ePosters - Case Reports
Unknown authors
Abstract
CAS001 Disseminated intravascular coagulation, a rare and life threatening haematological complication of systemic lupus erythrematous N Mendiratta; Fortis Memorial Research Institute, Gurugram, Haryana, India Case Detail: We present a rare case of a young female diagnosed with Systemic Lupus ERythrematous who presented to us with multi organ involvement. Initially admitted in her hometown with acute liver injury, where she recieved heavy courses of antibiotics but LFT kept deterioating. Admitted with hepatitis (SGOT 9250 SGPT 7583) in a liver institute, she soon went on to develop renal shutdown.She received one cycle of plasmapheresis following which LFT improved. Patient was initially being treated for infection in view of multi organ involvement. As she continued to deterioate she was shifted under Rheumatology care. Further work up was done but within a day she developed profuse bleeding from all sites. Doubt on Infection remained the priority as patient went into Frank DIC (Raised D Dimer, Deranged Coagulation parameters) she developed bleeding from nostrils, oral cavity, diffuse alveolar Haemmorrage requiring 10 to 12 units of Cryoprecipitate, FFP, Blood transfusion. Her work up was done further. The Acute Promyelocytic Leukemia work up was negative. APLA was ruled out as well. Suspicion remained for TTP as she had thrombocytopenia but peripheral smear did not show any evidence of schistocytes and ADAMTAS 13 levels were negative. As she had already received heavy doses of antibiotics but continued to deterioate, hence a bold decision was made to give her pulse steroids. She continued to be on dialysis over the next 3 to 5 days. Intravenous Immunoglobulins were given simultaneously. PAtient responded well to the treatment and was shifted out of ICU. Her bleeding stopped and she was eventually discharged after 21 daysofinhospitalstay. FINAL DIAGNOSIS1. Systemic Lupus Erythrematous with - Disseminiated intravascular Coagulation- Acute Fulminant hepatitis- Myositis- Diffuse Alveolar Haemmorrage- Acute Kidney Injury with Renal Shutdown (On dialysis support)- Bicytopenia CAS002 Giant cell arteritis presenting as pyrexia of unknown origin-an interesting case report S P S, A NX, A Ali, A Warrier; Aster Medcity, Ernakulam, Kerala, India Case Detail: Giant cell arteritis (GCA) is a primary granulomatous vasculitis affecting the large and medium sized arteries. The common symptoms are headache, weight loss, jaw claudication and visual symptoms and associated elevated inflammatory markers. GCA presents with usually atypical manifestations like cough, glossitis, lingual infarction, neurological manifestations, aortic aneurysm, and myocardial infarction in approximately 40% of patients.[1] PUO as a presenting manifestation is very rare and may be found in only 15% of patients. We present here a case of GCA which initially presented as PUO.[1] Case Report: A 65-year-old female, a known case of Type 2 Diabetes Mellitus and Dyslipidaemia was evaluated for persistent fever of 1 month duration with myalgia, lower abdominal pain, headache, and weight loss of 4 kgs over a period of 3 months. She also had profound anorexia, nausea, and watery stools of increased frequency. Blood routines showed leucocytosis, elevated CRP (46 mg/dl), ESR (103 mm/hr) and serum alkaline phosphatase levels (223 U/l) with negative blood and urine cultures. These were in line with the EULAR criteria for Polymyalgia Rheumatica (without USG parameters). She was started on Prednisolone and other supportive management. A PET-CT taken for the workup of PUO did not show any focal abnormality and serum ferritin levels were also normal (against Still’s disease). Over the next 2 days, she was afebrile (without any antibiotics or steroids) but had persistent loose stools. Hence a colonoscopy was performed, and biopsy taken to screen for inflammatory bowel disease which was essentially normal. In view of the persistent symptoms like anorexia and headache, low dose Wysolone was continued along with Amitriptyline. Two weeks later, she presented with increased joint pain and pain over temporomandibular joint on mouth Opening. Even though she was afebrile, inflammatory markers were still high. Doppler ultrasonography of bilateral temporal artery was hence taken which showed hypoechoic lesions, also called “halo sign” [Figure 1] which was suggestive of temporal arteritis. She was started on Methotrexate and steroids were continued. Gradual resolution of symptoms was noted.Figure 1: (a and b) Hypoechoic lesion visible on ultrasound of bilateral temporal artery-“halo sign”CAS003 Leprosy masquerading as relapsing polychondritis R Goel; IPGMER, Kolkata, West Bengal, India Case Detail: Case Details: A 23-year male presented with 3-years history of numbness and paraesthesia in bilateral feet and left forearm, 1.5-years history of fever with inflammatory polyarthritis and 6-months history of recurrent episodes of reddish painful swelling of ears, nose and periorbital region [Figure 1]. Initially, he was diagnosed as Relapsing Polychondritis owing to auricular chondritis, nasal chondritis, seronegative non-erosive inflammatory polyarthritis and peripheral neuropathy (Nerve conduction study suggested bilateral tibial nerve axonopathy). He was prescribed steroids and methotrexate but his symptoms worsened. Re-evaluation revealed tender nerve thickening involving bilateral ulnar, common peroneal and right greater auricular nerve, multiple hypopigmented normoaesthetic macules over neck, trunk and bilateral upper arms, tender inguinal lymphadenopathy and erythematous tender nodules over left shin and left antecubital fossa suggestive of Erythema Nodosum. Left Inguinal Lymph node biopsy with Fite-Faraco stain showed collections of foamy histiocytes (also known as ‘Lepra cells’/’Virchow cells’) interspersed with lymphocytic infiltrates with globi of Lepra bacilli within and around the foamy histiocytes [Figure 2]. Skin biopsy showed septal panniculitis smear and biopsy show Lepra of Leprosy with 2 Lepra was The patient was started on for Leprosy and dose steroids. his fever and joint and improved. in but case presented as auricular the nerve thickening and were in case which which is of be kept negative biopsy and smear as low 1: Left inguinal node biopsy globi of bacilli within and around foamy histiocytes A case of to and in R Goel; IPGMER, Kolkata, West Bengal, India Case Detail: with for with to the presented to us with the of pain following 1 month acute and patient had increased in and of all 4 and pain, and joint in all 4 lesion was and revealed and of with diffuse to Patient was with was given owing to as and as Her disease was with with in view of and 4 and multiple like and 1: view and of with of of with of the A of the as a of P Goel; India A was as in The of for the in the treatment of also are though in the of is a for the of and as the on in view of the of is a in the of of is to the disease and diagnosed in or the not and be with Case initially presented with left pain had present for weeks He was as a case of Over the pain in region and was and a and were 1]. A a in the month of he a of of bilateral with and [Figure 1]. and of of showed of was in right and left and increased a of bilateral of the 1: A The duration for the of in case was weeks with a of The dose of in of is to but to the in from the to develop is and to a doses of A of be for the patient who of pain and of The be for as is for of along with for of be treated with or joint is for the of and D are also systemic - A or a D A A S A India of India Case Detail: A male in his presented with thickening of the over the and feet of a month duration and of Skin thickening was to of [Figure to of weight loss in are associated with The patient any history of A of revealed a and and USG of with suggestive of the patient had a of and on We with and admitted the patient with a of diffuse Systemic renal kept as a given the of the disease and weight A revealed a node in the left revealed of unknown with and 1 on showed was abnormality in and The revealed and biopsy was for a in of the the patient was started on for and were with in thickening and of The patient is being to the to further. are usually in of diffuse Systemic with in the of as in the present is a or a is still for out The of and normal with thickening the of as in a case with and with Systemic but with of symptoms not in the disease with a history of weight loss or other systemic the of of are in 1: of and S India Case Detail: is a panniculitis and A presented in the of life with multiple episodes of fever polyarthritis panniculitis following or was in and fever with and inflammatory polyarthritis and of revealed leucocytosis, very evidence of was with to revealed in in loss of of in The interesting case of 1: of granulomatous on the inflammatory on the and suggestive of granulomatous of the with to of and suggestive of granulomatous after with and in the suggestive of granulomatous on bilateral Detail: A female was his to with of in in over the 4 months. The loss of was over the 2 months. revealed of granulomatous with bilateral She was for for the of the and She was to Rheumatology to screen for associated systemic disease in view of the history and in the revealed on the bilateral As the had present for the 4 and had increased in over the one and a The of pain in the from bilateral on the was history of any painful or A of other did not any or was a history of on the which had not for the months. was lesion the of was in the right of granulomatous were The patient was started on oral steroids was done which was for a in 4 of the The patient was after the report and methotrexate was A of steroids was after the the had and the had in - the and the of joint in D Research and India Case Detail: A a of was to of Kidney - in the he presented with cough, with for days. He also of and swelling of lower He was found to serum of with Further in revealed negative normal negative multiple work was and 3 was normal. was The Renal biopsy was suggestive of with to in also showed diffuse acute with The was with with He was started on and treated with pulse with pulse 5 of were also He was started on which was to 5 He was on treatment he developed with fever and in showed He was treated with of He was well in the of he to fever with and along with right pain and was he had and of the systemic was normal. revealed with ferritin and suggestive of with had The are in He responded well to of antibiotics as The made was Acute with with associated on In showed usually is the common is usually involving one large joint as the or The is the joint in the presents with acute joint pain, and a or to the of fever is in 40% to of lower are in with the being the of from the joint is the for with a blood cell greater and or a of a in the the lupus in patient A A S P P India and A female, presented with multiple erythematous initially over the to upper oral over a period of with history of was history of joint pain, or any systemic involvement. multiple with erythematous were present over [Figure 1] upper which to with showed of Patient history of of episodes of She did not any or was 1: lupus on and She had on was present with of the were within the normal of lesion showed with cell the with lymphocytic suggestive of She was diagnosed as lupus was treated with oral oral of was within a of [Figure Case of A India Case Detail: is a He presented with bilateral pain 5 was diagnosed as of treatment his the of and was He which did not give any was diagnosed as He was started on Methotrexate and pain had and he was of is a inflammatory associated with is found in of with with other and is usually negative but a may be for and - of one who also or The of is to a of to in the and - in patients. The of is usually in the and and in and The of in with was and In as infection or a inflammatory involving and in the of which is a in the of and which is the where and joint to the is the lesion in in to in are in but not in of are in the Case Patient and presented with pain joint and are of revealed - joint was diffuse with He was for - - - Patient was started on with and to to and of the treatment Patient is with the A rare case of primary in a to S A Rheumatology India is and of loss, and persistent be primary or to a like with to of (a in primary in the of a who had as the presenting manifestation of primary who initially on and oral which and responded to A presented with of of her and with of the of was history of oral or focal neurological She had of right Systemic was normal. revealed thrombocytopenia and blood were negative. The serum urine liver and renal serum USG were all within normal for and was normal. showed negative and normal serum The and and lupus were after of 13 weeks were and and the and history of in the of the patient was diagnosed with primary She was started on oral and oral with The within the next weeks with of her her steroids were and she was on the patient was to later, she had with which did not to and was normal. of she was 3 doses of one She showed after with of the lupus as a rare manifestation of systemic lupus P A and India Case Detail: A female with of abdominal 2 days. She was diagnosed with was on oral She for she had peripheral or was tender with for of the was showed showed revealed a low with with normal levels are in 1 and in of urine showed of USG revealed with or revealed diffuse thickening of suggestive of was normal. Initially, she was given of normal for was to as was As the blood were the of lupus to was She received a pulse dose of Intravenous for 3 along with but to She eventually of intravascular 1: on on day 3 of patient had presented with and showed a low negative were ruled out the of of was a the of - infection or presenting as The was up which responded well to with antibiotics in of The which did not well with of was the ESR which was within the normal showed other of the of presenting as was She was given a pulse dose of oral after in to which did not the she of intravascular is with other in case of presenting as D A A N A and Research India Case Detail: A female to the with of and which revealed large and with on 2 patient with of associated with 2 days, and fever 1 the patient had pulse of of of with and of The had bilateral Patient was given her Patient was shifted to and urine and started on and and was was patient had bilateral was on left right on left on left upper and lower after neurological was in for young APLA all negative. and history was and increased and was She was on pulse - for negative. showed 5 and negative and was showed for taken who pulse for 5 and to oral Patient responded to and was on day 4 of pulse She was kept on and eventually and the patient was and shifted to showed and was given and patient with and and she was started on Patient was discharged on and 1: - in of on and on with the R S A R of India Case Detail: is a case of a who presented with diffuse and and was treated as A male presented with and pain with persistent the He with a He had involving the and any He also of pain over multiple showed increased and blood in and increased in and of He was diagnosed as and treated with multiple any he had pain over and diffuse any was joint disease was of as showed was elevated A was which showed of to well involving nasal septal and in left and right The patient nasal and biopsy of in showed suggestive of A of was Patient and of 1: of to well involving nasal septal A case of and A of S Kolkata, West Bengal, India Case Detail: is one of the presenting with other and is a of a case presenting with to of and of patient a female any presented to us with of 2 weeks history of in the and along with a history of upper infection 3 to the symptoms She did not any for and on She had history of any history of any in the history of any and any blood or showed left any Left in showed serum were normal. liver 1 and out to be in and showed only in were all were normal. biopsy report and showed normal and increased with normal and cell with stain showed were normal. done showed right is to be biopsy showed of was and of was made as the is of started on steroids and her and to and within 3 days. Patient is to up on with blood her up after 1 her to 1: biopsy with stain normal the and - and A in a of A rare of pain S A Rheumatology India is one of the for of primary in lower in the and in the are as the is and other or or or a and are a is of in and to the of in the of with persistent Report: A with of and of presented with a history of left The pain and He had history of The was for to of the left of was any The patient was diagnosed as with and was treated with and with In of left showed a well lesion in of with within or of showed a lesion in on [Figure with on [Figure in are and normal. of was Patient was He and was to a in as in the present a in - and The in on the of of the on to and 1 to 2 are of and with and 3 are of a large of and In is not for the not be treated the of is to pain and to a which is very with or or with a in inflammatory bowel A A India and A male presented with of inflammatory low pain for with 3 He had history of was history of peripheral or any his was 3 1 any of peripheral or or or of was 10 10 He had bilateral 4 on [Figure on [Figure 2]. markers were was negative. showed low showed levels for was negative. of his showed with 1: bilateral 4 He had taken for his pain steroids for his bowel symptoms with a case of with with of to he was 12 weeks of his disease was with in pain of from to his from to 1]. He was continued on 2 weeks 1: and 12 weeks after The R S S of India The of in multiple is very rare and We report 2 with A female out of presented with bilateral 10 of which pain on She was to a As she she developed over her and pain in the she was She had history of or She well in over to and over inflammatory markers and negative and of showed multiple involving all and temporomandibular was evidence of along the of and The were with of all case is of a who presented with swelling of she had in the were on right and right not any in 1: over right and to right well over left and to right inflammatory markers and negative and showed evidence of involving on with the joint cavity, multiple of showed multiple involving all in R S R of India presented with of painful over which and he was 2 He developed in and which in and with of the nodules had with of He also had joint involving and which was with and with He was not to his his over lower and of which had with of showed of and right upper and lower and of the and systemic was 1: nodules in the and multiple around and inflammatory elevated and Patient was diagnosed as a case of with and diffuse He was started on treatment with low dose Methotrexate and of A India Case Detail: with history of recurrent lower 3 presented to the with and 1 in the revealed patient had and She was admitted for a and was Patient continued to out and was evaluated for the of was ruled out from Patient in and was on the view of and patient was evaluated for Her was and showed She was treated with steroids and and she responded to the and the disease in A S P Kolkata, West Bengal, Research and 1: - Systemic lupus is to affecting and is or for of disease in in and with Report: patient was a a case of diagnosed in and admitted in with of of in associated with over left lower revealed and He was with oral steroids and He was in and found to persistent of and joint associated with lupus He was with 2 and of the were being on and steroids he continued to disease with as lupus polyarthritis and persistent Hence he was started on in He had to with resolution of and received dose of on following which he developed with of fever and swelling of left lower revealed left lower with and on workup for negative. He was with and other were continued but he had a and to his on day of was to the of and the were with Lupus with acute and of in and A case of in a female S P N S P P India Case Detail: A female, presented to the with of lower The symptoms had started approximately weeks after The patient history of or She had a history of 1 weeks of her history was the patient had over the right and of the were to systemic and was showed elevated of and levels of The blood liver and renal were within normal right 2 [Figure of with joint revealed right [Figure with [Figure any [Figure Blood were and for were of was negative for The of was of and on blood for The patient was started on a of and as the for her to as is a of of to the She was for any of the In supportive and were to pain and joint the of the symptoms 1 later, her showed a in inflammatory markers and to within the normal blood were negative for The patient was discharged with for the of as is a infection the the of or with patient any history of of or be in the of presenting with joint pain, in 1: - right joint - in right - in right view view - normal. of unknown A to India of India PUO in are to and being for of inflammatory being common of Case A 21 presented with of joint pain for 1 with a weight loss of over months. revealed over and and systemic was showed with of and Kidney and and urine - and showed with bilateral was was on criteria Patient was diagnosed as a case of disease and was with Prednisolone after pulse dose of of for 3 Methotrexate and 3 his joint pain but he remained the workup for to to infection like PET-CT was done which showed in right of was done and of was for was Methotrexate and was continued. 3 resolution of symptoms was in and disease is a of with fever of or leucocytosis, or usually of the patient responded to steroids and but of fever was to or of case report on of as of PUO and R S R of India A male patient presented with history of for which initially started over trunk and to upper and lower of the and He also of with multiple in the oral and nasal He had weight loss of He was admitted in a for cough, right pain and of and to inflammatory markers were normal. and was negative. showed right showed for and was negative. showed and Skin biopsy was which showed granulomatous of and He was treated and A month later, he was with a lesion over left of increased and was negative. was which showed a lesion in the left into to the left of mouth with of left left and left 2 A biopsy was and showed and with along with focal to medium He was for management. over upper and lower over lower over of and right over left of 3 over and and swelling over right in left nasal of and systemic was 1: over and over of swelling with atypical with and markers and negative. showed and infiltrates with in the right and lower and in left upper the atypical were and were suggestive of large cell was diagnosed with large cell and on presenting as India Case Detail: A male presented with of being He also a history of the of and He admitted to low for the was history of complication and had normal and were of normal he was and was 3 for was weight was and his was was and the of the upper lower was and [Figure with normal was He was normal male and was left and were with a of and the was acute inflammatory markers were elevated low serum serum and were also with serum ferritin suggestive of of serum and levels along with serum and blood were also within the normal