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1.  Primary abdominal nocardiosis masquerading as tubercular pelvic inflammatory disease in an immunocompetent individual 
BMJ Case Reports  2013;2013:bcr2012008076.
We report the case of a 30-year-old housewife who presented with fever and lower abdominal pain, and was diagnosed with an adnexal collection. Initial evaluation was suggestive of tubercular pelvic inflammatory disease (PID). Subsequently, from a culture of pus aspirated from the collection grew out Nocardia species. She was treated with amikacin and cotrimoxazole and made a complete recovery. Clinical and laboratory evaluation for immunosuppression was negative. Primary abdominal nocardiosis is an unusual cause for PID and an important differential diagnosis for tuberculosis.
doi:10.1136/bcr-2012-008076
PMCID: PMC3603827  PMID: 23355581
2.  Tuberculous mediastinal abscess as a paradoxical reaction in an immunocompetent individual 
BMJ Case Reports  2012;2012:bcr0120125498.
A 22-year-old man, diagnosed 7 weeks before with pulmonary tuberculosis and started on antitubercular therapy, presented with non-exertional retrosternal chest pain since the past week. He was diagnosed on the strength of thoracic radiograms and CT imaging to have a mediastinal abscess, which was percutaneously drained. He was continued on the same regimen of drugs. Analysis of the fluid obtained was suggestive of tuberculous aetiology. Steroids were not required.
doi:10.1136/bcr.01.2012.5498
PMCID: PMC3339156  PMID: 22604761
3.  An unusual cause for hyponatremia with seizures 
BMJ Case Reports  2012;2012:bcr0920114784.
A 50-year-old Asian Indian female with known hypertension presented with persistent vomiting but no other symptoms of meningism. Clinical examination and basic laboratory parameters were entirely normal except for significant hyponatremia. Further investigation was suggestive of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Subsequently, despite steady correction of hyponatremia, the patient developed generalised seizures. Cerebrospinal fluid (CSF) analysis performed was inconclusive. Screening for a chronic meningitis underlying SIADH, yielded positive blood and CSF titres for venereal disease research laboratory (VDRL), which were confirmed by Treponema pallidum haemagglutination (TPHA). The patient was treated for neurosyphilis and made a complete recovery. Hyponatremia resolved and she had no further episodes of seizures. She was tested for HIV infection which was negative. On follow-up, she remained TPHA positive but VDRL titres became negative.
doi:10.1136/bcr.09.2011.4784
PMCID: PMC3316798  PMID: 22605698
4.  Ketosis-prone type 2 diabetes mellitus in a patient with Sheehan’s syndrome: a rare convergence of two distinct endocrine entities 
BMJ Case Reports  2012;2012:bcr1120115131.
A 36-year-old housewife, previously diagnosed with Sheehan’s syndrome on glucocorticoid and thyroxine replacement therapy, presented with unprovoked diabetic ketoacidosis. Ketoacidosis was corrected with intravenous fluids and insulin therapy. Further evaluation was suggestive of type 2 diabetes mellitus. On follow-up, she experienced repeated episodes of hypoglycaemia and insulin was tapered and stopped. Adequate glycaemic control was maintained with metformin monotherapy.
doi:10.1136/bcr.11.2011.5131
PMCID: PMC3263140  PMID: 22665875
5.  An unusual cause for recurrent jaundice in an otherwise healthy male 
The Australasian Medical Journal  2012;5(10):541-543.
A 41-year-old Asian-Indian male presented with recurrent episodes of jaundice over the past six months. Physical examination was normal, barring mild icterus. Laboratory parameters revealed indirect hyperbilirubinemia. Further evaluation yielded a diagnosis of severe nutritional vitamin B12 deficiency. Indirect hyperbilirubinemia was ascribed to ineffective erythropoiesis. Underlying Gilbert's syndrome was ruled out by provocative testing with lipid-restricted diet. Presentation of severe vitamin B12 deficiency with isolated hyperbilirubinemia without concomitant major haematologic or neurologic dysfunction is unusual and potentially underdiagnosed. Awareness of this possibility can permit early diagnosis of vitamin B12 deficiency and forestall development of severe haematologic and neurologic sequelae.
doi:10.4066/AMJ.2012.1404
PMCID: PMC3494826  PMID: 23173018
Recurrent jaundice; indirect hyperbilirubinemia; vitamin B12 deficiency; ineffective erythropoiesis
6.  Cranial melioidosis with extradural extension after a fall in the bathroom 
The Australasian Medical Journal  2012;5(8):455-458.
A 32-year-old diabetic male, with a past history of head injury and seizures, presented with a painful swelling over his forehead present for the past three months. Cranial MRI demonstrated the presence of a scalp collection with extradural extension through a bony defect. Biopsy from the area showed caseating necrosis suggestive of tuberculosis. Although the patient failed to return for initiation of anti-tubercular therapy for the next 11 months, the swelling did not progress, and there were no constitutional symptoms. The indolent nature of the swelling prompted re-evaluation and delayed cultures of pus from the collection grew Burkholderia pseudomallei.
doi:10.4066/AMJ.2012.1374
PMCID: PMC3442190  PMID: 23024720
Cranial epidural abscess; melioidosis; Burkholderia pseudomallei
7.  A rare case of seronegative culture-­proven infection with Brucella suis 
The Australasian Medical Journal  2012;5(7):340-343.
Brucellosis is a chronic infection produced by members of the Brucella family. Diagnosis of this condition requires either isolation of the organism in culture or positive serological tests.
We describe a 27-year-old male admitted as a case of pyrexia of unknown origin (PUO), who tested negative for Brucella IgM ELISA test on preliminary evaluation but was subsequently diagnosed on the strength of positive blood and bone marrow cultures to be a case of brucellosis secondary to Brucella suis infection. In addition to highlighting the pathogenic potential of an unusual organism, this case demonstrates the unreliability of standard serological tests based on the Brucella melitensis antigen for infection with other species of Brucella.
doi:10.4066/AMJ.2012.1177
PMCID: PMC3412998  PMID: 22905059
Brucella suis; pyrexia of unknown origin; serological tests

Results 1-7 (7)