RESUMO
The sensory ataxic variant of Guillain-Barre syndrome (GBS) is a rare subtype, with limited case reports available. We present the case of a previously healthy 26-year-old female university student who presented with bilateral foot numbness and unsteady gait for five days, without limb weakness. There were no signs of infection or recent history suggestive of infection. Examination revealed reduced pain and light touch sensation, as well as proprioception impairment in the bilateral distal lower limb, accompanied by an ataxic gait. Bilateral upper and lower limb power was normal. Cerebrospinal fluid (CSF) studies showed albuminocytological dissociation, while nerve conduction studies indicated unrecordable sensory responses with normal motor responses. Through a comprehensive evaluation of history, examination, and investigations, other potential differential diagnoses were excluded. Then the patient was diagnosed with a sensory ataxic variant of Guillain-Barre syndrome and treated with intravenous immunoglobulin (IVIG). Over time, the patient demonstrated gradual improvement and was able to resume her university studies four months after discharge.
RESUMO
Chlorophenoxy herbicides are a major herbicide used by Sri Lankan farmers. One common variety of chlorophenoxy herbicides is 4-chloro-2-methyl-phenoxy acetic acid (MCPA). Reports of clinical toxicity of MCPA in humans are limited. To our knowledge, liver damage is a rare manifestation of MCPA poisoning, which has not yet been reported in Sri Lanka. We report a case of a farmer who presented with a heterogeneous pattern of liver damage after being exposed to the MCPA pesticide for six months and who later fully recovered with treatment.
RESUMO
In a fast-evolving COVID-19 pandemic, co-infection with mucormycosis has been reported in some parts of the world. It is still unknown whether one of the either diseases makes the patient susceptible to developing the other. The co-occurrence of them significantly elevates the mortality risk and is commonly reported in immunocompromised individuals. We herein report a case of COVID-19 infection with rhinocerebral mucormycosis without prior steroid use or underlying immunosuppressive diseases.
RESUMO
Dengue is an important arboviral disease in the tropics and subtropics. Although mild to moderate elevation of liver transaminases is a common phenomenon, dengue infection leading to hepatic failure is a rare complication in adults. We present a case of dengue fever in a young adult, leading to the rare complication of acute liver failure, without dengue shock syndrome. We tried evidence-based management with therapeutic plasma exchange, which led to a significant improvement in liver function.
RESUMO
Systemic lupus erythematosus (SLE) is a relatively common autoimmune disease with recently reported cases of lupus-associated protein-losing enteropathy (LUPLE) as an unusual manifestation. It is a well-recognized clinical entity predominantly affecting middle-aged Asian females. LUPLE is diagnosed by exclusion of possible causes for hypoalbuminemia in a patient with positive anti-nuclear antibody (ANA). LUPLE as the first manifestation of SLE is rare but it is a well-recognized complication secondary to SLE. We report a case of a 39-year-old Sri Lankan lady who was investigated for generalized body swelling, pleural effusions, ascites and pericardial effusions due to hypoalbuminemia. Her ANA was positive with speckled pattern and intestinal biopsy samples revealed evidences of chronic inflammatory cell infiltrates in laminapropria. Her investigations were not suggestive of liver diseases, albuminuria or malnutrition. We excluded all possible etiologies for protein-losing enteropathy although gold standard tests to confirm it was not available in our center. In conclusion, LUPLE should be considered as an etiology for all the unexplained protein-losing enteropathies. We suggest to treat LUPLE with prednisolone, hydroxychloroquine (HCQ) followed by steroid-sparing agents such as azathioprine. Prognosis was excellent following appropriate treatment.
