Pituitary microadenoma with hypopituitarism presenting as hyponatremia.

The incidence of pituitary adenoma has been increasing these days. Majority of the cases are incidental findings on imaging; and these patients may be asymptomatic without any laboratory abnormalities. However, a non-functional sellar mass can initially present with hypopituitarism.

Hashimoto's thyroiditis aggravated by goitrogenic diet presenting as rhabdomyolysis worsened by alcohol intake.

Hashimoto's thyroiditis (HT) is the most common form of primary hypothyroidism. Several muscular manifestations like pain, weakness, stiffness and elevated muscle enzymes have been noticed in hypothyroidism. Alcohol is also known to cause myositis and rhabdomyolysis.

Afebrile scrub typhus infection with cardiac manifestation.

Scrub typhus is an acute febrile disease transmitted via bites from mite larvae (chigger) infected with Orientia tsutsugamushi. Arrhythmias, ischaemic changes and QT prolongation are some of the observed ECG abnormalities. The patient being reported presented with angina and was found to have sinus bradycardia with ST elevation in inferior leads and T wave inversion in lateral leads.

Hypocalcemic Seizure Due to Vitamin D Deficiency.

Aim: To emphasize the importance of vitamin D supplementation.

Background: The incidence of vitamin D deficiency has been increasing worldwide, probably due to decreased exposure to sunlight and unbalanced diet. Severe hypocalcemia following vitamin D deficiency is rather uncommon, and this leading to seizures in adults is a rare scenario.

Hyperkalemic Cardiac Arrest in a Patient with Diabetic Ketoacidosis.

Aim: To highlight the occurrence of cardiac arrest due to hyperkalemia in diabetic ketoacidosis (DKA).

Background: Diabetic ketoacidosis is a commonly encountered condition. These patients can have normal or mildly elevated levels of potassium.

Normocomplementemic Urticarial Vasculitis: An Unusual Presentation.

Urticarial vasculitis (UV) is a form of cutaneous vasculitis which lasts for >24 h. Clinically, the patients present with erythema and wheals. The level of complement decides the type of UV.

Superior vena cava syndrome due to mediastinal Gardner fibroma presenting as syncope.

Superior vena cava (SVC) syndrome refers to the clinical manifestation due to an obstruction in the SVC; resulting in decreased venous return from the head, neck and upper extremities. The obstruction can occur either due to tumour invasion of the vessel wall with associated thrombus or due to vessel wall compression by the tumour mass. The patient being reported is a young male who presented with recurrent episodes of syncope and was found to have mediastinal Gardner fibroma causing SVC syndrome.

Total angiographic regression of coronary atherosclerosis with optimal medical therapy.

Coronary artery disease has shown a dramatic increase worldwide. According to the current guidelines, optimal medical therapy (OMT) is recommended as the first-line treatment for stable angina; with revascularisation being reserved for those with persistent or progressive symptoms despite intensive medical therapy. We report the case of a young man with stable angina, who was advised percutaneous coronary intervention for stenosis of left anterior descending artery.

Acute hepatitis due to infectious mononucleosis.

The syndrome of infectious mononucleosis is commonly seen with Epstein-Barr virus (EBV) infection. It may cause acute hepatitis, which is usually self-limiting and characterised by mildly elevated liver enzymes, but rarely jaundice. The patient being reported showcases EBV infection with jaundice, which is an uncommon scenario.

Transient splenial lesion due to non-cirrhotic hyperammonaemia in dengue fever.

Transient splenial lesion(TSL) is seen in a variety of conditions and is detectable only on MRI of the brain. Dengue fever (DF) is a common viral infection encountered in the tropics. The affected patients may face neurological complications like encephalopathy and intracranial haemorrhage, or even ischaemic stroke.

Multiple renal calculi due to hypercalcaemia induced by over-the-counter vitamin D intoxication.

Renal stone disease is a common and painful condition. Even though it is rarely fatal, patients describe it as the worst pain in their life. While dietary calcium may decrease the risk of stone formation, patients on supplemental calcium are at higher risk.

Solid pseudopapillary neoplasm of pancreas: an unusual aetiology for haematochezia.

Solid pseudopapillary neoplasm of the pancreas is a rare condition. It is mostly seen among young women, with abdominal pain as the presenting complaint. This is a case of a young woman who presented with haematochezia, and was found to have splenic vein thrombosis and left-sided portal hypertension as a result of mass lesion at the tail of the pancreas which was diagnosed as solid pseudopapillary neoplasm.

Severe bone marrow suppression due to methotrexate toxicity following aceclofenac-induced acute kidney injury.

Methotrexate is one of the most commonly used drugs in autoimmune disorders like rheumatoid arthritis. Gastrointestinal symptoms like nausea and stomatitis, skin rashes, alopecia, central nervous system symptoms like headache and confusion, hepatotoxicity and myelosuppression are some of the adverse effects. However, low oral doses on a weekly basis seldom show any signs of toxicity.

Pyopericardium progressing to tamponade in a patient with immune thrombocytopenia.

Pericardial effusion can develop during any stage of pericarditis, and small effusions that appear rapidly can cause cardiac tamponade. Pyopericardium is a rare aetiology for tamponade. This is a case of an elderly diabetic lady, on steroid therapy for immune thrombocytopenia, who presented with fever and acute dyspnoea.

Rhabdomyolysis: a rare complication of Hashimoto's thyroiditis precipitated by statin therapy.

Hashimoto's thyroiditis (HT) or chronic lymphocytic thyroiditis is the most common form of primary hypothyroidism. Muscular manifestations like weakness, pain, stiffness and elevated muscle enzymes have been noticed in hypothyroidism. Statins are also known to cause myositis and rhabdomyolysis.

Pontine haemorrhage disguised as Bell's palsy.

Isolated facial nerve palsy is a common presentation of Bell's palsy, but rarely seen in pontine lesions. The patient being reported is a middle-aged man who developed isolated facial nerve palsy and was initially treated as Bell's palsy. However, on MRI of the brain, he was found to have pontine haemorrhage.

Twenty-Four Syndrome: An Untold Presentation of Pontine Hemorrhage.

Pontine hemorrhages are relatively uncommon. Various atypical manifestations of pontine stroke like eight-and-a-half syndrome, fifteen-and-a-half syndrome, and sixteen syndrome have been described in the past. We came across a case of pontine bleed that presented with bilateral facial palsy, bilateral horizontal gaze palsy, and contralateral sensorineural hearing loss accounting to the hitherto not described "twenty-four syndrome" with Horner's syndrome and left hemiparesis.

Blue Finger Syndrome: An Unusual Presentation of Rheumatoid Arthritis.

Blue Finger Syndrome (BFS) is a benign and rare condition with an idiopathic aetiology. It is characterised by an acute bluish discoloration of fingers which may be accompanied by pain. This is a case of a middle aged female who presented with painless bluish discoloration of right hand and was diagnosed to have BFS.

Delirium in Parkinson's Disease: A Cocktail Diagnosis.

Mental disturbances have been described in patients with Parkinson's Disease (PD). Of these, the common conditions are delirium and psychosis. Delirium has been attributed to change of environment, especially hospital stay and infections; while psychosis is due to drugs like dopamine agonists.

A Case of Macrophage Activation Syndrome with Acute Respiratory Distress Syndrome.

Macrophage Activation Syndrome (MAS) is a rare form of Haemophagocytic Lymphohistiocytosis (HLH) associated with rheumatologic conditions. It is characterised by haemophagocytosis and cytokine overproduction, resulting from the activation and uncontrolled proliferation of T lymphocytes and macrophages. The patient being reported is an elderly female with Rheumatoid Arthritis (RA), who presented with fever and was found to have MAS.