Delayed diagnosis of leprosy in a Kuwaiti child

Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, and some visceral tissues. The skin lesions take the form of macules, papules, plaques, nodules and diffuse infiltration. If hypo-pigmented macules are the only manifestation of leprosy in patients living in non-endemic areas, they may be misdiagnosed as other more common skin diseases. We report the case of an 8-year-old Kuwaiti boy who presented with hypo-pigmented macules for the last four years. He was given various diagnoses until neurologic manifestations set in. That was when the diagnosis of leprosy was suspected and confirmed by biopsy. Awareness of leprosy should be raised in non-endemic countries like Kuwait which have a sizeable expatriate work force coming from endemic areas

Herpes zoster infection in an infant

Herpes zoster in infancy is rare but can develop following intrauterine or postnatal exposure to Varicella zoster virus. We report a case of herpes zoster in a 5-month-old male baby, whose mother had varicella infection at 5-months of gestation. He was treated with acyclovir and first generation cephalosporin for herpes zoster with staphylococcal skin infection

Kikuchi-fujimoto disease

Kikuchi-Fujimoto disease [KFD] manifests in most cases as unilateral cervical lymphadenopathy, with or without accompanying fever. The disease mainly affects young women and has a self-limited course. It should be included in the differential diagnosis in suspected cases of viral infections, tuberculosis, reactive lymphadenitis, systemic lupus erythematosus and metastatic diseases. It can be histologically confused with lymphoma. The disease is benign and self-limiting and an excisional biopsy of an affected lymph node is necessary for diagnosis. There is no specific therapy

Relationship between leptin levels and suppressed CD4 counts in HIV patients

To examine the relationship between serum leptin levels and suppression of CD4 count in HIV-infected individuals with highly active antiretroviral therapy [HAART]. Thirty seropositive HIV male patients selected from the Infectious Disease Hospital were classified into two groups according to their immunological and virological response to HAART. The first group included 15 male patients with low viral load and low CD4 counts; the second included 15 male patients with low viral load and high CD4 counts. Morning serum leptin and tumor necrosis factor-alpha levels of HIV patients were measured and correlated with fasting serum insulin, Homeostasis Model Assessment for Insulin Resistance [HOMA-IR], HIV viral load and CD4 count. Serum leptin levels were significantly higher in patients with high CD4 counts than in patients with low CD4 counts [mean serum leptin level 47.3 vs. 10.9 ng/ml, respectively; p < 0.0001]. A positive correlation was observed between serum leptin levels and CD4 counts [r = 0.697; p < 0.0001]; positive correlations were also seen between leptin levels and fasting serum insulin and HOMA-IR [r = 0.633, p < 0.0001, and r = 0.537, p < 0.003, respectively]. Serum leptin level was higher in HIV patients with high CD4 count and correlated with fasting serum insulin and HOMA-IR, thereby indicating that HAART treatment could lead to decreased levels of leptin in HIV patients, which might lead to impaired immunological recovery

Atypical presentation of vibrio cholera

Cholera is known to be one of the most infectious diseases and is characterized by profuse watery diarrhea, vomiting and muscular cramps leading to dehydration, collapse and high mortality. Cholera is not endemic in Kuwait. We report a case of a Kuwaiti patient with atypical presentation of cholera that was diagnosed accidently by detection of Vibrio cholera in constipated stool. The patient was given treatment and discharged after clinical and laboratory cure. This patient is considered the first Kuwaiti cholera carrier over last ten years [documented by prevention control department in Kuwait]

Severe hyperparathyroidism versus parathyroid carcinoma: a clinical dilemma

No clinical or laboratory data allow a preoperative diagnosis of parathyroid carcinoma and only occasionally does a definitive finding differentiate an adenoma from a carcinoma. We present a case of primary hyperparathyroidism presenting with severe elevation of parathyroid hormone and serum calcium as well as complications. We go on to discuss the case in the light of a literature review. The severity of the elevation of the parathyroid hormone, other biochemical alterations, the presence of skeletal and renal complications and of a neck mass should alert the clinician to a possible parathyroid carcinoma. Radical surgery is the only effective therapy for parathyroid carcinoma, and should always be performed if a preoperative suspicion is entertained

brucellosis a common infectious cause of Pyrexia of unknown origin in Kuwait?

To investigate the prevalence of brucellosis and to compare it with other causes of pyrexia of unknown origin [PUO] in Kuwait Retrospective study Infectious Disease Hospital, Kuwait All patients admitted to Infectious Disease Hospital with a diagnosis of PUO between January 2001 and December 2004 were included in this study. Age, gender, nationality, occupation, residence and laboratory investigations One hundred thirty six patients were admitted with PUO to the hospital. Their mean age was 36.7 +/- 11.69 years [range: 14-80 years]. The mean duration of hospitalization was 8.7 +/- 7.8 days. Infectious diseases were the most common causes of PUO. Brucellosis was diagnosed in 80 [58.8%] patients, respiratory tract infection in 10 [7.4%], gastrointestinal diseases in 14 [10.3%] and HIV was diagnosed in three patients. Other diseases such as thyroiditis and glaucomatous hepatitis were diagnosed in 15 [11%] patients. Brucellosis patients had high alanine amino transferase [ALT] level and lower white blood cell [WBC] count than other PUO patients [56.9 +/- 40.6 Vs. 38 +/- 31.4, p < 0.003 and 7.1 +/- 3.9 Vs. 8.5 +/- 4.04, p < 0.01 respectively]. Brucellosis was common among Asian population [58.8% compared to Gulf residents 31.3% and other nationals 10%, p = 0.022]. Brucellosis is common among patients in high-risk occupations [62.5% compared to non-high risk occupations 37.5%, p < 0.0001]. Brucellosis is the common infectious cause of PUO among Asian and patients in high-risk occupations in Kuwait

Is low back pain prevalent among Kuwaiti children and adolescents?

To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. Subjects and A cross-sectional multistage stratified random sample of 400 schoolchildren [199 males and 201 females] of ages 10-18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% [50.8% in male and 64.7% in female students], while the point prevalence was 35% [20.6% in male and 39.3% in female students]. More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students [92.1% in males, 84.6% in females] reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students [58.4%, compared to females 36.2%] reported low-back pain caused by accident or with duration of recovery less than a week [21.8% for males as compared to 16.2% for female students]. Female students reported more recurrent or continual low-back pain. Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students