Extrapulmonary disseminated tuberculosis with tuberculous adrenalitis: a stitch in time saves nine.

A 40-year-old manual labourer presented with easy fatiguability, recurrent vomiting and loss of weight of 3 months, duration. Upon examination, there was significant axillary and cervical lymphadenopathy. No pallor, icterus or clubbing was evident. There was generalised hyperpigmentation and multiple oral ulcers. The blood pressure 90/60 mm Hg in the right upper limb in the supine position. Investigations showed a low serum cortisol. Mantoux test was strongly positive (20 mm).A fine needle aspiration biopsy of the cervical lymph node revealed reactive changes. Bone marrow aspiration and biopsy were normal. Cervical lymph node biopsy showed caseating granulomas suggestive of tuberculous lymphadenitis. A CT scan of the abdomen showed bilaterally enlarged adrenal glands with hypodense areas suggestive of necrosis. He was diagnosed with extrapulmonary disseminated tuberculosis with tuberculous adrenalitis. He was started on directly observed therapy (DOTS) for disseminated tuberculosis and 40 mg of prednisolone. He is improving with treatment.

Idiopathic intracranial hypertension as the initial presentation of systemic lupus erythematosus.

A 14-year-old girl was referred for evaluation of headache with episodes of transient blurring of vision, and intermittent fever for 4 weeks. On examination she was conscious and febrile, with multiple annular purpuric skin lesions present over the face and back. Neurological examination revealed a bilaterally extensor plantar response, with bilateral papilloedema. Lumbar puncture yielded clear spinal fluid with a very high opening pressure with a normal biochemistry and cytology. Neuroimaging showed evidence of raised intracranial tension. She was provisionally diagnosed to have idiopathic intracranial hypertension (IIH) and started on anticerebral oedema measures. Despite medication, she continued to be symptomatic. On the sixth day of admission, her antinuclear antibody and antidouble-stranded DNA registered positively in high titres. She was diagnosed with systemic lupus erythematosus (SLE) with IIH and was started on corticosteroids, with dramatic recovery of her symptoms and clinical signs. Reports of SLE, the maiden presentation of which is IIH, are rare in the literature.

Fatal haemoptysis due to ruptured aortic arch aneurysm with aorto-pulmonary fistula.

An 80-year-old woman presenting with a single episode of acute haemoptysis yielded a cup of fresh blood. She gave a history of acute onset breathlessness and retrosternal chest discomfort, breathlessness and chest discomfort (1 day). She had no history of pulmonary tuberculosis or bleeding diathesis. She was diagnosed with hypertension 20 years before, but she discontinued medications. On examination she was conscious, alert, pale and without cyanosis or icterus. Pulse rate was 100/mt, regular BP 200/140 mm of Hg right upper limb in the supine position. The radiograph of her chest showed an aortic arch aneurysm. A high-resolution computed scan of the chest showed a leaking aortic arch aneurysm with haemothorax and destruction of the bronchoalveolar architecture. Surgical correction was planned but she succumbed because of hypovolaemic shock. This case is reported as it is an important differential diagnosis of refractory haemoptysis.

Rosai Dorfman disease: appearances can be deceptive.

A 14-year-old boy was referred to us with a history of progressive painless massive symmetrical cervical lymphadenopathy, provisionally diagnosed as lymphoma. Multiple biopsies were needed, and confirmed the diagnosis of Rosai Dorfman disease (RDD), which is a very rare benign condition. Sinus histiocytosis with massive lymphadenopathy, also known as RDD, manifests as bulky lymphadenopathy in children and young adults. Extranodal sites such as the skin, upper airways, gastrointestinal tract and central nervous system can be involved. There is a characteristic pattern of lymphoid proliferation with a thick fibrous capsule, distention of lymphoid sinuses, accumulation of plasma cells and proliferation of large, often atypical, histiocytes showing emperipolesis is characteristic. The disease is considered to be benign and usually self-limited. We emphasise the need for doing a repeat lymphnode biopsy even if the prior histopathology is suggestive of reactive lypmhnode hyperplasia in every case of persisting lymphadenopathy.

Acute onset quadriplegia.

A 50-year-old man, with history of chronic alcohol intake was brought in a stuporous state to the emergency services having been found in that condition in his home the same day. Examination revealed the patient in an akinteic mute state with apparently normal cranial nerves, hypotonia and quadriplegia with bilateral extensor plantar reflex. CT scan and MRI of the brain revealed bilateral infarct parasagittally with normal Magnetic resonance venogram suggestive of bilateral anterior cerebral artery infarct. Follow-up magnetic resonance angiogram revealed an azygous anterior cerebral artery thus proving an infarct of unpaired anterior cerebral artery infarct as the cause for quadriplegia in this patient.

Diagnostic value of microwaves in neurological disorders.

UNLABELLED: Lumbar puncture is a key diagnostic investigation in neurological diseases. The effect of microwaves on various biological tissues is an active area of research. This study describes a novel in-vitro method of cerebrospinal fluid (CSF) analysis using microwaves. AIM: To analyze normal and abnormal samples of CSF using microwave in the frequency range 2-3 GHz and to compare the variation of dielectric parameters of the CSF in the above frequency. MATERIALS AND METHODS: CSF of 34 patients admitted in the internal medicine ward during a six months period was analyzed for cells, protein and sugar content. The effect of microwaves on the CSF was measured using cavity perturbation technique and the dielectric properties in 2-3 GHz range were studied and compared. CONCLUSIONS: Microwaves, at frequencies of 2437 MHz, 2682 MHz and 2968 MHz, using the cavity perturbation technique can be used as a potential diagnostic tool in the analysis of CSF in diseases of the central nervous system.