Defying the paradigm — rescue thrombolysis in a postoperative patient with pulmonary embolism

Parenteral anticoagulation is recommended for patients of intermediate — high early mortality risk pulmonary embolism. Rescue reperfusion is considered if signs of hemodynamic decompensation appear. Recent surgery is a contraindication to thrombolysis. Percutaneous catheter directed thrombolysis and surgical embolectomy can be done in such patients. However, they are not readily available. We hereby report a case of rescue thrombolysis in a post lower segment caesarean section (LSCS) patient with pulmonary thromboembolism. We could successfully achieve thrombolysis in our patient with improvement in clinical and hemodynamic parameters and with no major bleeding from any site

A rare case of isoniazid induced sideroblastic anemia

Sideroblastic anemia is a rare cause of anemia. Most of it accounts for the genetic cause, while drug induced is still uncommon. Our patient, a 20 year old female, is a known case of right frontal tuberculoma on ATT presented with complaints of generalized weakness and loss of appetite. On evaluation, she was found to have severe anemia and bone marrow studies confirmed it to be sideroblastic anemia. On revisiting the history, it was noted that she was not taking pyridoxine supplements as advised along with antitubercular drugs. Our patient is one among the few documented cases of Isoniazid induced sideroblastic anemia.This case needs attention because it is a preventable cause of anemia and the clinicians need to be aware about the compliance of the patient with the supplementary drugs.

Visceral leishmaniasis escaping the diagnosis and withstanding treatment in a case of recurrent pyrexia

Though visceral leishmaniasis (VL) is the leading parasitic infection causing deatharound the world after malaria, it is a less suspected cause of pyrexia of unknown origin (PUO). We present a case of a middle aged man who was diagnosed with VL only months later owing to the stealthily masquerading disease as also to a generally low index of suspicion for it. A 59-year-old from Uttarakhand presented to us with complaint of fever of a few weeks duration. He was found to have a bicytopenia with elevated liver enzymes. Routine imaging studies were non-contributory. Cultures revealed candidemia while tests for viral and other atypical infections were negative. A bone marrow examination (BME) revealed haemophagocytosis. Positron emission tomography–computed tomography (PET-CT) showed mildly FDG avid hepatosplenomegaly. He was treated as a case of candidiasis with secondary hemophagocytic lymphohistiocytosis (HLH) and was discharged. He was readmitted months later with recurring fever. Repeat investigations revealed pancytopenia with marked hepatosplenomegaly. A repeat BME, however, revealed Leishmania donovani (LD) bodies. Patient was treated with liposomal amphotericin B (LAmB) and discharged. Though the patient’s symptoms improved soon after, he was again admitted a couple of months later and found to have VL persisting in the BM aspirate. This report underscores the need to extensively evaluate cases of PUO rather than summarily dismissing them as routine. VL is one of the less suspected etiologies despite being the second largest parasitic killer

Study of hematological profile of systemic lupus erythematosus

Background: Hematological abnormalities are prevalent in systemic lupus erythematosus (SLE), with approximately 72% of patients experiencing anemia, primarily in the form of autoimmune hemolytic anemia. Other manifestations include leukopenia (32%), lymphopenia (54%), and thrombocytopenia (23%). This study aimed to further investigate these hematological manifestations, which may serve as presentations of SLE and might be overlooked if suspicion levels are low. Methods: A descriptive observational study was conducted over 18 months at a Sir Ganga Ram hospital, a tertiary care centre. One hundred thirteen SLE cases, comprising newly diagnosed patients and previously diagnosed patients’ records, were reviewed, with 13 cases excluded based on exclusion criteria. One hundred patients with hematological abnormalities and fulfilling ≥4 SLICC criteria for SLE diagnosis were included in the study. Results: One hundred cases of SLE with hematological abnormalities (88 women, 12 men) were analyzed. At presentation, 83% (n=84) of patients displayed hematological manifestations. The most prevalent abnormality was anemia, present in 72% of the study group, with a mean hemoglobin level of 10.073 gm/dl. Additionally, leukopenia, lymphopenia, thrombocytopenia, and pancytopenia were observed in 32%, 54%, 23%, and 14% of cases, respectively. Neutropenia was detected in only 5% of cases. Conclusions: Hematological manifestations are the most common presenting signs of SLE in North India. Anemia, with a multifactorial basis, is the most frequent hematological abnormality throughout the disease course. A high index of suspicion is crucial when evaluating cases of anemia in daily clinical practice

A young non-smoker with high ADA pleural effusion. It’s not always tuberculosis

Lung cancer is posing an ever-increasing medical and social problem due to its increasing morbidity and mortality. Here we report a case of a young male who was being treated as tubercular pleural effusion but was ultimately diagnosed with non-small cell carcinoma. While considering the diagnosis of pleural effusion, in the context of country endemic for tuberculosis like India, it is not surprising that many clinicians rather prefer to consider pulmonary tuberculosis as the first differential, while keeping diagnosis of malignancy as the least likely differential diagnosis in the young patient

Mediastinal germ cell tumour masquerading as loculated pleural effusion

Benign mediastinal teratomas often discovered while patients are still asymptomatic. Almost all arise in the anterosuperior mediastinal compartment. Most symptoms result from compression of adjacent structures. We report a case of a large teratoma arising from the anterior mediastinum that presented a confusing clinical picture of loculated pleural effusion which was successfully diagnosed and treated by surgical excisio