Olanzapine Induced Dilated Cardiomyopathy

A 28-year-old male patient with bipolar disorder taking olanzapine and lorazepam for almost 10 years presented with weight gain, diabetes, and anasarca was examined in this study. Evaluation of the patient revealed he was in heart failure. The reason for his heart failure was ambiguous and an investigation into it revealed negative results. Literature search conducted showed a few reported cases of putative olanzapine induced cardiomyopathy. One such relatively rare case is presented here.

Diabetic ketoacidosis with Ebstein's anomaly in an adult

Ebstein's anomaly is a rare form of congenital malformation of the heart, characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialisation of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet. It may not be detected until late in adolescence or adulthood. The clinical manifestations of Ebstein's anomaly vary greatly. We are reporting a case of 35-year male who presented with generalized fatigue, palpitation and effort intolerance. Laboratory investigations confirmed the diagnosis of diabetes ketosis. Transthoracic echocardiography showed severe Ebstein's anomaly with severe tricuspid regurgitation, no residual atrial septal defect, but with severe right ventricular dysfunction. Though only few studies showed the high prevalence of abnormal glucose metabolism in young adult patients with complex congenital heart disease, but Epstein's anomaly with diabetes ketosis was nowhere mentioned

Atypical manifestations of typhoid fever.

BACKGROUND: High fever, toxaemia, constipation during first week of fever, complicated by encephalopathy and perforation during third week of fever are the typical manifestations of typhoid fever. However, the classical presentation of typhoid fever has considerably changed now. AIM: To study atypical presentations of typhoid fever. SETTING: A teaching unit of a hospital in South India METHOD: All culture-positive adult patients of typhoid fever admitted over a period of seven years were studied RESULTS: Thirty-two adult patients were admitted. Fifteen (46.9%) patients presented with atypical manifestations. Atypical manifestations observed were burning micturition with normal urine examination (n= 5, 15.6%) diarrhoea in first week (6.2%), encephalopathy in first week (3.1%), isolated hepatomegaly (6.2%), pneumonitis (3.1%) and bone marrow depression (6.2%). Out of 32 Salmonella typhi culture positive patients, 10 (31.3%) patients had multidrug resistant (MDR) strain. Patients with MDR strains had atypical manifestations (5/10=50%) not significantly more often than patients having multidrug sensitive strains (10/22=45.5%) (Z <2). All patients responded to treatment. CONCLUSION: It appears atypical manifestations do not necessarily mean a worse prognosis in typhoid fever. Patients having high fever presenting with pneumonia, early encephalopathy, early diarrhoea or bone marrow depression in a typhoid endemic area, should be suspected for this disease.

Hepatic artery mycotic aneurysm of tubercular aetiology.

Hepatic artery aneurysm caused by tuberculosis is extremely rare, the commonest being atherosclerosis and vasculitis. A 13 year boy admitted with suspected disseminated tuberculosis had a hepatic bruit. Patient died of aneurysmal rupture before antemortem etiological diagnosis could be established. Postmortem examination revealed widespread tubercular lesions in the chest and abdomen and hepatic artery aneurysm.