Jyotirmoy Pal

Interstitial Lung Disease as Presenting Feature of SLE

Interstitial lung disease (ILD) has been considered as an unusual pulmonary manifestation of systemic lupus erythematosus. Patients of ILD usually present with progressive dry cough and exertional dyspnea. ILD is usually seen in long standing SLE patients and follows a chronic course. ILD as the initial manifestation of SLE is very rare. Our middle aged female patient presented with pulmonary symptoms, renal impairment and arthralgia. She was finally diagnosed as having SLE by relevant autoantibody profile and renal biopsy along with HRCT proven ILD.

Middle Cerebral Artery Dissection Presenting with Intracerebral and Subarachnoid Hemorrhage

Dissecting aneurysm of the intracranial arteries is uncommon and isolated dissection of middle cerebral artery (MCA) is much rarer. Cerebral infarction is the usual presentation of MCA dissection in first two decades, hemorrhagic manifestation being much rare. We describe a young male patient who presented with acute onset headache and left sided hemiparesis due to acute intra-parenchymal hemorrhage. Digital subtraction angiography finally revealed dissection involving M2 segment of right MCA as the possible cause of intracerebral hemorrhage in this patient. This type of uncommon presentation of MCA dissection is rarely reported before.

IgG4 Related Disease-The Great Masquerade

IgG4 related disease is an uncommon disease that presents with diverse clinical manifestations. Interestingly the disease is a great masquerade of many other autoimmune and malignant conditions. Rare occurrence and varied clinical phenotype makes this disease a challenging one for the clinicians. Here we present a case of IgG4 related disease in a 50 year old female, who initially presented with low grade fever, sicca symptoms, eyelid swelling with proptosis along with bilateral salivary gland enlargement. Final diagnosis was made from characteristic histopathological finding and markedly elevated serum IgG4 level.

Leptospirosis complicated with meningoencephalitis and pancreatitis – A case report -

In severe leptospirosis multi organ involvement is common. Pancreatitis and meningo encephalitis are two uncommon manifestations of leptospirosis. Our patient presented with fever, jaundice, altered sensorium and subsequently developed severe pain abdomen. He was finally diagnosed as having icteic leptospirosis complicated with pancreatitis and meningoencephalitis. Simultaneous presence of these two complications in a patient of leptospirosis probably not been documented before.

Dilated cardiomyopathy presenting like superior vena cava syndrome

Dilated cardiomyopathy (DCM) commonly presents with exertional dyspnea, fatigue, dependent edema and ascites. Jugular venous distension with prominent positive waves, S3 gallop, and regurgitant murmur are usual signs of DCM. There is one reported case of DCM presented with superior vena cava (SVC) thrombosis. Our patient presented with classical clinical features of SVC syndrome, later on confirmed as having DCM and there was no evidence of structural SVC obstruction.