Background: Dengue is the most common arboviral infection in the world. Dengue hemorrhagic fever (DHF) presents with manifestations like bleeding gums, melena, menorrhagia, epistaxis and hemoptysis which are well documented. Spontaneous intramuscular hematoma is a rare manifestation of DHF and very few such cases were reported so far. Case Report: We report four cases of DHF complicated by spontaneous muscle hematomas, of which three were managed conservatively and one case needed transcatheter embolization. Conclusion: Sudden onset abdominal or back pain with decreasing hemoglobin level in the setting of dengue fever should incite a suspicion of spontaneous muscle hematoma. Nevertheless, orificial bleeding should be ruled out first. Diagnosis is by ultrasonogram or computerised tomography. Such cases are managed conservatively with fluid resuscitation, packed cell transfusion and analgesia. Most of the patients improve well with appropriate management. Intervention by embolization is rarely needed.
Allergic bronchopulmonary aspergillosis commonly occurs in patients with pre-existing lung disorders like bronchial asthma or cystic fibrosis. We present the case of an elderly asthmatic lady who presented with acute dyspnoea and was found to have left sided lung collapse due to mucus plug obstruction. On further investigation, she was found to have aspergillosis. Allergic bronchopulmonary aspergillosis presenting as lung collapse is a rare scenario.
Diabetic ketoacidosis (DKA) is a life threatening acute complication of type 1 diabetes. Since diabetic patients may have hypertriglyceridemia, they are at risk of developing acute pancreatitis (AP). Hyperamylasemia may suggest a diagnosis of AP, but levels may be elevated in DKA. Hence, serum lipase levels correlate better with the diagnosis of AP. However, pancreatic enzymes are excreted by the kidneys and their levels are elevated in patients with chronic kidney disease (CKD). This report describes a patient with type 1 diabetes and CKD stage 4, not on hemodialysis, who presented with DKA and had very high levels of pancreatic enzymes in the absence of pancreatitis.
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