Antithyroid drugs have been used as the mainstay of treatment in thyrotoxicosis since the 1900's. Agranulocytosis is a recognised rare severe adverse drug reaction defined as an absolute reduction of circulating granulocytes, classically resulting in a neutrophil count below 500/μL. Individuals with such severe neutropenia are likely to experience life threatening, and fatal infections. Hence, physicians initiating ATDs should caution patients regarding common presentations including fever and sore throat, which should further prompt other doctors on early detection of this potentially fatal adverse effect.
Cardiomyopathies represent a wide spectrum of myocardial disease where each type of cardiomyopathy have distinctive morphological features, the overlap between 2 distinct types of cardiomyopathies is rare, we are describing a case of hypereosinophilic cardiomyopathy where the morphological features of both ventricles simulate non compaction cardiomyopathy and hypereosinophilic cardiomyopathy .although the non-compaction features are not typical the overlap between the cardiomyopathies caused an unusual myocardial morphology .the endocardial fibrosis progressed to form a fibrous endocardial mid left ventricular ring that caused significant mid LV obstruction ,the severe LV obstruction progressed to biventricular failure .the patient was referred to surgery to relieve the obstruction with improvement in his NYHA class and LV functions after the operation .this case highlights the possibility of having atypical myocardial features that cannot fit in one type of myocardial disease, it also shows a severe progressive form of endocardial fibrosis to the extent of causing severe LV obstruction.
Context: Insulin autoimmune Syndrome is an extremely rare cause of both hyperglycemia and hypoglycemia. Ketoacidosis in type 2 diabetes mellitus presenting as Insulin Autoimmune syndrome is also rare. It is difficult to treat and no protocols exist for its treatment. Steroid therapy has been tried with some success and other immunosuppressants may have a role.
Case Report: Herein, we report a 74-year-old male presenting with ketoacidosis, requiring 1200 units insulin per day and still no decline in blood sugar levels. His Insulin autoantibodies were strongly positive and he had dramatic response to steroids. This report is the first case of insulin autoimmune syndrome presenting with hyperglycemia and diabetic ketoacidosis, in India, requiring more than1000 units of insulin.
Conclusion: Insulin auto antibody syndrome should be considered in the differential diagnosis of unexplained hyperglycemia or hypoglycemia. An elevated insulin antibody titer in a patient not previously exposed to insulin, helps to clinch this rare condition.
Osteitis pubis is defined as an idiopathic, inflammatory disease of the pubic symphysis and surrounding structures. Osteitis pubis most commonly occurs among athletes but can also occur among non-athletes as a result of any pelvic stress (eg, trauma, pelvic surgery, pregnancy). We present the case of an eldery man with a history of urological interventions who developed pubic pain afterwards. Laboratory examination showed raised inflammatory variables but no leukocytosis. The MRI described bone marrow edema in the pubic ramus and inflammation in the pubic symphysis. Medical management included rest, analgesic and anti-inflammatory drugs (NSAIDs and steroids).
Torticollis in children has different causes and a persistent twisted neck position should always be more closely investigated. Prior the introduction of Magnetic Resonance Imaging and Computed Tomography scanning the diagnosis of atlantoaxial rotatory fixation was based on conventional X-ray examination. Atlantoaxial rotatory subluxation is a rare condition and in our patient it was associated with an Arnold–Chiari malformation, a condition affecting the brain consisting of a downward displacement of the cerebellar tonsils through the foramen magnum. In the report we present a case, communicating of a late-diagnosed atlantoaxial subluxation in 8 years old child reporting clinical presentation with radiological findings of a C1-C2 subluxation associated to an Arnold Chiari M. and a summary description of rehabilitation approach. The attempts to reduce subluxation and improve movement were fortunately successful thanks to traction, physiotherapy and muscle relaxant even if atlantoaxial rotatory fixation persisted for more than 2 – 3 months.
