scholarly journals Haemophagocytic Lymphohistiocytosis (HLH) in Adult with Dengue Infection

2021 ◽  
Vol 16 (2) ◽  
pp. 287-294
Author(s):  
Ahmad Khaldun Ismail ◽  
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Presentation ◽  
Dengue Infection ◽  
Specific Treatment ◽  
Bone Marrow Aspiration ◽  
Clinical Findings ◽  
Severe Dengue ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Life Threatening ◽  
High Index Of Suspicion

Haemophagocytic lymphohistiocytosis (HLH) or haemophagocytic syndrome is a rare but life-threatening syndrome of excessive immune activation with nonspecific clinical presentation. HLH is one of the complications in dengue infection. A 69-year-old lady was treated for severe dengue with multi-organ dysfunction with superimposed pneumonia, requiring mechanical ventilation. However, persistent cytopenia despite blood transfusion without evidence of haemorrhage raised the suspicion of HLH. Further blood investigations revealed hypertriglyceridaemia, hypofibrinogenaemia and hyperferritinaemia. Bone marrow aspiration showed haemophagocytosis. Patient fulfilled the diagnostic criteria for HLH by HLH-2004 trial. Her HScore is 281, with the probability of having HLH is 99.9%. Patient’s condition improved after administration of intravenous immunoglobulin (IVIG) and intravenous dexamethasone in tapering doses. Early specific treatment of HLH with IVIG and/or corticosteroid is important but diagnosis is usually delayed due to nonspecific clinical findings and laboratory results. High index of suspicion with the aid of diagnostic criteria by HLH-2004 trial and HScore is helpful to recognise this syndrome.

scholarly journals Intussusception in an infant complicating dengue infection

2020 ◽  
Vol 8 (1) ◽  
pp. 190
Author(s):  
Fadila . ◽  
Md. Faraz Omair ◽  
Neeta Kevlani
Keyword(s):  
Dengue Infection ◽  
Management Strategies ◽  
Abdominal Distension ◽  
Clinical Findings ◽  
World Health ◽  
Severe Dengue ◽  
Diagnostic Dilemma ◽  
Abdominal Emergency ◽  
Health Organization ◽  
High Index Of Suspicion

Intussusception is the most common abdominal emergency in children younger than 2 years of age. A 6-month-old child presented as dengue with gross abdominal distension to our hospital. Dengue was managed using standard therapy as per world health organization protocol, while abdominal pathology, later found out to be intussusception, required exploratory laprotomy. At the outset, abdominal distensions in the setting of a severe dengue infection, could be misdiagnosed as ascites due to capillary leakage, masking the clinical findings of acute abdomen on examination.  Although unusual, it is possible to find two concurrent illnesses simultaneously, one complicating the typical clinical course expected from the other, and this needs high index of suspicion due to different management strategies of both. We describe here the diagnostic dilemma of such a case.

scholarly journals A clinical corelation study of dengue fever with hepatic dysfunction in children and their outcome

2021 ◽  
Vol 8 (4) ◽  
pp. 706
Author(s):  
Srividya G. M. ◽  
Poornima Lakshmi
Keyword(s):  
Hepatic Dysfunction ◽  
Total Bilirubin ◽  
Complete Blood Count ◽  
Dengue Infection ◽  
Liver Function Tests ◽  
Significant Rise ◽  
Warning Signs ◽  
Severe Dengue ◽  
Serum Total Bilirubin ◽  
Life Threatening

Background: The study was hepatic dysfunction in childhood dengue infection and to study clinical co-relation like severity, clinical features, and outcome.Methods: Dengue sero positive patients of 100 were admitted during the study period and examined for hepatomegaly and jaundice and subjected to complete blood count, liver function tests, ultrasound abdomen, PT, APTT, HBsAg, HCV, Widal and analysed.Results: All patients presented with fever, most commonly occurred in age group of 5 to 7 years, hepatomegaly was the commonest clinical sign seen, thrombocytopenia was seen in 88% of cases, serum total bilirubin was raised in 10% of subjects with severe dengue infection. Serum SGOT was raised in 74 % of patients with dengue. When compared between the groups, rise in SGOT occurred in 74% of patients with probable dengue, 98% with warning signs and 100% in severe dengue. SGPT was raised in 58% of patients with dengue infection. When compared between the groups, rise in SGPT occurred in 42% of patients with probable dengue, 66% with warning signs and 81% in severe dengue. SGPT was raised in 28% of patients with dengue infection. When compared between the groups, rise in SGOT occurred in 9.5% of patients with probable dengue, 32% with warning signs and 82% in severe dengue. Prothrombin time was raised in 11% of patients. When compared between the groups, rise in PT occurred in 6.4% with warning signs and 72% in severe dengue. When compared between the groups, rise in APTT occurred in 6.4% of patients with warning signs and 72% in severe dengue. When compared between the groups fall in serum protein occurred in 12.7% with warning signs and 54.5% in severe dengue. 2 cases of severe dengue expired, in which the enzyme levels were highly elevated.Conclusions: Significant rise of liver enzymes helps in recognition of severe forms of dengue infection. As hepatic dysfunction in dengue is transient and reversible, early identification of the same should help to reduce life threatening complications. This can help to reduce the morbidity and mortality due to dengue infection.al population.  

scholarly journals Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent Aspiration Pneumonia

2020 ◽  
Vol 8 ◽  
pp. 232470962093164
Author(s):  
Aditi Vian Varma-Doyle ◽  
Kristen Garvie ◽  
Seema Walvekar ◽  
Mae Igi ◽  
Radha Mayuri Garikepati
Keyword(s):  
Bipolar Disorder ◽  
Respiratory Failure ◽  
Aspiration Pneumonia ◽  
Ivig Therapy ◽  
Conversion Disorder ◽  
Clinical Findings ◽  
Symptom Improvement ◽  
Csf Analysis ◽  
Life Threatening ◽  
High Index Of Suspicion

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy affecting both motor and sensory peripheral nerves. Typically presenting after a gastrointestinal or a respiratory tract infection, it manifests as ascending paralysis with concomitant areflexia in patients. Cytoalbuminologic dissociation is a supportive finding on cerebrospinal fluid (CSF) analysis. Due to variability in presentation, misdiagnosis and delay in treatment can occur, and consequently, GBS can become life threatening due to respiratory failure. We report ascending paralysis in a 36-year-old woman with known history of bipolar disorder who recently recovered from aspiration pneumonia following a drug overdose event. Given her psychiatric history, she was initially misdiagnosed as conversion disorder. Intravenous immunoglobulin (IVIG) therapy was initiated at our hospital due to strong suspicion of GBS, based on history and physical examination findings consistent with flaccid quadriparesis and impending respiratory failure. CSF analysis and radiological findings subsequently supported our clinical suspicion and clinical findings. Concurrent IVIG therapy, pain management, aggressive physical and respiratory therapy, and monitoring resulted in symptom improvement. One must have a high index of suspicion for GBS when presented with acute inflammatory demyelinating neuropathies in patients who present with ascending paralysis. Early initiation of therapy is key and can prevent life-threatening complications.

scholarly journals Peripartum cardiomyopathy: a rare complication in a teenage pregnancy

2021 ◽  
Vol 10 (7) ◽  
pp. 2854
Author(s):  
Uma Chourasia ◽  
Jyoti Nath Modi
Keyword(s):  
Multidisciplinary Team ◽  
Teenage Pregnancy ◽  
Rare Complication ◽  
Clinical Findings ◽  
Peripartum Cardiomyopathy ◽  
Team Approach ◽  
Successful Management ◽  
Emergency Cesarean ◽  
Life Threatening ◽  
High Index Of Suspicion

The aim of this case report was to present a rare case of peripartum cardiomyopathy (PPCM) in an adolescent primigravida, and discuss its presentation and successful management. PPCM is a relatively rare yet life threatening cardiac complication of pregnancy. It often remains undiagnosed as its symptoms may simulate the physiological symptoms of pregnancy and peripartum period. An early diagnosis is crucial for improving survival. We herein report an unusual case of PPCM in an young and otherwise healthy primigravida. A 19-year-old primigravida presented at 33 weeks of gestation with, severe pre-eclampsia with dyspnea, cough and discomfort in the chest. Based on clinical findings and ECG, the echocardiography was done, and a definitive diagnosis of PPCM was made. The patient was managed for heart failure and preeclampsia by a multidisciplinary team. Emergency cesarean was done for obstetric indication and patient was managed conservatively in intensive care unit. Patient improved clinically and was discharged at day 10. Peripartum cardiomyopathy though typically associates with advanced maternal age can occur in very young women as well. A high index of suspicion for PPCM is recommended on a background of `severe preeclampsia with breathlessness. Timely echocardiography for diagnosis, and a multidisciplinary team approach are a key to successful management. Clinical significance of the study was to shed new light on the unusual presentation of PPCM and to contribute to the existing knowledge of PPCM.

scholarly journals Vestibular migraine: diagnosis challenges and need for targeted treatment

2016 ◽  
Vol 74 (5) ◽  
pp. 416-422 ◽  
Author(s):  
Felipe Barbosa ◽  
Thaís Rodrigues Villa
Keyword(s):  
General Population ◽  
Diagnostic Criteria ◽  
Clinical Presentation ◽  
Clinical History ◽  
Clinical Findings ◽  
Neural Mechanisms ◽  
Vestibular Migraine ◽  
Important Interaction ◽  
Therapeutic Recommendations ◽  
Variable Clinical Presentation

ABSTRACT Approximately 1% of the general population suffers from vestibular migraine. Despite the recently published diagnostic criteria, it is still underdiagnosed condition. The exact neural mechanisms of vestibular migraine are still unclear, but the variability of symptoms and clinical findings both during and between attacks suggests an important interaction between trigeminal and vestibular systems. Vestibular migraine often begins several years after typical migraine and has a variable clinical presentation. In vestibular migraine patients, the neurological and neurotological examination is mostly normal and the diagnosis will be based in the patient clinical history. Treatment trials that specialize on vestibular migraine are scarce and therapeutic recommendations are based on migraine guidelines. Controlled studies on the efficacy of pharmacologic interventions in the treatment of vestibular migraine should be performed.

scholarly journals Haemophagocytic lymphohistiocytosis in an adult with postacute COVID-19 syndrome

2021 ◽  
Vol 14 (9) ◽  
pp. e245031
Author(s):  
Daniel Wiseman ◽  
John Lin ◽  
Jean-Pierre Routy ◽  
Gordan Samoukovic
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Clinical Presentation ◽  
Healthy Adult ◽  
Multiorgan Failure ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Initial Infection ◽  
First Case ◽  
Life Threatening

Haemophagocytic lymphohistiocytosis (HLH) causing multiorgan failure has been reported as an acute clinical presentation of COVID-19. However, the literature surrounding HLH in the context of a postacute COVID-19 syndrome is limited. This report presents a case of a life-threatening HLH occurring 6 weeks after a pauci-symptomatic COVID-19 infection in a previously healthy adult. A bone marrow aspirate confirmed the HLH and the patient was successfully treated with dexamethasone and etoposide. To our knowledge, this is the first case of HLH occurring as a postacute COVID-19 syndrome following a pauci-symptomatic initial infection.

scholarly journals Study of hepatic dysfunction of dengue fever in children

2017 ◽  
Vol 4 (3) ◽  
pp. 901
Author(s):  
Tamil Selvan ◽  
Saravanan P. ◽  
Nagaraj M.V. ◽  
Mrigender Nath Tudu
Keyword(s):  
Dengue Fever ◽  
Hepatic Dysfunction ◽  
Dengue Infection ◽  
International Health ◽  
Clinical Findings ◽  
Health Concern ◽  
Severe Dengue ◽  
Febrile Child ◽  
Common Symptom ◽  
Gender And Age

Background: Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. It is estimated that worldwide nearly 2.5 billion people continue to live at risk of contracting the infection while 50 million cases and 24,000 deaths tend to occur in 100 endemic countries. Hepatic dysfunction is common in dengue fever and the degree of liver dysfunction in children varies from mild injury with to severe injury.Methods: Prospective and descriptive study was conducted on all the laboratory confirmed cases of dengue fever in children admitted at SIMS and RC over a period of 1 year from Dec 2015 to Nov 2016 both clinically and biochemically.Results: This study reveals, the prevalence of hepatic dysfunction in 30.6% (174/568) of the cases. Among the gender and age, majority of the hepatic dysfunction were seen in males 55.7% (97/174) and in the age group of 10-18 years 44.2% (77/174). Based on the severity, majority of hepatic dysfunction was seen in severe dengue cases 59.2% (103/174). Among clinical findings, most common symptom was jaundice 27.5% (48/174) and commonest sign was hepatomegaly 39.6% (69/174). The commonest liver function test altered was AST level in 45.4% (79/174) of the cases. Commonest abdominal USG finding was gall bladder edema in 90.8% (156/174) of the cases. The mortality was nil in this study.Conclusions: This study concludes prevalence of hepatic dysfunction was seen 30.6%, most of them seen in severe dengue 59.2% of the cases suggesting any febrile child with hepatic dysfunction, dengue infection should be suspected.

scholarly journals Nephrotic-range proteinuria in a patient with dengue fever: a case report from Bangladesh

2019 ◽  
Vol 12 (2) ◽  
pp. 86-89 ◽  
Author(s):  
Shapur Ikhtaire
Keyword(s):  
Renal Function ◽  
Nephrotic Syndrome ◽  
Dengue Fever ◽  
Renal Involvement ◽  
Dengue Infection ◽  
Specific Treatment ◽  
Severe Dengue ◽  
Urine Protein ◽  
Nephrotic Range Proteinuria

We report a case of nephrotic range proteinuria with 24-hour urine protein level of 18.3 g/day, which developed following dengue fever (DF). The patient did not exhibit classical features of nephrotic syndrome (NS) and his renal function was not compromised during his illness. Proteinuria resolved without any specific treatment and precluded renal biopsy. Though the dengue fever and associated renal disorders are self-limiting, renal involvement in severe dengue infection is growingly seen in recent years and could cause increased mortality and long-term morbidity. IMC J Med Sci 2018; 12(2): 86-89

scholarly journals Haemophagocytic lymphohistiocytosis in Adult- A Case Report and Literature Review

2016 ◽  
Vol 33 (3) ◽  
pp. 166-176
Author(s):  
Syeda Fahmida Hossain ◽  
Nazmul Kabir Qureshi ◽  
Zahid Mahmud ◽  
Md Iqbal Hossain
Keyword(s):  
T Lymphocytes ◽  
Age Groups ◽  
Vascular Diseases ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Diagnostic Challenge ◽  
Laboratory Findings ◽  
Collagen Vascular Diseases ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease of normal but overactive histiocytes and lymphocytes that commonly appears in infancy, although it has been seen in all age groups. The disease may be inherited or acquired due to infections, collagen vascular diseases and malignancies. The pathological hallmark of the syndrome is uncontrolled activation of T lymphocytes and macrophages, together with an impaired cytotoxic function of NK cells and CD8+ T lymphocytes, resulting into massive cytokine release (e.g., interferon ”, TNF á, interleukin[IL]-6, 8,10,12,18 etc) from these cells and overwhelming inflammation. Lymphocytes and macrophages, sometimes with haemophagocytic activity accumulate in bone marrow, spleen, liver, or lymph nodes. This immune dysregulatory disorder is characterized by fever, hepatosplenomegaly, lymphadenopathy, skin rash, cytopenias, hepatitis, coagulopathy, neurological symptoms. We report a case of 65 years old male presenting with fever and erythroderma who developed typical clinical and laboratory findings consistent with diagnosis of HLH according to HLH-2004 guidelines. Despite receiving etoposide based chemotherapy, the patient succumbed rapidly from progressive HLH. This case high lightened the diagnostic challenge and the need for keeping a high index of suspicion for promptly diagnosis and treatment of this potentially life threatening condition as clinical features and laboratory investigations are non specific.J Bangladesh Coll Phys Surg 2015; 33(3): 166-176

scholarly journals Retrospective clinicopathological analysis of scar endometriosis and its surgical management

2021 ◽  
Vol 10 (2) ◽  
pp. 658
Author(s):  
Kavitha Yogini Duraisamy ◽  
Devi Balasubramaniam ◽  
Karthikha Ravi ◽  
Aravinth Subramaniam
Keyword(s):  
Abdominal Wall ◽  
Diagnostic Laparoscopy ◽  
Clinical Presentation ◽  
Abdominal Mass ◽  
Clinical Findings ◽  
Pelvic Endometriosis ◽  
Scar Endometriosis ◽  
History Of ◽  
Extrapelvic Endometriosis ◽  
High Index Of Suspicion

Background: Scar endometriosis is a rare form of extrapelvic endometriosis. It is defined as presence of endometrial glands and stroma in the abdominal wall. They have a variable clinical presentation and present to various doctors. Abdominal mass along with cyclical pain is pathognomic of scar endometriosis. Objective was to analyse the clinical presentation and surgical outcomes of scar endometriosis.Methods: It was a retrospective observational study. We have collected records of 28 patients of scar endometriosis managed at GEM Hospital over a period of 3 years. Patients demographic features, previous surgery, clinical findings, surgical findings, association with pelvic endometriosis as noted on diagnostic laparoscopy, need for mesh,  recurrence rate on follow up were noted.Results: Mean age of patients was 32.1 years. History of previous caesarean surgery/hysterotomy was present in all patients. Major clinical presentation was cyclical pain. MRI or USG was done and abdominal wall lesions were demonstrated in all cases. Diagnostic laparoscopy was done in 26 of these patients and showed associated endometriosis in 9 patients. Plane of endometriosis was found to be subcutaneous for 9 cases, sheath in 7 and muscular in 12 cases. HPE was proven in all cases.Conclusions: Scar endometriosis is rare. High index of suspicion is needed for diagnosis, especially in cases of previous caesarean sections. MRI and USG are useful tools for diagnosis. Complete wide local excision of scar endometriosis is the primary modality of treatment. Diagnostic laparoscopy along with the procedure is helpful in diagnosing associated pelvic endometriosis.

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