We describe a case of a patient who presented with a 20-day history of vomiting, generalised weakness and loss of appetite and a 2-day history of altered sensorium. On examination, he was grossly emaciated and there were no palpable lymph nodes. Central nervous system examination revealed nystagmus with bilateral lateral recti palsy and abdominal examination showed mild hepatomegaly. MRI of the brain showed bilateral and symmetrical hypertense signal changes in T2-weighted and fluid-attenuated inversion recovery sequences with diffusion restriction in the paramedian ventromedial thalamus. These findings were compatible with Wernicke's encephalopathy. He was started on thiamine supplementation with which neurological signs improved. An ultrasound of the abdomen showed mild hepatomegaly with multiple hyperechoic lesions and wall thickening of the pyloric antrum. Upper gastroduodenoscopy showed ulcerative lesions involving the antrum, pylorus and duodenum. Biopsy revealed moderately differentiated adenocarcinoma. The patient underwent palliative gastrojejunostomy and was clinically better at discharge. It is important to consider Wernicke encephalopathy in patients with gastric cancer who have acute neurological symptoms.
We describe a patient who presented to us with fever, decreased appetite, weight loss and dry cough for 1 month with no abnormalities on examination. A chest radiograph showed a mediastinal shadow. CT of the chest revealed multiple mediastinal lymph nodes. Bronchoalveolar lavage was negative for acid-fast bacilli and cytological examination did not show malignant cells. Serum ACE levels were high (93 U/L). Bone marrow aspiration and biopsy did not reveal any pathology. Mediastinoscopy-guided mediastinal lymph node biopsy showed features of granulomatous lymphadenitis. This case report summarises an unusual presentation of tuberculosis in an adult.
50.8% cases conformed to the WHO definition of severe malaria indicating most present with complications. High parasite index and abnormal renal function are predictors of mortality and complications. Early diagnosis, anticipation of complications, close monitoring and combination therapy to over come drug resistance helps to contain the extent of mortality.
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