Publications

Large vessel vasculitis (LVV) is known to affect the aorta and its branches. Takayasu arteritis (TAK) is a well-recognized LVV. TAK typically manifests with limb claudication, syncope, angina, absent pulses and unequal blood pressure. These symptoms stem from fibrotic and irreversible processes like stenosis and contribute to morbidity and mortality. Early atypical presentations may lead to delayed diagnosis. This underscores the importance of early diagnosis to arrest inflammation and prevent permanent damage. We present three cases where LVV was identified in patients with unusual symptoms, emphasizing the necessity for a high index of suspicion among healthcare providers. This is especially crucial in the primary care setting where patients first encounter general practitioners.

The occurrence of marked leukocytosis in hemoglobinopathies is generally uncommon. Herein, we describe a 41-year-old male patient with a history of chronic alcoholism who presented for the first time with shortness of breath and abdominal distension. On complete blood counts and peripheral smear examination, there was a microangiopathic hemolytic anemia with leukemoid reaction, which turned out to be beta thalassemia trait on hemoglobin high-performance liquid chromatography. He was ultimately diagnosed with beta thalassemia trait in conjunction with chronic alcoholic liver disease and spontaneous bacterial peritonitis. The presence of leukocytosis accompanied by cytopenias in other hematopoietic cell lines and organomegaly presents a considerable diagnostic challenge. Increased leukocyte counts do not invariably indicate leukemia. A comprehensive analysis of the hemogram, which includes an examination of each cell line, relevant indices, and a thorough peripheral smear evaluation in relation to the clinical presentation, is essential for determining suitable investigations and management strategies.

A 39-year-old woman with a 1-year history of seronegative arthritis was admitted for shortness of breath, left-sided chest pain, and joint pains. Upon physical examination, the tips of her right leg's fifth toe showed dry gangrene. Laboratory results revealed proteinuria and positivity for antinuclear antibody, ribonucleoprotein/Smith (RNP/Sm) antibody, Smith, and anti-double-strand deoxyribonucleic acid (DNA) antibody. The chest radiograph showed cardiomegaly, and computed tomography (CT) of the chest revealed pleural effusion. Initial pleural investigations revealed exudative pleurisy, low adenosine deaminase (ADA), and pleural effusion with cytology positive for lupus erythematosus (LE) cells. Rigid thoracoscopy revealed necrotic parietal pleura. Acid-fast bacillus (AFB) yielded positive results with Ziehl-Neelsen stains. Based on the above clinical, cytohistological, and serological findings, a coexistence of lupus pleuritis with tuberculous serositis (TS) was diagnosed in the background of systemic lupus erythematosus (SLE) with renal crisis. After 2 months of antitubercular therapy (ATT) with maintenance dose of steroids, following symptomatic improvement, pulse steroids and cyclophosphamide were initiated for SLE with renal crisis, and ATT was continued for 6 months. Postcompletion of ATT, the patient had complete resolution and was in remission of SLE.

We present the case of a woman in her early 70s with chronic-phase chronic myeloid leukemia (CML-CP), initially diagnosed in 2002. After achieving deep molecular response (DMR) with imatinib for over a decade, the patient discontinued treatment, entering treatment-free remission (TFR) for around 7 years. She later presented with fever, fatigue, and abnormal blood counts. Restarting imatinib led to a near-complete molecular response, emphasizing the potential for late molecular recurrence (LMRec) in TFR, and underscoring the importance of long-term monitoring in CML patients who discontinue tyrosine kinase inhibitor (TKI) therapy.

We present the case of a 45-year-old woman who survived a suicide attempt with partial hanging and presented with electrocardiographic (ECG) abnormalities that mimicked acute coronary syndrome (ACS). She exhibited ST-segment abnormalities and QT interval prolongation, all of which resolved within 1 month. This case highlights the importance of recognizing stress-induced cardiomyopathy, such as Takotsubo cardiomyopathy, which can present with ECG changes similar to ACS, particularly in patients experiencing extreme emotional distress or suicide attempts.

INTRODUCTION: Splenic abscesses are rare and primarily affect immunocompromised patients. Burkholderia cepacia, an opportunistic, multidrug-resistant pathogen, is an uncommon cause of such infections. This case describes a 69-year-old male with multiple myeloma, diabetes mellitus, and chronic kidney disease who developed a B. cepacia splenic abscess, emphasizing the pathogen's emerging role in immunocompromised individuals.

CASE PRESENTATION: A 69-year-old male with type 2 diabetes mellitus and chronic kidney disease was admitted with fever and generalized weakness. Notably, he had been hospitalized 3 months earlier for bacteremia due to B. cepacia, which was treated with intravenous antibiotics. During the current admission, imaging revealed multiple splenic abscesses. Blood and splenic aspirate cultures confirmed B. cepacia. The patient was diagnosed with multiple myeloma based on a history of recurrent infections, hypercalcemia, anemia, A:G reversal, and bone marrow biopsy findings. He was treated with intravenous antibiotics and supportive care, leading to clinical improvement.

CONCLUSION: This case highlights the importance of considering B. cepacia as a causative agent in splenic abscesses, particularly in patients with newly diagnosed hematologic malignancies. Early recognition and appropriate antimicrobial therapy are crucial for improving patient outcomes.

BACKGROUND: Acute respiratory failure is a life-threatening emergency requiring intensive care. Nerve conduction and repetitive nerve stimulation studies are invaluable to solve dilemmas related to the diagnosis and management. The results of these tests are available immediately, and prompt treatment can be given as illustrated in this case.

CLINICAL DESCRIPTION: A 7-year-old boy presented in circulatory shock and impending respiratory failure to the casualty without any preceding illness.

MANAGEMENT AND OUTCOME: The clinical picture, blood reports, and neurophysiological findings of repetitive compound muscle potentials on nerve conduction and a progressive decremental pattern on repetitive nerve stimulation were suggestive of acute organophosphate poisoning. This led to prompt institution of appropriate treatment comprising Ryle's tube aspiration, respiratory support, and administration of neostigmine and pralidoxime. The diagnosis was later confirmed by low serum pseudocholinesterase levels.

CONCLUSION: This case exemplifies the importance of neurophysiological study in the diagnosis of organophosphate poisoning.

Leptospirosis is an infection caused by the bacteria Leptospira. The disease presentation varies from self-limited acute febrile illness to complications involving multiple organs such as the liver, kidney, lungs, and bleeding diathesis. We present a case of a middle-aged female admitted with acute febrile illness, thrombocytopenia, and respiratory failure. She was diagnosed with leptospirosis-induced acute respiratory distress syndrome (ARDS) and was on noninvasive mechanical ventilation (NIV). The patient developed a stroke during the course of her admission, which was due to a large cerebral infarction. The patient was treated for leptospirosis, respiratory failure, and the cerebral infarction with antibiotics, steroids, and antiplatelet agents. She eventually recovered from both her ARDS and stroke and was discharged. To the best of our knowledge, this is the first reported case from India of leptospirosis presenting with both ARDS and cerebral infarct. There is a dearth of literature wherein leptospirosis neurological involvement is in the form of ischemic stroke. This would further encourage research and guideline formulation for the management of both leptospirosis ARDS and ischemic stroke occurring as a complication.

We read with interest an article titled "Clinical Phenotypes and Disease-specific Health-related Quality of Life in Patients of Chronic Obstructive Pulmonary Disease" published in JAPI.1 We have the following comments to offer.

Continuing medical education (CME) and continuing professional development (CPD) play a crucial role in ensuring healthcare professionals remain up to date with the latest advancements, improve their clinical skills, and ultimately provide the best care to their patients.1,2 Clinicians, whether they are doctors or other healthcare professionals, have clear expectations from CME programs. Since these programs play a vital role in their professional development, it is essential that CME activities meet their needs and provide value.