Chronic Lithium Toxicity in Old Age Patients Taking Angiotensin Receptor Blocker: A Case Report.

Chronic lithium toxicity is a potentially serious side effect on patients taking lithium for a prolonged period with the diagnosis of mood disorders. The toxicity is even higher in patients taking drugs that interfere with the metabolism of lithium like angiotensin receptor blockers and in older patients with reduced kidney function. In this report, we present the case of a 62-year-old woman who presented to the emergency department with symptoms including loose stools, generalised body weakness, slurred speech, coarse hand tremors, and dystonia persisting for fifteen days. She had been under lithium therapy for bipolar type 1 disorder for 15 years before experiencing these symptoms, which emerged shortly after the addition of telmisartan (angiotensinogen receptor blocker) for hypertension. Keywords: angiotensin receptor blocker; bipolar disorder; case reports; lithium; telmisartan.

Migraine among Patients Presenting With Headaches to the Department of Internal Medicine in a Tertiary Care Centre.

Introduction: Migraine is one of the common neurovascular disorders characterized by persistent headaches ranging from moderate to severe pain. It has a high prevalence affecting more than one billion population each year across the world and has high morbidity, especially among young adults and females. The exact cause and mechanism of the migraine is unknown. The aim of this study was to find out the prevalence of migraine among patients presenting with headaches to the Department of Internal Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Internal Medicine in a tertiary care centre from 1 August 2022 to 31 October 2022. Ethical approval was taken from the Institutional Review Committee. All the patients presenting to the Department of Internal Medicine with headaches as primary complaints were included. Patients with incomplete information and altered sensorium were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 69 patients, the prevalence of migraine was 13 (18.84%) (9.61-28.07, 95% Confidence Interval). Of those diagnosed with migraine headaches, 4 (30.77%) were male patients, and 9 (69.23%) were female patients. The mean age of diagnosis of migraine headache was 30±11.5 years. Conclusions: The prevalence of migraine among patients presenting with headaches to the Department of Internal Medicine was found to be higher than in the other studies done in similar settings. Keywords: aura; headache; migraine; prevalence.

Acute Pancreatitis, Shock, and Multiple Organ Dysfunction Syndrome in Scrub Typhus.

Scrub typhus is an endemic disease caused by the bites of infected chiggers (larval mites) harboring causative bacteria Orientia tsutsugamushi. Acute pancreatitis is a rare but occasionally fatal complication of scrub typhus infection caused by vascular and perivascular inflammation of the pancreas.A 34-year-old female presented with severe epigastric pain and multiple episodes of vomiting. Extensive evaluation of the patient revealed acute pancreatitis secondary to scrub typhus. The patient also had septic shock and multiple organ dysfunction syndrome. The patient was mechanically ventilated and treated with doxycycline, and pancreatitis was managed conservatively.

Etoricoxib Induced Toxic Epidermal Necrolysis in a case of Systemic Lupus Erythematosus: A Case Report.

Toxic epidermal necrolysis is a potentially life-threatening dermatological condition whose pathogenesis and exact treatment are not yet known. Drugs like anticonvulsants, allopurinol and non-steroidal anti-inflammatory drugs like etoricoxib, a selective cyclo-oxygenase-2 inhibitor prescribed for pain management are associated with a high risk of toxic epidermal necrolysis. It is also associated with immunodeficiency and dysregulated immune reactions like systemic lupus erythematosus, an autoimmune disease in which organs and cells undergo damage initially mediated by tissue binding auto-antibodies and immune complexes. Here, a 34 year old lady was presented in emergency with multiple maculopapular rashes over the neck and trunk region after treatment with etoricoxib for osteoarthritis of the left foot.

Multiple Wasp Stings Leading to Rhabdomyolysis Induced Acute Kidney Injury with Incidental Ectopic Kidney: A Case Report.

Rhabdomyolysis refers to skeletal muscle breakdown causing a release of different intracellular proteins including myoglobin and several electrolytes in the bloodstream. Elevations diagnose rhabdomyolysis in serum creatine kinase. Mass envenomation by multiple wasp stings can cause rhabdomyolysis followed by acute kidney injury, although it is scarce. A 24-year-old male presented to our tertiary centre in an anaphylaxis-like state after multiple wasps sting, rapidly developing rhabdomyolysis followed by acute kidney injury. Despite having an ectopic kidney with a pre-existing renal parenchymal disease, he recovered and was discharged, which in itself is a rare entity of low clinical incidence. Wasp stings can potentially result in serious clinical manifestations, which need to be watched over, assessed and promptly treated. Keywords: acute kidney injury; case reports; creatine kinase; hymenoptera; rhabdomyolysis.