Navigating the Diagnosis and Management of Rheumatoid Arthritis in the Context of Sickle Cell Disease: A Dual Challenge.

Sickle cell disease is a common condition in the eastern part of India and can often present with pain crisis, vasculo-occlusive crisis and anemia. These patients seldom have coexisting rheumatological illnesses like rheumatoid arthritis that are camouflaged with the pain crisis of sickle cell disease, leading to a delay in the diagnosis and a delay in initiating the treatment which leads to a poorer quality of life. Herein we discuss a case of sickle cell disease presenting concomitantly with the features of rheumatoid arthritis and the challenges faced in the diagnosis and treatment.

Disseminated Intravascular Coagulation Manifesting as Diffuse Alveolar Hemorrhage in a Scrub Typhus Patient: A Rarely Thought of Complication.

Scrub typhus is a common cause of an acute, unexplained febrile illness. Without proper treatment, it can lead to life-threatening complications and even death. We present the case of a 16-year-old girl who presented with complaints of fever with reddish spots all over her body for 10 days and breathing difficulty for three days. She had an episode of gum bleeding just prior to admission and two episodes of hemoptysis after admission. She had severe thrombocytopenia, a low serum fibrinogen level, raised D-dimer levels, a raised activated partial thromboplastin time as well as a raised prothrombin time, and an international normalized ratio. Her chest radiograph showed diffuse bilateral interstitial infiltrates. A diagnosis of disseminated intravascular coagulation and diffuse alveolar hemorrhage secondary to possible hematological malignancy or vector-borne infectious disease was made. She was treated with intravenous doxycycline and broad-spectrum antibiotics, along with other supportive measures. Bone marrow aspiration and biopsy showed normal trilineage differentiation, normal erythropoiesis, myelopoiesis, and megakaryopoiesis. Finally, a positive immunoglobulin M (IgM) antibody for scrub typhus clinched the diagnosis. Her condition improved over the next week, and she was discharged with the advice to continue oral doxycycline for a week. This case highlights one of the rare complications of scrub typhus, disseminated intravascular coagulation, and the importance of timely initiation of treatment in such patients.