Thyrotoxicosis presents as periodic paralysis

Dr.Shyma (Neurology, )

38 yr old male presented with weakness of both lower limbs of one day duration. No bladder or bowel symptoms, sensory symptoms. Neurological examination showed lower limb power of three out of five bilaterally and hypotonia of Lower limbs. Reflexes were normal, plantar flexor and no sensory level. MRI spine -normal. Nerve conduction study-Normal. Lab evaluation showed thyrotoxicosis with hypokalemia. Patient improved dramatically with treatment of the cause .

Disregard subtle clinical signs at your peril

Dr.Arun (Endocrinology, )

22 year old graduate, noticed stretch marks over her abdomen few months before presentation but was otherwise totally asymptomatic. Over the next few months, she noticed 2 kg weight gain. BP and blood glucose were normal. She had no Cushingoid features but had hyperpigmentation of knuckles. A dexamethasone suppression test was borderline abnormal. Further tests confirmed mild cortisol excess and a pituitary microadenoma on MRI. Although we initially thought a wait and watch approach is better, she continued to gain weight and was keen to undergo TNTS. Postoperatively she is in remission.

Heart failure precipitated by unaccustomed exertion in an elderly male

Dr.Rajeev (Gastroenterology, General Practice / Family Medicine, )

An 82-year-old man presented it to gastroenterology OP clinic with bloating and hiccups following a physically strenuous trip to a place of worship the day prior. He had no coronary risk factors. Sinus tachycardia of 100 with ectopic beats, and a systolic murmur were found. He was suspected to have ischaemic heart disease and referred to cardiology immediately. He was diagnosed with acute coronary syndrome, NSTEMI with acute left heart failure. Troponin-I was elevated at 200.4. He was treated with diuretics, heparin and antiplatelet treatment, on which he improved rapidly.

Look , there is a tick !

Dr.Anuradha (Dermatology, )

A 60 year old man presented with a painful brownish raised skin lesion near the right eye of 5 days duration. On examination there was a tender shiny brownish papule near the medial canthus of right eye(Image 1). On closer examination a 'movement ' of the lesion was appreciated and it was found to be an insect(tick) that was holding on to the skin. It was removed using a fine curved forceps( Image 2). Ticks are blood sucking ectoparasites which may transmit various diseases. It may remain unnoticed on human skin until it becomes painful. This case is being presented to hightlight the importance of careful examination which may point towards the diagnosis.

Hypothyroidism as a cause of recurrent Vomiting

Dr.Rajeev (Gastroenterology, General Practice / Family Medicine, )

A 28 year old woman presented with recurrent vomiting of several years duration. There were no other gastrointestinal symptoms. She had no neurological symptoms. There were no allergies. Her blood tests showed a TSH of 75 and a low T4 of 2.98. She was started on Thyroxine.

Botox causes fecal incontinence

Dr.Rajeev (Gastroenterology, General Practice / Family Medicine, )

A 39 year old woman, a resident of Canada presented recently in India with fecal and flatus incontinence after she was given Botox 20 U x 2 doses in 1 year ago in Canada. It was done for an anal fissure. She had apparently had a normal colonoscopy prior. There are no signs of spontaneous improvement yet. This complication has affected her ability to work and overall quality of life.

Colon polyp in a 34 year old man

Dr.Rajeev (Gastroenterology, General Practice / Family Medicine, )

A 34 year old asymptomatic man underwent screening colonoscopy due to family history of colon cancer. A 10 mm sessile polyp was found and removed. Biopsy is pending.