Intestinal Behcet’s : A Rare Presentation of Behcet’s Disease

We herein present a case of 48 years old female patient presented with fever, bloody diarrhea followed by palpable purpuric rash over the body along with recurrent oral and genital ulceration. These were associated with history of symmetric polyarthralgia. On examination moderate anemia, signs of anterior uveitis were found. In blood parameters thrombocytopenia along with elevated Erythrocyte Sedimentation Rate, C-Reactive Protein were noted. On further investigations the serological tests were found to be negative for Dengue, Chikungunya, HIV, HBV, HCV. Complement C3 found to be low. Colonoscopic biopsy is diagnostic of Indeterminate Crohn’s Disease with IgA, G, M, C3, Fibrinogen immunostaining in skin biopsy. ANA, P-ANCA, C-ANCA were found to be nonreactive for the patient. All of the above mentioned points were pointing towards Behcet’s disease. For confirmation, Anti Saccharomyces Cerevisae Antibody was found to be positive . Skin pathergy test was positive. So, we diagnosed this case as behcet’s disease.

A Prospective Study to Evaluate the Possible Role of Cholecalciferol Supplementation on Autoimmunity in Hashimoto’s Thyroiditis

Introduction : Several studies have reported a low Vitamin D status in Autoimmune Thyroid Diseases (AITD), indicating association between Vitamin D deficiency (<20 ng/ml) and thyroid autoimmunity. If supplementation of Vitamin D decreases anti-TPO antibody titres, in future it may become a part of AITDs' treatment, especially in those with Vitamin D insufficiency (21-29 ng/ml) or deficiency. Objectives : Our study aims to assess any potential therapeutic role of Vitamin D in the management of HT. Study Design : It is a randomised, double blind, single centre, placebo-controlled study. Results : Significant negative correlation between Serum anti TPO Antibody and Vitamin D level; statistically significant reduction of anti TPO Antibody titre in intervention group compared to placebo group. Conclusions : Vitamin D can be a therapeutic option in Hashimoto's Thyroiditis.

Isolated Unilateral Third Cranial Nerve Palsy : A Rare Presentation of Dengue Fever

We herein report a case of unilateral 3rd cranial nerve palsy in a 15 years old boy. It can be due to numerous aetiologies like infectious, inflammatory, malignant, metabolic or vascular. In our case the nerve palsy was preceded by history of high grade fever of 5 days. Involvement of 3rd cranial nerve started 9 days after fever onset, insidiously, presenting as Ptosis and Diplopia. No history of altered sensorium, limb weakness, diurnal variation. Routine investigation was normal. Integrated Counselling and Testing Centre (ICTC) was negative. Cerebrospinal Fluid (CSF) study revealed viral picture but was negative for neurotropic viral panel. MRI brain was essentially normal except for presence of small Lipoma over prepontine cistern. Antinuclear Antibody (ANA) and Antineutrophil Cytoplasmic Antibodies (ANCA) were negative. Serology for Dengue was sent considering the history of high grade fever associated with blanchable rash. Dengue IgM report came out to be reactive. CSF Dengue IgM also came out to be reactive. Patient was put on short course of oral steroid therapy and cranial nerve palsy improved gradually. Neurological complications of dengue is uncommon. Few cases of Cranial Nerve Involvement associated with Dengue have been reported in the literature, most of them are associated with encephalitis. But in our case Cranial Nerve involvement was not associated with Encephalitis, it was probably due to immune reactions secondary to Dengue, making this case atypical.