Thyrotoxic Neuropathy - A Case Report

Thyrotoxic neuropathy is a rare entity in literature. The association between thyrotoxicosis and neuropathy is under-recognized. We here present a rare case report in which patient was presented with ascending sensory-motor paralysis coupled with respiratory muscle weakness which closely resembles Guillain–Barré syndrome (GBS). But relevant history suggested thyrotoxic features, thus a timely focused investigation revealed the diagnosis. It was confirmed in nerve conduction studies (NCS) and other necessary investigations ruled out other differential diagnosis. Patient was treated with anti-thyroid drugs. On follow up patient’s power improved and NCS after 6 months came out to be normal which established the diagnosis. Thyrotoxic neuropathy is a close differential diagnosis of LGBS and other commonly encountered neuroparalytic illnesses. So high degree of suspicion is needed to diagnose this potentially treatable neuropathy

Rheumatoid Arthritis 1st Time Presenting With Bilateral Pleural Effusion- A Rare Presentation

Rheumatoid arthritis is the most common chronic autoimmune disorder involving joints and extra-axial system. Varied presentations have been described in the literature. Pulmonary involvement is also common. Inflammatory pleural effusions are an uncommon complication and are rarely seen in about 2% to 5% of patients with rheumatoid arthritis. Here, we present an interesting case where the patient presented with bilateral pleural effusion early in the disease. On further evaluation of the patient and the pleural fluid, it was found to be consistent with pleural effusion secondary to rheumatoid arthritis. The patient responded to oral non-steroidal anti-inflammatory drugs along with disease-modifying agents

Liver Cirrhosis First Time Presented With Delirium Unveiled As Accidental Secondary Hypothermia

Liver cirrhosis is a condition which is defined histopathologically but cannot be diagnosed clinically without any non-invasive tests. There are various etiologies of cirrhosis such as alcoholic liver disease, chronic viral hepatitis B, C, and non-alcoholic fatty liver diseases. Liver, not only function as an organ for detoxification, conjugation, and synthesis but also it regulates body heat. Cirrhosis patients thus are prone to body heat loss and hyperthermia. We present a case with undiagnosed liver cirrhosis patient, 1st time presenting with altered sensorium, revealed as accidental secondary hypothermia with ECG changes of hypothermia. The patient treated for hypothermia only after which she recovered.

Lymphocytic Hypophysitis Masquerading As Transient Secondary Hyperadrenalism Followed By Panhypopituitarism

Lymphocytic hypophysitis (LH) is a rare inflammatory disease of the pituitary gland. This condition strikingly shows female preponderance and commonly affects women during pregnancy or in the post-partum period. It’s a clinical presentation and radiological features may mimic pituitary adenoma. Though its treatment modality is uncertain steroid remains the 1st option for treatment. Here, we report an unusual case of LHin a 21-year-old female patient where initially, the patient presented with hyperadrenalism and secondary hyperthyroidism followed by pan-hypopituitarism (Addisonian crisis) which is attributed to initial autoimmune destruction of the gland followed by subsequent fibrosis. Thus, it is a rare case report which exquisitely explains this rare presentation and such cases should be investigated thoroughly since there are many differential and response to steroids is remarkable

Role of diffusion weighted MRI in characterization of renal diseases

Background: MRI has the unique ability to show both structure and function objectively without any radiation exposure to the patient. Apparent diffusion coefficient (ADC) is a quantitative parameter that combines the effects of capillary perfusion and water diffusion. Renal parameters have shown inverse relationship with the ADC values in these studies. So, ADC values have a potential to serve as a marker of renal function. The aim of the present endeavor was to study the role of DW MRI in characterization of renal function and to find out the clinical use of DW MRI in renal diseases; and establish the relationship between renal function assessed by eGFR and that by DW MRI calculated in terms of ADC values in various renal diseasesMethods: Total 30 patients were included in the study. The study was carried out in department of radiodiagnosis at Dr. RPMGC Kangra. 1.5 Tesla MRI machine was used. The ADC value was calculated at upper, mid and lower pole of each kidney and the mean was taken. Then the mean of right and left kidneys was taken to calculate the mean ADC of the patient.Results: Serum creatinine in present study ranged from 0.67 to 13.9mg/dl, with mean value of 7.28mg/d. Serum urea ranged from 22 to 293mg/dl with the mean of 119.6mg/dl. There was significant inverse correlation occurred between ADC values and serum urea (r=-0.43, p=0.02). There was significant inverse correlation between ADC values and serum creatinine (p=0.01) and a positive correlation between eGFR and ADC values (r=0.14, p=0.47).Conclusions: ADC values consistently decreased with increasing stage of renal failure, so these can be used as an indirect maker of renal function. Authors conclude that lower would be the ADC value more advanced would be the stage of renal failure. DW MRI can also be detect early stages of renal failure even when the serum maker are within normal range.