Late onset takayasu arteritis: a case report and literature review

Takayasu arteritis [TA] is a chronic inflammatory disease of the aorta and its major branches. It most often affects young women in the second and third decades of life. TA has been reported in children as young as six-month-old to adults of all ages. The initial complaints may be non-specific constitutional symptoms [e.g., fever, weight loss, lethargy]. Because these complaints lack specificity, the correct diagnosis may be delayed for months or years. There have been reported cases of TA associated with other auto-immune diseases as well as cases of atypical initial localizations [e.g., pulmonary] which had a late onset of disease. We present a case of TA in a 52-year-old Srilankan woman referred from the polyclinic with a chief complaint of headache of three months duration and arthralgia of 15-year duration

Sweet's syndrome

Sweet's syndrome [acute febrile neutrophilic dermatosis] is characterized by classical skin lesions accompanied by fever and malaise. Systemic involvement may be present and lung involvement in Sweet's syndrome has been reported in the form of bilateral pulmonary infiltrates,bronchiolitis obliterans organizing pneumonia and pleural effusion. There are dense papillary neutrophilic infiltrates on histopathology. We present a case of Sweet's syndrome with right lower lobe consolidation and persistent fever which was non-responsive to antibiotics but showed clinical improvement with clearing of radiological opacities on oral steroid therapy

Metformin induced lactic acidosis in a patients with Anorexia Nervosa: a case report and literature review

Severe lactic acidosis is a rare but life threatening complication of metformin, particularly in patients with renal failure. The mortality rate of metformin induced lactic acidosis is about 50%. Metformin is usually prescribed in type 2 diabetes and is a recognized cause of lactic acidosis in predisposed diabetic patients. We present a case of anorexia nervosa [AN] admitted with severe lactic acidosis and acute renal failure induced by six months of self medication with metformin attempting further weight reduction. The patient was volume resuscitated and started on bicarbonate infusion. She underwent immediate hemodialysis with rapid and prompt recovery. The relation between metformin induced lactic acidosis and anorexia nervosa is not known before. Reversible tubular dysfunction that may mimic Fanconi syndrome has been documented in one report. AN can be considered an additional risk factor for metformin induced lactic acidosis

prevalence of atrial fibrillation among acute medical admissions in Kuwait

To establish the prevalence of atrial fibrillation [AF] among acute medical admissions to the Adan Hospital, Kuwait, and to evaluate the clinical features of the patients. Subjects and Of 2,833 acute medical admissions to the Adan Hospital from January 1 to May 31, 2003, 120 patients with AF were included in the study. The patients were divided into paroxysmal or persistent [PPAF], and chronic atrial fibrillation [CAF]. The prevalence of stroke and clinical features of the CAF patients with and without strokes were studied. All the patients with AF underwent echocardiography to evaluate left ventricular ejection fraction [LVEF] and left atrial dimension [LAD]. The prevalence of AF in the study period was 4.24%, of which 68.3% had CAF and 31.7% had PPAF. The prevalence of heart failure, ischemic heart disease, systemic hypertension, and diabetes mellitus was 27.5, 55.8, 65.8, and 53.3%, respectively. Patients with CAF were older and had a higher prevalence of heart failure compared to PPAF patients. Of the patients with CAF, 26.8% had at least one episode of stroke. The CAF patients had lower LVEF and larger LAD than PPAF patients. Stroke patients with CAF had lower LVEF and larger LAD as compared to those without stroke. Atrial fibrillation is a common admission diagnosis in our hospital. Patients with AF commonly suffer from heart failure, hypertension, diabetes mellitus, and ischemic heart disease. There was a high prevalence of stroke among CAF patients