A Rare Case Report of Leprous Macrocheilia in Borderline Tuberculoid Leprosy with Type 1 Reaction

It is well known that Mycobacterium leprae tends to target the cooler parts of the body and can involve the oral cavity. Despite this, macrocheilia - a condition where the lips become enlarged - caused by leprosy is rarely documented. There are few reported cases of leprous macrocheilia in India. We present a unique case of an elderly woman with borderline tuberculoid leprosy in type I reaction who developed leprous macrocheilia.

Stiff person syndrome: An unusual paraneoplastic neurological phenomenon in Carcinoid tumour

@#Stiff person syndrome is a rare neurologic disorder characterised by rigidity of the truncal and proximal limb muscles with intermittent superimposed spasms. It’s unique because it lacks similarity to any other neurologic disorder. Possibly tetanus is the closest related condition with both inhibiting central gamma-aminobutyric (GABA) systems. Stiff person syndrome is extremely rare with less than 20 cases reported from South Asia which has a population of nearly 2 billion. In its classic form, it is associated with the presence of high titres of glutamic acid decarboxylase (GAD) antibodies. Paraneoplastic stiff person syndrome comprising of around 5% of the patients has been reported with malignancies of the breast, colon, lung, thymus and Hodgkin’s lymphoma. Antibodies against amphiphysin and gephyrin are detected in paraneoplastic stiff person syndrome. We report a 58 year old Sri Lankan male with stiff person syndrome with a high GAD antibody titre and classical electromyographic changes, who was found to have an underlying carcinoid tumour. We postulate that stiff person syndrome was a paraneoplastic phenomenon secondary to the carcinoid in this case. Although neurological syndromes such as sensory neuropathy, limbic encephalitis and, myelopathy have been described as paraneoplastic features in carcinoid, we believe this is the first report of stiff person syndrome associated with carcinoid tumour.

Resistance to activated protein C (APC) in Indian patients of thrombophilia.

In a pilot study, 28 consecutive patients with thrombosis and 23 age and sex matched healthy normal controls were investigated with normalised APC sensitivity ratio (n-APC-SR) to know the defect exists and if so its prevalence in India. Six of the 28 (21.4%) thrombotic patients had n-APC-SR of < 0.76 (range 0.55 to 0.74) as compared to the normal control value (0.97 +/- 0.105). Our study shows APC resistance defect in a significant proportion (21.4%) of Indian patients with thrombotic disorders.

Mast cell in leprosy.

Mast cell distribution in the affected skin and in the apparently normal skin at least 10 cm away from the lesion was studied in 250 leprosy patients. These cells were found and were more numerous in the apparently normal skin of established cases of leprosy as well amongst indeterminate group. Absence of mast cells was conspicuous in 16.7% LL, 41.7% BB, 40.9% BT, and 68.0% TT lesions. It is suggested that mast cells might play a role in the early stages of the disease and in postreactional connective tissue proliferation.

Effect of melatonin on glucose tolerance and blood glucose circadian rhythm in rabbits.

Experimental studies on pinealectomized animals and in vitro studies using pancreatic tissue, have indicated that the pineal gland has a suppressive effect on the pancreatic B cells which secrete insulin. In this study, melatonin, was injected into rabbits and a statistically significant decrease in glucose tolerance was noted. The effect of melatonin in influencing the circadian rhythm of blood glucose was also studied in rabbits. Results showed that melatonin influences the circadian rhythm leading to a shift in the occurrence of minimum levels from 16.00 hr to 04.00 hr (next day) during fasting and from 16.00 hr to 20.00 hr during feeding. Also melatonin treatment lead to a statistically significant rise in blood glucose levels. It is probable that melatonin administration reduces glucose tolerance and influences the blood glucose circadian rhythm mainly through its effects on insulin release by pancreatic B cells.