Afebrile scrub typhus infection with cardiac manifestation.

Scrub typhus is an acute febrile disease transmitted via bites from mite larvae (chigger) infected with Orientia tsutsugamushi. Arrhythmias, ischaemic changes and QT prolongation are some of the observed ECG abnormalities. The patient being reported presented with angina and was found to have sinus bradycardia with ST elevation in inferior leads and T wave inversion in lateral leads. His coronary angiography was normal. Further evaluation leads to the diagnosis of scrub typhus infection. Following doxycycline therapy, his ECG became normal. Afebrile scrub typhus infection with cardiac manifestation is an uncommon scenario.

Hypocalcemic Seizure Due to Vitamin D Deficiency.

AIM: To emphasize the importance of vitamin D supplementation. BACKGROUND: The incidence of vitamin D deficiency has been increasing worldwide, probably due to decreased exposure to sunlight and unbalanced diet. Severe hypocalcemia following vitamin D deficiency is rather uncommon, and this leading to seizures in adults is a rare scenario. CASE DESCRIPTION: This is the case of a 70-year-old female, a known case of coronary artery disease, who presented with one episode of seizure. Computed tomography of her brain revealed diffuse age-related atrophic changes, and electroencephalogram showed diffuse cerebral dysfunction. She was found to have severe hypocalcemia with secondary hyperparathyroidism due to vitamin D deficiency. Vitamin D bolus was given along with calcium correction, following which she improved. CONCLUSION: There are a few reports of hypocalcemic seizures among children; however, the incidence is rare among adults. Calcium and vitamin D supplementation forms the mainstay of treatment. CLINICAL SIGNIFICANCE: Hypocalcemic seizure is uncommon, especially among adults. Vitamin D deficiency resulting in hypocalcemic seizure, to the best of our knowledge, is an unreported scenario. This case highlights the importance of vitamin D supplementation in those with reduced sunlight exposure. HOW TO CITE THIS ARTICLE: Manappallil RG, Krishnan R, Veetil PP, Nambiar H, Karadan U, Anil R, et al. Hypocalcemic Seizure Due to Vitamin D Deficiency. Indian J Crit Care Med 2020;24(9):882-884.