Adesh Kumar Gadpayle

A rare case of dengue encephalitis.

Dengue fever has a variable clinical spectrum ranging from asymptomatic infection to life-threatening dengue haemorrhagic fever and dengue shock syndrome. However, neurological complications, in general, are unusual. Dengue encephalopathy is not an unknown entity; however, dengue encephalitis, a direct neuronal infiltration by the dengue virus, is an extremely rare disease. Although dengue is classically considered a non-neurotropic virus, there is increasing evidence for dengue viral neurotropism, suggesting that, in a proportion of cases, there may be an element of direct viral encephalitis. An MRI brain rarely shows focal abnormalities in dengue encephalitis. We report an interesting case of dengue encephalitis during an outbreak in Delhi, India. The diagnosis was confirmed by blood and cerebrospinal fluid dengue serology and (NS1) antigen assay. The case showed extensive lesions involving the midbrain, cerebellum, thalamus and medial temporal region on both sides of the MRI brain, which is an uncommon manifestation of dengue fever.

Vitamin supplementation: unmonitored prescription can be dangerous.

A 75-year-old illiterate woman presented with severe dehydration and altered sensorium. Investigations revealed severe hypercalcaemia with deranged renal function. ECG showed changes of hypercalcaemia and hypokalaemia. Since the patient was aged and had an acute presentation, malignancy was considered as the probable aetiology. Following prompt supportive treatment, she regained consciousness on the second day of admission. Later on, she provided a history of daily intake of vitamin D3 (cholecalciferol) sachet (60 000 IU/sachet) for the last 2 weeks, which had actually been prescribed to be taken once per week. Further investigation revealed very high levels of serum vitamin D. This case has been presented to reiterate the importance of known, but often overlooked facts: ECG can provide an important clue regarding the underlying metabolic encephalopathy; mega-dose supplementation of these seemingly innocuous vitamins should be monitored; and treatment regimes should be properly explained and monitored in elderly people.

Atypical respiratory complications of dengue fever

In last decade, dengue has emerged as one of the most important vector born disease. With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.

An unusual case of heart failure due to Plasmodium vivax infection with a favorable outcome

Although malaria is one of the oldest types of parasitic infection, we have recently witnessed substantial changes in the outcome of malarial infections. Severe Plasmodium vivax infections have recently become more frequent, and are occasionally associated with fatal outcomes. Cardiac arrhythmia and myocardial failure have also been reported, typically in association with Plasmodium falciparum infections. We report a case of myocarditis and heart failure, due to Plasmodium vivax infection, along with the favorable outcome.

Changing Trends in Malaria

Malaria continues to dominate the scene involving the infectious diseases even though the figures suggest that the incidence of malaria is decreasing. Transmitted by the bite of the anopheles mosquito, malaria has undergone varying epidemiological and clinical changes with Plasmodium vivax malaria becoming complicated along with the Falciparum malaria with multi-organ involvement and can be fatal at times. Early and accurate diagnosis of malaria is imperative for effective management. More recently, Rapid Diagnostic Tests (RDTs) have been introduced into routine use, and molecular methods like polymerase chain reaction are useful in certain situation. Artemesinin based combination therapy have become the drug of choice especially for complicated malaria with Synriam being the latest addition which is a fixed dose formulation containing the short acting arterolane and long acting piperaquine.

Multidrug resistant citrobacter: an unusual cause of liver abscess

Liver abscesses are infectious, space occupying lesions in the liver, the two most common abscesses being pyogenic and amoebic. A pyogenic liver abscess (PLA) is a rare condition with a reported incidence of 20 per 100 000 hospital admissions in the western population. The right lobe of the liver is the most common site in both types of liver abscess. Clinical presentation is elusive with complaints of fever, right upper quadrant pain in the abdomen and hepatomegaly with or without jaundice. The aetiology of PLA has changed in the past few decades and may be of biliary, portal, arterial or traumatic origin, but many cases are still cryptogenic. The most common organisms causing PLA are Gram-negative aerobes, especially Escherichia coli and Klebsiella pneumoniae. Studies have shown a high degree of antimicrobial susceptibility of isolated organism resulting in an overall lower mortality in PLA. Here, we present a case of PLA caused by multidrug-resistant Citrobacter freundii, which is an unusual organism to be isolated.

Lung Bullae, Cavitation and Right Ventricular Thrombus Formation with Saprophytic Aspergillus Colonisation: A Rare Presentation of IdiopathicPulmonary Embolism

Pulmonary Embolus (PE), in association with Deep Vein Thrombosis (DVT) is one of the three major cardiovascular causes of death. There are several risk factors for PE but still many cases are idiopathic. Cavity, bullae and lung abscess formation are unusual finding in PE. Right Ventricular (RV) thrombus secondary to PE itself is also rare. Here, we present a case of a young male patient with no prior risk factors, who came to us with a large bullae and cavitation in lung which was secondary to PE. Later he developed RV thrombus and saprophytic fungal colonisation of affected lung which was all attributed to PE. Patient was managed conservatively with anticoagulation and his repeat echo after two months showed clearance of RV thrombus.

Acquired urethral meatal stenosis: a rare sequel of an aggressive form of Behcet's disease.

Behçets disease (BD) is characterised by the triad of recurrent oral and genital aphthous ulceration, skin lesions and ocular inflammation. This disease frequently affects other systems including neurological, locomotor, cardiac or vascular systems. Recurrent oral and genital aphthous ulcerations are the hallmarks of BD. We hereby report a case of rapidly evolving and aggressive form of BD in a young man presenting with extensive ulcerative lesions in orogenital region leading to obstructive uropathy resulting in acquired urethral meatal stenosis due to inflammatory activity.