Cushing Syndrome Caused by Pituitary and Adrenal Hybrid Tumor: A Rare Case Report

Introduction: Cushing syndrome is a rare endocrine disorder caused by a variety of underlying etiologies. It can be due to exogenous or endogenous high cortisone levels (ACTH-dependent or ACTH-independent). We herein report a case of ACTHdependent Cushing syndrome caused by pituitary and adrenal hybrid adenoma. Case report: A 42-year-old female presented with a complaint of hematemesis. She had hirsutism, central obesity and violaceous striae on her abdomen and thigh. On detailed clinical examination and relevant investigation, we found that the cause of hematemesis was esophagitis with necrotic gastric ulcer due to Cushing syndrome caused by the pituitary and adrenal hybrid adenoma. Discussion: Cushing syndrome is a rare endocrine disorder characterized by increased exogenous or endogenous serum cortisol levels, which lead to various clinical presentations. Early identification of the disease and its cause is critical. The entire clinical presentation must be considered for correct diagnosis, which is generally delayed due to the overlapping symptoms of the disease with various specialities. Conclusion: Diagnosis and management of Cushing’s syndrome continues to present considerable challenges and necessitates referral to higher centers. Its diverse presentation warrants a complete clinical, physical, radiological and endocrine examination

Myocarditis with Unidigital Gangrene in Scrub Typhus Patient – Rare Case

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, an obligate intracellularbacterium. The disease is of greatest public health importance in rural areas of Asia and the Western Pacific Islands. Theclinical manifestations range from subclinical disease to organ failure. The chief target of organism is the vascular endotheliumof various organs. There is inflammation in and around the blood vessels that causes endothelial damage resulting invascular leakage and organ dysfunction. Case report: A 70-year-old female patient, farmer by occupation, presented tous with features of acute febrile illness and shortness of breath and was diagnosed as scrub typhus with myocarditis. Shesubsequently developed gangrene of right little finger. The patient was investigated for infectious and noninfectious causesof vasculitis leading to gangrene. We established that the cause for gangrene was scrub typhus as evidenced by presence ofeschar and positive serology. Conclusion: We report for the first time a case of scrub typhus complicated by both myocarditisand gangrene. Both myocarditis and unidigital gangrene are unusual complications of scrub typhus. Hence, scrub typhusshould be ruled out in patients who present with these complications

Mobile digital x-ray and portable cartridge based nucleic acid amplification test machines for point-of-care diagnosis of TB in rural India

Abstract Background There is no experience of point-of-care (POC) microbiological confirmation for TB in India in field settings. Methods Under the TB-Free Haryana project, a mobile van-mounted digital x-ray and portable GeneXpert system screened all presumptive TB patients with strong clinic-radiological suspicion for TB. Results Of 1673 x-rays, 215 (13%) had findings suggestive of TB, 109 had strong clinical suspicion and were eligible for POC GeneXpert, in whom a test was performed in 82 (75%) cases; 59 (72%) tested positive and were initiated on treatment within 24 h. Conclusions A mobile van equipped with digital x-ray and POC GeneXpert is feasible and has a good success rate with potential for replication. </jats:sec