The eye in dengue fever, a rarely appreciated aspect of dengue expanded syndrome: a case report.

BACKGROUND: Dengue fever is a mosquito-borne illness prevalent mainly in the tropics. It is feared for causing the dengue hemorrhagic spectrum of the disease leading to significant morbidity and mortality. Its rarer manifestations are categorized as the expanded dengue syndrome, and though being recognized, they are not fully appreciated and understood. The involvement of the eye in dengue fever is one such phenomenon. CASE PRESENTATION: A 27-year-old South-Asian woman presented on day 2 of dengue fever, without capillary leakage, for further management. Despite developing hepatitis, she had an otherwise uncomplicated progression of the illness because she did not develop capillary leakage. On day 8 of the illness, she had the lowest platelet count and developed bilateral blurred vision. Examination revealed that only gross movements were detected in the left eye, and the right eye had a visual acuity of 6/9. She was diagnosed with foveolitis in the right eye and central serous chorioretinopathy in the left eye, along with hemorrhages in both eyes. These were confirmed by funduscopy, fluorescein angiography, optical coherence tomography, and macular scans. She received systemic and intravitreal steroids and was assessed regularly. After 6 months of observation, her visual acuity was 6/6 in the right eye and 6/9 in the left eye, which remained the same thereafter. DISCUSSION: The exact mechanism of eye involvement in dengue viral infection is poorly understood. Multiple causes have been suspected and include viral factors, immune mediation, capillary leakage, stress, and hemorrhage. Eye involvement is classically seen at the lowest platelet count and when the count begins to rise. Though symptoms are nonpathognomonic, blurring of vision is the commonest complaint, but the range of presentation is extensive and variable. Ophthalmological assessment and funduscopy are very useful in addition to advanced assessments. There is no clear consensus on management; suggestions range from conservative care to aggressive steroid therapy with immune modulation and even ophthalmological intervention. Recovery can be full or partial with a variable time scale. CONCLUSION: The extensive spectrum of possible visual symptoms should prompt the clinician to suspect any visual complaint as potential dengue eye involvement. Guided studies and screening are needed to better understand the true incidence of eye involvement in dengue fever.

Portal vein thrombosis associated with psoriasis: a case report.

BACKGROUND: Psoriasis is no longer viewed as an isolated dermatological ailment and instead is considered a systemic disease. The extension of this spectrum has heightened the known risk of morbidity and mortality due to the involvement of cardiovascular system and the risk of venous thrombosis. A number of cases have reported the increased occurrence of deep vein thrombosis and pulmonary embolism in the background of psoriasis, however portal vein thrombosis has not been reported to date. We report an index case of chronic portal vein thrombosis in a diagnosed patient with psoriasis. CASE PRESENTATION: A 67-year-old South-Asian female previously diagnosed and treated for psoriasis presented with a four month history of abdominal pain associated with abdominal distension. Clinical examination revealed an enlarged spleen and free fluid in the abdomen. Imaging with ultrasonography and computed tomography of the abdomen revealed features compatible with chronic portal vein thrombosis with cavernous transformation. CONCLUSION: This case highlights the importance of having clinical awareness of occurrence of thrombosis in patients with psoriasis. Typical symptoms favoring thrombosis should prompt thorough investigation to exclude this rare yet possible complication in patients with psoriasis, including that of portal vein thrombosis. Prophylaxis with anticoagulation still lacks strength of evidence to be justified in psoriasis. The exact pathogenesis of venous thromboembolism in psoriasis is still unexplained and further studies are needed to clarify the causal association.

Dengue haemorrhagic fever presenting with cholestatic hepatitis: two case reports and a review of literature.

BACKGROUND: Dengue fever is a common mosquito borne viral fever in South Asia, which causes significant morbidity and mortality. Dengue fever is well known to involve the liver, especially in dengue hemorrhagic fever. The hepatic involvement is usually that of a mild hepatitis with transaminase derangement without jaundice. In cases of dengue hemorrhagic fever where shock has ensued, a severe hepatitis with gross derangements of transaminases and bilirubin may occur. These are two rare cases of adult patients with dengue hemorrhagic fever presenting with a cholestatic type of jaundice. CASE PRESENTATION: This case report describes two female patients aged 30 and 46 years who presented with fever, icterus and biochemical analysis revealed cholestatic jaundice. Evolution of the clinical picture and dropping platelets prompted serological investigations in the form of dengue non-structural protein 1 antigen and dengue immunoglobulin M which confirmed acute dengue infection. CONCLUSION: These cases highlight the importance of considering dengue fever as a differential diagnosis even in the presence of a cholestatic jaundice, especially in countries where dengue fever is endemic, and in travelers returning from dengue endemic countries. The early diagnosis of dengue fever and timely institution of supportive fluid management is essential to prevent morbidity and mortality.

Haemolytic uremic syndrome a hitherto unreported complication of humpnosed viper envenomation.

Merrem's humpnosed viper bite is known to cause incoagulable blood, acute renal failure, acute respiratory distress syndrome, Raynaud's phenomenon and gangrene of the distal limb. Venom-induced consumptive coagulopathy (VICC) is the commonest coagulopathy that occurs following snake envenomation which is characterised by prolonged clotting times. In a small proportion of patients with VICC, microangiopathy is also seen. The authors report a novel case of haemolytic uraemic syndrome following a merrem's humpnosed viper bite, which highlights the need for comprehensive and serial haematological evaluation to detect the condition and initiate timely plasma exchange. The authors recommend screening of all victims of humpnosed viper bite for haemolytic uremic syndrome which might otherwise be overlooked and stress the need for further studies to see the role of haemolytic uremic syndrome following humpnosed viper bite.