Tony Ete

Sterno Clavicular Joint Osteoarthritis in a Patient With Rheumatoid Arthritis: A Case Report With Classical Sonographic Features

Osteoarthritis of the sternoclavicular joint (SCJ) is a common entity. Plain radiographs and computed tomographic scans are the modalities commonly used for diagnosis of SCJ osteoarthritis. Classical imaging findings are joint space narrowing, marginal sclerosis, and osteophyte formation. Widespread application of ultrasonography (US) in the evaluation of multiple musculoskeletal pathologies has been made recently. However, the sonographic features of SCJ osteoarthritis have not been reported. We report a case of unilateral SCJ osteoarthritis in a patient with rheumatoid arthritis (RA) and describe its typical sonographic features.

Interstitial Lung Disease as Presenting Feature of SLE

Interstitial lung disease (ILD) has been considered as an unusual pulmonary manifestation of systemic lupus erythematosus. Patients of ILD usually present with progressive dry cough and exertional dyspnea. ILD is usually seen in long standing SLE patients and follows a chronic course. ILD as the initial manifestation of SLE is very rare. Our middle aged female patient presented with pulmonary symptoms, renal impairment and arthralgia. She was finally diagnosed as having SLE by relevant autoantibody profile and renal biopsy along with HRCT proven ILD.

A Classical Image of Dermographism

Clinical Image: A 31year old male presented with complain of itching followed by localised swelling of the part that has been scratched. He also complained of swelling of parts of limb and back on being hold tightly, stroked or rubbed and intermittent swelling of lips. Symptom was worsened by abrasive and tight clothings. The patient had no history of respiratory symptoms suggestive of asthma. General survey and systemic examination was normal other than raised skin within minutes on scratching left arm with a pinhead suggestive of dermographism (Panel A-G). Routine blood count revealed haemoglobin 13 gm/dl, a leucocyte count of 8000/ cumm with increase in the percentage of eosinophils. The absolute eosinophil count was 880/cumm. Serum IgE level was 835 IU/ml. The patient was treated with albendazole (400 mg), levocetrizine (5 mg) for four weeks and with a H2 receptor antagonist with an advice to follow after one month.

Scrub Typhus Presenting with Bilateral Lateral Rectus Palsy in A Female.

Scrub typhus, a rickettsial disease is endemic in several parts of India usually presenting with acute symptoms. Fever, maculopapular rash, eschar, history of tick exposure and supportive diagnostic tests usually leads to diagnosis. Scrub typhus should be included in the differential diagnosis in occasions when a patient presents with fever with or without eschar and isolated cranial nerve palsy. Here we are reporting a case of Scrub typhus who presented with fever and altered sensorium of short duration, eschar formation and bilateral lateral rectus palsy. Patient was treated with doxycycline with complete reversal of neurodeficit.

Acute Pancreatitis in a Patient with Complicated Falciparum Malaria.

Malaria is one of the most common protozoan diseases, especially in tropical countries. The clinical manifestation of malaria, especially falciparum malaria varies from mild acute febrile illness to life threatening severe systemic complications involving one or more organ systems. We would like to report a case of complicated falciparum malaria involving cerebral, renal, hepatic system along with acute pancreatitis. The patient was successfully treated with anti malarial and other supportive treatment. To the best of our knowledge there are very few reports of acute pancreatitis due to malaria. Falciparum malaria therefore should be added to the list of infectious agents causing acute pancreatitis especially in areas where malaria is endemic.

Hemophagocytic Syndrome Associated with Scrub Typhus: A Case Reportfrom North East India

Scrub typhus infection is an important aetiology of acute undifferentiated fever in south-east Asia and India. Haemophagocytic Lymphohistiocytosis (HLH) (haemophagocytic syndrome) is a potentially fatal hyper inflammatory syndrome that is characterized by histiocyte proliferation and haemophagocytosis. We describe a case of Haemphagocytic syndrome secondary to scrub typhus which presented with fever, rash, pancytopenia, epistaxis and haematuria who responded dramatically with respect to haematological parameters and clinically following prompt antimicrobial therapy. Scrub typhus with hemophagocytic syndrome can be complicated by multiorgan failure. Patients with scrub typhus usually have an excellent response to treatment; therefore, early diagnosis and prompt administration of antimicrobial therapy may prevent the development of serious complications.

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.

MRI features of multiple system atrophy

Multiple system atrophy (MSA) is a synucleinopathy, characterized by combined manifestations of cerebellar, parkinsonian, and autonomic features. It is subdivided into two main types-parkinsonian MSA (MSA-P) and cerebellar MSA (MSA-C). Magnetic resonance imaging (MRI) of the brain is a valuable tool in diagnosing this condition as it shows many characteristic features, such as the ′hot cross bun′ sign. This is a cruciform hyperintensity imaging feature, seen at the level of pons in axial T2-weighted MRI images. This sign is typically seen in patients with MSA-C. This reported case describes a patient with MSA-C with characteristics brain MRI features.

IgG4 Related Disease-The Great Masquerade

IgG4 related disease is an uncommon disease that presents with diverse clinical manifestations. Interestingly the disease is a great masquerade of many other autoimmune and malignant conditions. Rare occurrence and varied clinical phenotype makes this disease a challenging one for the clinicians. Here we present a case of IgG4 related disease in a 50 year old female, who initially presented with low grade fever, sicca symptoms, eyelid swelling with proptosis along with bilateral salivary gland enlargement. Final diagnosis was made from characteristic histopathological finding and markedly elevated serum IgG4 level.

Leptospirosis complicated with meningoencephalitis and pancreatitis – A case report -

In severe leptospirosis multi organ involvement is common. Pancreatitis and meningo encephalitis are two uncommon manifestations of leptospirosis. Our patient presented with fever, jaundice, altered sensorium and subsequently developed severe pain abdomen. He was finally diagnosed as having icteic leptospirosis complicated with pancreatitis and meningoencephalitis. Simultaneous presence of these two complications in a patient of leptospirosis probably not been documented before.