RESUMO
A 50-year-old female patient presenting with joint pains, Raynaud's phenomenon, epistaxis, and telangiectasias was posed with a diagnostic conundrum, i.e., whether to accept the diagnosis of mixed connective tissue disease (MCTD), for which she fulfilled all the criteria, or test for another probable disease, namely hereditary hemorrhagic telangiectasia (HHT), even though only some clinical features were present and all diagnostic criteria were not satisfied. Taking the patient's onset of epistaxis as an important clue, the patient was counseled for genetic testing for HHT, which was positive. Treatment for both MCTD and HHT is underway, and appropriate surveillance is planned for the patient.
RESUMO
Acute poisoning with pesticides and insecticides can sometimes result in unexpected clinical manifestations. Awareness regarding all possible signs and symptoms of poisoning with these compounds can help in timely diagnosis and treatment. Deliberate ingestion of imidacloprid, a neonicotinoid insecticide, despite being minimally lethal to humans, proved to be life-threatening to a 14-year-old boy. A prompt diagnosis of methemoglobinemia followed by the administration of methylene blue led to successful recovery.
