patients had an acute HBV infection, whereas 18.5% had a chronic HBV infection. There was a significant increase in the biomarkers of inflammation, C-reactive protein (CRP) and interleukin 6, and liver injury (liver transaminases, FIB-4 index, and APRI) among the drug-naive chronic HBV-infected patients. The study also revealed significant anemia and leucocytosis in patients with chronic HBV infection. Further, the study showed a strong correlation between CRP and alanine transaminase among patients with chronic HBV infection. Conclusion: There was increased anemia, inflammation, and liver fibrosis among the drug-naive chronic HBVinfected patients; hence, public education is required so patients with viral hepatitis B in Ghana would visit the clinic earlier enough for proper clinical management.

Leukocytosis and Spurious Hypoxemia.

Abnormally low pO2 and oxygen saturations on arterial blood gases (ABGs) test have been reported in the patients who have very high WBC and platelet counts; generally in the setting of hematological malignancies. This is presumably related to the consumption of oxygen by the active cellular elements in the arterial blood sample during the process of ABG analysis. This phenomenon which is also known as "spurious hypoxemia" or "oxygen steal" or "leukocyte/platelet larceny" is suspected when there is no other obvious explanation for hypoxemia on ABG, especially in the setting of normal oxygen saturations by the pulse oximetry. It is important for medical professionals to be aware of this condition so that appropriate workup and triage can be performed on such patients, which may otherwise lead to unnecessary hospitalization and escalation of care.

Laboratory markers predictive of fulminant Clostridioides difficile infection refractory to fluid resuscitation.

BACKGROUND: Old age, leucocytosis, hypoalbuminemia, and elevated creatinine have been identified as risk factors for fulminant Clostridioides difficile infection (CDI). High ATLAS scores have also been linked to fatal disease. The affiliated studies, however, involved patients prescribed metronidazole - a regimen no longer standard of care. The variables were thus reassessed in patients prescribed optimal therapy. METHODS: Adults hospitalized with CDI at University of Kentucky Medical Center were retrospectively reviewed. Enrolled subjects were separated according to disease classification i.e. non-severe/severe versus fulminant CDI. Fulminant patients were further subdivided into hypotensive persons responsive to fluid resuscitation, and those with sequent shock, ileus, or megacolon. Following partition, the cohorts underwent correlation analysis. FINDINGS: Forty-five subjects had non-severe/severe disease. Thirteen fulminant CDI patients responded to fluid resuscitation. Seventeen fulminant CDI patients developed shock, ileus, or megacolon. Median WBC counts, albumin values, and ATLAS scores varied among the cohorts. Although WBC counts were similar among the fulminant subsets, declining albumin values and increasing ATLAS scores mirrored disease worsening. Logistic regression revealed albumin values < 20 g/L (odds ratio [OR] 3.91) and ATLAS scores ≥ 6 (OR 5.03) to predict critical illness in hypotensive persons. CONCLUSION: Median WBC counts, albumin values, and ATLAS scores differed in patients separated by CDI severity. A notable variance in albumin values and ATLAS scores between fluid responsive fulminant disease and critical illness was moreover seen. The finding suggests hypoalbuminemia and high ATLAS scores in hypotensive CDI patients may herald shock, ileus, or megacolon.

COVID-19-Induced Hyperleucocytosis in Chronic Lymphocytic Leukaemia.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the current global pandemic, coronavirus disease 2019 (COVID-19). COVID-19 usually presents with respiratory symptoms but can affect multiple organ systems. A wide spectrum of complications can occur depending upon the comorbidities of patients. There is limited literature available regarding the presentation and outcome of COVID-19 in chronic lymphocytic leukaemia (CLL) patients. We report 2 cases of COVID-19-induced hyperleucocytosis (WBC count >100,000/µl) in CLL patients. LEARNING POINTS: Lymphopenia has been associated with severe disease and is a poor prognostic factor in COVID-19 infected patients; however, our cases show COVID-19-induced hyperleucocytosis (WBC count >100,000/µl)/lymphocytosis in CLL patients.Prior reports suggest that ibrutinib may have a protective effect against COVID-19 by decreasing inflammation and preventing progression to ARDS.

Affiliation and essence of SARS CoV2 (COVID-19) on blood parameters of infected patients: A retrospective study.

BACKGROUND: Till date, SARS CoV2 (COVID-19) is a pandemic viral infection in the world with the main and strong impact on respiratory airway, but this virus can affect any system of the human body. AIMS: This research is aimed to dictating the effect of SARS CoV2 infections on hematological, biochemical, and arterial blood gas parameters by using their mean values. SETTINGS AND DESIGN: This retrospective study was included a total no. of 97 SARS CoV2 positive patients from 27 March to 15 May 2020. All positive patients were consented and took all the significant details. MATERIALS AND METHODS: We review the total 97 COVID-19 positive patients after obtaining all the hematological and other relevant clinical data from laboratory and medical records. The subjects were tabulated into three categories named; admitted (Gp A), discharged (Gp B), and expired (Gp C) patients and compared their hematological, biochemical parameters, and arterial blood gas analysis by using blood or serum and processed by proper methods. STATISTICAL ANALYSIS: The data was cleaned, edited, checked for completeness, and processed then entered in SPSS version 20 statistical software. RESULTS: Blood samples were collected of all positive patients. Most of the patients had X-ray changes. Blood parameters showed that patients who were expired (Gp-C) suffered from anemia, lymphopenia, leucoytosis, neutrophilia, and thrombocytopenia with high ALT, pCO2 and low pO2 than admitted and expelled patients. CONCLUSIONS: Result from this study provides that WBC count, absolute lymphocyte count, neutrophil count, and pO2 were independently associated and an important forecaster of mortality from SARS CoV2. All healthcare provides to regularly monitor above parameters indicators of COVID-19 infected patients to improve their quality of life and to reduce the risk of mortality rate.

Severe Clostridium difficile infection with extremely high leucocytosis complicated by a concomitant bloodstream infection caused by Klebsiella pneumoniae after osteomyelitis surgery: A case report.

INTRODUCTION: Clostridium difficile is one of the most common healthcare-associated infections. Pseudomembranous colitis is a serious complication of Clostridium difficile infection (CDI) after septic surgery and antibacterial therapy. A sudden white blood cell (WBC) count increase and extremely high leucocytosis may be a predictor of a poor outcome. PRESENTATION OF CASE: A 77 years old male was hospitalised because of lower leg osteomyelitis and was operated. He received antibacterial treatment with Cefazolin for three days and then developed a high WBC count. The course of the disease was fulminant, with a rapid increase in the WBC count up to 132,000/mm3 and a septic shock, and required cardiovascular and ventilatory support. The patient was started on intravenous Metronidazole (500 mg every eight hours) and oral Vancomycin (500 mg every six hours). The patient's condition gradually improved over a period of six days. Then a hyperthermia above 39 degrees Celsius, hypotension and painful abdominal bloating developed, and the WBC count peaked to 186,000/mm3. The blood cultures were positive for Klebsiella pneumoniae. The patient died. DISCUSSION: In our case, we describe a community-onset, healthcare-facility-associated, severe CDI complicated by a blood stream infection. The administration of oral Vancomycin, which is highly active against the intestinal flora, could have been responsible for the persistence and overgrowth of Klebsiella pneumoniae. CONCLUSIONS: Severe CDIs after orthopaedic surgery and antibacterial treatment complicated by the development of nosocomial infection significantly worsen the prognosis of the disease. Careful consideration of antibacterial therapy and early symptom recognition may help prevent catastrophic events.

Leucocytosis and Stroke in a Lung Cancer Patient.

Significant leucocytosis in the setting of an underlying malignancy may be attributed to several causes and is not uncommon; however, extreme leucocytosis (>50×109 cells/l) and hypereosinophilia is less common and may represent a paraneoplastic syndrome. The underlying mechanism is thought to be bone marrow stimulation by tumour-produced cytokines, most notably interleukin-5 (IL-5) and granulocyte-macrophage colony-stimulating factor (GM-CSF). This paraneoplastic syndrome is likely reflective of extensive disease and dissemination, and options for treatment are limited but include tumour resection, corticosteroids and hydroxyurea. In this report, we discuss an unusual case of known stage III lung adenocarcinoma presenting with an ischaemic stroke and extreme leucocytosis and hypereosinophilia. LEARNING POINTS: To illustrate an unusual presentation of progression of non-small-cell lung adenocarcinoma.To highlight the prognostic significance of extreme leucocytosis and hypereosinophilia in patients with an underlying malignancy.

Initial leucocytosis and other significant indicators of poor outcome in severe traumatic brain injury: an observational study.

BACKGROUND: Globally, severe traumatic brain injury (TBI) has been the principal cause of mortality among individuals aged 45 and below. The incidence of road traffic accidents in Malaysia is one of the highest in the world with thousands of victims sustaining severe disabilities. The aim of this study is to determine the association between leucocytosis and extended Glasgow Outcome Scale (GOSE) scores as well the relationship of other factors and the outcomes of severe TBI. METHODS: This was a retrospective observational study. A total of 44 consecutive patients who were admitted to Sarawak General Hospital from January 1, 2018, to September 30, 2018, with severe TBI were included. Data were collected from discharge summaries and hospital medical records. Chi-square and t test were used. SPSS was employed. RESULTS: Of a total of 44 patients with severe TBI, 18 patients (41%) died during the same admission. The mean age of patients was 37.1 years with 93.2% of affected patients being male. 56.9% of patients presented with a Glasgow Coma Scale (GCS) of 6 and less. A large percentage (86.3%) were discharged with a GOSE of less than 7. Older age and low admission GCS (6 and less) were significantly associated with poor GOSE scores on discharge and after 6 months (p < 0.05) on multivariate analysis. Leucocytosis on admission was also associated with poor outcomes where patients with higher total white counts on presentation attaining lower GOSE scores (p < 0.05). CONCLUSION: We concluded that leucocytosis was significantly associated with poor outcomes in severe TBI patients in addition to other factors such as advanced age and poor GCS on arrival.

Hematological and immunological responses in the African catfish Clarias gairepinus exposed to sublethal concentrations of herbicide Ronstar®.

The aim of the study was to investigate the effects of sublethal concentrations (0.3, 0.6 and 1.2 mg L-1) of the herbicide Ronstar on the hematology and some immune parameters in Clarias gariepinus juvenile (mean weight and length 58.72 ± 2.46 g and 27.60 ± 1.62 cm, respectively). The hematological and some immune parameters were studied for 21 days in a static renewal bioassay system in which the water and the herbicide were changed daily. The erythrocyte count, hemoglobin concentration (Hb), and packed cell volume (PCV) were significantly (p < 0.05) reduced in the treatment groups. When compared with the control, there were significant (p < 0.05) leucocytosis, lymphocytosis, neutropenia and monocytopenia in the treatment groups. Both the mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) were reduced ((p < 0.05) in the Ronstar-exposed fish. The result showed that the treated fish suffered hypochromic microcytic anemia. The total immunoglobulin and phagocytic indices (phagocytic capacity and phagocytic index) were significantly (p < 0.05) reduced in the treatment groups. while the respiratory burst was significantly (p < 0.05) increased in the treatment groups. The result showed that exposure to Ronstar had adverse effects on the hematology and immunocompetency of the fish.

Anaplastic thyroid carcinoma with leucocytosis.

BACKGROUND: Anaplastic thyroid carcinoma is a high-grade tumour with poor prognosis. Most of the cases are easily diagnosed on cytology and some of these are associated with increased neutrophils in cytology specimen as well as in the blood. The objective of the study is to determine the frequency of neutrophilia with fever in anaplastic thyroid carcinoma. METHODS: This descriptive cross-sectional study was performed in the Department of Pathology Ayub Teaching Hospital Abbottabad as well as in association with Advance lab Abbottabad. All the cases diagnosed as anaplastic thyroid carcinoma on cytology were included, histopathological examination was done only in 5 cases. The duration of study was from October 2016 to October 2019 were included in the study. RESULTS: Out of 150 cases of thyroid cytology 09 were diagnosed as anaplastic thyroid carcinoma. The mean age of patients was 65.7±6.96. Gender distribution was 5/9 (55.6%) males and 4/9 (44.4%) were females. Out of which 05 were confirmed on histopathology 3 patients died within a month and 1 patient refused a biopsy. All of these cases were associated with an increased number of neutrophils on cytology and WBC count is 04 cases showed leucocytosis. All of them presented with rapidly growing mass in long-standing goitre with a median duration of 2 months. Weight loss was seen in 4/9 (44.44%), 3/9 (33.33%) presented with hoarseness of voice while only 1/9 (11.1%) patient presented with superior vena caval syndrome. CONCLUSION: In long-standing goitre rapid increase in size with fever and leucocytosis are suggestive of anaplastic thyroid carcinoma which should be investigated promptly.