Lemierre syndrome: a diagnostic dilemma of critical care in the post-COVID era.

Lemierre syndrome (LS) is referred to as the 'forgotten Disease' owing to its rarity in the postantibiotic era with an estimated yearly incidence of 1/million population. The classic triad of LS includes internal jugular vein thrombosis, oropharyngeal infection and metastatic septic emboli. We present a case of typical LS with Fusobacterium and Prevotella infection, presenting with peritonsillar abscess and jugular vein thrombosis complicated by sepsis, acute hypoxic respiratory failure due to multiple pulmonary emboli and severe thrombocytopaenia in the absence of disseminated intravascular coagulation.

Fibrinogen as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke - Evidence From the Indian Population.

Background: Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial. Objective: To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke. Design: Single-centre prospective observational study. Methods: 141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome. Results: Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], P = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], P < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], P < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], P < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], P = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], P = .038). Conclusion: The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.

Extremely Elevated Prostate-Specific Antigen in Acute Prostatitis: A Case Report.

Elevated prostate-specific antigen (PSA) levels are mostly suggestive of prostate cancer, but they are elevated in non-cancerous prostatic conditions as well. However, extreme levels of PSA as reported here have not been observed in cases other than prostatic cancer so far. Our patient had a significantly elevated PSA of 1,398 ng/mL in acute prostatitis. The purpose of this case report is to review the patient's atypical and rare presentation of extremely high PSA in acute prostatitis in the background of benign prostatic hyperplasia (BPH) and chronic prostatitis.

Critical approach to atypical spectrum of melioidosis: a case-series based literature review.

Melioidosis is an emerging infectious disease with highest predominance in Southeast Asia, but it has a significantly lower incidence across other parts of the globe. The most common systemic involvement seen in melioidosis is pulmonary, followed by multiple visceral and cutaneous abscesses. Infrequently, melioidosis manifests with atypical presentations such as spontaneous bacterial peritonitis (SBP), acute pyogenic meningitis or septic arthritis. Our primary case discusses an extremely rare presentation of melioidosis with SBP. There have not been any cases of SBP reported secondary to melioidosis infection. The second case exhibits development of acute pyogenic meningitis from haematogenous dissemination of this organism, while the final case demonstrates musculoskeletal melioidosis as an uncommon presentation. Of note, this case series also discusses the guidelines of management of melioidosis and illustrates the tremendous impact of appropriate and timely antibiotic therapy on mortality and morbidity secondary to melioidosis.

Cerebral salt wasting induced hyponatraemia presenting as catatonia.

Cerebral salt wasting (CSW) is an important cause of hyponatraemia in the background of a central nervous system disease. It causes hypovolaemic hyponatraemia and is associated with polyuria and high urine sodium levels. It is important to distinguish it from the more common syndrome of inappropriate antidiuretic hormone and this is primarily based on the volume status. Although CSW has been known to present with confusion, stupor, abnormal behaviour and seizures, its association with catatonia is yet to be reported. We report a case in which the patient developed CSW and hyponatraemia as a sequela of tuberculous meningitis and presented with catatonia. Prompt correction of hyponatraemia resulted in complete reversal of catatonia. This highlights the importance of evaluating all patients with catatonia for electrolyte abnormalities, especially hyponatraemia as its correction leads to excellent outcomes.