A case of twenty nail dystrophy affecting a 12 year old boy

Nail diseases in children may be congenital or acquired and occurs in 3 to 11% of pediatric population. Twenty nail dystrophy is a nail disorder with a classical presentation, often affecting all twenty nails. It is an idiopathic disorder in childhood but can be associated with other diseases such as lichen planus, alopecia areata, psoriasis, eczema, IgA deficiency, atopic dermatitis, ichthyosis vulgaris and vitiligo. Twenty nail dystrophy is otherwise called trachyonychia. Typically, the condition is bilateral and symmetrical affecting all the nails of hands and feet. It is cosmetically disfiguring and can be source of anxiety for children and parents, which can impact further the quality of life. Twenty nail dystrophy is of two types, based on the clinical presentation namely opaque or shiny trachyonychia. Since this nail disorder is associated with a number of dermatologic diseases, children require long term follow up. We report a case of a 12-year-old boy with a three-year history of twenty nail dystrophy with no relevant family history of skin or nail diseases. The child had isolated nail manifestation without any other dermatologic condition. Twenty nail dystrophy is a self-limiting disease, which is treated conservatively. The aim of this report is to highlight importance of a thorough physical examination to diagnose nail disorders in early stages, which will be helpful to clinicians to distinguish the different nail conditions and associated illness and decide on the correct management. It is important to counsel the family about the benign nature of the disease and good prognosis.

Self limiting fetal bradycardia associated with maternal evidence of dengue and chikungunya virus co-infection: a case report

Dengue and chikungunya infections are commonly encountered by the clinicians in a tropical country like India. We report this case to emphasize the rare manifestations of self-limiting intrapartum bradycardia in fetuses of chikungunya and dengue infected mothers. A primigravida at 32 weeks of gestation presented with history of fever for one day. The blood investigations were positive for both dengue and chikungunya virus infection. On the third day of fever, NST showed a low baseline fetal heart rate of 95 to 100 beats per minute but good beat to beat variability and three accelerations in 10 minutes. This pattern persisted for 48 hours. Although, the finding initially appeared alarming, the change in baseline heart rate of fetus was transient and self-limiting and recovered completely. Hence, a judicious approach and close fetal surveillance can avoid hasty decisions regarding an early termination of pregnancy.

Azithromycin-induced Abnormal Self-limiting Neuropsychiatric Manifestation: A Case Report

Azithromycin is one of the most commonly prescribed antibiotic. It is also considered as one of the safest antibiotic withadvantage of once a day dosage. It is also available as over-the-counter medicine. Most commonly encountered adverseeffect of azithromycin is gastrointestinal, mostly nausea, diarrhea, bloating, and indigestion. We present the case of a youngmale patient who presented with symptoms of upper respiratory tract infection and was prescribed tablet azithromycin 500 mgfor 4 days. On taking first dose of azithromycin 500 mg, the patient noticed sudden-onset acute confusional state within 2 hof ingestion. He had vivid thoughts, confusion, disorientation, and blurring of vision which lasted for 20–30 min. This episodesubsided spontaneously without any intervention. Such episode with azithromycin is exceedingly rare and hardly noticed infour patients till date. Knowledge of such azithromycin-induced neuropsychiatric manifestation is necessary and should bekept in mind.