Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Melioidosis, endemic in Thailand and in the Northern Territory of Australia is an emerging infectious disease in India which can present with varied forms. A case of melioidosis, presenting as a rare anterior mediastinal mass which can masquerade as malignancy or tuberculosis, is described here. With treatment, our patient initially showed an increase in the size of mediastinal node and development of new submandibular node.. To the best of our knowledge, this phenomenon has not been documented in the literature and the same is highlighted in this case report. </p> <p>Case Presentation</p> <p>A 43-year-old Asian man with diabetes presented with fever, loss of appetite, weight loss for one month and painful swelling below his left mandible for five days. An examination revealed an enlarged left submandibular lymph node and bilateral axillary lymph nodes. A chest X-ray showed mediastinal widening. Computed tomography of his thorax showed a lobulated heterogeneously enhancing anterior mediastinal mass encasing the superior vena cava suggestive of malignancy. An excision biopsy of the lymph node showed granulomas suggestive of tuberculosis but bone marrow culture and lymph node aspirate culture grew <it>Burkholderia pseudomallei</it>. He was treated with parenteral ceftazidime and amoxicillin-clavulanic acid. During the course of treatment, he developed an enlargement of the submandibular lymph node on the opposite side. It gradually subsided with the continuation of therapy orally with a combination of cotrimoxazole and doxycycline for six months. A repeat computed tomography chest scan showed resolution of the mediastinal mass.</p> <p>Conclusion</p> <p>Melioidosis can present as a mediastinal mass that mimics tuberculosis or malignancy. During the initial phase of treatment of melioidosis, the appearance of new lymph nodes or an increase in the size of the existing lymph nodes does not mean treatment failure. Inexperienced clinicians may consider this as treatment failure and may switch treatment. To the best of our knowledge, this is the first report documenting this phenomenon in melioidosis cases.</p

CYCLOPHOSPHAMIDE INDUCED FATAL CYTOPENIA: A CASE OF PARAQUAT POISONING

Paraquat is an effective herbicide widely used in India, but is highly toxic on human exposure. Cyclophosphamide is used as pulse therapy in combination with methylprednisolone for paraquat poisoning management. Neutropenia and thrombocytopenia are the main side effects which may occur with cyclophosphamide in cancer treatment due to bone marrow suppression. Hereby we report a rare case of cyclophosphamide-induced fatal cytopenia in a patient with paraquat poisoning. This is a case of 24 y old male who came to the emergency department of our hospital with a history of alleged consumption of 50 ml of paraquat liquid. On admission, he complained of pain and burning sensation in the throat and retrosternal region. Different treatment modalities, namely, pulse therapy with cyclophosphamide and methylprednisolone; and hemoperfusion were used to manage patient's condition. Within few days, the patient developed severe neutropenia and thrombocytopenia. Despite several blood transfusions, the patient expired due to fatal manifestations of cytopenia

Schiff Base Complexes for Catalytic Application

Primary amines are combined with an aldehyde group to generate Schiff base compounds, which are called condensation imine products. This class of compounds has a general structure, R-C=NR\u27, where R and R\u27 represent alkyl/aryl/cyclohexyl/heterocyclic group. These compounds contain an azomethine group that is basic in nature due to, (i) the presence of lone pair of electrons on the nitrogen and (ii) electron-donating nature of the double bond. Hence, these compounds, as ligands, participate in the formation of metal complexes. The presence of lone pair of electrons on the nitrogen atom and the hybridization involved explains the physical, chemical, and spectral properties of nitrogen-containing moieties. In the case of (sp2) hybridization (trigonal structure), the lone pair of electrons occupies either a symmetrical unhybridized 2p orbital that is perpendicular to the plane of trigonal hybrids or a symmetrical hybrid orbital, whose axis is in the plane, leaving behind only the π-electrons in the unhybridized 2p orbital. A very similar type of hybridization is experienced by the nitrogen atom in the azomethine group. Traditional phosphine complexes of nickel, palladium, and platinum, particularly those of palladium, have played an extremely important role in the development of homogeneous catalysis. Schiff base complexes as catalysts have been studied for various organic transformations such as oxidation, epoxidation, reduction, coupling reactions, polymerization reactions, hydroformylations, and many more

Recurrent Pseudomonal Pneumonia

Community-acquired pneumonia due to Pseudomonas aeruginosa typically occurs in patients with pre-existing lung disease and immunocompromised individuals. We report the case of a previously healthy young adult who presented with recurrent episodes of pneumonia due to Pseudomonas aeruginosa complicated by pleural effusion. Careful and extensive evaluation ultimately revealed the unusual reason behind the patient’s illnes

Hydroxyurea Induced Perimalleolar Ulcers

Hydroxyurea (HU) is an antineoplastic drug commonly used to treat chronic myeloproliferative disorders. Common dermatological side effects include hyperpigmentation, scaling, erythema, alopecia, desquamation of face and hands. Leg ulceration following HU therapy is less common and very few cases have been reported so far. Objective of this paper is to increase the awareness of hydroxyurea induced leg ulcers which will aid in the early diagnosis and appropriate treatment. The first case was a chronic myeloid leukemia (CML) patient on HU 1.5 g/day for 5 yr, who had bilateral painful perimalleolar ulcers for 6 months. The second case was a CML patient on HU 1.5 g/day for 3 yr who developed bilateral lateral malleolar ulcers. Third case was a polycythemia vera (PV) patient on HU 1 g/day for 5 yr who presented with painful medial malleolar ulcer of 2 months. The last case of our report was an elderly PV patient on HU 1.5 g/day for 2 yr and presented with lateral malleolar ulcer which persisted on reducing the dose of HU. In all the 4 cases the ulcers healed on stopping HU. Our report confirms the association of chronic hydroxyurea therapy and perimalleolar ulcers which respond promptly after discontinuation of the drug. The heightened awareness among the physicians will promote early diagnosis and prompt relief from the agonizing ulcers

Antiretroviral therapy outcome in human immuno-deficiency virus infected patients in a tertiary care hospital

Background: Human immunodeficiency virus (HIV) presently accounts for the highest number of deaths due to any infective agent in the world. The present study assessed the one year treatment outcome following antiretroviral therapy in HIV positive, treatment naïve patients in a tertiary care hospital.Methods: Adult HIV positive, antiretroviral treatment naive patients who were started on antiretroviral therapy (ART) between 1st January 2011 and 31st May 2013 were included in the study. Data was collected from their case records. CD4+cell count, haemoglobin level, weight, occurrence of opportunistic infections (OIs) and adverse drug reactions (ADRs) were analysed at baseline, 6 and 12 months following start of antiretroviral therapy. Data was analysed using parametric and nonparametric tests.Results: Data of 325 patients was analysed. Overall, the median increase in CD4+ count at 1 year after initiation of treatment was observed to be clinically significant. Patients on tenofovir based regimen showed a significantly greater increase in the median CD4+ count (P = 1.12×10-05) and haemoglobin (P = 0.002) as compared to those on non-tenofovir based regimen. A total of 151 ADRs were recorded in the study, of which the most common were skin rash 24%, anaemia and gastrointestinal side effects 17% each. Frequency of opportunistic infections gradually declined after ART. At the end of 1 year of treatment, the cumulative loss to follow up was 7.4%.Conclusions: By following the current national guidelines, the desired immunological and clinical response following initiation of ART can be achieved while minimizing drug toxicity

Lipoid Proteinosis Mimicking Congential Inmunodeficiency

Lipoid proteinosis is a rare congenital disorder that can present with a variety of symptoms. A nineteen year old Indian male with dysmorphic features was admitted with a twelve year history of recurrent ulcerations over the upper limbs and oral cavity. Although the initial presentation was strongly suggestive of a congenital immune-deficiency syndrome, all investigations for immunodeficiency disorders were negative. Subsequent evaluation yielded a diagnosis of lipoid proteinosis