Common mental disorders in South Asian patients with systemic sclerosis: a CIS-R-based cross-sectional study.

There are not many studies looking at psychological impact of physical morbidities amongst patients with systemic sclerosis. Our aim was to describe the prevalence of common mental disorders (CMD) in systemic sclerosis patients, as against the population prevalence of CMDs. We also wanted to assess the utility of revised clinical interview schedule (CIS-R), a standardised interview technique for screening CMDs in systemic sclerosis (SSc). We prospectively recruited 93 consecutive patients fulfilling the 2013 ACR/EULAR criteria for systemic sclerosis from our single tertiary care centre. They were interviewed using CIS-R interviewing technique. These patients were assessed for the presence of psychiatric symptoms and presence of common mental disorders. Various associations of documented mental health issues and ICD-10-based psychiatric diagnosis were also analysed. A total of 29 (31%) out of 93 individuals with systemic sclerosis had a common mental disorder as per the earlier defined CIS-R cut off score of 12 and above. Fatigue (50.5%) and sleep issues (43%) were the commonest symptoms. Thirty-four patients (33.6%) fulfilled a total of 39 ICD-10 psychiatric diagnoses. Total CIS-R score is significantly associated with duration of Scleroderma in univariate analysis (p = 0.019), but there was no significant association on a multivariate analysis. Depression [18.3% as against 5% in Asian Indian general population], followed by obsessive compulsive disorder (OCD) [15.1% as against 0.7% in general population in India] were the top two ICD-10 psychiatric diagnosis in SSc. The occurrence of both depression and OCD, therefore, are far in excess compared to community prevalence. Additionally, modified CIS-R cut off of 10 instead of 12 can also improve the sensitivity (94%) of this screening interviewing tool for an ICD-10 psychiatric diagnosis. Depression is 3.4 times and OCD is 20 times commoner in our cohort of SSc than general population in India. A modified CIS-R cut-off score of 10 may further help in early recognition of these mental disorders in SSc and their referral to a psychiatrist.

Intramuscular lymphoma: uncommon presentation of Hodgkin's disease.

Extranodal presentation in lymphoproliferative disorders is a well-recognised entity. However, musculoskeletal involvement is extremely rare. We describe the case of a 64-year-old farmer who presented to us with constitutional symptoms of fever, loss of weight and loss of appetite for 2 years and physical examination revealing generalised lymphadenopathy with hepatosplenomegaly. Biopsy of an axillary lymph node showed mixed cellularity variant of Hodgkin's lymphoma. CT of the thorax and abdomen revealed a collection in the right psoas muscle. Guided biopsy of the psoas deposit was suggestive of Hodgkin's lymphoma. PCR and cultures for Mycobacterium tuberculosis tested negative. Here we describe a rare presentation of Hodgkin's lymphoma with intramuscular involvement.

Chronic multifocal osteomyelitis: A rare presentation of melioidosis.

A 45-year-old gentleman presented with fever, weight loss, and painful swelling of both knees. His history was significant for type 2 diabetes mellitus. Blood cultures grew Burkholderia pseudomallei, and imaging revealed osteomyelitis of bilateral distal femura and proximal tibiae, with no involvement of the joint space. He underwent debridement and was initiated on ceftazidime followed by eradication therapy with trimethoprim-sulfamethoxazole. He recovered well with no further complications. Melioidosis is a rare cause of multifocal osteomyelitis and is a differential to be considered in an appropriate clinicoepidemiological setting.