Calcification of the auricular cartilage termed as "petrified ears" is a rare condition characterized by stiffness of auricular cartilages making them non-malleable and unable to get folded. Though appearing as an insignificant finding, it may be manifestation of an underlying systemic condition with masked systemic deteriorations. We present here report of a patient who presented with petrified ears and was found to have alkaptonuria.Our patient, a 40-year-old male, presented with three-years' history of progressive stiffness of ear pinna, two-years' history of off and on swelling of knees and one-year history of discoloration of skin over thumb, index, and middle fingers in both hands. He also had a lifelong history of darkening of urine. On examination, he had non-foldable, thickened, firm pinna with a few palpable hard papules and hyperpigmentation of overlying skin (Figure 1a, 1b). The ulnar borders of hands and fingers showed bluish-grey hyperkeratotic plaques of variable sizes (Figure 1c, 1d). He had wasted right leg with atrophy of overlying skin and right sided pes cavus (Figure 1e). Crepitus was positive in both knees and straight leg raising was normal. He had no tenderness over spine. His hemoglobin was 11.9 g/dL (normal: ≥13 mg/dL) and total leucocyte count was slightly low (3.5x10 9 /L; normal: 5-11x10 9 /L), however, platelet count, thyroid function tests, plasma glucose, serum calcium, parathyroid hormone, and vitamin D 3 levels, and urine routine examination were normal. On urine visual examination,
Background. Tuberculosis (TB) coinfection in human immunodeficiency virus- (HIV-) infected patients is considered a risk of antiretroviral therapy (ART) failure. Coadministration of antitubercular therapy (ATT) with ART is another challenge for TB management. Objective. The study was aimed at investigating contributing factors affecting treatment outcomes in HIV-/TB-coinfected patients. Design. Cross-sectional. Setting. Samples were collected from the Pakistan Institute of Medical Sciences Hospital Islamabad. Subject and Methods. Clinicodemographic and immunovirological factors between the two groups were compared. The Student t -test and chi-square test were applied to compare outcome variables, and logistic regression was applied to determine the effect of TB on virological failure (VF). Main Outcome Measures. TB coinfection did not increase VF even in univariate ( p = 0.974 ) and multivariate analysis at 6 and 12 months of 2nd-line ART start. ARV switching was significant ( p = 0.033 ) in TB-coinfected patients. VF was significantly high in ATT-coadministered patients along with a viral load of ≥1000 ( p = 0.000 ). Sample Size and Characteristics. We recruited seventy-four HIV patients on 2nd-line ART; 33 coinfected with TB were followed for at least 12 months. Conclusion. In HIV-/TB-coinfected patients, CD4 count, CD4 gain, and VF remained comparable to HIV patients with no TB infection. ATT significantly affects the treatment outcome, suggesting drug-to-drug interactions. These factors are important to revisit the therapeutic guidelines to maximize the benefit of dual therapy in resource-limited settings.
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