Half and half nail or Lindsay’s nail

A 62-year-old diabetic patient came to the outpatient department due to increasing tiredness in the past few months. On examination, his distal half of fingernails revealed pinkish red transverse band which is sharply demarcated by a dull white band proximally, consistent with half and half nail. Further evaluation showed evidence of chronic kidney disease due to long standing poorly controlled diabetes. Although half and half nail is seen in many conditions, it is relatively a specific clinical marker of end stage kidney disease and hence serves as an important diagnostic clue

Leukocytoclastic Vasculitis: A peculiar presentation of Scrub typhus

Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus among other acute febrile illnesses present with prodromal symptoms of fever, malaise, myalgia, anorexia followed by a distinct maculopapular rash, hepatosplenomegaly, and lymphadenopathy. In this case report, we present a patient who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil Felix test, a diagnostic titer of 1:640 against OX-K was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with Doxycycline and showed a drastic improvement in his symptoms. Keywords: Scrub Typhus, Rickettsia; Vasculitis; Doxycycline

PHENYTOIN-INDUCED ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS

ABSTRACTPhenytoin is the first line antiepileptic for generalized tonic-clonic seizures. It is still the go to†drug despite the availability of newer antiepileptics,chieflybecause of its lowcost and highefficacy.Phenytoinis associatedwith toxicitiesinvolvingmultiple organsystemssuch asbrain,blood, and skin. One of the most common adverseeffectsis the developmentof skin rashes.It can rangefrommild tolife-threateningskineruptions.This is a case reportof a younggirlwhodevelopedacutegeneralizedexanthematouspustulosis followingphenytointherapyforposttraumaticseizures.Keywords: Drug-induced rash, Anti-epileptic, Type-4 hypersensitivity, Hydantoi

Association of Vitamin D Deficiency and Newly Diagnosed Pulmonary Tuberculosis

Introduction. Vitamin D has a significant role in host immune defense against Mycobacterium tuberculosis. It has been suggested that pulmonary tuberculosis may be associated with lower levels of vitamin D. Present study was therefore undertaken to identify the association between vitamin D deficiency and pulmonary tuberculosis. Methods. A case-control study was conducted in a tertiary care hospital from 2014 to 2016, including 50 adult newly diagnosed sputum positive pulmonary tuberculosis patients as cases and 50 age and sex-matched healthy participants as control groups. All participants in the study group had undergone detailed clinical examination and routine laboratory investigations, including vitamin D, calcium, and sputum for AFB. The clinical characteristics, X-ray findings, sputum AFB, and vitamin D levels were analyzed and compared with data obtained from healthy controls. Results. In both groups, the majority were men (88%). BMI was significantly (<0.0001∗) lower in the tuberculosis group (19.40 (17.20, 22.0) vs. 24.00 (22.50, 25.47)). Serum vitamin D levels were significantly lower (P=0.012) in the tuberculosis group (19 (7.75, 27.25) ng/dl) as compared to the control group (25 (19.75, 32.00) ng/dl). Out of 50 TB patients, 27 (54%) had vitamin D deficiency, while among healthy controls, only 13 (26%) had vitamin D deficiency. Among vitamin D deficient PTB patients, 44% had 3+/hpf AFB in sputum smear examination. Conclusion. The prevalence of vitamin D deficiency in pulmonary tuberculosis cases is very high. Hypovitaminosis D was associated with more severe clinical symptoms, higher sputum smear positivity, and extensive lesions in chest radiograph among pulmonary tuberculosis patients