Haemophagocytic lymphohistiocytosis with lung cavity and lytic bone lesion in a 45 day infant.

Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal, hyper inflammatory condition which is caused by a highly stimulated but ineffective immune response. We are presenting here, a case of HLH which occurred in a 45 day infant. Presence of lung cavity and a lytic bone lesion in the skull, as was seen in this case, have not been reported in HLH in the literature. This raises a possibility of a simultaneous occurrence of HLH and Langerhans cell histiocytosis. In a child who presents with septicaemia but does not respond to treatment, the possibility of HLH needs to be considered.

Successful management of inoperable klatskin's tumour by high dose intra luminal brachytherapy without the need for post radiation stenting.

We present a case of Klatskin's tumour managed by high dose Intra Luminal Brachytherapy without the need for post radiation stenting. We achieved significant reduction in the cost of treatment and avoided complications associated with stenting. We were able to attain a symptom and disease free survival period of 30 months till the patient finally succumbed to metastatic peritoneal disease. We assume that small Klatskin's tumours as in the presented case with a size less than 3 cms when subjected to high dose Intra Luminal Brachytherapy with the help of 3D computed planning ensuring good tumour coverage may not require post radiation assisted biliary drainage.