Shubha Seshadri

A case of organophosphate poisoning presenting with seizure and unavailable history of parenteral suicide attempt.

Organophosphate (OP) poisoning is common in India. Only few case reports of parenteral OP poisoning have been described. We report a case of self-injected methyl parathion poisoning, presenting after four days with seizure, altered sensorium, and respiratory distress which posed a diagnostic and therapeutic dilemma. Despite nonavailability of history of OP poisoning, he was treated based on suspicion and showed a good clinical response to treatment trial with atropine and pralidoxime, and had a successful recovery. Atypical presentations may be encountered following parenteral administration of OP poison, and even a slight suspicion of this warrants proper investigations and treatment for a favorable outcome. Persistently low plasma cholinesterase level is a useful marker for making the diagnosis.

Posterior circulation ischemic stroke following Russell's viper envenomation

Ischemic stroke following viper bite is rare. We report a case of posterior circulation ischemic infarction following viper bite in a previously healthy woman. Soon after being bitten by the snake on the left leg, she developed local redness, echymosis and one hour later became drowsy. On examination she had skew deviation of eyes and down gaze preference, generalized hypotonia. A CT scan of brain showed infarcts in cerebellar hemispheres and occipital lobes on both sides and that was confirmed on magnetic resonance imaging of brain. Her coagulation profile was deranged. Most common and serious central nervous system complication following snake bite is intracranial hemorrhage. Ischemic stroke commonly involves anterior circulation. Bilateral cerebellar and occipital infraction is not yet reported in literature. Exact cause for the development of infarction is not clear. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favorable outcome.

Late postpartum preeclampsia with posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome is a reversible syndrome characterized by headache, seizures, altered mentation, and loss of vision associated with white matter changes on imaging. We report here a 27 year-old lady three weeks postpartum, presenting with posterior reversible encephalopathy syndrome. She was treated successfully with antihypertensives and showed dramatic improvement. This condition is important to recognize and needs to be treated promptly to prevent morbidity and mortality in pregnancy and postpartum.

Disseminated tuberculosis presenting as mesenteric and cerebral abscess in HIV infection: case report

Disseminated tuberculosis in HIV infection involves multiple organs. Pulmonary and lymph node involvement are the commonest form of tuberculosis in HIV infection [1, 2]. Other forms of tuberculosis in the absence of lung and lymph node involvement are rare. Various forms of abdominal [3, 4] and neurological [5, 6] tubercular involvement in HIV infection have been reported. But tuberculosis presenting simultaneously with mesenteric and brain abscess has not been reported yet. We report a case of disseminated tuberculosis presenting as mesenteric and cerebral abscess in a HIV case without involving lung and lymph nodes. Bone marrow smears and fine needle aspiration cytology (FNAC) from mesenteric lesion were positive for acid fast bacilli (AFB) and the diagnosis of tuberculosis was confirmed by positive polymerase chain reaction (PCR). He responded well to treatment with anti tubercular drugs.

A rare case of seronegative culture-­proven infection with Brucella suis

Brucellosis is a chronic infection produced by members of the Brucella family. Diagnosis of this condition requires either isolation of the organism in culture or positive serological tests.We describe a 27-year-old male admitted as a case of pyrexia of unknown origin (PUO), who tested negative for Brucella IgM ELISA test on preliminary evaluation but was subsequently diagnosed on the strength of positive blood and bone marrow cultures to be a case of brucellosis secondary to Brucella suis infection. In addition to highlighting the pathogenic potential of an unusual organism, this case demonstrates the unreliability of standard serological tests based on the Brucella melitensis antigen for infection with other species of Brucella.

Melioidosis masquerading as enteric fever.

Melioidosis is endemic in Southeast Asia and northern Australia, but it has been rarely reported from India. Recent reports have shown that melioidosis is an emerging infection in this part of the world, but enteric fever is more commonly seen in India. We present a 50-year-old male with diabetes who presented with acute onset of febrile illness. Preliminary investigations were suggestive of enteric fever, and he showed a partial response to parenteral ceftriaxone; however, it later turned out that he had melioidosis. The widal titres were persistently elevated even following treatment with meropenem.

Isolated pulmonary valve endocarditis in a patient with aplastic anaemia

A 42-year-old female patient of aplastic anaemia on maintenance blood transfusion presented with a 3-week history of fever, cough, dyspnoea and pedal oedema. Upon examination she was found to have severe pallor, temperature of 101°F, tachycardia, bilateral pitting pedal oedema, raised jugular venous pressure, ejection systolic murmur (grade 2/6) in pulmonary area and petechiae over extensor aspect of both lower limbs. Blood investigations revealed low haemoglobin, thrombocytopaenia and mild increase in serum creatine. Chest x-ray was normal. Initial 2D trans thoracic echocardiography performed after hospital admission was normal. Antibiotics were started empirically to treat a possible underlying infection. Subsequently, three sets of blood cultures grew Enterococcus faecalis. Upon searching for the source, repeat echocardiograph done showed 2×0.5 cm vegetation on both pulmonary leaflets with severe pulmonary regurgitation, all other valves were free of vegetations. She was treated with intravenous antibiotics for the endocarditis and improved.