A possible case of systemic lupus erythematosus presenting with generalised oedema.

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown aetiology affecting various systems within the body. We report the case of a patient with generalised subcutaneous oedema as the only presenting feature, which led to the possible diagnosis of SLE without a specific cause. The patient presented to the Sultan Qaboos University Hospital in Muscat, Oman, in April 2013. The oedema had been present for two years before admission. Other potential causes of oedema in patients with SLE were excluded, including SLE of renal origin and SLE due to protein-losing enteropathy or drugs. This was confirmed by the patient's normal serum albumin level and negative proteinuria. Laboratory investigations showed high levels of positive antinuclear antibodies (>1:640), positive anti-double-stranded deoxyribonucleic acid results, high levels of anti-ß2-glycoprotein 1 and immunoglobulin M and low levels of both complement components 3 and 4. The oedema improved immediately in response to steroids and immunosuppressive medications. Physicians should be aware that generalised subcutaneous oedema can be the only manifestation of SLE.

Palpitations caused by a Seizure with Autonomic Features.

Palpitations are a common symptom of presentation in medical practice. They are usually caused by cardiac arrhythmias, psychiatric problems or other miscellaneous causes, such as anaemia or endocrine causes. They are rarely due to autonomic seizures. We report a 55-year-old woman who presented at Sultan Qaboos University Hospital, Oman, with recurrent episodes of palpitations. Her associated symptoms included breathlessness and excessive sweating, followed by a sensation of dizziness. During subsequent episodes, she experienced symptoms of rising abdominal pain followed by a loss of consciousness. Positive electroencephalogram findings, as well as the response of the symptoms to antiepileptic drugs, were strongly suggestive of temporal lobe epilepsy as the possible diagnosis. The fact that the cardiac investigations, performed during an interictal period, were unremarkable also supports the hypothesis that the palpitations were linked to seizures. Epilepsy should be considered as a differential diagnosis of palpitations, especially if the palpitations are episodic.

Clinical presentation of hypothyroidism.

OBJECTIVE: This study was to review the common and unusual symptoms of hypothyroidism. METHOD: A retrospective study was done of forty thousand patients attending Sultan Qaboos University Health Center (SQU), within a period of three years. Sixty-three patients proved to have either clinical or subclinical hypothyroidism and were screened for the different symptoms & signs of hypothyroidism. RESULTS: The well-known symptoms and signs of hypothyroidism reported in the medical textbooks were uncommon in this study. Symptoms such as dysarthria and dysphagia not usually mentioned in the medical textbooks were reported. CONCLUSION: Early diagnosis by screening both middle-aged as well as older patients is advantageous.

Hypothyroidism presenting with dysarthria.

Hypothyroidism is a common endocrine disorder with characteristic clinical symptoms and signs. Typical symptoms of hypothyroidism are lethargy, cold intolerance, slowing of intellectual and motor activity, decreased appetite, weight gain, and dry skin. A 39-year-old female presented to the clinic with dysarthria as the chief symptom. Subsequent questions revealed that other symptoms were confined to the otolaryngeal region, which were episodes of mild dysphonia, dysphagia, sleep apnea, and snoring. Laboratory data revealed marked hypothyroidism and positive tests for antithyroglobulin and antimicrosomal antibodies. After administration of thyroxin, the dysarthria and the other symptoms rapidly disappeared. Dysarthria may be the presenting symptom of hypothyroidism and can be resolved after hormone replacement therapy.