Maculopapular rash presentation of febrile illness in an adult with Varicella zoster virus infection.

Varicella zoster usually manifests as maculopapular rash (MPR), which later progresses to vesicle. It can also manifest as MPR without progression to the vesicle stage. This atypical manifestation is more common in adults and immunocompromised patients. A 30-year-old female presented with high-grade fever and rash over face and body for 5 days. She was diagnosed to have Varicella zoster virus (VZV) infection by positive VZV immunoglobulin M enzyme-linked immunosorbent assay and polymerase chain reaction. We present this case to increase awareness among clinicians on the atypical manifestations of VZV and prevent complications by early diagnosis.

A rare case of ectopic thoracic kidney and spleen.

A 23-year-old male presented with fever of 5 days duration. His peripheral smear was positive for Plasmodium vivax. He was treated for malaria and responded. During investigation with USG it was found that he had absent left kidney. An abdominal contrast enhanced CT scan revealed ectopic kidney and spleen in the left hemithorax. This was a rare case of ectopic thoracic kidney and spleen.

Prevalence of microvascular complications in metabolic syndrome in comparison to type 2 diabetes mellitus.

To identify the prevalence of microvascular complications in patients with metabolic syndrome and compare them with patients with only diabetes mellitus, a retrospective study was carried out at a tertiary health care centre in South India with 150 patients, in two groups of 75 with almost identical age distributions. The test group (n = 75) fulfilled the NCEP AT III guidelines for metabolic syndrome. The control group (n = 75) had only diabetes mellitus and no other components of metabolic syndrome. They were assessed for the microvascular complications of diabetes mellitus, namely retinopathy (by direct ophthalmoscopy and zeiss f450 plus fundus camera), nephropathy (using overnight spot albumin/creatinine ratio) and neuropathy (using clinical features, abnormal results on Achilles tendon reflex and sensory perception by 10 g Semmes Weinstein monofilament). In the test group, 33.3% were found to have retinopathy, while in control group 13.3% had retinopathy; 38.7% in the test group and 22.7% in the control group had nephropathy; 50.7% in the test group and 26.7% in control group had neuropathy. On comparison the test group had statistically significant (retinopathy p < 0.05, nephropathy p < 0.001 and neuropathy p < 0.05) increase in the prevalence of microvascular complications as compared to the control group. Patients with metabolic syndrome have more prevalence of microvascular complications as compared to patients with only diabetes mellitus.

Rathke's cleft cyst--an uncommon cause of headache in a young boy.

Developmental disorders of the pituitary can present like a mass lesion in the region of the pituitary and produce pressure effects. Rathke's cleft cyst is one such developmental disorder of the pituitary which presents in early life producing pressure effects namely visual disturbances due to its proximity to optic chiasma, headache, and hormonal imbalance due to pituitary malfunction. In this case report a 19 years boy presented with symptoms of headache and gradual loss of vision over one year period. Neuro-imaging study demonstrated a cystic lesion in the region of the pituitary. Trans-sphenoidal hypophysectomy was performed. Histopathology of the biopsied material was suggestive of Rathke's cleft cyst. Following surgery the boy had a good visual recovery. So early diagnosis and removal of a Rathke's cleft cyst has a good prognosis as compared to a craniopharyngioma which is a very close differential diagnosis.

Gastro-intestinal stromal tumour--a case report.

Gastro-intestinal stromal tumours are a heterogenous group of mesenchymal tumours mostly arising from the stomach and small intestine which may be benign or malignant. A 32-year female presented with abdominal pain and progressive distension of abdomen. On examination liver was enlarged 10 cm below right coastal margin, spleen was also enlarged and non-tender. Shehad marked pallor. On CT scan a hypervascular mass was seen in close relation to the duodenum and is continuous with the lumen of the 2nd part of duodenum. Upper GI scopy showed a proliferative growth in periampullary region with the histopathology of the growth showed features of gastrointestinal stromal tumour. There was no signs of malignant changes. Blood transfusion along with iron and folic acid tablet was the choice of treatment.

Sweet's syndrome preceding carcinoma of the adrenal cortex.

A case of Sweet's syndrome preceding carcinoma of the adrenal cortex is reported. Sweet's syndrome can be a rare premalignant manifestation of carcinoma of adrenal cortex.

An unusual presentation of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystem connective tissue disease caused by the damage of tissues and cells by pathogenic auto-antibodies and immune complexes. A 27-year-old female presented with chronic diarrhoea was diagnosed as intestinal tuberculosis. But further evaluation diagnosed it a case of SLE and diarrhoea subsided with treatment. The case is reported because of its atypical presentation.