Disseminated Histoplasmosis Presenting as Skin Nodules.

Aim: We present a case of histoplasmosis presenting with skin nodules and lymphadenopathy from a non endemic area. Case Presentation: A 60-year-old male presented with multiple skin nodules and lymphadenopathy. Discussion: Histoplasmosis is a rare fungal infection caused by dimorphic fungus Histoplasma capsulatum, occurring in AIDS patients and other immunocompromised individuals. It usually causes pulmonary infection, following which dissemination to the other parts of the body can occur through lymphatics and bloodstream. Skin lesions mimicking tuberculosis or malignancy can be presenting feature of disseminated histoplasmosis in 10% of patients. Histoplasmosis is endemic in Central and South America and Africa. In India it is endemic in east Indian states. Conclusion: Due to non specific clinical presentations, low clinical suspicion especially from non endemic areas and lack of proper diagnostic facilities, a diagnosis of histoplasmosis is not sought. Delay in diagnosis often leads to delayed treatment increasing morbidity and mortality.

Detection of endosulfan isomers and metabolites by GC-MS in the exhumed body of an infant.

Endosulfan is a broad spectrum, non-systemic contact, and alimentary insecticide. It is a mixture of two isomers. The analysis of this insecticide, its isomers a and b endosulfan and other metabolic fragments, especially endolactone and a chlorinated dicarboxylic product in the autopsy material of an infant was performed by GC-MS in an alleged case of infanticide related to a dowry demand case. It confirmed that the child had been poisoned with endosulfan prior to death. No autopsy material, except ash and bone were left of the mother, as her par-ents-in-law had cremated her body. A new method was developed on GC-MS for the detection of this insecticide, which can be highly useful for routine analysis of insecticides in forensic laboratories. A study of various metabolites of endosulfan was also performed which may be informative for metabolic pathways studies.

Congenital jejunal leiomyoma in a neonate.

Leiomyomas of the small intestine are rare in neonates. We report a neonate with jejunal leiomyoma, who presented with acute intestinal obstruction.

Bilateral proptosis due to metastatic Ewing's sarcoma of the orbit: fine needle aspiration cytology (FNAC) and histopathology of a case.

Bilateral proptosis due to metastatic Ewing's sarcoma is an extremely rare presentation and thus merits reporting. The role of fine needle aspiration cytology in the diagnosis is highlighted.

Adrenocortical involvement in aluminium phosphide poisoning.

The effect of aluminium phosphide (AlP) which is a systemic poison on the adrenal cortex was studied in 30 patients of AlP poisoning. A significant rise in the plasma cortisol level (greater than 1048 nmol/l) was observed in the twenty patients. Mortality was 50 per cent. Autopsy study could be undertaken only in 10 patients. Histopathology showed mild to moderate changes. In the rest (10 patients), the adrenal cortex was critically involved and the cortisol level failed to rise beyond normal levels (less than 690 nmol/l). The histopathology revealed severe changes (complete lipid depletion, haemorrhage, necrosis etc.) and all these patients died. In the critically ill patients, the cortisol levels remained low because of severe adreno-cortical involvement. The changes in the adrenal cortex could be due to shock or to cellular toxic effect of phosphine. The histopathological changes in various viscera showed congestion, edema and cellular infiltration. In the heart, there were patchy areas of necrosis, while the liver showed fatty changes and the lungs showed, in addition areas of gray/red hepatization. There was no adrenal apoplexy or extensive haemorrhage that could explain shock in these patients. Cardiogenic shock could not be confirmed due to lack of facilities for haemodynamic monitoring, but there was histopathological evidence in support of cardiovascular shock.

Adult respiratory distress syndrome following aluminium phosphide ingestion. Report of 4 cases.

Four cases of adult respiratory distress syndrome (ARDS) following aluminium phosphide ingestion (ALP) are being reported. The dose of the intoxicant varied from 2 tablets (6.0 gm) to 3 tablets (9.0 gm). All patients had shock at admission and developed ARDS within 6 hours. The exhalation of Phosphine, (PH3) detected by positive silver nitrate paper test, was the possible noxious triggering factor in our cases. The cases are being reported because of their rare occurrence.