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1.  Adenocarcinoma of lung masquerading as systemic auto-immune disease 
BMJ Case Reports  2012;2012:bcr0220125822.
A 40-year-old previously healthy male presented with acute onset painless dimness of vision in both eyes since the past week and low-grade fever, anorexia and weight loss for the past 1 month. He had been evaluated at a local hospital and diagnosed to have a posterior cerebral artery territory infarct on the left side on the strength of cranial CT. Shortly after receiving antiplatelets and warfarin he had developed severe coagulopathy as evidenced by haematemesis, epistaxis and haematuria. Preliminary investigation revealed prolonged clotting parameters, renal failure and anaemia. Cerebral MRI showed multiple areas of cortical haemorrhage. In the course of his hospital stay, he developed further stigmata of auto-immunity including Coomb’s positive haemolytic anaemia, recurrent venous thromboses and a palpable purpuric truncal rash. He was eventually diagnosed to have an adenocarcinoma of the lung, and was subsequently referred to an oncologist for further therapy.
doi:10.1136/bcr.02.2012.5822
PMCID: PMC3387439  PMID: 22707679
2.  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
3.  Community acquired bilateral upper lobe pneumonia with acute adrenal insufficiency: A new face of Achromobacter Xylosoxidans 
The Australasian Medical Journal  2012;5(10):531-533.
Achromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection.
doi:10.4066/AMJ.2012.1279
PMCID: PMC3494824  PMID: 23173016
Achromobacter xylosoxidans; pneumonia; adrenal insufficiency
4.  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
5.  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
6.  A rare case of community acquired Burkholderia cepacia infection presenting as pyopneumothorax in an immunocompetent individual 
Burkholderia cepacia (B. cepacia) infection is rarely reported in an immunocompetent host. It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity and mortality. It has also been included in the list of organisms causing nosocomial infections in an immunocompetent host, most of them transmitted from the immunocompromised patient in which this organism harbors. We report a rare case of isolation of B. cepacia from the bronchoalveolar lavage fluid of an immunocompetent agriculturist who presented with productive cough and fever associated with a pyopneumothorax. This is the first case of community acquired infection reported in an immunocompetent person in India.
doi:10.1016/S2221-1691(11)60215-3
PMCID: PMC3609255  PMID: 23569891
Burkholderia cepacia; Pyopneumothorax; Community acquired; Immunocompetent; Agriculturist
7.  Tubercular neuritis: A new manifestation of an ancient disease 
The Australasian Medical Journal  2011;4(12):674-676.
A 25-year-old housewife presented with a burning sensation over both legs for the past 15 months, and fever with weight loss for the past six months. She had noticed a lump in her left breast one month ago. Examination revealed hyperaesthesia and allodynia over the lower limbs. Nerve conduction studies confirmed the presence of sensory neuropathy. Nerve biopsy was suggestive of a chronic axonopathy. Subsequently sputum as well as aspirate from the breast lump tested positive for acid fast bacilli. Treatment with anti-tubercular therapy resulted in full recovery. Peripheral neuropathy is a unique and unusual presentation of tuberculosis.
doi:10.4066/AMJ.2011.1029
PMCID: PMC3413966  PMID: 22905042
peripheral neuropathy; disseminated tuberculosis; sensory polyneuropathy
8.  Galactorrhea with menstrual irregularity: something other than a prolactinoma? 
We report the case of a 29-year-old female who presented with galactorrhea and irregular menstrual periods. Laboratory tests showed elevated levels of serum prolactin, raising the possibility of a prolactinoma. However, further evaluation revealed an unusual and unexpected cause for her illness.
PMCID: PMC3982619  PMID: 24733533
galactorrhea; hyperprolactinemia; prolactinoma; Wilson’s disease

Results 1-8 (8)