Hantaviruses are a large family of enveloped viruses with two medically important families Cricetidae and Muridae which are known to cause rodent-borne diseases worldwide. Some strains cause clinical syndromes with multiorgan involvement in humans such as hantavirus haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), which is also known as hantavirus pulmonary syndrome. Clinical differentiation of this infection from other endemic infections in Sri Lanka such as leptospirosis and rickettsial infections is extremely difficult due to overlapping clinical and epidemiologic features such as exposure to rodents and farming. Here, we report two serologically confirmed cases of hantavirus infection from Sri Lanka with different presentation. The first patient had a combination of HCPS and HFRS. The second patient was treated for HPS complicated with acute respiratory distress syndrome (ARDS). Both had a significant clinical, biochemical, and radiological response with early initiation of corticosteroids. However, further studies are required to assess whether steroids hasten the recovery of severe hantavirus infections. We believe that hantavirus infection is an important emerging disease in the country and should be considered as a differential diagnosis in patients presenting with an acute febrile illness as well as in patients presenting with ARDS. Early diagnosis and prompt treatment improve prognosis.
Abrus precatarius is a tropical climber, whose seeds contain abrin, which is known to cause toxicity in humans. We report a case of a young girl, who presented with haemorrhagic enterocolitis, bilateral septal vein thrombosis, and basal ganglia haemorrhage leading to seizures and coma, following ingestion of toxic A. precatarius seeds. To the best of our knowledge, this is the first ever case to describe such an intracranial complication of abrin poisoning.
Brachymetacarpia and brachymetatarsia are unique clinical entities associated with numerous rare conditions. Primary hypoparathyroidism is distinct from pseudohypoparathyroidism and pseudopseudohypoparathyroidism by lacking skeletal changes such as short metacarpals or metatarsals. Here, we present a case of a 64-year-old patient with brachymetacarpia and brachymetatarsia presented with hypocalcemic symptoms and signs, bilateral cataracts, and basal ganglia calcifications, subsequently diagnosed with idiopathic primary hypoparathyroidism. This is a rare case describing such an infrequent observation of brachymetacarpia and brachymetatarsia in primary idiopathic hypoparathyroidism.
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