Sn Mahajan

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.

Dynamics of Electroencephalogram (EEG) in Different Stages of Chronic Kidney Disease

AIM To study Electroencephalogram (EEG) in different stages of chronic kidney disease (CKD). MATERIALS AND METHODS This observational study was carried out in the Department of Medicine, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha conducted over a period of 24 months, spanning from August 2011 to August 2013. Eighty three cases of CKD at different stages were studied. EEG was done in all the subjects and the various EEG dynamics like morphometric waveform patterns, symmetricity, amplitude were recorded and compared with the different stages of CKD. RESULTS We found that characteristic changes were observed with increasing severity of CKD. Slow delta wave patterns were more prominent in stage 5 (p<0.0001), asymmetric discharges, dysthymia, sharp wave transients and low amplitude wave forms were more prominent beyond Stage 4 (p<0.0001). CONCLUSION EEG can be used as an effective tool for detection of subclinical or latent uremic encephalopathy. EEG findings which are characteristics of uremic encephalopathy can be present in CKD patients without overt signs of encephalopathy. So, EEG can be used as a prognostic indicator of response to clinical therapy of CKD.

A case of Plasmodium vivax malaria associated with severe autoimmune hemolytic anaemia

Anemia in malaria is multifactorial. Autoimmune hemolysis is an extremely rare cause of anemia in malaria and more so in vivax malaria. A 35-year-old female presented to us with fever and anemia. She was diagnosed as vivax malaria with autoimmune hemolytc anemia by a positive Direct Coombs test. We treated her with antimalarial durgs, corticosteroids, and transfused her with the least incompatible blood. The patient recovered and was discharged. Hence, we suggest that autoimmune hemolysis be considered an important cause of anemia in Plasmodium vivax ( P. vivax ) malaria.

Congenital hypoparathyroidism presenting as recurrent seizures in an adult

Hypocalcemia due to hypoparathyroidism may manifest as serious neurologic symptoms such as seizures, movement disorders, or raised intracranial pressure. Several patients were observed to have these dangerous neurologic complications even without subtle signs of hypocalcemia like tetany, chvosteks sign or carpopedal spasms. We present a case of recurrent hypocalcemic seizures due to congenital hypoparathyroidism.

A Rare Case of Sporadic Inclusion Body Myositis (s-IBM).

Sporadic inclusion body myositis (s-IBM) is an acquired inflammatory myopathy. Clinical presentation is variable. The usual presentation is progressive weakness and atrophy of the arms and leg muscles, especially of the quadriceps femoris which is invariably affected. It is classified under inflammatory myopathies, along with polymyositis and dermatomyositis. We present a case of s-IBM who presented with gradually progressive quadriparesis with characteristic quadriceps wasting and weakness in neck flexors. Electromyography revealed myopathic potential and muscle biopsy revealed features of inclusion body myositis.

Profile of Non Alcoholic Fatty Liver Disease (NAFLD) In Healthy Young Adults.

Aims and Objectives: 1) To Study Occurrence of Non Alcoholic Fatty Liver Disease in Healthy Young Adults. 2) To Study Profile of subjects with Non Alcoholic Fatty Liver Disease in Healthy Young Adults. Materials and Methods: Study Design: A cross sectional study. Sample Size: 550 cases. Data Collection: 24 months (October 2013 To September 2015) Written informed consent was taken from the subjects after explaining the nature of the evaluation to them. Each person was subjected to a thorough history and physical examination as per the proforma. Methodology: History of Alcohol consumption, Jaundice, Medication, Family history of risk factors was obtained. Blood pressure and anthropometric measurements of the subjects were taken and biochemical investigations like fasting plasma glucose, fasting lipid profile, AST (SGOT) & ALT (SGPT). Ultrasonography of abdomen was done to detect fatty changes in the liver, which was performed by a single experienced radiologist who was blind to the study. Results: Out of 550 subjects, 83(15.09%) had fatty liver. There was statistically significant difference in NAFLD and normal group in Non biochemical factors like blood pressure, BMI, Waist circumference, WHR and Family history of risk factors and Biochemical factors like Fasting plasma Glucose (FPG), SGPT, Total Cholesterol, Triglycerides, LDL, VLDL. Conclusion: The present study concludes that the occurrence of NAFLD in healthy young adults was 15.09%. There is strong strength of association in developing into fatty liver with factors such as Waist-Hip ratio, waist circumference, body mass index (BMI), SGPT, total cholesterol, Triglycerides, LDL and VLDL.

Systemic sclerosis presenting with severe digital ischemia: A rare case report

Digital ischemic loss is a cause of significant morbidity in patients with systemic sclerosis (SSc). Both small and large digital arteries are involved causing perfusion defects leading to ischemia. Microvascular disease causes intimal proliferation and luminal narrowing of small digital arteries, macrovascular disease causes narrowing or occlusion of larger digital arteries. Immediate clinical evaluation and treatment are mandatory at the onset of critical digital ischemia to prevent digital loss. We present a case of 38-year-old female suffering from SSc who presented with acute onset severe digital ischemia of all four limbs.

The Brescia Cimino Aneurysm.

AV (arteriovenous) fistulas are recognized as the preferred access method for haemodialysis over cental venous catheter .Bracheocephalic fistula and radiocephalic fistula are the types of fistula done.AVF also have complications like aneurysm .A case of 71 yr old female of ckd on haemodialysis with a side-to-end Cimino-Brescia AVF presented with aneurysm of A V FISTULA.

Congenital Tricuspid Valve Dysplasia with Infective Endocarditis Presenting as Cardiac Tamponade

Tricuspid valve endocarditis is mainly a disease of intravenous drug abusers. Tricuspid valve dysplasia is also an uncommon congenital cardiac anomaly which can also predispose to endocarditis making the situation still rarer. We present a case of a 20 year old male who presented with massive pericardial effusion with severe right sided heart failure with congenital tricuspid valve dysplasia and endocarditis. Introduction: Tricuspid valve endocarditis is disease of intravenous drug abusers. It is very rare to have endocarditis associated with tricuspid valve dysplasia. Incidence of Tricuspid valve dysplasia is 1% of all congenital heart disease[1]. The lower incidence of right-sided endocarditis compared with left-sided endocarditis has been attributed to the lower rate of congenital and rheumatic heart disease affecting the right-sided valves. Isolated native tricuspid valve endocarditis (TVE) accounts for only 5% to 10% of all cases of infective endocarditis[2]. Pericardial effusion can be a devastating complication of severe right sided heart failure. This is a unique case describe dysplastic tricuspid valve with endocarditis , right heart failure with failure related massive pericardial effusion causing tamponade . A 20 year old Hindu male presented to us with chief complains of dyspnea on exertion, palpitation, fever on and off since 2 weeks, swelling in both lower limbs since 2 years, There was no history of paroxysmal nocturnal dyspnea, cough, hemoptysis and chest pain. On examination blood pressure was 90/60mmHg in left arm supine position, pulse rate120/min regular. Pulsus paradox of 16mm was present. Jugular venous pressure was raised with prominent ‘x’ descent. Bilateral Pitting edema feet present. There was no evidence of endocarditis. CVS examination revealed muffled heart sounds, respiratory examination normal , per abdomen revealed soft tender hepatomegaly. Provisional diagnosis of pericardial effusion was made. Investigations revealed, Normal hemogram, ESR-40 in first hour, three blood cultures were positive for viridians streptococci, chest xray suggested massive pleural effusion(fig 1) , 2Dechocadiography suggested tricuspid valve dysplasia with severe tricuspid regurgitation, right ventricular failure, small hyperechoic calcific mass on the tip of the anterior tricuspid leaflet, spontaneous echo contrast in right atrium and large pericardial effusion.(fig 2-4) Patient was treated with Inj ceftriaxone 2gm iv12 hourly , Inj peniciilin, (2-3 million U IV 4 hourly), inj vancomycin(15mg/kg 12hourly) was given along with supportive therapy. In view of breathlessness pericardiocentesis was done and pigtail catheter was introduced for continuous drainage of effusion. Cytology suggestive of transudative fluid which was negative for Acid fast bacilli, gram staining, culture for AFB. In view of mass lesion and history of fever intravenous antibiotics was given for 2weeks. Pericardial sac became empty by day seven. Fever responded after 2 weeks of treatment . Repeat echocardiography shown resolution of pericardial effusion. Patient was advised for surgery of tricuspid valve repair & was referred to higher centre. Fig 1Chest x ray showing massive pericardial effusion .View with orientation on pt. heart, shows grossly dilated RV, RA with large pericardial effusion. Fig2the Tricuspid leaflets seen in this view are septal and anterior.The leaflets appear short, malformed, thickened and do not shows proper coaptation. A small hyperechoic mass is noted on tip of anterior Tricuspid leaflet which moves with the leaflet.

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.