ABSTRACT
Introduction and importance: Most dengue infections are asymptomatic, and some of them develop haemorrhagic manifestations with or without shock. However, dengue can sometimes present with very rare complications like pyomyositis. Case presentation: A healthy 27-year-old male, presented with a 2-day fever, confirmed to be dengue through a positive non-structural protein 1 test. Despite initial symptomatic management, his condition worsened and he was hospitalized. Leucocyte and platelet counts dropped to the lowest value on the seventh day of illness, followed by the gradual development of chest pain, persistent fever, and severe limb pain. Radiographic evaluation revealed pleural effusion, and multiple intramuscular haematomas complicated by pyomyositis. Pleural effusion resolved on its own. Pyomyositis resolved with 6 weeks of appropriate antibiotics and aspiration of pus. Clinical discussion: Dengue infection, caused by a dengue virus transmitted through Aedes mosquitoes, is a significant public health concern in many parts of the world. Dengue haemorrhagic fever is a severe form of dengue infection characterized by vascular leakage, thrombocytopenia, and bleeding manifestations. Although musculoskeletal manifestations are common in dengue fever, the occurrence of multiple muscle haematomas and pyomyositis as complications of Dengue haemorrhagic fever is rare. Drainage or aspiration of pus combined with the antibiotics according to the pus culture and sensitivity report is the management strategy. Conclusion: Prolonged fever with severe musculoskeletal pain and focal tenderness on examination in a dengue patient, warrant radiographic testing (ultrasonography or MRI) considering the differentials of haematoma, myositis, or pyomyositis.
ABSTRACT
Bladder neck contracture is a common complication of the TURP. Traumatic inflictions may lead to the formation of scar tissue around the bladder neck which makes this tubular structure narrower than the normal. It causes urinary flow obstruction associated with pain, heaviness, hesitancy and incomplete bladder emptying. In Ayurveda, such features have been described under the context of Vatakundalika and Mutrotsanga under the chapter 58 named 'Mutraghata Pratishedha Adhyaya'of Uttar Tanta of Sushruta Samhita. Bladder neck resection surgery is considered as the surgical treatment in this case but the recurrence rate is high. In Ayurvedic texts, Uttarabasti has been indicated in the treatment of various urinary disorders. A 70-year-old male patient visited the Outdoor Patient Department (OPD) of hospital of National Institute of Ayurveda (NIA), Jaipur, Rajasthan, India; with chief complaints of difficulty in micturition, pain during micturition along with poor stream of urine for the last 2.5 years. He had past history of surgical intervention of Transurethral resection of prostate (TURP) for prostatomegaly and transurethral incision of bladder neck (TUI-BN) of bladder neck contracture. This was diagnosed as a case of recurrent urinary bladder neck contracture and was managed with Uttarabasti of Bala-Ashwagandhadi Taila and oral Ayurvedic medicines with encouraging results. Ayurveda may prove helpful in such type of recurrent and recalcitrant cases and the intervention of Uttarabasti Karma is specifically indicated for the same.
