Azathioprine causing cholestatic jaundice in a lupus nephritis patient: A case report and review of literature

The systemic lupus erythematosus (SLE) is an autoimmune disease affecting predominantly females of reproductive age group. Pregnancy is advised only after a period of disease quiescence for at least six months. Azathioprine (AZA) and prednisolone are the immunosuppressants commonly used during pregnancy in lupus nephritis. Azathioprine causing cholestatic jaundice has been reported only a few times but none in a patient with lupus nephritis, pregnant or otherwise to the best of our knowledge. We present an interesting case of a young pregnant patient of lupus nephritis (LN) developing cholestatic jaundice in the third trimester, causingdiagnostic dilemma between drug-induced jaundice and Intrahepatic cholestasis of pregnancy which resolved after withholding azathioprine. We should be aware of this uncommon adverse effect of this very commonly used drug in SLE patients

Acute pancreatitis associated with cholera

Acute Pancreatitis (AP) is the inflammation of the pancreas, common causes being gall stones, alcohol, iatrogenic and trauma. Infections, mainly viral, are a rare cause of acute pancreatitis, mainly reported as case reports or series in the literature. Cholera caused by Vibrio Cholera, though rare these days, is characterized by vomiting and profuse watery diarrhea. We present an interesting case of Cholera complicated by mild pancreatitis with no other obvious cause following admission which was managed conservatively with full recovery. We are highlighting an unheard complication of cholera

Sjogren’s syndrome presenting with recurrent hypokalemic paralysis

Sjogren’s syndrome is an autoimmune disorder commonly affecting females and presents with the dryness of the mouth and eyes. Here, we present an interesting case of Sjogren’s syndrome, initial presentation with distal renal tubular acidosis (RTA) causing recurrent hypokalemic paralysis, and dyspnea requiring ventilator support. The patient improved dramatically with potassium and alkali supplementation. She has been on follow-up for the past 3 months and remains asymptomatic. Only a few case reports and series have been reported on such initial presentation of Sjogren’s syndrome. To conclude, one must be aware of distal RTAs associated with autoimmune disorder presenting with hypokalemic paralysis

Peritoneal dialysis catheter insertion by nephrologist using minilaparotomy: Do survival and complications vary in obese?

Introduction: Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population. Materials and Methods: We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12−36 months follow-up. Results: 245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results. Conclusions: Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight