Sine Scleroderma.

Systemic sclerosis (SSc) is a connective tissue disorder of unknown aetiology. A small subset (10%) of patients with limited systemic sclerosis have all other features of the disease without any skin involvement and is known as systemic sclerosis sine scleroderma (ssSSc). Severe Critical Limb Ischaemia is rare in sine scleroderma.The present case showed severe critical limb ischaemia with severe PAH,Esophageal dysmotility,Glomerulonephritis(a rare association) with hypertension. Although skin thickening is considered as a hallmark of systemic sclerosis, there should be a high index of clinical suspicion in patients presenting with possible manifestations of systemic sclerosis without sclerodermatous cutaneous involvement because early diagnosis and treatment can reduce the morbidity and mortality in it.

MEN Type I (Wermer Syndrome).

MEN I inherited as an autosomal dominant disorder leads to hyperplastic/ neoplastic changes in parathyroid, pituitary and endocrine pancreas along with other characteristic tumours. Hyperparathyroidism is the most common manifestation of MEN I. Our case was a female patient aged 42 years who was diagnosed with parathyroid adenoma, coincident with pancreatic neoplasm and adrenal adenoma. Hyperparathyroidism was noted initially and hemiparathyroidectomy was performed. Though adrenal adenoma and pancreatic neoplasm were detected on CECT, patient was symptom free from them and thus steps were taken to treat the chief complaint of presentation which was multiple bone pains. Post-operatively patient's serum Ca levels, serum PTH levels dropped drastically to normal ranges and there was remarkable improvement in complaints of patient. A multidisciplinary approach involving physicians, endocrinologists, oncologists, ENT surgeons and radiologists is pivotal for optimizing patient treatment. Treatment consists of surgery and drug therapy, often in association with radiotherapy or chemotherapy.

Bilateral Masseter and Internal Pterygoid Muscle Hypertrophy: A Diagnostic Challenge.

OBJECTIVE: To describe an unusual case of bilateral masseter and pterygoid muscle hypertrophy. CLINICAL PRESENTATION AND INTERVENTION: A 23-year-old male patient presented with a bilateral, painless swelling of 1 year duration at the parotid areas without improvement after using antibiotics/systemic corticosteroids/non steroidal anti-inflammatory agents. His medical history was not significant. The initial differential diagnosis included salivary gland/jaw bone/masseter pathology, but the MRI revealed only an increase in the size of the masseter and pterygoid muscles. The patient was informed of the benign nature of the swelling and was advised to discontinue the use of non steroidal anti-inflammatory agents. CONCLUSION: The bilateral hypertrophy of masseter muscles should be considered in differential diagnosis in cases of unilateral or bilateral swelling of the parotid or lateral mandible area.