Dancing Feet Syndrome in Diabetes : Para-ballism and Para-chorea in a Diabetic Patient with Diaphragmatic Myoclonus

While movement disorders in Diabetes have long been recognized,the terminology of diabetic striatopathy is relatively more recent. Herein,we report a rare case of diabetic striatopathy in a 62-year-old woman with uncontrolled Type 2 Diabetes Mellitus who presented with Para-ballismus and Para-chorea along with diaphragmatic Myoclonus, a constellation of rarely reported before simultaneously in a hyperglycemic state.While these movement phenomena are extremely rare, the case also highlights they may persist even after acute control of hyperglycaemia, emphasizing on the need for achieving long term Glycemic control for its management

Snake bite induced delayed hypopituitarism: a rare case report

Hypopituitarism following snake bite induced AKI and dialysis is an uncommon complication. Often the presentation is delayed and Can present with a myriad of features. We present a case of a 27 year old male patient, with past history of snake bite and acute kidney injury (AKI) requiring dialysis and which subsequently resolved, presenting to us with fatigability and weakness, absence of secondary sexual character and poor academic performance. On examination, the patient had pale white and coarse skin. Hoarseness of voice was present. There was proximal upper and lower limb muscle weakness present with pseudo myotonia on examination. There was loss of axillary and pubic hair with low testicular volume. Routine reports suggested mildly elevated creatinine with severely elevated Triglyceride levels. Creatine phosphokinase (CPK) was raised. Hormonal profile revealed low free thyroxine (FT4) and serum 8 a.m. Cortisol but an inadequate increase in thyroid stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH) levels were suggestive of central hypopituitarism. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), Insulin-like growth factor 1 (IGF-1) levels were reduced. Neuroimaging revealed empty sella suggestive of pituitary apoplexy. The above were suggestive of delayed hypopituitarism following post snake bite dialysis mediated pituitary apoplexy. In all cases of snake bite, a common occurrence in our country the possibility of hypopituitarism should be kept in mind and the hormonal profile followed up closely along with the renal parameters.

Unusual coexistence between lupus nephritis and neurofibromatosis 1: a case report and review of previous cases.

The association of Neurofibromatosis 1 (NF 1), an autosomal dominant genetic disease with autoimmune diseases like systemic lupus erythematosus is rare, five case reports are there in medical literature showing such association. Here we have documented a case of Lupus nephritis associated with Neurofibromatosis 1 diagnosed in the same setting, in a 24 years old female patient presented with oliguria, hypertension, anasarca, cafe-au-lait spots, palmer freckling, subcutaneous nodules, alopecia areata and positive family history for NF 1.

A rare cause of bleeding gastric ulcer: multiple myeloma.

The causes of GI bleed are many and varied with peptic ulcers accounting for about 50% cases. Multiple myeloma is the most common lymphoid neoplasm in older adults and accounts for approximately 10% of all hematologic malignancies. Extraosseous manifestations are said to be present in less than 5% of patients with Multiple Myeloma with GI ulcers only being described rarely. In this report we describe a case of a 58 year old lady presenting with weakness, palpitations, gum bleeding with recent onset melena. She had severe anaemia with thrombocytopenia and markedly elevated ESR. An UGI endoscopy revealed a 1x0.5 cm ulcer infiltrated by lymphoplasmacytic cells and histiocytes with a few neutrophils. Serum globulin fraction was markedly high and Serum protein electrophoresis revealed it to be a case of multiple myeloma with Igʎ secreting monoclonal cells. Bone marrow aspirate revealed 40 % plasma cells with some binucleate and trinucleate forms. The patient was diagnosed as stage III multiple myeloma (International staging system) and treated with dexamethasone, zoledronic acid and thalidomide. Our case highlights a very atypical presentation of multiple myeloma and alerts the clinician to keep an eye of suspicion in dealing with peptic ulcer cases especially in the elderly.

Two unusual neuro-psychiatric manifestations of malaria in a tertiary care hospital: a review of literature.

Malaria, a highly prevalent parasitic disease in tropical country, have some atypical neuro-psychiatric manifestations seen in both vivax and falciparum malaria. We are reporting two cases of unusual neuro-psychiatric manifestations of malaria admitted in our hospital, one with intralobar haemorrhage and other with atypical psychiatric features. The rarity of the presentation has been highlighted with possible pathogenesis discussed after literature review.

Role of clinical biochemistry laboratory in the diagnosis of diabetes mellitus.

Clinical biochemistry and laboratory help is needed at all stages of diagnosis of diabetes. Laboratory plays a key role in the management of diabetes and its complications like renal, metabolic, and others. Monitoring of treatment is also guided by regular blood sugar estimation and self-monitoring of blood glucose level.