Kyrshanlang G Lynrah

Miliary tuberculosis with pulmonary and extrapulmonary component complicated with acute respiratory distress syndrome

Miliary tuberculosis results from the lymphohematogenous spread of the tubercle bacilli to the vascular beds in the lungs and other organs. Diagnosis is made by clinical judgment and chest X-ray showing miliary mottling of the lung fields. Another imaging study like computed tomography imaging of the lungs and abdomen can also be supportive in diagnosing miliary tuberculosis. We present a case of miliary tuberculosis in an immunocompetent young male with atypical manifestation of a left-sided pleural effusion and a life-threatening complication of acute respiratory distress syndrome during hospital stay which required noninvasive mechanical ventilation and steroids therapy, along with antitubercular medication.

Concurrent Lesions in Oesophagus: an Approach to Diagnosis with a Case Report

Carcinomas of the oesophagus are the ninth most common malignancy globally and the sixth most common malignancy in males. Squamous cell carcinoma (SCC) is, by far, the most common type of malignancy arising in the oesophagus [1]. Neuroendocrine carcinomas (NEC) of the oesophagus are rare and aggressive neoplasms, presenting at an advanced stage, usually with metastasis [2]. NEC of the oesophagus may also present as a collision tumour, with another tumour growing in its close proximity and getting juxtaposed with the NEC [3, 4], or as a composite tumour, with the NEC showing differentiation towards other malignancy, commonly SCC or adenocarcinoma [5]. These possibilities are rare, and rarer was our case scenario in which NEC and SCC were present at two different anatomical sites of the oesophagus, but neither as a composite nor as a collision tumour. Various possible differentials need to be considered in the work-up of such a case to reach at a conclusion. This is especially true when the treatment modality does not include radical surgery, and the tumour is not available in toto for histopathological examination (HPE). Case Report

Hemophagocytic Syndrome Associated with Scrub Typhus: A Case Reportfrom North East India

Scrub typhus infection is an important aetiology of acute undifferentiated fever in south-east Asia and India. Haemophagocytic Lymphohistiocytosis (HLH) (haemophagocytic syndrome) is a potentially fatal hyper inflammatory syndrome that is characterized by histiocyte proliferation and haemophagocytosis. We describe a case of Haemphagocytic syndrome secondary to scrub typhus which presented with fever, rash, pancytopenia, epistaxis and haematuria who responded dramatically with respect to haematological parameters and clinically following prompt antimicrobial therapy. Scrub typhus with hemophagocytic syndrome can be complicated by multiorgan failure. Patients with scrub typhus usually have an excellent response to treatment; therefore, early diagnosis and prompt administration of antimicrobial therapy may prevent the development of serious complications.

Spectrum of renal lesions in systemic lupus erythematosus: Six years' experience at a tertiary health care centre in north east India

A total of 30 patients with SLE and clinical renal disease were diagnosed between 2006-2011. Out of these, three cases were known cases on treatment and 27 cases came to the hospital for the first time. Two cores of renal biopsies taken under ultrasound guidance, after an informed consent, were processed routinely and stained using haematoxylin and eosin stain, Periodic acid Schiffs stain, Gomoris methenamine silver stain and Masson trichrome stain. Immunohistochemical evaluation using IgG, IgA, IgM, C3 and C1q antibodies was done when tissue was adequate.