ECAST Or exercise collapse associated with sickle cell trait is a rare phenomenon associated with sickle cell trait and is an important presentation of sickle cell disease in sports medicine. Collapse is seen following vigorous physical activity, which is due to excessive heat, dehydration and other factors associated with physical exercise. This rare syndrome is often missed by the treating physicians as a result of a lack of knowledge about this rare entity leading to massive underreporting. It is important to identify ECAST as a cause of the collapse in young athletes to prevent mortality and morbidity and in order to provide prompt treatment. We report a case of a 25- year-old young male who was a bodybuilder and reported to the gym after a one-year-long break due to lockdown restrictions of COVID19. After a vigorous exercise session, he collapsed in the gym and was brought to the emergency department. After proper history taking and examination, he was suspected to be a case of ECAST due to a history of a similar episode three years back which was treated as a case of exertional syncope with intravenous fluid therapy and a family history of Sickle cell trait with his mother and father both having sickle cell AS Pattern. Ultimately our patient turned out to be a case of Sickle Cell Trait with evidence of AS pattern on Hb electrophoresis and a small-sized spleen visualized on CT Scan of the abdomen. The patient was managed successfully with intravenous fluids and blood transfusion and was discharged in a stable condition. He was counseled about moderating his exercise and is doing well on follow-up.
Tuberculosis (TB) is a multiorgan disease that can affect any part of the body. Though it is thought to be affecting mainly the pulmonary system, genitourinary TB is a rare but important manifestation of TB. It has been reported in <0.5% of extra pulmonary tuberculosis. Amongst instances of genitourinary TB, glandular TB is even scarcer. Maximum patients seek medical intervention later in the progression of ailment due to the attached stigma linked with tuberculosis and in view of affected site and part of the body and the reluctance on the patient’s side. In this case report, a 58-year-old male presented to Medicine Department with the complaint of a non healing wound on the scrotal region with excoriation since one month and irritability with altered sensorium since a week. Ultimately, it turned out to be a case of tubercular meningitis resulting from a neglected scrofula with neck rigidity, Kernig's and Brudzinski's sign positive. Though many case reports involving tubercular meningitis have been reported, a neglected scrofula remains a rare manifestation of tubercular meningitis.
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