This case series details clinical observations in 7 survivors of accidental hydrogen sulphide inhalation toxicity at a petroleum refinery in Sri Lanka. One survivor developed status epilepticus and severe neurotoxicity whilst another survivor developed delayed respiratory failure; both patients required intensive care management. One victim manifested mild bronchospasms in the immediate post-exposure period and another developed mild perioral numbness 2 days following the exposure. A brief literature review explores the manifestations, pathophysiology and available modalities of treatment of hydrogen sulphide inhalation toxicity.BackgroundHydrogen sulphide (H2S) is a highly toxic gas. Accidental deaths following H2S exposure is a known hazard amongst petroleum workers exposed to by-products of refineries. Toxicity results mainly due to cellular respiratory poisoning which impairs oxidative phosphorylation. The heart, brain and the lungs are the organs most commonly affected in H2S inhalational toxicity leading to varied clinical presentations.

We report four cases of anorexia nervosa (AN) seen over a period of 5 months in the psychiatry unit of a general hospital. The report is unusual because two of the patients were male, all were between 13 and 15 years of age and AN is thought to be rare in Sri Lanka. All four patients had features typical of AN. There are implications for clinical practice in Sri Lanka if the prevalence of AN is rising because all these patients presented to psychiatrists late in their illness, some in an advanced state of weight loss.

IntroductionConstrictive pericarditis is a rare complication in the post–renal transplant period. It poses a diagnostic dilemma even in the modern era. Its incidence is not known and tuberculosis is implicated in some of the cases.Case presentationA 54-year-old Sri Lankan man, in the sixth year of transplant presented with resistant ascites, shortness of breath and elevated creatinine from the baseline. Pre-transplant he was empirically treated for tuberculosis pericarditis and was on isoniazid prophylaxis for 1 year following transplantation. Two-dimensional echocardiography and cardiac catheterization confirmed the diagnosis, and pericardiectomy was performed, which resulted in full resolution of the symptoms as well as the graft function. The histology or bacteriology failed to demonstrate features suggestive of tuberculosis in the surgical specimen.ConclusionIn constrictive pericarditis, a causative factor is difficult to find. Isoniazid prophylaxis shows benefit in preventing tuberculosis-associated constrictive pericarditis.

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In the modern era where antibiotics are freely available, gonococcal septic arthritis is a rarity . Here we report a probable case of localized gonococcal septic arthritis involving the shoulder joint . There are no such cases reported from Sri Lanka up to now .

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