Pravin Kumar Jha

Fatal complication of ductal arteritis in a malnourished child

Proper counseling and timely intervention in cases of congenital heart lesions is absolutely essential and vital because rare and potentially fatal complications can arise out of simple lesions like patent ductus arteriosus (PDA). The incidence of infective arteritis in untreated PDA is less than 1%. Pulmonary showering from infected PDA vegetation is not uncommon. Vegetations usually occur on the pulmonary artery end of duct where the high velocity jet strikes and embolic events are usually to the lungs rather than the systemic circulation. The mycotic aneurysm of branch pulmonary circulation is rare but is a recognized entity. Aneurysms occur within the pulmonary circulation in conjunction with infective endocarditis or in association with pneumonia. The pulmonary findings of infective endocarditis in pulmonary computed tomography have a wide range of vascular abnormalities, such as intravascular filling defects, total vascular cut off, vascular enhancement, or enlargement of an occluded vessel. Localized mycotic aneurysm of affected pulmonary artery along with perivascular ground-glass opacities are important ancillary findings. A severely malnourished 7-year-old female child was referred from local healthcare facility for evaluation of high fever. The parents were aware of a hole in the heart. Echocardiography showed a large aneurysmal patent ductus arteriosus with left to right shunt, and a very large vegetation sitting on pulmonary end Article history: Received 22 January 2016 Accepted 1 April 2016 Available online 3 May 2016

Abdominal histoplasmosis mimicking tuberculosis in an immunocompromised patient

Histoplasmosis should be considered as a differential diagnosis especially in immune-compromised patients presenting with gastrointestinal symptoms even in areas where histoplasmosis is non endemic. The presenting symptoms often mimic abdominal tuberculosis. There are reports of simultaneous infections of both histoplasmosis and tuberculosis in patients with acquired immunodeficiency syndrome (AIDS). With early diagnosis and aggressive antifungal therapy gastrointestinal histoplasmosis has a very good prognosis. Here we are reporting a case that initially presented with clinical and radiological evidence initially suggestive of abdominal tuberculosis which on further work up was diagnosed as abdominal histoplasmosis.