Behcet's disease associated with hyperthyroidism: case report and review of literature

Behcet's Disease is a multi-system, chronic inflammatory disorder characterized by chronic relapsing course. Its principal manifestations are oral and genital ulcers as well as inflammation of the eyes, skin and joints, while vascular and neurological complications may results in death. The etiology and pathogenesis of the disease are still obscure and specific treatment is not available. We report the case history of a patient with Behcet's Disease. He presented with fever, arthritis and weight loss of 3-week duration. He was also found to have hyperthyroidism, extra-pulmonary tuberculosis, and strongyloidiasis. Although, the association between thyroid diseases and auto-immune connective tissue disorders as well as tuberculosis is well recognized, there had been, to the best of our knowledge, no reports of Behcet's Disease associated with thyroid dysfunction. However, further studies are required to investigate any association between Behcet's Disease and thyroid dysfunction

Varicella induced thrombocytopenia in adults

To describe the frequency and severity of thrombocytopenia associated with adult chickenpox patients admitted in the hospital. This was a hospital based descriptive study conducted from January 2005 to March 2008 at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates. The study was designed to record demographics, clinical information, hematological and biochemical changes observed in each patient. The data was entered into a structured proforma separately. Patients with history of chronic liver disease, immunocompromized status [HIV/Drugs], history of blood disorder, recent intake of drugs/conditions which can cause thrombocytopenia and active alcohol consumers were excluded from the study. Full blood count including platelet count was performed by an automated Beckman Coulter machine. To verify the hematological finding, the cases with low platelet count [thrombocytopenia] were subjected to peripheral smear examination. A total of 110 patients were recruited into the study. The mean age +/- SD of the patients under the study was 32.9 +/- 9.7 years and males outnumbred the females, 83.6%vs 16.3%. Forty six [41.8%] patients developed thrombocytopenia and their mean platelet count was 111.8 +/ -30.59x10[3] /ul [24-149x10[3] /ul]. High frequency of thrombocytopenia was observed in patients who also had associated varicella pneumonia, hepatic dysfunction and renal impairment. None of the patients with thrombocytopenia developed bleeding manifestations during the course of the disease. Platelet count returned to the reference range within 1-2 weeks of the treatment of varicella without platelet transfusion. Thrombocytopenia is frequently associated with chickenpox. The incidence of thrombocytopenia was observed higher in patients with the evidence of disseminated disease. Furthermore, low platelet count usually does not cause bleeding tendency and count improves with the treatment of varicelta

Hematological and biochemical changes in typhoid fever

The hematological and biochemical changes due to multi-organ involvement in typhoid fever are not uncommon. The aim of this study was to determine the frequency and severity of the above changes in adult patients admitted to the hospital because of typhoid fever. This was a hospital based descriptive study conducted at the Infectious Diseases unit and medical wards at Rashid Hospital Dubai, United Arab Emirates, from March 2005 to February 2008. The study was designed to include demographics, clinical information, hematotogical and biochemical changes observed in each patient. Only patients whose blood culture yielded Salmonella typhi were included in the study. Full blood count, liver function tests, blood culture, urea, electrolytes, malaria parasite and coagulation profile were performed for all the patients, whereas viral hepatitis serology and ultrasound abdomen were limited to those with disturbed liver function tests. The patients with ALT> 3 times of normal were screened for viral hepatitis [A, B, and C] serology, whereas the patients' with significant hematologicat changes were subjected to bone marrow examination. A total of 75 patients were enrolled into the study. The mean age +/- SD of the patients under the study were 28.4 +/- 8.7 years and males outnumbered the females, 81.3% vs. 18.6%. The most common hematological changes observed were; anemia [61.3%], thrombocytopenia [40%], leucocytosis [10.6%] and leucopenia [4%]. Whereas, the biochemical changes included; raised alanine aminotransferase [73.3%], aspartate aminotransferase [62.7%], bilirubin [30.6%], alkaline phosphatase [44%], prothrombin time [57.3] and blood urea [12%], but the serum albumin was found to be low in 40%. The patients with raised ALT had high frequency of thrombocytopenia [p <0.04], raised serum bilirubin [p <0.02], alkaline phosphatase [p <0.01] and prothrombin time [p 10-fold of normal levels in 8%, serum bilirubin was >3mg/dI in 10.3% and prothrombin time was 3 sec above the control in 8% patients. All the patients were discharged in good health once hematotogical and biochemical changes returned to reference range. Typhoid fever causes significant hematological changes as well as hepatic dysfunction. The involvement of liver was associated with high frequency of extrahepatic complications. Despite the high incidence and serious nature of the hematological changes and liver involvement, these changes are transient and respond favorably to the appropriate antimicrobial therapy

Loa loa infection in non-endemic area: a case study and disease review

Loiasis is a cutaneous filarial parasite of humans caused by the filarial nematode Loa loa, which is transmitted to humans by day-biting Chrysops flies. Human loiasis is confined to the rain forest and swamp forest areas of Western and Central Africa; however; sporadic cases hove been reported from other parts of the world including India. United Arab Emirates is relatively free from arthropod-borne parasitic diseases, but the region remains vulnerable to the introduction of such infections from areas where they are endemic due to a high traffic of a large expatriate population. We report a suspected case of loaiasis in a patient from India who lived and worked in Dubai, UAE, for several years and who had never visited Africa in the past. We assume that this is the first case of loaiasis reported from the gulf region where transmission of the infection has occurred outside the endemic areas

Hepatic dysfunction is frequent in varicella infection

To determine frequency and severity of hepatic dysfunction in adult chickenpox patients admitted in our hospital. This was a hospital based descriptive study conducted from January 2005 to December 2007 at the Infectious Diseases Unit, Rashid hospital Dubai, UAE. The demographics, clinical information, radiological and biochemical changes observed in each patient were entered in a proforma. Full blood count, liver function tests, blood sugar, urea and electrolytes were done for all the patients, whereas, patients with clinical and/or biochemical evidence of hepatic dysfunction were subjected to viral hepatitis serology, coagulation profile, blood culture and ultrasound abdomen. Management was done as per standard guidelines for the management of chickenpox and its complications. A total of 105 patients were entered into the study. Serum alanine transaminases [ALT] levels were above the reference range in 50.9%. Among the 52 patients with raised serum ALT levels, 16 [30.7%] had levels > 3 times, 4 [7.6%] had > 5 times and 5 [9.6%] had > 10 times of normal levels. Serum bilirubin was increased above the normal value in 20% and was greater than 3-folds in 4.9%. High frequency of thrombocytopenia [p < 0.009], pneumonia [p0.004], impaired renal function [p < 0.01] and disturbed coagulation profile [p < 0.01] were observed in patients with hepatic dysfunction. Overall, five [4.9%] patients expired and two [1.9%] of them had acute fulminant hepatic failure. We observed that liver is frequently involved in adult chickenpox patients and the severity of hepatic dysfunction ranges from mild elevation of transaminases levels to acute fulminant hepatic failure