Introduction and aimMucormycosis is a lethal opportunistic infection caused by filamentous fungi of the family Mucoraceae (black fungus). There has been a sudden increase in the incidence of these cases during the second wave of the COVID-19 pandemic due to the immunocompromised state caused by the disease and its treatment. Early diagnosis and appropriate medical management are essential to reduce disease morbidity and mortality. Through this study, we aim to study the clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis as well as evaluate the clinical outcomes in each case. Methods and materialsThis was a prospective study that included only confirmed mucormycosis cases admitted in Tata Main Hospital (TMH) from April 2021 to July 2021. A case of mucormycosis was defined as the one in which clinical and radiological features were consistent with mucormycosis and fungus was demonstrated in the tissue by potassium hydroxide (KOH) mount/culture/histopathological examination (HPE). Data relating to epidemiology, risk factors, clinico-radiological features, and outcomes were analyzed and expressed as a percentage of total cases. ResultsOf the total 15 cases, three patients (33.3%) had active COVID-19 infection, eight (53.3%) were in the post-COVID-19 state, two (13.4%) had COVID-19 like illness and two (13.4%) patients did not have COVID-19 in the recent past. There was male predominance with the male to female ratio being 2.75:1. The commonest associated co-morbid condition was diabetes mellitus (13 patients, 86.7%). Amongst the myriad manifestations, periorbital swelling was the commonest symptom (11 patients, 73.3%). Among neurological manifestations, involvement of cranial nerves was found in nine (60%) patients with the third cranial nerve being the most commonly affected nerve (eight patients, 53.3%). Cavernous sinus thrombosis (CST) was found in one (6.7%) patient. Diagnostic nasal endoscopy (DNE) revealed eschar at various sites in 13 patients (86.7%). Central retinal artery occlusion (CRAO) was found bilaterally in one patient (6.7%) while two patients (13.3%) had CRAO on the left. Radiologically, the most commonly involved sinuses were maxillary and ethmoidal (eight patients, 53.3%). Bilateral sinus involvement was more common (46.7%) than unilateral sinus involvement. The average length of stay (LOS) was 17.5±7.8 days. The overall mortality was 40%. Five (33.3%) patients developed secondary bacterial infections. All patients received medical therapy with intravenous amphotericin B. In addition, seven (46.7%) patients underwent functional endoscopic sinus surgery (FESS) with debridement of which, five (71.4%) patients survived and made a good recovery. One patient (6.7%) with pulmonary mucormycosis underwent lobectomy. ConclusionNew-onset headache, black nasal discharge, periorbital swelling, retro-orbital pain, visual diminution, restriction of eye movements should prompt an immediate search for mucormycosis especially in the background of his...
Background Water and electrolyte disorders commonly encountered in children post-surgery involving hypothalamus and posterior pituitary, are central diabetes insipidus, syndrome of inappropriate secretion of anti-diuretic hormone and cerebral salt wasting disease. Delayed diagnosis and inadequate management of such cases may lead to worsened neurological outcomes with a high mortality rate. Case presentation Here we report the case of a 7-year-old girl who underwent surgical resection of a craniopharyngioma, following which she initially developed central diabetes insipidus. However, later on in the course of her illness she developed symptomatic hyponatremia with natriuresis which was diagnosed to be due to cerebral salt wasting disease. This combination of central diabetes insipidus and cerebral salt wasting syndrome is a rare occurrence and poses a diagnostic challenge. Diagnosis and management can be even more difficult when these conditions precede or coexist with each other. Conclusion In such cases development of hyponatremia should always prompt consideration of unusual causes like cerebral salt wasting disease in addition to the classically described syndrome of inappropriate secretion of anti-diuretic hormone. Hence, a thorough knowledge of these disorders along with intensive monitoring of fluid and sodium status is critical for timely diagnosis and management of these patients.
Ankylosing spondylosis (AS) is characterised by bilateral sacroiliitis, asymmetric peripheral oligoarthritis, association with the human leucocyte antigen-B27, enthesitis and dactylitis. The association of IgA vasculitis with AS has been documented in few case reports. We present a rare case of a man in his 40s with AS, who presented with fever, bloody loose stools, abdominal pain, lower limb arthritis, palpable purpura over the lower limbs. He subsequently, also developed renal involvement in the form of proteinuria. His skin biopsy showed evidence of leucocytoclastic vasculitis, while renal biopsy showed focal proliferative, necrotising IgA glomerulonephritis. He was thus diagnosed to have Henoch Schonlein purpura with IgA nephropathy in the background of AS. He was treated with steroids and mycophenolate mofetil with resolution of his symptoms.
Aspergilloma describes the saprophytic colonization of an area of devitalized lung tissue. It usually develops in pre-existing pulmonary cavities caused by tuberculosis, sarcoidosis and other such conditions. It is found in almost 15% to 25% of patients with cavitatory lesions resulting from tuberculosis. In developing countries with high prevalence of tuberculosis, like India, aspergilloma is often misdiagnosed as tuberculosis. Hemoptysis is often equated with TB, and most patients are diagnosed clinically. Here we report one such case of a 56 year old male patient with past history of tuberculosis, who was initially diagnosed and being treated as a relapse of tuberculosis on the basis of hemoptysis and chest radiograph findings, till further detailed investigations revealed an aspergilloma in a post tubercular cavity as the cause of his symptoms.
Introduction: Dengue is the most rapidly spreading mosquito-borne viral disease. Liver is the most commonly affected organ and manifests as asymptomatic transaminitis to acute liver failure. Aim: (1) To study the clinical and biochemical profile of liver involvement. (2) To find the association between severity of hepatic dysfunction, morbidity and mortality in the admitted patients. Method and Material: This was a prospective study involving confirmed dengue fever cases admitted in Tata Main Hospital from January 2018 to December 2019. Cases were classified into non-severe dengue and severe dengue based on 2009 WHO classification. Severity of hepatic dysfunction was divided into grades A, B, C and D and correlation with various outcomes which included length of stay, complications and mortality was studied through relevant investigations. Results: Out of the 175 cases, Non-severe Dengue (NSD) was seen among 72.6% patients while severe dengue (SD) in 28.5% patients. Normal liver function was found in 68.6%, Grade B liver injury in 8% while Grade C and Grade D liver injury in 16.6% and 16.8% patients respectively. Mean AST levels were found to be higher than those of ALT levels. Longer hospital stay, complications like shock, acute kidney injury (AKI), thrombocytopenia and mortality were significantly more in patients with higher grades of liver dysfunction (p=0.03), while ARDS and MODS were seen only in patients with Grade C and Grade D liver injury. Conclusion: AST and ALT levels were statistically higher in Dengue fever patients with worse outcome. They can thus, serve as prognostic markers of severe Dengue.
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