Tag: Medicine

UNUSUAL CAUSE FOR PERIANAL PAIN

Dr.Seenaj (Medicine, )

49 years old lady known case of Idiopathic Thrombocytic purpura on regular follow up complained about vague pain and discomfort in the perianal area associated with constipation for the last 3 days. She also said about the feeling of something being present inside the anal region. Even though the examination was normal she was taken up for a lower GI scopy and a foreign body was removed. There was absolutely no history of trauma

Cold case in hot environment

Dr.Akash (Medicine, )

Soldier posted in Srinagar came with B/L LL edema of 2 days and numbness itching pain redness. H/o trekking in snow with boots and socks drenched in cold water.O/E there was local swelling warmth tenderness decreased touch pain temperature with normal pulses.Labs revealed elevated CRP AST>ALT, CK. He was started on IV antibiotics, IV fluids, NSAIDS .TT was given.He showed improvement in clinical and lab parameters. With the history labs Trench foot was considered .It is caused by prolonged exposure to wet cold but non freezing condition (0-15C). It is a clinical diagnosis

Paraneoplastic syndromes-a diagnostic dilemma

Dr.Shyamala (Medicine, )

71 year old Male, a reformed smoker since 10 years,presented with repeated admissions for symptomatic hyponatremia to different centers. He had been investigated for common causes including endocrine conditions. At admission,Na +was 104.During examination, patient was noted to have clubbing. Chest xray was not helpful.but a CT thorax revealed the hidden culprit-a malignant lesion in the left lung.The case has been handed over to the oncologist

Paraneoplastic syndromes-a diagnostic dilemma

Dr.Shyamala (Medicine, )

71 year old Male, a reformed smoker since 10 years,presented with repeated admissions for symptomatic hyponatremia to different centers. He had been investigated for common causes including endocrine conditions. At admission,Na +was 104.During examination, patient was noted to have clubbing. Chest xray was not helpful.but a CT thorax revealed the hidden culprit-a malignant lesion in the left lung.The case has been handed over to the oncologist

Hyponatremia - keep endocrine causes in mind during evaluation

Dr.Mini (Endocrinology, )

A 60 year old male presented with the third episode of symptomatic hyponatremia within a span of 10 months. Prior to the first episode , he had been on hydrochlorothiazide - losartan combination for hypertension and this was subsequently changed to Telmisartan-Cilnidipin combination. TSH was 1.09. During the current episode, TSH was 1.48 and T4 was 4.03(low) suggestive of secondary hypothyroidism. An MR imaging showed a pituitary macroadenoma with suprasellar and bilateral parasellar extension.

another reason to stay away from mosquitos in Cochin

Dr.Jobi (Laparoscopy, )

a 45 yr old lady presented with a 2 cm subcutaneous inflammatory swelling over manubruim sterni of 3 weeks .It responded to antibiotic therapy , but the swelling persisted with itching. She is diabetic and gives a H/O carcinoma right breast treated 10 yrs back. since the swelling persisted , she underwent an excision biopsy which revealed Dirofilaria worm in subcutaneous fat nodule. Dirofilaria is a vector-borne parasitic disease of dogs and cats and is transmitted by mosquitoes. human are accidental hosts and can present with subcutaneous nodules or occualr filariasis

A cough syncope which could have been prevented?

Dr.Sheetal (General Practice / Family Medicine, )

59 yrs old, male pt, k/ c of HT, CAD,occasional smoker had 2 episodes of cough syncope resulting in a black eye,lacerated wound over forehead n haemartrosis knee. H/o dry hacky cough since few mths which persisted despite t/t. O/e no chest signs.xray -increased BVM.lab-mild leucocytosis,ESR 28.Holter monitoring N.He was treated with antibiotics, bronchodilators n antitussives. Drug history revealed ACE inhibitors which was stopped. He responded to t/t with no recurrence of syncope. On follow up he was free from cough. The incidence of ACE-I induced cough is reported to be 5-35%. ( Lit rev.)

Bilateral Pneumonia - R/O Heart Disease

Dr.Madhu (Cardiology, )

A 40 year old gentleman was being treated for bilateral pneumonia. As he had ongoing symptoms, he was sent for an echocardiogram which revealed Severe Calcific Mitral Stenosis. Patients being treated for “Bilateral Pneumonia “ often have underlying heart disease - ACS / Valvular Heart Disease / Myocarditis etc. An echocardiogram is mandatory prior to discharge of such patients - else the diagnosis would be missed.

A case of pleural effusion in chronic liver disease

Dr.Neeraj (Gastroenterology, )

60 year old male diagnosed 6years back as chronic liver disease- ethanol related. He has stopped ethanol since then and is on regular follow up since then. Now presented with worsening of breathlessness. On examination detected to have right sided pleural effusion. CXR- massive right pleural effusion. Further evaluation of pleural fluid revealed high SPAG, ADA of 52U/L, cultures- sterile. He was diagnosed to have tubercular effusion and started on ATT after careful monitoring of LFTs. His symptoms have improved and pleural effusion has settled.

A case of pleural effusion in chronic liver disease

Dr.Neeraj (Gastroenterology, )

60 year old male diagnosed 6years back as chronic liver disease- ethanol related. He has stopped ethanol since then and is on regular follow up since then. Now presented with worsening of breathlessness. On examination detected to have right sided pleural effusion. CXR- massive right pleural effusion. Further evaluation of pleural fluid revealed high SPAG, ADA of 52U/L, cultures- sterile. He was diagnosed to have tubercular effusion and started on ATT after careful monitoring of LFTs. His symptoms have improved and pleural effusion has settled.