Double trouble - primary biliary cholangitis and coeliac disease in a young female: a case report.

In this case report, we describe a patient who was diagnosed with both Primary Biliary Cholangitis and Coeliac Disease, presenting with symptoms and signs of severe malabsorption and portal hypertension. Extensive workup was done including duodenal and liver biopsies and our patient was ultimately found to have both autoimmune diseases. An association between the two diseases has been reported multiple times during the past four decades with current guidelines recommending screening patients with primary biliary cholangitis for coeliac disease.

Dengue and Hypokalemic Paralysis: A Rare Association.

Dengue is one of the most common mosquito-borne viral illnesses in tropical areas, including Pakistan. Presentation varies from a self-limiting flu-like illness to life-threatening conditions like hemorrhagic shock and multi-organ dysfunction leading to death. In the absence of vomiting and diarrhea, electrolyte abnormalities are rare findings. Though Guillain-Barré syndrome is a known association of viral illnesses presenting with flaccid paralysis, there is a possibility for dengue to cause hypokalemia without apparent gut or renal losses. Dengue-associated hypokalemic paralysis is an underrecognized entity but has a favorable outcome. The clinician should suspect this in patients presenting with motor weakness in dengue-endemic areas. Neurological complications of dengue are reported frequently now, so early recognition of these neurological manifestations is needed for the successful recovery of patients. Here, we discuss a case of dengue-induced hypokalemia presenting with acute flaccid paralysis.

Acute Hypokalemic Paralysis And Hashimoto's Thyroiditisa.

Acute hypokalemic paralysis (AHP) is a life-threatening emergency. It is exceptionally unusual for hypothyroidism to present with AHP. This association can be either primary or secondary through distal renal tubular acidosis. We report two cases who presented with acute quadriplegia. The succeeding investigations revealed severe hypokalemia and autoimmune hypothyroidism. The second case was found to have Sjogren's syndrome additionally. The underlying aetiology of hypokalemia in both cases was found to be dRTA. The combination of such conditions is reported sporadically. Here we also discuss the potential association of AHP with autoimmune conditions by proxy through dRTA.

Hemophagocytic Lymphohistiocytosis: A Rare Cause of Pyrexia of Unknown Origin.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome due to excessive immune activation leading to hyperinflammation. It may be familial due to mutations in immune regulatory genes, especially genetic defects of lymphocyte toxicity. The sporadic cases are triggered by infections (mostly viral), malignancies, and autoimmune diseases. Herewith we report the case of a 20-year-old male with febrile illness who was ultimately diagnosed with HLH.