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1.  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
2.  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
3.  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
4.  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

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