SLE Neuropathy-Anything New?

SLE (systemic lupus erythematosus) is a multisystem autoimmune disorder of unknown aetiology which can present with myriad clinical presentation. The neurological manifestations of SLE consist of central nervous system (CNS) and peripheral nervous system manifestations (PNS). The CNS manifestations are aseptic meningitis, cerebrovascular accidents (stroke), demyelinating disorders, headache, involuntary movements like chorea, myelopathy, acute confusional states, cognitive dysfunction, mood disorder, seizures, psychosis and cranial nerve palsies.1 The PNS manifestations are Guillain Barre syndrome (GBS), autonomic disorder, mononeuropathy, polyneuropathy and plexopathy.1 Neuropathy in SLE can be clinically classified as mononeuritis multiplex and symmetrical and asymmetrical polyneuropathy. Symmetrical polyneuropathy being the most commonly seen clinical entity amongst the neuropathies in SLE. The neuropathy can be slowly progressive or acute in onset. Electrophysiologically, neuropathy is classified as axonal neuropathy, small fibre neuropathy, demyelinating neuropathy, mixed axonal-demyelinating sensorimotor polyneuropathy and plexopathy. Axonal neuropathy is further divided into sensory, sensorimotor and mononeuritis multiplex. Demyelinating neuropathy can be of two types: acute inflammatory demyelinating polyneuropathy (AIDP) and sensory demyelinating polyneuropathy. Anecdotal case reports also suggest that CIDP can occur as part of SLE neuropathy.2.

The study of complications of vivax malaria in comparison with falciparum malaria in Mumbai.

INTRODUCTION: Severe malaria due to P. vivax infection is increasingly observed now a days. Organ failure in vivax malaria is caused by mechanisms of inflammation as well as sequestration. In this study we have compared the complications in vivax malaria with those in falciparum or mixed malaria. AIMS AND OBJECTIVES: 1) To study various complications in adult inpatients of vivax malaria. 2) To compare the incidence of complications in vivax, falciparum and mixed malaria. MATERIALS AND METHODS: This was a retrospective observational study done at a tertiary care hospital in Mumbai over 3 months period. All adult indoor patients positive for malarial infection based on peripheral smear or malarial antigen (LDH) spot test were included in the study. Their demographic profile, complications, course in ward till discharge or death was noted. Data was analysed using appropriate statistical tests. RESULTS: 680 cases of malaria were included in the study. 338 were infected with P. vivax, 206 with P. falciparum, 136 with mixed infection. Severe disease was present in 162 (23.82%) cases of malaria of which 50 (31%) had vivax infection, 64 (39%) had falciparum infection and 48 (30%) had mixed infection. The complications seen in vivax malaria were: thrombocytopenia (68%), leukopenia (19%), ARDS (3%), high bilirubin (5%), acute renal failure (3.5%), anemia (3%), mucosal bleeding (8%), cerebral malaria (3.5%), hypotension (5%), metabolic acidosis (4%) and death (1.77%). CONCLUSIONS: 31% cases of severe malaria had vivax monoinfection. Thrombocytopenia, leukopenia, acute respiratory distress syndrome, hypotension, mucosal bleeding were seen as frequently as in falciparum and mixed malaria. Acute renal failure, cerebral malaria, high bilirubin, anaemia, metabolic acidosis and death were also found in vivax malaria but less frequently than in falciparum and mixed malaria.

Reflex sympathetic dystrophy following pacemaker insertion.

A 55 year old male presented with pain and swelling over dorsum of right hand and small joints, and loss of sweating over right hand since two months. He was a known case of mitral valve prolapse (MVP) with mitral regurgitation and complete heart block for which pacemaker was implanted 1 year back. Bilateral wrist X-ray was suggestive of pronounced demineralization (osteopenia) in the right hand. He was thus diagnosed to have reflex sympathetic dystrophy syndrome (RSDS) considered to be induced by pacemaker insertion. After treatment with amitryptiline and indomethacin his symptoms dramatically improved.

Pheochromocytoma presenting as hypertension in pregnancy.

Pheochromocytoma is a curable, rare cause of hypertension, characterized by symptoms and signs related to increased catecholamine secretion. Pregnancy and labour increase the risk of hypertensive crisis. However, antepartum diagnosis reduces both maternal and foetal mortality, allowing for safe cesarean section and resection of tumor. Control of hypertension with alpha blockers and beta blockers is the medical treatment. Surgical removal of the tumour is the definitive treatment. Hypertensive crisis needs to be treated aggressively. We report this case for the rare presentation of pheochromocytoma presenting as hypertension in pregnancy.