Takayasu's arteritis in association with tuberculosis in a young woman

A possible relationship between Takayasu's arteritis [TA] and Tuberculosis [TB] has been proposed. Both diseases present similar chronic inflammatory lesions and occasionally granulomas on the arterial walls. We report a case of simultaneous presence of Takayasu's arteritis and tuberculosis in a 20 year old lady. She presented with fever, pain and intermittent claudication of all four limbs and easy fatigability for two months. We found an enlarged lymph node in left axillary region. All the peripheral pulses were absent and measurement of blood pressure was not possible. Her ESR was 62 mm in 1[st] hour and C reactive protein was 12mg/L. Duplex vascular USG revealed significant narrowing of both subclavian arteries and descending abdominal aorta. Histopathology of left axillary lymph node showed caseating tubercles suggestive of granulamatous tuberculous lymphadenitis

Coexistence of systemic lupus erythematosus and Addison's disease

An 18 years olds girl, presented with complaints of continued low grade fever, jet black skin rash and photosensitivity, generalized hyperpigmentation, marked anorexia with extreme lethargy, dull aching abdominal pain with frequent loose stools. Painless oral ulcers, moderate loss of hair, remarkable weight loss, with joint pain, morning stiffing, colour changes of fingers on exposure to cold with digital ulceration. She was amenorrhoic during the period of illness. She was extremely ill with moderate anaemia, raised temperature, postural hypotension, pigmented butterfly rashes on the face and discoid lesions all over the body. Marked pigmentation on the palmer creases, base of the nails, knuckles of the hands, buccal mucosa, gums, tongue, aerola of breasts and valvae, with oral ulcers were present. There were symmetrical polyarthritis with restriction of movement. Laboratory investigations showed an elevated ESR, low haemoglobin, normal platelets, total and differential count of WBC, prothrombin time and APTT were normal, with positive ANA and anti-ds DNA antibody, normal IgG anticardiolipin antibody and a positive direct Coombs' test, with moderate proteinuria. X-ray chest and KUB regions were normal. Abdominal CT scan showed bilateral adrenal cortical atrophy. Tuberculin test was negative. There was hyponatraemia and relative hyperkalaemia. Low serum cortisol level at 8:00 am and positive short synecthine test. Treatment started with prednisolone 1mg/kg in three divided doses which resulted in dramatic improvement, then prednisolone was gradually tappered to 7.5 mg daily. She was in remission during four years follow-up

Puffer fish poisoning: a clinical analysis

To ascertain the clinical manifestations, complications and clinical outcome of Puffer fish poisoning. Setting: The study was carried out in the Department of Medicine and Paediatrics, Khulna Medical College Hospital [KMCH], Khulna, Bangladesh. The period of study ranged from admission of patients till discharge. Subjects and On April 18, 2002, a large number of patients from eight families were admitted to KMCH. A presumptive diagnosis of Puffer fish [tetrodotoxin] poisoning was made on the basis of history of recent consumption of Puffer fishes [Fugu] and classical clinical presentations. The cases were clinically reviewed periodically and routine investigations were done. A total of forty-five persons developed manifestations of Puffer fish poisoning out of which thirty-seven needed hospitalizations. Important symptoms observed were peri-oral tingling sensation [24], weakness of both lower limbs [22], tingling and numbness throughout the body [18], headache [15] etc. Twenty-two patients developed ascending paralysis and 17 of them developed respiratory muscle paralysis. Out of thirty-seven admitted patients twenty-nine improved with conservative treatment. Eight patient died due to respiratory failure. Although Puffer fish is available in our country and Puffer fish poisoning is sporadic, ignorance regarding its proper cooking process may lead to serious clinical hazards including fatality. It has no specific treatment. Health personnel should have sufficient knowledge regarding its clinical manifestations, complications and management. People should be made aware of the potential risk of eating Puffer fish