Sk Diwan

Acute dengue myositis with rhabdomyolysis and acute renal failure

Dengue is an acute mosquito-borne infection caused by dengue viruses from the genus flavivirus. Neurologic complications have been attributed chiefly to metabolic alterations and to focal and sometimes massive intracranial haemorrhages, but anecdotal cases and limited case series have indicated the possibility of viral CNS and skeletal muscle invasion causing encephalitis and myositis. We present a case of a 40-year-old male who presented with severe dengue myositis resulting in quadriparesis, respiratory failure and acute renal failure with red urine. His elevated serum creatine kinase (CK), serum and urine myoglobin levels justified rhabdomyolysis as the cause of acute renal failure. A muscle biopsy revealed inflammatory myositis. He required ventilator support for respiratory failure and was treated conservatively. This case highlights the severe and persistent muscle involvement in dengue which is a rarity.

Case report of Plasmodium falciparum malaria presenting as wide complex tachycardia

Abstract Malaria caused by Plasmodium falciparum is a multisystem disorder and may have diversity of clinical presentations. We are presenting a case report of patients of falciparum malaria who presented to us with palpitation and fever. On electrocardiogram he had wide complex tachycardia. This case reiterates the need to think of malaria in any case with symptoms of fever with chills, even with various unusual presentations like palpitation due to wide complex tachycardia, especially in endemic country like India.

Sub cuteneous swelling as the first clinical manifestation of small cell carcinoma of lung.

Subcutaneous swelling as first clinical presentation of small cell lung carcinoma is uncommon and rarely reported in literature. This case highlights a rare presentation in which subcutaneous swelling was the first clinical manifestation of a small cell carcinoma of lung which also had metastasis to rib bone, muscle and pleural involvement as pleural effusion. We describe the case of a 64-year-old male patient who presented with dyspnea, pleuritic pain, loss of weight and nodule on his anterior chest, back and left arm suspicious of lipoma. Biopsies revealed small cell carcinoma of lung. This case demonstrates the meticulous work up of subcutaneous swelling in the clinical scenario of breathlessness, chest pain and loss of weight.

Wegener's granulomatosis presenting as spontaneous pneumothorax in young adult

Pulmonary involvement in Wegeners granulomatosis (WG) usually starts with nonspecific symptoms such as cough, dyspnea, hemoptysis, and pleuritis. Spontaneous pneumothorax as initial presentation is extremely rare. Although its real incidence is unknown, according to different classic series, it ranges between 3 and 5% of the cases. In this case, a 28-year-old male presented with complaints of epistaxis and breathlessness, which was diagnosed as WG with pneumothorax on the basis of chest X-ray and computed tomography (CT) chest and pathological confirmation by high level of serum cytoplasmic antineutrophil cytoplasmic antibody (ANCA).

Myocardial infarction in organophosphorus poisoning: Association or just chance?

Journal of Emergencies, Trauma, and Shock I 7:2 I Apr Jun 2014 Acute myocardial infarction as a result of acute OPP though have been reported but are exceptionally rare.[2] The mechanism of toxicity of organophosphorus compounds is the irreversible binding of the compounds with the serum cholinesterase enzyme and converts this enzyme into a inactive protein complex with subsequent accumulation of increased amount of acetylcholine at the neuromuscular junction leading to persistent stimulation and subsequent disruption of the nerve transmission both in peripheral and central nervous system.[3]

Tropical calcific pancreatitis in HIV patient

Sir,A 36-year-old female from rural central Maharashtra with known case of human immunodeficiency virus infection (CD4 cell count, 249 per cubic millimeter) for six months on regular anti retroviral drugs presented with epigastric pain, nausea, and few episodes of vomiting for 3 days. She was taking a combination of lamivudine and zidovudine (from local civil hospital where anti retroviral drugs are provided free of cost). There were similar episodes of such type of abdominal pain. Abdominal pain was mid epigastric, dull aching in nature, increased after taking meal and some times radiating to back. She was also diagnosed recently as insulin diabetes mellitus and taking regular insulin. She was a nonsmoker and nonalcoholic. We had no reports regarding investigations performed during previous episodes and had not identified other causes of pancreatitis. On examination, vitals were stable and tenderness was present in the epigastric region. There was no palpable abdominal mass or other specific findings noted on physical appearance. At the time of admission, hemoglobin was 7.9 g/dl, total leukocyte count was 4800 and platelet count was 431,000. Her fasting and post meal blood sugar were 180 and 220 mg per dl on regular insulin. Her serum lipase was 193 U per liter (normal range up to 180 U/litre). Serum amylase and lipase levels are widely used as screening tests for acute pancreatitis in patients with acute abdominal pain or back pain. Values greater than three times the upper limit of normal virtually clinch the diagnosis if gut perforation or infarction is excluded.

A case of tuberculous lymphadenitis with erythema nodosum

Sir, Erythema nodosum (EN), a painful disorder of the subcutaneous fat, is the most common type of panniculitis. Generally, it is idiopathic, although the most common identifiable cause is streptococcal pharyngitis. EN may be the first sign of a systemic disease such as tuberculosis (TB), bacterial or deep fungal infection, sarcoidosis, inflammatory bowel disease, or cancer. Certain drugs, including oral contraceptives and some antibiotics, also may be etiologic. We present a case of tubercular lymphadenitis with EN.

Rheumatoid interstitial lung disease presenting as cor pulmonale

Rheumatiod arthritis (RA) is a multisystem connective tissue disorder. The predominant presentation is polyarticular, symmetric peripheral arthritis with relative sparing of axial skeleton. Inflammatory synovitis is the pathologic hallmark. Extra-articular manifestations of RA can involve several other organ systems and amongst them pulmonary manifestations occur commonly. We report a case of rheumatoid interstitial lung disease presenting as cor pulmonale.

Hyperreactive malarial syndrome with noncirrhotic portal hypertension

Patients from tropical areas where malaria is endemic sometimes present with massive splenomagaly, that is usually known as tropical splenomegaly syndrome after ruling out other possible causes of splenomegaly. At present this condition is defined as hyperreactive malarial syndrome (HMS). One of the rarest and unique complication of HMS is prehepatic type of portal hypertension/ noncirrhotic portal hypertension. We report a case of HMS with prehepatic portal hypertension.