Cerebrospinal fluid involvement in a case of visceral leishmaniasis associated with hemophagocytic lymphohistiocytosis

Hemophagocytic Lymphohistiocytosis [HLH] implies a benign generalized histiocytic proliferate with erythrophagocytosis and it includes familial hemophagocytic lymphohistiocytosis and secondary hemophgocytosis. Spinal fluid changes like mild to moderate pleocytosis [most of the cells are lymphocytes and macrophages] and sometimes hemophagocytosis are seen in primary HLH but are not reported in secondary HLH. Here we report a case of a previously healthy 10 months old male infant who was diagnosed as familial HLH with evidence of CSF hemophagocytosis. He was started on the HLH 2004 treatment protocol with no improvement. A second bone marrow aspiration revealed leshmania donovani antibodies and he was started on anti-leishmania treatment with dramatic response.To the best of our knowledge, this is the first case of secondary HLH with evidence of hemophagocytosis in cerebrospinal fluid

Vitamin D deficiency rickets with hyperphosphatemia

Two interesting and unusual cases of vitamin D deficient rickets with hyperphosphatemia are presented and reviewed with regard to clinical presentation, diagnosis, treatment, and course. The cases were successfully treated with high doses of vitamin D. Renal tubular resistance to parathyroid hormone, secondary to vitamin D deficiency or chronic hypocalcemia, is discussed as the possible cause of this condition

Two cases of extravascular calcification

Two cases of extravascular calcification following calcium infusion are described. It is recomended that calcium solutions should be diluted and given by continuous infusion to avoid serious ulcerations which may result from the extravasation of calcium

Surgical emphysema complica ting kerosene poisoning

A young boy who developed subcutaneous emphysema following kerosene ingestion is presented. Treatment included the insertion of subcutaneous needles to extract the air and relieve his respiratory and cardiac embarrassment

Unusual age of presentation of hand-foot syndrome

Hand-foot syndrome is a type of sickle cell crisis usually seen in the first year of life. A known case of sickle-thalassemia presented with the hand-foot syndrome at 12 years of age, after exposure to cold weather