To study visual and neurological outcome after treatment according to ONTT protocol

To evaluate the visual and neurological outcomes of Optic Neuritis Treatment Trial (ONTT). 40 Patients presenting with optic neuritis were enrolled in this study to analyze the Visual and Neurological outcomes after treatment according to ONTT Protocol, with emphasis on signs of anaemia, protein calorie malnutrition, vitamin deficiency, generalized lymphadenopathy, sinusitis, septic foci. Patients were followed up for three subsequent visits to assess the rate of visual recovery.Maximum patient 35(87.5) treated according to ONTT protocol while 5 (12.5%) treated with oral steroids alone. Maximum 33 eyes (70.2%) attain BCVA > 6/36 after 1st follow-up (with in 1 month) while 10(21.3%) eyes attain BCVA of 6/6 after 1st follow-up. 11 eyes (25.6%) attain BCVA 6/6 after II follow-up. General prognosis for recovery of vision was good and was slightly worse in more severely affected cases in the present series. Pallor of the optic disc and defect of vision did not always correspond–3 eyes which showed temporal of the disc at the end of follow up had a final vision of 6/9 or better in each eye.

Pure red cell aplasia secondary to rheumatoid arthritis: a case report

Background Rheumatoid arthritis is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia is a rare manifestation of rheumatoid arthritis and is sparsely documented in the literature, with a variable clinical outcome following immunosuppressive therapy. Case presentation A 63-year-old Sinhalese female presented with transfusion-dependent anemia associated with deforming inflammatory arthritis. She also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of rheumatoid arthritis following initial clinical workup and additional blood and bone marrow investigations revealed pure red cell aplasia as a secondary manifestation of rheumatoid arthritis after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions, and hematological malignancy. She responded well to oral prednisolone, cyclosporine A, and hydroxychloroquine, and she attained complete recovery in 2 months. Conclusion Pure red cell aplasia is a disabling illness that may lead to transfusion-dependent anemia, which may occur due to rare extrapulmonary manifestation of rheumatoid arthritis. The diagnosis of pure red cell aplasia secondary to rheumatoid arthritis may be challenging where hematological investigations, including bone marrow biopsy, will aid in the diagnosis, and early diagnosis and treatment will bring about a better outcome.

Digital gangrene as an unusual paraneoplastic manifestation of hodgkins lymphoma—a rare case report

Background Hodgkin’s lymphoma presenting with digital ischemia and gangrene is a rare manifestation. Paraneoplastic manifestations are rare in Hodgkin’s lymphoma but can occur in the form of paraneoplastic cerebellar degeneration (PCD) and dermatomyositis/polymyositis. This case report adds an exceptional presentation of Hodgkin's lymphoma as digital ischemia and gangrene. Case presentation We report a case of a 60-year-old male patient who presented with fever, cough, shortness of breath, the pain in the right middle finger. On examination bluish-black discoloration of the right middle finger, left middle finger, ring finger, and generalized lymphadenopathy was noted. On further evaluation, he was found to have anemia, eosinophilia, and severe thrombocytopenia with a normal coagulation profile and negative rheumatological workup. Arterial Doppler of both upper limbs showed the normal study. He was diagnosed to have Hodgkin’s lymphoma on the lymph node and bone marrow biopsy. He was started on chemotherapy with partial improvement in symptoms and was lost to follow-up after 2 cycles. Conclusions Digital ischemia can be a rare paraneoplastic manifestation of Hodgkin’s lymphoma.

Nodal mycobacterial spindle cell pseudotumor: A diagnostic pitfall

Inflammatory pseudotumor (IPT) is a rare benign mass forming lesion that has been reported in virtually every organ, and can closely mimic spindle cell neoplasms. Mycobacterial spindle cell pseudotumor (MSP) represents a small proportion of IPT of the lymph node, which occur in immunocompromised patients, posing a diagnostic challenge. We report three cases of MSP involving two AIDS patients who presented with generalized lymphadenopathy, and one immunosuppressed patient with a mediastinal mass. Biopsy in these cases revealed effaced architecture replaced by proliferating fibrohistiocytic spindle cells, fibrosis and polymorphic inflammatory infiltrate. Inflammatory pseudotumors and other spindle cell neoplasms of the lymph node can show overlapping morphologic features, resulting in diagnostic confusion. A differential diagnosis of Mycobacterial spindle cell pseudotumor should be kept in mind when approaching localized or generalized lymphadenopathy in an immunocompromised patient.

Severe Fever with Thrombocytopenia Syndrome with Necrotizing Lymphadenitis in a Patient who Underwent 18F-FDG PET/CT: A Case Report

Severe fever with thrombocytopenia syndrome (SFTS), also known as fever, thrombocytopenia, and leukopenia syndrome, is an emerging tick-borne infectious disease in Asian countries. SFTS should be suspected in patients presenting with fever, thrombocytopenia, and leukopenia and have a history of tick exposure in an endemic area. Since SFTS can be accompanied by lymphadenopathy, particularly generalized lymphadenopathy, it can be confused with a primary malignancy, such as lymphoma. The study reports a case of SFTS accompanied by multiple lymphadenopathies, which mimicked malignant lymphoma on F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

Pure Red Cell Aplasia Secondary to Rheumatoid Arthritis

BackgroundRheumatoid arthritis (RA) is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia (PRCA) is a rare manifestation of RA and is sparsely documented in the literature with a variable clinical outcome following immunosuppressive therapy. Case presentationA 63-year-old female presented with transfusion-dependent anaemia associated with deforming inflammatory arthritis, who also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of RA following initial clinical workup and additional blood and bone marrow investigations revealed PRCA as a secondary manifestation of RA after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions and haematological malignancy. She responded well to oral prednisolone, cyclosporine A and hydroxychloroquine, where she attained complete recovery in two months. ConclusionPRCA is a disabling illness that may lead to transfusion-dependent anaemia, which may occur due to rare extrapulmonary manifestation of RA. The diagnosis of PRCA secondary to RA may be challenging where haematological investigations, including bone marrow biopsy, will aid in the diagnosis, and early diagnosis and treatment will bring about a better outcome.

Atypical Presentations of Systemic Lupus Erythematosus by Cerebral Venous Thrombosis and Generalized Lymphadenopathy without Antiphospholipid Antibodies: Case Report

Introduction: Atypical presentations of systemic lupus erythematosus SLE) with features outside of the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria can make the diagnosis of SLE elusive. Case Presentation: We describe a case of a healthy 31-year old female who presented with syncope preceded by progressive headache, serositis, and generalized lymphadenopathy. CT-head and MR-venogram confirmed a cerebral venous thrombosis (CVT). Subsequent workup revealed high titers of antinuclear (ANA), anti-double stranded DNA (anti-dsDNA), anti-Smith (anti-Sm) antibodies, as well as low complement levels, lymphopenia and neutropenia. Diagnosis of SLE was confirmed by SLICC classification criteria. Antiphospholipid antibodies (APLA) were negative. While in hospital, she sustained a seizure secondary to the CVT. Conclusion: We discuss considerations for atypical SLE presentations by CVT (without APLA syndrome) and generalized lymphadenopathy, and the nuances of SLE diagnosis using existing classification criteria.

Role of Imaging in a Case of Toxoplasmosis Presenting as Generalized Lymphadenopathy

Toxoplasmosis is caused by Toxoplasma gondii an obligate protozoan intracellular parasite. The disease has variable prevalence globally and is usually asymptomatic. Pregnant and immunocompromised people are at risk of getting infected. Enlarged lymph nodes are the most frequently observed clinical form of Toxoplasma in humans, mostly affecting posterior cervical nodes. Other organs usually affected are the brain and eyes. We present a case of toxoplasmosis with generalized lymphadenopathy mimicking metastasis in a lady with a previous history of operated pancreatic neoplasm.