A Curious Case of Black Limb in Tuberculosis.

With a global burden of 10 million new cases per year, tuberculosis (TB) is a major health problem in developing countries like India, with an incidence of 2.69 million. With its varied presentations and huge infected numbers, TB continues to remain a dilemma to physicians. The incidence of peripheral gangrene in TB has been rarely reported. Presentation is mostly in the form of symmetrical peripheral gangrene related to sepsis and disseminated intravascular coagulation. Here, we present a case of 26-year-old male who presented as tubercular pyopneumothorax with peripheral gangrene involving a single limb.

A rare case of hydatid cyst of the neck with concurrent pulmonary hydatid disease.

Echinococcosis, commonly known as hydatid disease, is a zoonotic infection caused by dog tapeworm Echinococcus granulosus. Hydatid disease of the head and neck region is scarcely reported even in endemic areas. We herein report a case with with neck swelling and respiratory symptoms subsequently diagnosed to have disseminated echinococcosis of the neck and left lung.

Sarcoidosis presenting as bilateral optic neuritis after ChAdOx1 nCoV-19 vaccination.

Sarcoidosis is an idiopathic granulomatous disease and can virtually affect any organ system. Multiple factors, including tubercular antigens organic and environmental exposures, have been implicated in its pathogenesis. In addition to drugs, sarcoid-like reactions have been reported following varicella and influenza vaccination. Few reports of erythema nodosum and Lofgren syndrome have been reported after the COVID19 vaccination, though no histologic diagnosis was pursued in these cases. We herein report a case of sarcoidosis presenting with bilateral acute onset vision loss with a temporal association with COVID19 vaccination (ChadOx-1 n-COV, COVISHIELDTM). Symptoms started within two weeks of receiving the vaccine. Alternate causes for optic neuritis were excluded. Transbronchial lung biopsy showed the presence of non-caseating epithelioid cell granulomas. The patient received high-dose corticosteroids immediately after diagnosis, albeit with incomplete clinical improvement in vision on a three-month follow-up. In conclusion, we report a novel case of sarcoidosis-related optic neuritis following COVID19 vaccination.

Tuberculosis-Associated Septic Shock: A Case Series.

Tuberculosis septic shock (TBSS) is a rare diagnosis due to inherent diagnostic difficulty or attribution to alternate causes. We report six cases of TBSS, along with comorbidities, clinical characteristics, hospital course, and in-hospital outcomes. All patients were middle-aged, with a median age of 54.5 years (interquartile range (IQR): 47-62). Four patients were males, whereas two were females. Majority (n = 4, 66.7%) of patients had comorbidities. Diabetes mellitus (n = 3, 50%), systemic hypertension (n = 2, 33.3%), and chronic obstructive pulmonary disease (n = 1, 16.7%) were the reported comorbidities in included patients. Median Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission was 12 (IQR: 12-16). All patients had a microbiologic diagnosis of tuberculosis (TB). Four patients (66.7%) had respiratory secretions positive for Mycobacterium tuberculosis (MTB) by acid-fast bacilli (AFB) smear or cartridge-based nucleic acid amplification test (CBNAAT), two had sputum positivity, one had induced sputum positivity, whereas another had bronchoalveolar lavage specimen positive for MTB. One patient had lymph node aspirate positivity, and another had chest wall abscess positive for MTB. All had drug-sensitive TB. Five patients could be prescribed all four primary antitubercular drugs; one patient had deranged liver enzymes, requiring initiation of modified antitubercular therapy (ATT). Five patients were discharged successfully, whereas one patient died during the hospital stay. In-hospital mortality was 16.7%.