In general, self-mutilation may be defined as any self-directed, repetitive behaviour that causes physical injury. However, it is not uncommon in clinical practice, especially in psychiatric illness. Though, pathologic self-mutilation is difficult to adequately define and understand. Hereby we report a case of invasive meningococcal infection having behaviour of self eating fingers and toes besides well known clinical picture of disease. However meningococcaemia presentation may be atypical.A 40-year-old male farmer presented to our Medicine Emergency Department with complaints of fever with rashes for 4 days, irritability for 3 days followed by acts of self eating fingers and toes. At the time of admission patient was irritable. He had signs of meningeal irritation. Petechial rashes were distributed over back, abdomen and lower limbs [Table/ Fig-1&2]. Digital gangrene was present in fingers of hands and toes of legs. Patient had no pallor or icterus. His vitals were as B.P-124/70 mmHg, pulse rate-92/ min, respiratory rate was-18/min and temp-102°F. Systemic examination was unremarkable. He had no history of diabetes mellitus, hypertension, malignancy, coagulopathy, atherosclerosis, trauma, drug intake, alcoholism, vassculitis or any similar episodes in past.The relevant investigations are summarized in [ ABSTRACTNeisseria meningitidis most commonly manifests as asymptomatic colonization in the nasopharynx of healthy adolescents and adults. It may rarely present as invasive disease which may be either bacterial meningitis or meningococcal septicaemia. Hereby we report a case presented with fever and rashes, irritability followed by self mutilating behaviour who was diagnosed as a case of invasive meningococcal infection. He responded well to treatment with intravenous ceftriaxone and self mutilating behaviour was subsided completely after treatment. Necrosed tissues of fingers were amputated. With best of our knowledge, no similar case of self-mutilation associated with meningococcal infection has been reported yet.keywords: Bacterial meningitis, Ceftriaxone, Self mutilation antigen and IgM for dengue was negative. Smear examination of malaria parasite was negative. His blood culture was positive for meningococcus. CT head detected no abnormality. Analysis of Cerebrospinal Fluid (CSF) revealed turbidity, total leucocytes 208 cells/mm 3 with predominant polymorphs, protein 32 mg/dl and sugar 18 mg/dl with corresponding blood sugar 100mg/dl while CSF culture was sterile. On the basis of blood culture and clinical picture, diagnosis was made invasive meningococcal disease and patient was managed accordingly with adequate intravenous fluids and intravenous ceftriaxone. Skin care with supportive therapy was done during hospitalisation. Patient responded well to treatment. Amputations of fingers were done when a clear demarcation between live and dead tissue established. Besides this, we manage close contacts with ciprofloxacin and counsel them properly. Patient was discharged in asymptomatic state. He was alright i...
Drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse drug-induced reaction with a prolonged latency period which is characterized by a variety of clinical manifestations, usually fever, rash, lymphadenopathy, eosinophilia, and a wide range of mild-to-severe systemic presentations. Drugs are an important cause of DRESS in most of the cases. It is challenging to diagnose DRESS because of the diversity of cutaneous eruption and visceral organs involvement. We hereby report a 34-year-old female who developed DRESS syndrome following ingestion of nitrofurantoin for the treatment of urinary tract infection. She was managed conservatively and recovered after few weeks. Our aim of this study is to raise awareness to suspect DRESS syndrome in patients who present with unusual clinical features with skin involvement after initiating any drug.
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