An Interesting Case of Cholangitis.

Ascariasis is one of the most common parasitic infections in the world. It is mostly asymptomatic; however, rarely when the worms migrate to the biliary tract, they can cause biliary ascariasis. It typically presents with pain abdomen, jaundice, and fever. This case report is about a patient who presented with fever, icterus, breathlessness, loose stools, and altered sensorium but had no abdominal pain. The patient was diagnosed with biliary ascariasis using ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). The patient was treated with endoscopic sphincterotomy and albendazole. The patient remained stable after 10 days. The absence of abdominal pain highlights the variability of the presentation of biliary ascariasis.

Reversible myelofibrosis secondary to systemic lupus erythematosus.

Pancytopenia due to systemic lupus erythematosus (SLE) is rarely reported, and among those reported, it is mostly due to immunologically mediated cell destruction. Pancytopenia due to bone marrow fibrosis secondary to SLE is an extremely rare entity. Myelofibrosis secondary to SLE per se is reported only in 21 cases in the literature. Ours probably is the 22nd case report on SLE with myelofibrosis. Primary presentation of SLE with bleeding manifestation is also a rare phenomenon. Partial to complete regression of myelofibrosis is noted following treatment in secondary myelofibrosis caused by SLE. We report a case of a woman in her late 40s who presented to us with bleeding manifestations of petechial rash and menorrhagia, which on further evaluation showed pancytopenia due to myelofibrosis secondary to SLE. Our case underlines multiple features like primary bleeding manifestation and regression of myelofibrosis following treatment which is rarely reported in association with SLE.