Aseptic meningitis in Kikuchi-Fujimoto Disease - Rare manifestation of a rare disease.

Kikuchi-Fujimoto Disease (KFD) is a rare disease marked by necrotizing lymphadenitis, often presenting as unilateral cervical lymphadenopathy, along with various extranodal manifestations such as fever, skin rash, hepatosplenomegaly, and arthritis, etc. KFD is thought to be secondary to either a viral infection or an autoimmune process, however, evidence in favor of both models is scarce and non-definitive. We report a case of a young female who presented with persistent high-grade fever, bilateral cervical and axillary lymphadenopathy, and leukopenia. Excisional biopsy of affected lymph nodes revealed well-circumscribed foci of necrosis with karyorrhectic debris and scattered fibrin deposits characteristic of KFD. The patient was promptly initiated on non-steroidal anti-inflammatory drugs (NSAIDs), however, despite an early improvement in symptoms, the patient soon developed aseptic meningitis, a rare neurological complication of KFD. Intravenous followed by oral corticosteroid therapy reported a good prognosis, with no observable residual neurological deficits. Knowledge of the disease and its complications significantly helped in the avoidance of unnecessary investigations and a delay in treatment.

Unnecessary Use of Corticosteroids for managing early mild symptoms of COVID-19 may lead to Rhino-ortibal-cerebral mucormycosis in Patients with Diabetes - a case series from Lahore, Pakistan.

Rhino-orbital-cerebral mucormycosis (ROCM), a rare but fatal fungal infection, has recently emerged as a serious complication after corticosteroids therapy in COVID-19 patients, predominantly in diabetic and immunocompromised patients. The World Health Organization (WHO) COVID-19 current guidelines recommend corticosteroids administration in hospitalized COVID-19 patients requiring supplementary oxygen or mechanical ventilation. Herein, we report a case series of seven patients with COVID-19; three mild, three moderate, and one severe, from Lahore, Pakistan; all were using corticosteroids for managing their early mild symptoms of COVID-19 at home for around 2-3 weeks without a physician's advise, presented, and admitted with ROCM to Mayo hospital, Lahore, from March to June 2021. Out of the seven patients, five patients had uncontrolled diabetes mellitus (DM) as comorbidity. Eye pain, facial swelling and pain, nasal blockage, and black coloration around eyes, on palate, and oral mucosa were the presenting complaints at the time of admission. All the patients had radiographic imaging, including computed tomography (CT), paranasal sinuses (PNS), or brain magnetic resonance imaging (MRI) carried out at the hospital, which confirmed mucosal thickening and adjacent sinus bony erosions with intracranial extension. All the patients were treated with local debridement of the infected necrotic tissue along with intravenous liposomal Amphotericin B and Posaconazole or Amphotericin B depending on the case. Due to timely management, in six out of seven patients, prognosis was good due to early diagnosis and treatment, while one patient with severe COVID-19 illness deteriorated and died. The misuse of corticosteroids for managing early mild symptoms of COVID-19 in diabetic and other immunocompromised patients can lead to fatal ROCM, which can further increase their risk of developing severe COVID-19 and mortality. It is stressed that only physician's recommended therapeutic advice should be followed for managing early mild symptoms of COVID-19 in self-isolation and avoid the unnecessary use of corticosteroids. This case series also emphasizes that COVID-19 diabetic patients treated with corticosteroids need more vigilant monitoring and high suspicion of early diagnosis and treatment of invasive fungal infection. Early diagnosis and management can reduce morbidity and mortality.

Neuromyelitis Optica as an Initial Presentation of Systemic Lupus Erythematosus in a Young Male.

Aquaporin-4 antibodies are hallmark of neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) that are distinct disease entities. We report a 24-year male with NMO, who presented with Brown-Sequard syndrome. Clinical and laboratory parameters confirmed the diagnosis of systemic lupus erythematosus (SLE). Involvement of sympathetic trunk causing Horner's syndrome and a wide time lapse of 13 years from the occurrence of optic neuritis to myelitis with no relapses in between is a rarity to be seen in NMO associated with SLE.

Case report of a lupus patient with a severe flare and miliary tuberculosis: need for proper guidelines for management.

Systemic lupus erythematosus (SLE) is an autoimmune disease that is frequently treated with high doses of corticosteroids and other immunosuppressive drugs. Thus patients with SLE are at increased risk for infections with several pathogens including Mycobacterium tuberculosis. There are no established guidelines available for treatment of tuberculosis in SLE patients with high disease activity due to lack of relevant studies and management based more on physician expertise. We report a case of a young SLE patient with high disease activity index (SLEDAI19) as evidenced by the presence of a vasculitic rash, non-healing ulcer on forearm and proteinuria of >1 g/d along with miliary tuberculosis. She was treated with intravenous methylprednisolone pulse up to 3 g and antituberculous therapy, but the result was a fatal outcome. This case report emphasizes the need for formal guidelines for co-management of active tuberculosis and SLE with high disease activity.

Factors causing exam anxiety in medical students.

INTRODUCTION: To assess examination related anxiety among final professional medical students by VAS (Visual Analogue Scale) and to determine the factors contributing to exam anxiety among final professional medical students METHODS: A cross sectional study using structured self-administered questionnaire was carried out over four weeks in Dow Medical College using sample size of 120 students. Duration of study was four weeks in May 2006. Survey questionnaire consisted of VAS to measure exam anxiety and seventeen questions regarding life style, study style, psychological problems, and examination system. RESULT: A total of 120 students out of 200 (60%) filled in the questionnaire. There were 25.8% male and 74.2% female students. The average maximum Exam Anxiety marked on VAS was 64+/-28. Among different factors contributing to exam anxiety, extensive course loads (90.8%), lack of physical exercise (90%) and long duration of exams (77.5%) were the most important factors reported by the students. Most of the students had no knowledge of exam-taking and anxiety-reduction techniques and majority of those who knew these strategies did not implement them. CONCLUSION: This study indicates moderate level of exam anxiety based on a Visual Analogue Scale in students of a medical college and also highlights factors such as extensive course load, lack of exercise and long duration of exams which contribute to Exam Anxiety.