RESUMO
We present a middle-aged woman with a prior history of central nervous system (CNS) demyelinating disorder who presented with an acute onset quadriparesis and respiratory failure. The evaluation revealed distal renal tubular acidosis with hypokalemia and medullary nephrocalcinosis. Weakness persisted despite potassium correction, and ongoing evaluation confirmed recurrent CNS and long-segment spinal cord demyelination with anti-aquaporin-4 antibodies. There was no history of dry eyes or dry mouth. Anti-Sjogren's syndrome A antigen antibodies were elevated, and there was reduced salivary flow on scintigraphy. Coexistent antiphospholipid antibody syndrome with inferior vena cava thrombosis was also found on evaluation. The index patient highlights several rare manifestations of primary Sjogren's syndrome (pSS) as the presenting features and highlights the differential diagnosis of the clinical syndromes in which pSS should be considered in the Intensive Care Unit.
RESUMO
Abrus precatorius seeds are highly toxic and are often ingested as a means of suicide in India. Hemorrhagic gastroenteritis with erosions, hemolysis, acute renal damage, hepatotoxicity with elevated liver enzymes, and seizures are common manifestations of toxicity. We report two cases of Abrus precatorius poisoning with raised intracranial pressure (ICP) and papilledema that have not been described earlier in literature. One patient recovered completely with conservative management to lower raised ICP while the other patient expired before effective treatment could be institutedd. The cases are being reported to propose the need for routine fundus examination and brain imaging in severe abrus poisoning with CNS toxicity, as early institution of treatment for cerebral edema measures may be life saving.