Cronkhite-Canada Syndrome: A Rare Cause of Chronic Diarrhoea in a Young Man.

A young Indian man presented with nine-month history of chronic diarrhea, occasionally mixed with blood and intermittent colicky abdominal pain. He also complained of generalized body swelling for the last three months. On examination, he had diffuse hyperpigmentation of the skin and dystrophic nail changes. Upper and lower gastrointestinal endoscopy revealed multiple sessile polyps in the stomach, small bowel, and colon and rectum. Biopsy of polyps showed adenomatous changes with stromal edema and dilated glands. Cronkhite-Canada syndrome (CCS) was diagnosed and treated with glucocorticoids and enteral nutritional supplementation. There was an associated small intestinal bacterial overgrowth (SIBO) and stool was positive for clostridium difficile toxin. After 12 weeks of treatment, the patient achieved remission. Close correlation with clinical findings, including pertinent ectodermal abnormalities, endoscopic studies, and careful examination of biopsies will ensure a timely and correct diagnosis of CCS.

Takayasu's Arteritis with Systemic Lupus Erythematosus: A Rare Association.

We report the case of a 24-year-old nondiabetic, nonhypertensive lady with history of fatigue, dyspnoea and limb claudication. She has been diagnosed with Takayasu's arteritis. Subsequently she developed rash, alopecia, joint pain, and various other laboratory abnormalities which led to a diagnosis of SLE. Takayasu's arteritis (TA) rarely coexists with systemic lupus erythematosus (SLE). The absence of specific SLE markers in patients with TA who subsequently develop SLE suggests that the coexistence of these conditions may be coincidental. The antiphospholipid syndrome in patients with SLE may mimic the occlusive vasculitis of TA.

Two Uncommon Causes of Guillain-Barré Syndrome: Hepatitis E and Japanese Encephalitis.

We are presenting two cases of Guillain-Barré syndrome where it is preceded by hepatitis E virus (HEV) and Japanese encephalitis virus (JEV) infection, respectively. Our first case is a forty-three-year-old nondiabetic, nonhypertensive female who was initially diagnosed with acute HEV induced viral hepatitis and subsequently developed acute onset ascending quadriparesis with lower motor neuron type of bilateral facial nerve palsies and respiratory failure. Second patient was a 14-year-old young male who presented with meningoencephalitis with acute onset symmetric flaccid paraparesis. After thorough investigations it was revealed as a case of Japanese encephalitis. Our idea of reporting these two cases is to make ourselves aware about this potential complication of these two common infections.

Systemic infection and inflammation as trigger factors of ischemic stroke.

BACKGROUND: Chronic risk factors are well understood in cases of stroke as well as myocardial infarction. Till date, several triggers for stroke are still under evaluation. Researchers have previously evaluated the relationship between preceding infection and inflammation and stroke onset. PURPOSE: The purpose of study is to define the stroke triggers in a better way and to provide little more information for early intervention by controlling infections or other trigger factors. METHODS: In this retrospective study, a standardized questionnaire was carried out to evaluate the signs, symptoms of preceding (<14 days) infection, physical/mental health, drug history, TIA etc. of 70 ischemic stroke patients and 80 non-stroke out-patient department patients as control groups. Important biochemical tests e.g. high sensitivity CRP, leukocytes count, blood sugar, lipid profile, etc. were also taken into consideration. Recent (15 days) prior infection, mainly respiratory tract infection and urinary tract infection, which were likely to be important stroke triggers, were compared between the ischemic stroke groups and the non-stroke patients (control group). RESULTS: It was found that respiratory tract infection is the most common type of infection (48.5%) compared with the non-stroke control group (30%). Apart from this, there were clinical evidence of infections like gastroenteritis, RTI, UTI etc which were biochemically established by leukocytosis and increased high-sensitivity C-Reactive Protein levels, well-known early diagnostic tools that have good predictive value. This study reveals that well-controlled diabetic, hypertensive or non-diabetic normotensive patients can suddenly develop ischemic stroke following recent infection as evidenced by clinical features, increased levels of high-sensitivity CRP and leukocytosis. CONCLUSION: These diagnostic tools implicate the value of early treatment of febrile illness and introduction or adjustment of doses of antiplatelet agents, antibiotics, etc. to reduce the actual stroke incidence, though it needs multicentre large community based prospective trials to evaluate stroke prone state and effective preventive measures tools at the same time.