Symmetrical Peripheral Gangrene – A Rare Clinical Manifestation of Hodgkin’s Lymphoma

Symmetrical peripheral gangrene (SPG) is a cutaneous manifestation of a wide array of infective and noninfective etiological factors and occurs due to hypoxemia, vasoconstriction, primary endothelial damage and/or decreased cardiac output. It is a devastating complication of underlying septicemia and disseminated intravascular coagulation (DIC) with a high mortality rate and commonly requiring amputation of the affected limb in those who survive. We here describe a case that presented with fever, cough, blackish discoloration of fingers and generalized lymphadenopathy. Investigation revealed anemia, leukocytosis, coagulopathy and positive D-dimer test. Fine-needle aspiration cytology (FNAC) showed evidence of Hodgkin’s lymphoma.

Aetiological Profile of Anaemia in Elderly at a Tertiary Care Centre

Anaemia is a common clinical condition in elderly commonly associated with increased morbidity and mortality, increased hospitalization, decreased physical performance, loss of mobility and disability at higher rates than those people without anaemia. The present study was undertaken to assess the aetiological profile of anaemia in elderly. METHODSA cross sectional study was done among elderly patients with anaemia admitted in general medicine department and / or attending general medicine OPD, IGIMS, Patna, Bihar. 100 consecutive patients were selected as per inclusion and exclusion criteria. The patients were subjected to a thorough clinical examination and investigation, and data was analysed. RESULTSAnaemia is more common in males with a male to female ratio of 2.84:1. Maximum numbers of cases was in the age range of 61 to 70 comprising 70 % followed by 23 % in 71 to 80 years age group and 6 % in 81 to 90 years age group. Weakness was the most common presentation comprising 74 % cases. Comorbidities in patients along with anaemia were solid malignancy in 5 %, diabetes mellitus (DM) in 7 %, hypertension (HT) in 6 %, chronic kidney disease (CKD) in 5 %, cor pulmonale in 3 % and hypothyroidism in 1 %. 48 % patients were having moderate anaemia and 45 % patients were having severe anaemia. Morphologically most common variety of anaemia was normocytic normochromic contributing 57 % of the patients. Bone marrow examination done in 62 cases revealed hyper cellular marrow in 27, normocellular in 24, hypo cellular marrow in 6 and mildly hyper cellular to normocellular in 5 cases. Aetiological distribution showed 14 % of anaemia of chronic disease (ACD) and 14 % due to vitamin B12 deficiency. This was closely followed by iron deficiency anaemia (IDA) in 13 % cases. CONCLUSIONSAnaemia in elderly is a common clinical condition commonly presenting with nonspecific symptom. Normocytic normochromic anaemia is the most common morphological type of anaemia with various underlying treatable aetiologies.

An Incidental Finding of Polysplenia Syndrome in a Geriatric Patient: A Case Report.

Polysplenia syndrome is a rare congenital disease characterized by presence of two or more spleens and affection of other asymmetric organs. It is often recognized in childhood and rarely in adulthood. Here we report a case of polysplenia syndrome in an elderly female having multiple accessory spleens, stomach and aorta on right side of abdomen and liver, gallbladder, inferior vena cava and common bile duct on left side of abdomen. She was also having congestive cardiac failure with atrial fibrillation and lumbar vertebra collapse.

Cytodiagnosis of Microfilaria at Unusual Sites.

Filariasis is a major public health problem especially in tropical countries like India. It is routinely examined in night peripheral blood smears. Fine-needle aspiration cytology (FNAC) is not routinely used for its identification. It has always been detected incidentally, while doing FNACs for evaluation of other lesions. It has been found in lymph nodes, breast, thyroid, cystic lesions, etc. In few reported cases, it has been found even with primary/metastatic malignancy. We also found two cases of microfilaria incidentally. One on USG-guided FNAC of liver SOL (space-occupying lesion) reported as metastatic adenocarcinoma with microfilaria and other in a case of asymptomatic epitrochlear swelling reported as reactive hyperplasia of lymph node with microfilaria.

Acute Onset Hypokalemic Quadriparesis with Dengue Fever: A Case Report.

Dengue fever is an acute viral disease caused by dengue virus (DENV1- 4) and is endemic to India. It commonly presents as fever along with headache, bodyache, rashes, polyserositis, bleeding manifestations and rarely as cardiovascular, gastrointestinal, renal or neurological manifestations. Here, we report a case of dengue fever with hypokalemic quadriparesis. A 38-year-old male admitted with history of fever of 3-day duration and weakness of all four limbs of 1-day duration. His investigations showed Hb - 16.20 g/dL, platelet - 37,000/mm3, serum Na+ - 150.00 mmol/L, serum K+ - 2.50 mmol/L and positive dengue serology. Hypokalemic quadriparesis secondary to dengue fever should be considered as a differential diagnosis in a case of acute febrile illness with muscle weakness in tropical countries.

A Case of Gastric Diverticulum (Solitary Fundal Diverticulum) – Pictorial CME.

Gastric diverticula are uncommon form of diverticular disease. Akerlund classified gastric diverticula as congenital and acquired. The congenital gastric diverticulum is a ‘true diverticulum’ and involves all layers of the gastric wall. True diverticula make up 75% of all gastric diverticula, most commonly located near the gastroesophageal junction on the lesser curvature of the stomach. We report the case of a 46-year-old female patient who came for upper gastrointestinal endoscopy with history of upper abdominal pain; which was mild, continuous and increased after meals. She was diagnosed to have reflux esophagitis with mild antral gastritis and solitary fundal diverticulum.

A Clinical Study of Febrile Thrombocytopenia: A Hospital-based Retrospective Study.

Introduction: Febrile thrombocytopenia is a usually condition commonly caused by infections. The present study is intended to know the underlying etiology of febrile thrombocytopenia in our community, the various presentations and relationship between platelet count and severity of disease and prognosis. Material and methods: The study was conducted on 190 patients who presented with fever and thrombocytopenia and were admitted in Sri Ram Murti Smarak Institute of Medical Sciences (SRMS-IMS), Bhojipura, Bareilly, Uttar Pradesh from January 2011 to December 2011. Results and observations: Febrile thrombocytopenia affected all age group ranging from 18 to 88 years of age but was common in 18-40 years age group (52%) with male-to-female ratio 66.3:38.9%. It was common during the months of July to September. Fifty percent patients were having platelet > 50,001/mm3. Malaria was the commonest cause constituting 32.6%, which was closely followed by septicemia forming 31.2%. About 76.8% patients had good recovery. In 18 mortality cases, 83.33% were due to septicemia with multiorgan dysfunction and 16.67% were due to complicated malaria. Conclusion: Febrile thrombocytopenia is an important clinical condition commonly caused by malaria and septicemia.