Subdural Haematoma (SDH) Leading to Subfalcine Herniation in a Case of End Stage Renal Disease

Subdural haematoma (SDH) is characterized by bleeding into the sub dural space surrounding the brain. It is mostly associated with atraumatic brain injury. It usually results from tears in bridging veins that cross the subdural space. ESRD is a risk factor for SDH. Coagulation abnormalities, volume overload, haemodialysis and platelet dysfunction predispose to SDH in ESRD and increase the morbidity and mortality.1 We report a case of a 44-year-old female, a known case of chronic kidney disease on maintenance haemodialysis who developed SDH with resulting subfalcine herniation.

Atypical Presentation of Gitelman Syndrome (GS) Masquerading as Hypokalaemic Periodic Paralysis

Gitelman syndrome once considered to be a subset of Barter’s syndrome, is a disorder of the distal tubule.1,2 It is an inherited disorder of the thiazide sensitive sodium-chloride transport channel. It is characterised by its main clinical features of metabolic alkalosis, hypomagnesemia, hypokalaemia and hypocalciuria. It’s an infrequently diagnosed condition where there diagnosis is made based on the clinical and the biochemical parameters of the disease. We present a case of Gitelman syndrome in a young male who presented with recurrent episodes of weakness to different private hospitals with documented hypokalaemia and labelled as hypokalaemic periodic palsy (HPP), presented to us with quadriparesis and on investigation diagnosed as GS.

Splenic Abscess Complicating Scrub Typhus Induced Splenic Infarct - A Rare Case Report

Any condition leading to the interruption of blood flow to the spleen, such as blockage in the splenic artery due to a plaque or a clot in one of its branches leads to Splenic Infarction. It could also be due to infection, trauma, disseminated intravascular coagulation and vasculitis. The complications of splenic Infarct include pseudocyst, haemorrhage, rupture, aneurysm and rarely abscess formation due to infection of the infarcted region. Splenic abscess is a rare and potentially lethal clinical condition. We present a case of a 24-year-old male who was diagnosed with splenic infarct because of scrub typhus and later developed splenic abscess.Spleen is a lymphatic organ present in the left hypochondrium of the abdomen. It filters and stores the red cells, produces white blood cells and scavenges microorganisms like bacteria. Any condition leading to the interruption of blood flow to the spleen could cause an infarct. The infarction could be classified as partial or complete based on the extent of involvement. The area of the spleen which had loss of blood supply leading to the death of the area is called splenic Infarct. It could also be due to infection, trauma or certain diseases. Rarely splenic infarcts may lead to formation of abscess. The most commonly occurring symptoms of a splenic abscess pain in the abdomen, fever and nausea are not specific to splenic abscess.[1] Hematogenous spread is the most common cause of splenic abscess.[2]

Coexistence of Miliary Tuberculosis with Tubercular Sacroiliitis in a Young Immunocompetent Female.

The incidence of musculoskeletal tuberculosis accounts for about one-third of all cases of tuberculosis occurring in extra pulmonary sites. The involvement of sacroiliac joint is rare and is commonly seen in immunocompromised young adults. Here we report the case of a 22-year-old immunocompetent female who presented to us with breathlessness, cough, lower back pain on right side and high-grade fever of 15 days duration. HRCT showed miliary mottling of both the lungs. MRI hip with sacroiliac joints revealed sacroiliitis. A Mantoux test was positive with 22 mm induration after 48 hours. Sputum AFB was positive for Mycobacterium tuberculosis. Sputum CB-NAAT test was positive. Sacroiliac joint aspiration sample was positive for CB-NAAT. The patient was administered with antituberculous drugs after which her symptoms began to subside and CXR was found to be normal on subsequent follow ups.Tuberculosis (TB) is one of the world’s most devastating infectious diseases caused by Mycobacterium tuberculosis, affecting nearly one-third of the world’s population.(1) India accounts for about 27% of total Global TB burden.(2) Tuberculosis of the musculoskeletal system, though accounts for only 1-3% of total TB cases,(3) of which approximately 10% occurs at the sacroiliac joint.[4-7]The majority of cases of hip TB presents as painful, restricted movements of the hip and there comes, the dilemma of accurate diagnosis as several pathologies may mimic this presentation.

Acute B Virus Hepatitis with Fulminant Hepatic Failure Precipitating Crisis in Sickle Cell Disease.

Sickle cell disease (SCD) is a hemoglobinopathy which involves multiple organs in the body. Hepatobiliary manifestations in SCD are many. Acute and chronic HBV infection may be transmitted through multiple blood transfusions in SCD. We report the case of a 36-year-old male with sickle cell disease who presented to us in acute liver failure and sickle cell crisis due to acute hepatitis B virus infection. Sickle cell disorder is a broad category under which all the patients who have a point mutation (haemoglobin S-HbS) on at least one Beta chain due to substitution of valine in place of glutamic acid at position 6 are included. Due to this substitution, HbS molecules have a sticky site allowing the molecules to aggregate. This aggregation worsens in deoxygenated state leading to the development of long polymers, sickling of erythrocytes and haemolysis. The most commonly affected site in SCD is the hepatobiliary system. The presentation due to this involvement varies from benign hyperbilirubinemia to a spectrum of manifestations termed “sickle cell hepatopathy”.1