Meningeal Signs and Cerebellar Involvement in Scrub Typhus: A Case Report.

Scrub typhus is an arthropod-borne fever that follows the bite of the larval form of Leptotrombidium mite carrying Orientia tsutsugamushi. It remains a serious health problem in the Asia-Pacific region. While it commonly presents as an undifferentiated fever with chills and an eschar, complications like pneumonitis, acute respiratory distress syndrome, disseminated intravascular coagulation, and meningoencephalitis may cause scrub typhus to be fatal. However, regardless of the dramatic presentation, treatment with antibiotics, preferably doxycycline or even azithromycin, is effective in recovery.  In this case report, we present a case of meningitis and cerebellar involvement in an adolescent with positive scrub typhus serology in the absence of an eschar. This brought forward a diagnostic delay as other infections including tuberculosis were considered before scrub typhus due to unusual presenting symptoms and the lack of an eschar. Thus, in cases like these, it becomes imperative to be aware of the unusual manifestations to initiate antibiotics on time and prevent further complications.

Drug-Induced Gum Overgrowth With Low-Dose Amlodipine: A Case Report.

Drug-induced gingival overgrowth is an adverse effect of certain drugs, including amlodipine, in genetically susceptible individuals. Although the exact mechanism of gingival hypertrophy remains unclear, a unifying multifactorial hypothesis has been constructed. Gingival hypertrophy causes difficulty in speech and mastication, poor oral hygiene, and poor aesthetic appearance. Here, we present the case of a 49-year-old woman who developed gum hypertrophy following amlodipine use for two years. Maintenance of oral hygiene and substitution of offending agent is commonly the first step in management.

Maggots Around Colostomy Site: A Case Report.

Myiasis is a skin infection caused by developing larvae (maggots) of various Diptera fly species. The two most frequent flies that cause human infestations around the world are Dermatobia hominis (human botfly) and Cordylobia anthropophaga (tumbu fly). Maggots have been found to infest the nose, ear, orbit, tracheostomy wound, face, gums, and serous cavities, among other places. Maggots at the colostomy site are an uncommon occurrence. We report a case of maggots infestation surrounding the colostomy site. We came across a rather rare finding in a patient with advanced inoperable rectum cancer who initially complained of persistent nonspecific pain, discomfort, and foul-smelling discharge from the colostomy site. The issue at hand was identified to be maggots, and their removal alleviated the patient's symptoms. We underline the importance of regularly monitoring stoma sites to avoid maggot infestation, especially in tropical regions.

Successful Conservative Management of Uncomplicated Gallbladder Ascariasis.

Ascariasis is one of the common diseases in human beings worldwide. Most cases are asymptomatic. However, the high parasitic load can present with organ-specific symptoms due to the migration of worms to various regions of the body such as the lungs, nasal cavity, oral cavity, and biliary system, and sometimes with surgical emergencies like intestinal and biliary tree obstruction. Treatment modalities depend on the presentation and the complication associated with it. Uncomplicated cases can be initially managed conservatively and followed up subsequently. However, most cases of biliary ascariasis may require surgical intervention or endoscopic management due to failed management or complications. We report a case of a young male with gallbladder ascariasis diagnosed with ultrasonography and successfully treated with a single dose of albendazole 400 mg. Follow-up ultrasonography was done to evaluate the management.

Undiagnosed Case of Klippel-Trenaunnay Syndrome Presenting as Extensive Heterotrophic Ossification and Flexion Deformity of Right Lower Limb Requiring Amputation : A Case Report.

Klippel-Trenaunnay Syndrome is a rare disease characterized by a clinical triad of capillary malformation, soft tissue and bony hypertrophy, and atypical varicosity. This syndrome ranges from asymptomatic disease to life-threatening bleeding, embolism, and deformities. Management includes early diagnosis, prevention, and treatment of complications. We present a case of a 43-year-old male presenting with pain, swelling and deformity of the right leg for 30 years. On examination, diffusely enlarged tender right limb with several dark patchy discolorations, multiple tortuous vessels were found. Right leg X-ray showed heterotrophic ossification and distortion of ankle joint. Due to chronic severe pain, recurrent infection, contracture and flexion deformity of right leg, the patient underwent above knee amputation. This case focuses on the variable presentation and multiple problems faced by patients with Klippel-Trenaununay Syndrome as they get diagnosed late and shows the importance of high index of suspicion for early diagnosis and prevention of complications.