Patients with snakebites have highly variable presentations, and delayed diagnosis may lead to unfavorable outcomes. Here, we describe the case of a snakebite in a 23-year-old male who presented with myokymias. On management with mechanical ventilation and anti-snake venom, the patient improved and was discharged. The presence of myokymias may be an early clue to diagnosis and the need for mechanical ventilation in a patient with a snakebite.
Systemic lupus erythematosus (SLE), a disease of the immune system, has a relapsing-remitting course. It is known to affect multiple organ systems of the body, including the nervous system. Cranial neuropathy, particularly facial neuropathy, is an unusual complication of SLE whose pathogenic mechanism is still not understood. Cardiac involvement, like myocarditis and papilledema, is another rare presentation of SLE. A 23-year-old male had bilateral lower motor neuron type of facial palsy which on a thorough investigation was found to be as a manifestation of SLE confirmed by antinuclear antibodies and double-stranded DNA antibody positive test. Electrocardiogram and echocardiography were suggestive of myocarditis. Fundus examination revealed Grade 2 papilledema. The patient was managed with symptomatic treatment along with corticosteroids, to which he responded gradually. Bilateral facial nerve lower motor neuron type palsy is a rare manifestation of SLE which should be diagnosed promptly and can be managed with corticosteroids. The clinician should also keep an eye on infrequent manifestations like myocarditis and papilledema.
Miliary tuberculosis or disseminated tuberculosis is one of India's most typical forms of tuberculosis. It can have varied presentations, from classical pulmonary disease to affection of extra-pulmonary sites, the most common being the vertebral column. With a wide array of clinical manifestations, differentiating disseminated tuberculosis from common malignancies is no less than a herculean task for a clinician. Keeping a high index of clinical suspicion and detailed work up in the right direction can save the clinician and the patient from an exhaustive ordeal of futile investigations. Here, we present a rare case of miliary tuberculosis masquerading as a common malignancy of the elderly, re-emphasizing the need for a systematic approach to such confusing presentations.
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