A Case Series on the Recent Nipah Epidemic in Kerala.

During May 2018 there occurred an outbreak in Kerala, which started in Soopikkada Village, Changarothu Grama Panchayath in Perambra Taluk, Kozhikode district, of a febrile illness with altered sensorium and ARDS. The diagnosis was made from the second case that it is the dreaded nipah infection. Following that 18 cases tested positive for nipah virus infection of which 2 survived. Also there were four deaths with similar clinical picture but which occurred before the virus was identified. They were considered as probable cases.

An unusual cause of orthopnoea-hashimoto's thyroiditis presenting as bilateral diaphragmatic palsy.

We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.

Lemierres Syndrome in Pregnancy Secondary to Retropharyngeal Abscess.

Lemierres syndrome (LS) refers to suppurative thrombophlebitis of internal jugular vein (IJV) secondary to oropharyngeal infection. It is caused by the anaerobic bacteria Fusobacterium necrophorum. Here we report a case of LS secondary to retropharyngeal abscess in a pregnant lady with possible underlying connective tissue disorder. A 19-year old primigravida at 6-weeks of gestation, presented with fever, cough, dyspnea, right sided neck pain and swelling. Imaging showed right lower lobe pneumonia with bilateral pulmonary infiltrates and pleural effusion. Ultrasound of the neck showed right IJV thrombosis. Magnetic resonance imaging of the neck revealed a retropharyngeal abscess extending from C1 to C4 vertebral level. She had positive ANA, SS-A and Ro-52 titres. She was treated with piperacillin-tazobactam, metronidazole, enoxaparin and short course steroids. Even though she improved initially, fever recurred and she had a massive hemoptysis with hemothorax and expired.

Antiphospholipid antibody syndrome presenting with disseminated bleeding and spinal subdural hemorrhage.

STUDY DESIGN: Case report. OBJECTIVES: To report a rare cause of spinal subdural hematoma. SETTING: A tertiary care university hospital in Andhra Pradesh, India. METHODS: Detailed evaluation and reporting of a case admitted in the hospital. RESULTS: A case of antiphospholipid antibody syndrome (APS) was found to present with spontaneous spinal subdural hematoma and paraplegia. This is a very rare presentation of APS. CONCLUSION: This article describes a rare case of APS presenting with disseminated bleeding and spontaneous spinal subdural hematoma, resulting in paraplegia.