The study findings demonstrate an inverse relationship between CD4 counts and the occurrence of skin lesions. The majority of lesions were associated with stage 3 or stage 4 infection. Thus, specific cutaneous manifestations can be considered as good clinical indicators for predicting underlying immune status in resource-poor countries.

Phaeohyphomycosis is a collective term used for fungal infections caused by moulds and yeasts that have brown pigmented cell walls due to the presence of melanin. These are also known as dematiaceous fungi. We report this patient who presented with headache, right hemiparesis, slurred speech, and altered sensorium. Patient was a known case of rheumatic valvular heart disease (RVHD) and had undergone balloon valvotomy for mitral stenosis 1 year back. Radiological features were suggestive of high grade glioma. Left fronto-parietal decompressive craniectomy with complete excision of mass lesion was performed. Histopathological examination of the surgical specimen revealed multiple granulomas with giant cells. These giant cells contained branched septate pigmented fungal hyphae in their cytoplasm. After the histopathology report, patient was started on intravenous amphotericin and was discharged on oral itraconazole 200 mg twice daily. Unfortunately, the patient was non-compliant and stopped taking oral itraconazole after 1 month. He landed up in fulminant fungal meningo-encephalitis and died 10 weeks after the initial diagnosis. We report a rare case of cerebral phaeohyphomycosis in a patient of RVHD which, to our knowledge, is nowhere mentioned in the literature.

A 67-year-old woman presented with obstructive urinary symptoms and pain in abdomen. No hematuria was noted. CT scan and USG pelvis and abdomen showed peripheral enhancing lesion at bladder neck and along urethra suggestive of infective/inflammatory aetiology. Heterogeneously enhancing nodular thickness was seen along anterior bladder wall along with abdominal and inguinal lymphadenopathy. Vesicourethroscopy examination showed tight urethra; complete periurethral induration with mass involving trigone of bladder, diverticula was also noted. Biopsy of tumour was done and a diagnosis of adenocarcinoma was made.Following this, the patient received two chemotherapy cycles. CT abdomen after 2 nd chemotherapy showed residual urinary bladder wall thickening with invasion of vagina and vesico vaginal fistula. Patient underwent bladder exenteration surgery with hysterectomy and bilateral salpingo-oophorectomy with ureteric implantation into rectum. Postoperative period was uneventful.

No abstract

Chronic neutrophilic leukemia (CNL) is a rare chronic myeloproliferative disorder characterized by splenomegaly, sustained neutrophilic leukocytosis, raised serum vitamin B12 level and absence of the Philadelphia chromosome and BCR/ABL1 fusion gene. CNL can be distinguished from chronic myelogenous leukemia, leukemoid reaction and myelodysplastic syndrome. We report a case of 45 year old male patient with CNL.