Monica Gupta

Recurrent erythema nodosum: a red flag sign of hidden systemic vasculitis.

Takayasus arteritis is a rare, systemic vasculitis with varied presentations across multiple medical specialities. Here, we present a young woman who had recurrent episodes of erythema nodosum on the background of a low-grade fever and no vascular manifestations. The presence of a high erythrocyte sedimentation rate generated a high index of suspicion for underlying vasculitis, and radioimaging confirmed the suspicion of Takayasus arteritis. The patient was found to have type III diseases in the vasculitic stage and was managed with systemic corticosteroids.

Touraine–Solente–Gole’ syndrome

Touraine–Solente–Gole’ syndrome, also known as pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare familial disorder generally seen in males. Although it presents with characteristic morphological and radiological features, this is an uncommon diagnosis and is entertained only once other causes of secondary hypertrophic osteoarthropathy are carefully excluded.

Otophyma: a rare and frequently misdiagnosed entity

Otophyma is the term used for sebaceous gland hypertrophy and hyperplasia of the ear. It is usually the end stage of rosacea--a common, chronic, cutaneous disorder of unknown etiology. We hereby present a rare case of otophyma with its clinical features, its etiology, diagnosis, and review of medical and surgical therapy. This patient remained undiagnosed and mismanaged for many years before she was finally diagnosed with this rare condition and successfully managed by surgical technique. To our knowledge, this is the second case of otophyma presented in the otolaryngological literature.

Reversible dementia and gait disturbance as a result of polypharmacy

A 53-year-old man presented with gradually progressive difficulty in walking, excessive lethargy and forgetfulness of 3 months duration. There was a noticeable decrease in verbal spontaneity, initiative and occasional episodes of urinary incontinence. Treatment records revealed that patient was consulting three different specialists for his multiple comorbidities such as painful diabetic neuropathy, hypertension and insomnia. His medication pills were retrieved and it was ascertained that he was consuming amitryptiline and carbamazipine for last 4 years. Recently pregabalin along with escitalopram had been added to the regimen, that is, around 3 months previously, which corresponded with the onset of this …

Isolated renal hydatid cyst in a diabetic postmenopausal female

Isolated renal hydatid disease is very uncommon and is usually an unexpected disclosure during radiological imaging. Since it affects the kidney, renal mass, or colic, hematuria, pyuria, and dysuria are the predominant symptoms. We present a case of a 48-year-old diabetic postmenopausal female incidentally diagnosed with an isolated giant renal hydatid cyst while evaluating the cause of recurrent flank pain.

Body iron stores in middle-aged North Indian patients with type 2 diabetes and obesity

Introduction: Evidence from various epidemiological and clinical studies suggests that iron overload is proinflammatory and proatherosclerotic. Excess body iron has been positively associated with insulin resistance, type 2 diabetes and obesity. Aim of the Study: To study the relationship of body iron stores with type 2 diabetes and obesity in middle aged North Indian population. Materials and Methods: The participant population consisted of four groups of randomly selected participants (between 40 and 65 years of age and postmenopausal women); Group A: Normal individuals (controls), Group B: Obese nondiabetic individuals, Group C: Lean diabetic patients, Group D: Obese diabetic patients. Blood was examined for hematological, biochemical estimations, C-reactive protein, and serum ferritin (SF). Observation and Results: A total of 197 participants were enrolled. The mean SF levels (ng/ml) among males were: Group A (n = 18) 148.56 ± 119.90; Group B (n = 25) 129.11 ± 94.77; Group C (n = 27) 127.96 ± 109.65 and Group D (n = 22) 148.36 ± 104.94. The mean SF levels (ng/ml) among females were: Group A (n = 23) 67.44 ± 37.59; Group B (n = 25) 59.62 ± 43.56; Group C (n = 24) 77.97 ± 91.46 and Group D (n = 33) 66.46 ± 86.05. No statistical difference was found among the groups in both the sexes. Conclusions: Our observation is in sharp contrast to the earlier studies published from the West stressing that iron stores are increased in obesity and diabetes. We conclude that SF may not be a strong risk factor in the pathogenesis of obesity and diabetes in middle aged North Indians.

Citrobacter koseri: an unusual cause of pyogenic liver abscess

Liver abscess is a common pathology in the Indian subcontinent and usually results from amoebic or bacterial infection. Pyogenic abscesses usually occur in those with underlying predisposing factors like intra-abdominal infections, biliary infections or comorbidities like malignancy, immunosuppression, diabetes mellitus and previous biliary surgery or interventional endoscopy. Citrobacter is an unusual cause of pyogenic liver abscess and may occur in the setting of underlying comorbidities. We report a 56-year-old man with diabetes (operated for periampullary carcinoma 20 years ago), who presented with a history of fever for 1 week and on evaluation was found to have Citrobacter koseri-related hepatic abscess. The patient was managed with parenteral antibiotics, repeated aspiration of liver abscess and pigtail drainage.

Idiopathic hypoparathyroidism: an unusual cause of acute encephalopathy

Though hypoparathyroidism is not an uncommon diagnosis, it is an unusual cause of seizures in adults. The authors report a case of late onset epilepsy due to idiopathic hypoparathyroidism in a 50-year-old man. This case reiterates the importance of CT scan and serum calcium in the evaluation of patients with recurrent seizures.

Scrub typhus masquerading as acute pancreatitis

The clinical spectrum of scrub typhus ranges from mild to fatal depending on the virulence of bacterial strain, susceptibility of the host and promptness with which treatment is started. We report a case of a 14-year-old child with scrub typhus who developed acute pancreatitis. On serological confirmation, doxycycline therapy was started. The patient responded well and had no complications on follow-up. This case report highlights the importance of recognising an uncommon presentation of this common tropical disease, and its prompt diagnosis and early treatment for prevention of serious complications of the condition.

Fracture of temporary femoral haemodialysis catheter: our experience

We report two similar cases of fracture and proximal migration of temporary femoral haemodialysis catheters. The two cases were encountered 6 years apart. These types of occurrences, especially in centres where catheter reuse is practiced, are not uncommon but seldom reported in the literature. Alert dialysis staff on both the occasions took remedial steps in time, which prevented embolisation of the catheters into the inferior vena cava. Both the catheters were removed successfully by the surgical team.