Chronic diarrhea - The poetic masquerade.

Chronic diarrhea, by definition, is the passage of loose/liquid stools, with increased frequency (more than three times/day), or an output of over 200 g/day, lasting for a duration of four or more weeks. The clinical approach to identify the cause of chronic diarrhea generally depends on the local socioeconomic status. In high-income countries, systemic causes such as irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (lactose intolerance/coeliac disease) are primarily considered. In mid- to low-income countries, infective causes like chronic bacterial, mycobacterial, fungal infections, HIV, bowel cancer are considered before systemic causes/malabsorption syndromes. Amyloidosis, more accurately, reactive amyloidosis is one of the rarer causes of chronic/persistent diarrhea. Inflammatory colitis secondary to POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) as a cause for chronic diarrhea has been reported only in a handful of cases and is often missed. We present such a case of chronic diarrhea in a middle-aged man, who was eventually diagnosed to have POEMS syndrome.

POEMS syndrome associated with plasmacytoma of the clivus: "Time discovers the truth".

Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is characterized by the presence of a monoclonal plasma cell disorder, peripheral neuropathy, and one or more of the following features: Osteosclerotic myeloma, Castleman's disease (angiofollicular lymph node hyperplasia), increased levels of serum vascular endothelial growth factor (VEGF), organomegaly, endocrinopathy, edema, typical skin changes, and papilledema. [1] Solitary plasmacytomas most frequently occur in the bone but can also be found in soft tissues (extramedullary plasmacytoma). [2] We report a case that showed a rare association of POEMS syndrome with a plasmacytoma of the clivus.

Subcutaneous panniculitis like T cell lymphoma associated with erythromelalgia.

Erythromelalgia is a rare disorder that simulates a small fiber neuropathy and patients often have painful erythematous extremities during episodes. It is of two types: A primary or inherited form that is sometimes associated with a Na channel mutation or a secondary disorder associated with an underlying systemic disorder. We present a 19-year-old boy who presented to us with erythromelalgia and a febrile illness with systemic rash. Detailed work-up revealed another unusual condition: Subcutaneous panniculitis like T cell lymphoma (SPTCL). This is the first report of an association of erythromelalgia with SPTCL.

Cruciate bibrachial diplegia due to an acutely trapped fourth ventricle.

A 20-year-old female presented to us with bibrachial diplegia and dysarthria. She had an earlier history of craniosynostosis, multiple cranial surgeries and recent meningitis followed by ventriculoperitoneal shunting. Her symptoms started with a cruciate paralysis followed by rapid descending quadriparesis. Imaging revealed a trapped fourth ventricle as the cause of her descending paralysis.

Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction.

The authors reviewed 42 consecutive cases of decompressive hemicraniectomy after hemispheric ischemic stroke to assess predictors of outcome. On univariate analysis, advanced age and history of hypertension were significantly associated with unfavorable outcome, whereas thrombolysis was protective. Side of infarction, pupillary nonreactivity, degree of preoperative midline shift, and timing of surgery did not predict outcome. On multivariate analysis, older age independently predicted poor recovery (odds ratio 2.9 per 10-year increase in age).