Prakash Joshi

Diffuse Alveolar Hemorrhage: A Very Rare but Catastrophic Complication After Percutaneous Transluminal Coronary Angioplasty

In this write-up, we report a case of persistent hemoptysis after percutaneous transluminal coronary angioplasty (PTCA), which was diagnosed as diffuse alveolar hemorrhage (DAH). DAH is a life-threatening medical emergency that can be caused by numerous disorders and it, further, presents with hemoptysis, anemia, and diffuse alveolar infiltrates. Early diagnosis is usually required for this noninfectious cause in post PTCA patient, as it is very rare complication.

Tubercular monoarthritis of wrist

Tuberculosis (TB) has been a major health concern since decades, and millions continue to be afflicted with this disease. Extrapulmonary sites of TB must not be neglected as there is paucity of systemic manifestations and absence of distinct clinical features which delay its diagnosis and can lead to functional disability and severe infirmities. Osteoarticular TB is an infrequent form of the disease and monoarthritis of the wrist accounts for 1% of all cases of skeletal involvement. Hereby, we report a 45-year-old female patient with history of progressive pain and swelling of right wrist joint which is refractory to analgesics and anti-inflammatory drugs. She was diagnosed to have tubercular monoarthritis after synovial fluid analysis and radiographic findings. Standard antitubercular treatment for 6 months was given. The joint was salvaged after 9 months from the start of the treatment. Pain and swelling of joint were subsided and joint was rehabilitated with full range of motion and weight bearing.

A case of recurrent massive right sided pleural effusion-an unusual presentation of carcinoma prostate.

423 obvious lung mass or enlarged mediastinal lymph nodes. Sonography of pelvis showed prostatic enlargement with 150 ml post‐void residual urine. Pleural fluid examination showed hemorrhagic fluid, glucose 100 mg/dl, proteins 4.5 mg/dl; total cells were 480 with neutrophils 20% and lymphocyte 80%. Pleural fluid adenosine deaminase (ADA) was 32.35 IU/L. No growth of micro‐organism was seen on Gram and Zeil Nelson staining to rule out tuberculosis and no growth was seen after 48 hours of urine culture. Pleural fluid cytology revealed fragments from metastatic adenocarcinoma. His serum prostate‐specific antigen (PSA) was found to be>148 ng/dl. An ultrasound guided trans rectal prostate biopsy was done, which showed well‐differentiated adenocarcinoma of prostate and a Gleason’s Score of 6. He underwent surgical hormonal ablation by bilateral high inguinal orchidectomy and he was started on bicalutamide. After 4 weeks of surgery, he improved symptomatically, massive pleural effusion subsided and his serum PSA came down to 13.48 ng/ml. On last follow‐up at three months there was no pleural effusion on chest X‐ray and his serum PSA was 4.04 ng/ ml. Still there was no bony pain or tenderness.