ABSTRACT
We present two cases of chronic idiopathic thrombocytopenic purpura (ITP) on prolonged steroid therapy who developed subcutaneous and brain abscesses due to Nocardia asteroides. The special diagnostic and therapeutic challenges encountered in the patients because of severe thrombocytopenia are being highlighted.
Subject(s)
Adult , Brain Abscess/complications , Buttocks , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Nocardia Infections/complications , Nocardia asteroides , Prednisolone/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/complications , Soft Tissue Infections/complicationsABSTRACT
OBJECTIVE: Primary Sjogren's syndrome (SS) is rarely reported from India. We have studied the clinical spectrum and immunological profile of patients with primary SS. METHODS: A prospective analysis of patients with primary Sjogren's syndrome fulfilling San Francisco criteria, seen at our clinic in the last 10 years was carried out. RESULTS: The study included 26 patients, 21 being women. The presenting symptoms included dry eyes, dry mouth, and arthritis/arthralgia. Extra-glandular manifestations were glomerulonephritis, vasculitis, renal tubular acidosis and peripheral neuropathy. The important laboratory abnormalities were hypergammaglobulinaemia (16/20), antinuclear antibodies (18/26), anti-La (11/19) and anti-Ro (10/19). Minor salivary gland provided a definitive diagnosis in 16/26 (60%). CONCLUSION: The prevalence of primary Sjogren's syndrome is rare even in tertiary care rheumatology clinics. The clinical and immunological profile as seen here is similar to that reported in Western countries.
Subject(s)
Adult , Female , Humans , India/epidemiology , Male , Middle Aged , Prevalence , Prospective Studies , Sjogren's Syndrome/diagnosisABSTRACT
The poorer outcome of Indian patients with acute lymphoid leukemia (ALL) has been observed in earlier studies. However, little data is available on their immunophenotypic characteristics. The aim of the present study was thus to characterize the immunophenotypic subsets of Indian ALL patients and correlate with outcome at the end of induction chemotherapy. Immunophenotyping of 45 childhood and 25 adult ALL patients was performed by dual colour flow cytometry using a panel of B-lineage, T-lineage and Myeloid lineage specific monoclonal antibodies. Eighty and 17% of childhood and 92% and none of adults were B-lineage and T-lineage ALL, respectively. Aberrant myeloid marker expression was seen in 11% and 28% of childhood and adult groups, respectively. B-lineage ALL with aberrant T-lineage marker expression was observed in 4.4% and 8% of childhood and adult groups, respectively. Two each induction failures were observed in both childhood and adult groups. All of these were associated with aberrant expression of myeloid and/or T-lineage markers on B-lineage ALL. Aberrant expression of markers was associated with poorer outcome to induction chemotherapy in both childhood and adult ALL patients.
Subject(s)
Adolescent , Adult , Child , Flow Cytometry , Humans , Immunophenotyping , India , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Treatment OutcomeABSTRACT
Till date only three series of immunoproliferative small intestinal disease (IPSID) describing 22 patients have been reported from India. Seven patients with IPSID in two tertiary referral centers in India are included in the study. Diagnosis was based on typical clinical features [diarrhoea (7/7), weight loss (7/7), clubbing (6/7), fever (3/7), abdominal pain and lump (3/7)], biochemical evidence of malabsorption and duodenal biopsy findings. All patients were young males (mean age 29.8 +/- 11.8 years, range 17-53). Atypical features included gastric involvement (1/7), colonic involvement (1/7) and appearance of pigmented nails following anti-cancer chemotherapy (1/7) which disappeared six months after omitting doxorubin from chemotherapy regimen. Parasitic infestation was common. Ascaris lumbricoides (1/7), Giardia lamblia and hookworm (1/7), Strongyloides stercoralis and Trichuris trichura (1/7). In the latter patient S. stercoralis became disseminated after anti-malignant chemotherapy. One patient had gastric H. pylori infection. Four of the seven patients who were misdiagnosed as tropical sprue were treated with tetracycline. This raises doubt on efficacy of tetracycline alone in treatment of IPSID. One other patient was misdiagnosed and treated as intestinal tuberculosis. Early diagnosis and administration of chemotherapy may improve survival in this disease.