A vegetable-induced hemolytic crisis in a G6PD deficient person: a case report.

BACKGROUND: Hemolysis can occur in people with G6PD deficiency under oxidative stress. Acalypha indica is a tropical plant used as a medicinal plant as well as a vegetable. There are a few reported cases of Acalypha indica ingestion induced hemolysis in G6PD deficient people. All except one of them are from Sri Lanka. The information available at present (2017) about G6PD deficiency prevalence and variants of the G6PD gene among Sri Lankans is very sparse. There are no past reports on hemolytic crisis in a G6PD deficient person presenting mimicking leptospirosis. CASE PRESENTATION: A middle-aged Sri Lankan man presented on the third day of illness complaining of fever, head ache, arthralgia, myalgia, abdominal pain, vomiting, passing dark urine and reduced of urine volume. He gave a history of possible exposure to leptospirosis. He was pale, icteric and his liver was palpable 1 cm below costal margin and there were no other remarkable findings upon physical examination. He had neutrophilic leucocytosis. Leptospirosis was diagnosed. During the second assessment we noticed he was very pale and his urine sample pointed towards hemoglobinuria. Further questioning revealed he had consumed leaves of Acalypha indica as a vegetable. Acute hemolysis in a G6PD deficient patient following Acalypha indica ingestion was diagnosed. Blood transfusions were given to correct his anemia. Later, Brewer's test and quantitative assay of G6PD levels confirmed the diagnosis of G6PD deficiency. CONCLUSIONS: A hemolytic crisis following oxidative stresses in G6PD deficient patients can present mimicking leptospirosis. Further investigations may reveal why the great majority of cases of acute hemolysis in G6PD deficient person following Acalypha indica ingestion are from Sri Lanka.

A dengue infection without bleeding manifestations in an adult with immune thrombocytopenic purpura.

BACKGROUND: Dengue is the most prevalent and fast spreading arboviral infection affecting people. No specific drug is available to treat dengue. Thrombocytopenia with potential of serious hemorrhages is one of the hall mark features of dengue. Immune thrombocytopenic purpura is an autoimmune disease causing thrombocytopenia. If a patient with that gets dengue, we expect severe thrombocytopenia with bleeding manifestations. Only a handful of such cases were reported before, and they were managed in different ways. CASE PRESENTATION: A 30-year-old Sinhalese man recently diagnosed of immune thrombocytopenic purpura and on prednisolone was presented on the fourth day of fever, head ache, arthralgia, myalgia, and nausea. We started standard symptomatic dengue management and continued prednisolone. Dengue IgM and IgG antibody tests became positive. He was monitored by physical signs and serial full blood counts as the mainstay of monitoring. The patient never developed clinical bleeding manifestations and recovered. CONCLUSIONS: Considering the huge population at risk of dengue, generating more evidence on the topic and formulation of effective, simple guidelines to manage dengue in children and adults with immune thrombocytopenic purpura is going to be beneficial for many patients in the future.