Ruchee Khanna

Coexistence of frontal fibrosing alopecia with lichen planus pigmentosus

A 47-year-old, postmenopausal woman presented with asymptomatic, excessive hair loss on the frontal region of the scalp of one year’s duration. Over the same period, she had noticed progressive, diffuse pigmentation of the face. She reported no history of hair manipulation or cosmetic practices involving the hair prior to the beginning of hair loss and no regular use of facial cosmetics. She had been using antihypertensive medication (amlodipine and atenolol) for the previous four years and had been applying hair dye for five years with no untoward side effects. She had no history of gynecological or endocrine problems. Clinical examination revealed a 2-cm band of recession along the frontotemporal hairline; the underlying skin was smooth, shiny, and atrophic (Figs. 1 and 2). Follicular orifices were absent from the patches. Follicular keratotic papules were seen around the alopecia patches, but there was no perifollicular erythema. Interestingly, hairs in the eyebrows were preserved. There was diffuse hyperpigmentation of the forehead, ear lobule, preauricular region, and sides of the neck. Examination of mucosae and nails did not reveal any abnormality. The subject’s

Primary Amoebic Meningoencephalitis in an Infant due to Naegleria fowleri

Primary amoebic meningoencephalitis (PAM) caused by free-living amebae Naegleria fowleri is a rare and fatal condition. A fatal case of primary amoebic meningoencephalitis was diagnosed in a 5-month-old infant who presented with the history of decrease breast feeding, fever, vomiting, and abnormal body movements. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and infant was put on amphotericin B and ceftazidime. Patient condition deteriorated, and he was discharged against medical advice and subsequently expired. We also reviewed previously reported 8 Indian cases of primary amoebic meningoencephalitis (PAM) and observed that for the last 5 years, none of the patients responded to amphotericin B. Has an era of amphotericin B-resistant Naegleria fowleri been emerged? Management strategy of PAM needs to be reviewed further.

Acanthamoeba meningoencephalitis in immunocompetent: A case report and review of literature

A 30-year-old manual laborer from Karnataka, India presented with intermittent low grade fever and diffuse headache for 1 month. On examination, patient had enlarged supraclavicular and cervical lymph nodes. Patient had positive Kernig′s sign and neck stiffness. Motor, sensory and cranial nerve examinations were within the normal limits. Abdominal, cardiovascular and chest examination did not yield any positive findings. Contrast enhanced computed tomography head was normal. Patient was suspected to have extrapulmonary tuberculosis. Patient was started on antitubercular drugs. Diagnostic lumbar puncture was performed. Wet mount and Giemsa smear preparation of cerebrospinal fluid (CSF) showed trophozoites suggestive of Acanthamoeba. CSF was cultured onto non-nutrient agar with an overlay of Escherichia coli. Wet mount made from the culture media yielded cysts and trophozoites of Acanthamoeba spp. Patient was diagnosed with Acanthamoeba meningitis and was started on specific therapy with Rifampicin 600 mg once a day, Cotrimoxazole 960 mg twice-a-day and Fluconazole 400 mg once daily for 2 weeks. Patient had a complete recovery and was discharged from the hospital.

A Rare Cause of Anaemia in HIV/AIDS

Patients living with HIV are commonly diagnosed with anaemia which can have various aetiologies. However, one of the rare causes of anaemia in such patients is Auto Immune Haemolytic Anaemia (AIHA), which is difficult to diagnose due to the absence of reticulocytosis in HIV patients. Such patients can be treated with corticosteroids which can gradually be tapered off over a period of time. The following is a case of a 52-year-old male living with HIV who was diagnosed to have AIHA and was successfully treated with steroids.

Blastoid variant of mantle cell lymphoma with leukemic presentation - A rare case report

Mantle Cell Lymphoma (MCL) is a type of Non-Hodgkins lymphoma and has a wide spectrum of histopathological subtypes of which the blastoid or the blastic variant constitutes 10-15% of all cases. It is difficult to diagnose blastoid variant of MCL on the basis of morphology alone as it mimics lymphoblastic lymphoma and centroblastic large cell lymphoma, hence additional analysis like immunophenotyping and molecular studies aid in its diagnosis. We present a case of 45-year-old male who presented to medicine OPD with chief complaints of fever, fatigability and inguinal swelling. Complete blood count, peripheral smear and bone marrow examination was performed. Peripheral smear showed thrombocytopenia along with 53% abnormal cells. On bone marrow examination 43% abnormal lymphoid cells were seen. This case was diagnosed as blastoid variant of MCL on the basis of routine morphology and immunohistochemistry on bone marrow biopsy and flow cytometric immunophenotyping on peripheral blood.

Rare Case of Meningoencephalitis Due to Aspergillus and Acanthamoeba Coinfection

Aspergillus and Acanthamoeba cause central nervous system (CNS) infection mostly in immunocompromised hosts, disseminating via the hematogenous route from a primary focus in the respiratory tract. We are presenting a case of an immunocompetent patient diagnosed with Aspergillus and Acanthamoeba coinfection of the CNS, a rare finding. A positive cerebrospinal fluid (CSF) galactomannan antigen test confirmed the presence of Aspergillus, and direct visualization in CSF sample and culture confirmed the presence of Acanthamoeba.