Seronegative limbic encephalitis in association with Sjögren's syndrome: a rare case report.

Limbic encephalitis is often due to an autoimmune or paraneoplastic disease and is always a diagnostic challenge. We report a 31-year-old lady who presented with fever and proximal weakness to start with and afterwards developed refractory focal onset seizures and worsening cognition despite optimum treatment. Evaluation revealed hypokalemia with a normal anion gap metabolic acidosis. Magnetic resonance imaging (MRI) brain showed features of limbic encephalitis. Cerebrospinal fluid (CSF) showed lymphocytosis and CSF autoimmune, paraneoplastic and viral encephalitis panel were negative. However a blood ANA profile clinched the diagnosis when SS-A and Ro 52 were strongly positive. She was given steroids and subsequently plasma exchange. A labial gland biopsy confirmed the diagnosis of Sjögren syndrome. In cases of autoimmune limbic encephalitis with no identifiable cause, serological screening for rheumatological disorders is recommended. Sjögren syndrome is a rare aetiology for autoimmune limbic encephalitis. A detailed history and a step wise approach is always the key to the right diagnosis.

The emerging trends of falciparum malaria: a study from a tertiary centre in an endemic area of India.

OBJECTIVE: To document the various clinical manifestations, lab parameters, complications and outcomes of Falciparum Malaria. The above data would be correlated with the parasitic index to deduce whether it would be an effective measure of the same. METHODS: This was a prospective study among 183 inpatients aged above 18 from Kasturba Hospital, Manipal from May 2009 to January 2011. Ethical clearance was taken. Statistical analysis was done with the independent paired t test, linear correlation and Chi square test using SPSS 16. RESULTS: In this study 78% cases were males. Most cases occurred during the monsoons. Fever was the major presentation with others being jaundice, vomiting and head ache. 50.8 % had complications, including hepatic dysfunction (40.9%), renal failure (19.13%), shock (7%), altered sensorium (9%), ARDS (3.27%) and severe anemia (1.63%). Hypoglycemia and gram negative sepsis were rare. Parasitic index, renal parameters and death were correlating positively. ESR was significantly related (P<0.003) to complications and not to cerebral malaria. There were 12 mortalities out of which 9 were due to MODS and 3 due to ARDS. CONCLUSIONS: 50.8% cases conformed to the WHO definition of severe malaria indicating most present with complications. High parasite index and abnormal renal function are predictors of mortality and complications. Early diagnosis, anticipation of complications, close monitoring and combination therapy to over come drug resistance helps to contain the extent of mortality.

Domperidone induced galactorrhea: an unusual presentation of a common drug.

Domperidone is a prokinetic drug used for diabetic gastro paresis, hiccoughs, and vomiting. It is a peripheral D2 receptor antagonist with selective peripheral activity restricted to the upper gastro intestinal tract. It is not known to cross the blood brain barrier and hence, lacks neurological side effects. We would like to report a case of domperidone induced galactorrhea in a young female who presented with galactorrhea and other symptoms suggestive of prolactinoma.