Akanksha Choudhary

Multiple intracranial hemorrhages in pregnancy: A common autoimmune etiology

Systemic lupus erythematosus (SLE) is an autoimmune disorder, primarily affect female in fertile age. Pregnancy in SLE female is a high-risk situation which can adversely affect maternal-fetal dyad. SLE can flare during pregnancy or in postpartum period. We describe a case of a young pregnant female who presented because of right hemiparesis due multiple hemorrhages in the brain. The first presentation of the SLE with multiple intracranial hemorrhages in pregnancy, preceding the other characteristic clinical symptoms is rare. Here, we high lighten the major neurological issues and maternal-fetal dyad issues in SLE pregnancy and treatment strategies for management of SLE in pregnancy.

Stuck with pancytopenia in dengue fever: Evoke for hemophagocytic syndrome

The hemophagocytic syndrome is an atypical and rare manifestation of dengue fever (DF). We describe a 15-year-old girl developing DF associated hemophagocytic syndrome who responded with supportive treatment.

IL-5 in the plasma-cell-dominant Castleman disease: a nosological entity

A 40-year-old male presented with a history of low-grade fever, weight loss, night sweats and breathlessness of 3 months duration. On examination, the patient had freely mobile lump in left lumbar region. The lump was surgically excised. Histological examination and immunohistochemistry of the specimen were consistent with the diagnosis of plasma cell variant of the Castleman disease. The patient had polyclonal hypergammaglobulinemia, anemia, eosinophilia and elevated interleukin (IL)-6 level. The level of IL-5 was not measured; however, the presence of eosinophilia indirectly suggests an increased IL-5 level. He obtained complete remission after resection of lump and 20 months of surgery had no signs and symptoms of diseases recurrence with normal hematological parameters. We discuss the role of IL-5 in the pathophysiology of the Castleman disease along with dysregulated overproduction of IL-6.

Correlation of serum S-100 protein level with involvement of territory and size of lesion in acute ischemic stroke

Background: Cerebrovascular accident is the most common and devastating disorders in old age group. The diagnosis of stroke remains a clinical one, with confirmatory evidence obtained through neuroimaging. Neurobiochemical markers have gained special importance in the determination of brain damage resulting from acute stroke. Aim: In this study, we aimed to evaluate serum S-100 protein in blood samples from patients with acute ischemic stroke and investigate the relationship of serum S-100 protein level with the involved territory and size of the lesion. Methods: This was a prospective observational study conducted among 94 patients of acute ischemic stroke admitted to the Medicine Department within 48 h. Serum sample was collected within 48 h and was sent for measurement of serum S-100 protein level. Patients were classified according to involved territory as anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and more than one territory and correlate it with S-100 protein level. All patients had cranial computerized tomography scan and magnetic resonance imaging in the first 48 h. Neurological examination was done with National Institute of Health Stroke Scale in acute stage and Rankin scale at the time of discharge. Results: Serum S-100 protein levels were significantly higher and maximum in multiple territory involvements followed by MCA, PCA, and ACA infarct. Conclusions: As serum S-100 protein level correlates with the involved territory or infarct size, we can predict the involved territory with the level of S-100 protein.

Isolated bone marrow carcinomatosis: A rare presentation of poorly differentiated adenocarcinoma of the stomach in a young male

A 30-year-old man came with complaints of generalized body pain, fatigability, dyspepsia, anorexia, weight loss, and exertional breathlessness for 6 months with no history of chronic illness, addiction or blood loss from any site in body. His vitals were stable. The conjunctiva was pale. Lymph nodes were not enlarged. Hemogram showed bicytopenia with hemoglobin of 4.2 g/dL, leukocytes 15,500/mm3 and platelets of 62,000/mm3. The peripheral blood film showed leukoerythroblastic picture. The bone marrow biopsy revealed infiltration with malignant cells [Figure 1a, and b]. Gastroscopy showed an ulcerated hypertrophic mass lesion along the greater curvature of the stomach (3 cm × 3 cm). Histology of the gastric tissue showed poorly differentiated adenocarcinoma of the stomach, which stained positive for pan-cytokeratin applied with immunohistochemistry [Figure 1c and d]. The liver was normal on contrast enhanced computerized tomography. The serum alkaline phosphatase (ALP) value was 220 IU/L, serum lactate dehydrogenase (LDH), 250 IU/L, and serum calcium was 9.2 mg/dL. The liver and renal function tests, serum carcinoembryonic antigen, carbohydrate antigen-19-9, and coagulation profile was within normal limit. He tested negative for HIV, hepatitis B virus, hepatitis C virus, and coombs test. The chest X-ray, electrocardiogram, colonoscopy, digital X-ray of spine and echocardiogram were normal. He expired after 50 days of admission on supportive treatment in the form of blood product transfusion.

Spontaneous Soft Tissue Haematomas- A Rare Presentation of Chronic Myeloid Leukemic (CML).

Spontaneous soft tissue haematomas are rarely found in haematological malignancies. Chronic myeloid leukemia (CML) is a myeloproliferative disorder which rarely present with thrombo-haemorrhagic phenomenon. It is a malignant clonal disorder of pleuripotent stem cells that results in increase in myeloid, erythroid and platelets cells in peripheral blood and marked myeloid hyperplasia in bone marrow. It is characterized by the presence of Philadelphia chromosome (Ph) with BCR - ABL 1 fusion gene. This gene is responsible for the formation of 210 KDa chimeric proteins with enhanced tyrosine kinase activity which leads to the abnormal bone marrow cell proliferation and to the clinical and morphologic manifestations of leukemia. Cutaneous and mucous membrane bleeding is common in CML whereas bleeding in deep soft tissue is rarely found because of qualitative and quantitative platelet abnormalities. Here, we report a case of CML (BCR-ABL rearrangement positive) who presented with large haematoma in the anterior as well as posterior compartment of left thigh and treated successfully with hydroxyurea and imatinib.

Cardiogenic shock with 1° heart block after organophosphorus poisoning: A case report and review of cardiac complication in organophosphorus poisoning

Organophosphorus (OP) compounds have been widely used as pesticide in India. Because of wide use and easy availability, it is the most common poisoning. OP compound poisoning can lead to cardiac complications. Here we report a case of 26-year-old female who presented after ingestion of unknown quantity of chlorpyrifos. She had cardiogenic shock, 1° heart block with prolonged QTc interval, and sinus bradycardia. She recovered completely after treatment with atropine and pralidoxime.