Multiple Cerebral Abscesses In Decompensated Cirrhosis Of Liver As A Mimicker Of Hepatic Encephalopathy: A Case Report

Cirrhosis of the liver is a state of immune dysregulation. It can give way to many infections. Brain abscess, though uncommonly reported in cirrhotic patients, deserves special attention as it presents a diagnostic and therapeutic challenge for physicians. We present here, the case of a 65-year-old diabetic and hypertensive female patient, with cirrhosis of the liver, who presented to us with fever and altered sensorium. She had mild neutrophilic leukocytosis and her serum ammonia level was slightly elevated. She was managed conservatively for hepatic encephalopathy precipitated by infection. No obvious source of infection was found on routine investigation and culture. Broad-spectrum intravenous antibiotic coverage was provided at the earliest, but the patient succumbed to multiorgan failure.

Micro-albuminuria: a predictor of short-term mortality in acute ischaemic stroke.

We studied 89 non-diabetic patients of acute ischaemic stroke, confirmed by imaging, admitted within 24 hours of onset, to investigate the prevalence and significance of micro-albuminuria (MA) as a predictor of in-hospital mortality. Two control groups consisted of 70 patients with non-stroke chronic neurological diseases and 60 age- and sex- matched healthy individuals. Spot urinary albumin-to-creatinine ratio was measured in first morning sample on days 1, 4 and/or 7. Functional status was assessed daily for 7 days by National Institute of Health Stroke Scale (NIHSS). Outcome data were recorded for 14 days. MA was found in 61.79% of acute ischaemic stroke patients on day 1 compared to 13% in non-stroke neurological patients and 7% of healthy controls. Patients with MA were older and had a higher systolic blood pressure. The 14-day disease-specific mortality was higher in patients with MA (25.45%) compared to patients without it (5.88%). High day 1 MA (>100 microg/mg) and rising or static value from day 1 to day 4 or day 7 correlated with statistically more chance of death. Increasing MA had a positive correlation with higher NIHSS score. Thus, MA was found to be a reliable predictor of shortterm in-hospital mortality in acute ischaemic stroke.

An unusual presentation of tuberculous lymphadenitis.

A 43 years male presented with recurrent epistaxis and had generalised lymphadenopathy on examination. No haematological disorder could be established even after bone marrow aspiration and biopsy but the patient was found to have tuberculosis of the lymph node on histopathology, with severe thrombocytopenia in the peripheral blood and increased platelet precursor in the marrow suggesting peripheral platelet destruction. Anti-tuberculous therapy was started but the patient died due to subarachnoid haemorrhage.