Dr.Sheetal

Name: Dr.Sheetal Binu

Hospital: Sunrise

Specialties: General Practice / Family Medicine

Cases

A case of referred otalgia

Dr.Sheetal

37 yrs old male came with painful ulcer in the left oral cavity with pain in lt ear which progressed to severe burning pain in the left half of face with vesicular eruptions predominantly in the lower half of face, next day.past h/o chicken pox+. Hiv - Bcoz of predominant lt ear pain and 'stunned' feeling in lower part of face, it was suspected to b an evolving zoster oticus. Antivirals &steroids were given.7thN NAD. Audiometry N.With passage of time 5th N involv became clearer with eye involv.After skin lesions had healed,he had debilitating post herpetic neuralgia in the left ear.

A cough syncope which could have been prevented?

Dr.Sheetal

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.)

"Desiderosmia" - in iron defeciency anaemia.

Dr.Sheetal

40 yrs old female, was brought by her spouse with complaints of Pica ( eating lead pencils, raw rice) and unusual craving for the smell of petrol and naphthalene balls. She was found to have severe FDA(iron defeciency anemia-Hb5. 7gm/dl), secondary to menorrhagia. Lead levels were nontoxic. The symptoms disappeared after correcting the anaemia. Although Pica is known to occur in FDA, the craving of certain smells was first reported by B. Hansen et Al in the Blood journal in2016. He proposed the term Desiderosmia derived from " Desiderare" Latin for desire, and"osame" Greek for smell.

A near death escape...

Dr.Sheetal

22yrs old female pt was admitted with Dengue fever and severe thrombocytopenia. She refused blood or platelet transfusion citing religious beliefs and signed an informed consent for refusal of the same. She deteriorated rapidly due to heavy bleeding PV and malaena. Hb dropped from 13 to 2.5 gms/dl. She was stabilised with ivfluids, plasma expanders, ionotropes, haematenics and oxygen. High doses of Norethisterone suppressed the bleeding PV, but malaena continued. PT, aptt got prolonged. As a last resort factor 7a was given after consent. Bleeding stopped. Hb improved to 8.5 gm/ dl in 3-4weeks.

Holiday heart syndrome

Dr.Sheetal

42 yrs old male pt, was admitted with palpitations after being on a drinking binge. He looked dehydrated and had an irregularly irregular pulse. ECG showed atrial fibrillation with a ventricular rate of 120/min. Lab tests showed hypokalemia. He was rehydrated and given kcl correction after which the rythm reverted to sinus rythm. Cardiac evaluation was normal and the patient was discharged with advice to refrain from or reduce alcohol consumption.

Factitious hyperthyroidism

Dr.Sheetal

66 yrs old female pt, presented with palpitation. Clinical exam revealed s/o hyperthyroidism. Lab values confirmed it. Surprisingly all her previous lab records showed normalTFT. She gave history of taking a 3 months treatment for losing weight and was given a pill to be taken every morning. The content of the pill came as no surprise- Thyroxine. The pill was stopped resulting in normal TFT and resolution of palpitation.

COELIAC DISEASE WITH TUBERCULOSIS

Dr.Sheetal

72 yrs old lady, a k/c o coeliac disease was admitted in septic shock after an acute febrile illness. She was treated with broad spectrum antibiotics, iv fluids and ionotropes. Although she recovered well, she continued to have low grade fever with evening rise. Blood cultures and urine cultures showed no growth. CT Chest showed pleural effusion. It was exudative with lymphocytic predominance.ADA was elevated. She was given emperical ATT. She responded well and showed complete clinical and radiological resolution . studies have shown an association between coeliac disease and tuberculosis.