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Tuberculosis of spine is common in a developing country like India. However, involvement of spine at multiple levels along with involvement of rib and tubercular breast abscess in an immunocompetent patient without any pulmonary involvement is extremely rare. Here we report a case of 53-year-old immunocompetent lady who presented with quadriparesis and MRI (magnetic resonance imaging) of spine revealed multiple lesions involving cervical, thoracic, lumbar, and sacral region without any involvement of intervertebral disc. On detailed examination she was found to have a lump in right breast. Fine needle aspiration cytology of both paravertebral collection and breast lump revealed presence of acid fast bacilli. She was put on antitubercular drug for one year and she responded well to therapy.

Ectopic adrenocorticotrophic hormone (ACTH) syndrome (EAS) commonly occurs secondary to neuroendocrine tumours and small cell carcinoma of lung. EAS has also been reported in association with gastric carcinoids. But, the occurrence of EAS secondary to gastric adenocarcinoma has rarely been reported. A 45-year-old male patient from Bangladesh presented with abdominal pain, jaundice and hyperpigmentation. Extensive work-up revealed poorly differentiating mucin-secreting adenocarcinoma of stomach with lymphangitis carcinomatosa of lung, bilateral adrenal metastasis and malignant common bile duct (CBD) stricture. Laboratory reports were suggestive for ectopic ACTH production. Most of these features are very rare in adenocarcinoma of stomach, and all these rare events occurring in a single patient is probably the rarest.

A 20-year-old boy presenting daily febrile episodes was suspected to have developed acute hepatic failure. Serologic tests ruled out infectious and autoimmune causes apart from drug toxicity. During clinical examinations, he was found to have generalized enlarged lymph nodes that were then taken biopsy. It was diagnosed as classical Hodgkin’s lymphoma based on histological examination of the lymph node. A bone marrow biopsy showed marrow infi ltration by Hodgkin’s lymphoma with hemophagocytosis and secondary myelofibrosis. A percutaneous liver biopsy demonstrated hepatic involvement of the same disease. After an extensive work-up, the cause of liver failure was figure out to be only attributed to the involvement of the lymphoma. Hodgkin’s lymphoma as a cause of hepatic failure is rare and young patients diagnosed as Hodgkin’s lymphoma causing hepatic failure has been reported very rarely so far.

Nodular lymphocyte predominant Hodgkin’s disease occurs in 5% of all cases of Hodgkin’s disease. It occurs more commonly in male. Only 5% of all Hodgkin’s lymphoma cases develop spinal cord compression[1] and in only 0.2% cases, spinal cord compression occurs as the initial presentation[2]. So our case is rare both in the form of the unique variety of Hodgkin’s disease and also in the form of presentation.

Gallbladder carcinoma is more likely to occur in elderly females and the presence of periportal adenopathy often signifies advanced disease. Such patients are generally not taken up for surgery and are treated palliatively. Isolated periportal tuberculosis without the evidence of disease elsewhere is in itself a rarity. Here we present a case study of gallbladder mass suspected of being gallbladder carcinoma with portal lymphatic metastasis actually turning out to be that of gallbladder adenomyoma with periportal tuberculosis. This case illustrates how mass lesions of the gallbladder are commonly and falsely interpreted to be malignant.

The authors describe a case of 52-year-old male who presented with sudden onset deterioration of weakness of both lower limbs and retention of urine. He had 1 month history of gradually progressive weakness of legs. On examination, there were lower motor neuron signs in lower extremity, digital clubbing and a lump over left iliac fossa. Routine blood tests showed impaired glucose tolerance, confirmed by oral glucose tolerance test while renal parameters were normal. Magnetic resonance imaging of spine documented osteolytic lesions, long segment epidural mass in thoracic spine and a mass overlying the left iliac bone, both were revealed to be plasmacytoma following cytology. Ultrasonography of abdomen showed splenomegaly. Nerve conduction studies showed gross axonal, motor, asymmetric polyneuropathy with conduction block involving all the four extremities, mainly lower limbs with sensory sparing. Serum protein electrophoresis showed M spike, and bone marrow showed diffuse neoplastic plasma cell proliferation. Osteolytic lesion was present in skull radiograph. Then in the course of illness the patient developed acute renal failure due to acute interstitial nephritis as evidenced from proteinuria and kidney biopsy, which improved with steroids and chemotherapy but unfortunately we lost the patient after 2 weeks of initiation of chemotherapy.

Systemic Sclerosis (SSc) is a connective tissue disorder which involves multiple systems in a chronic progressive manner. Micro–angiopathic haemolytic anaemia is a distinguished feature of “scleroderma renal crisis”, which is manifested by severe hypertension, a rapidly progressing renal dysfunction and hyperreninaemia and is seen in patients with an early, diffuse form of the disease. A nervous system involvement is rare, though entrapment neuropathies have been reported. Who presented with a sequential loss of vision in both eyes; due to retinal vasculitis in right eye and optic nerve demyelination in the left eye. She also had severe Coombs’ negative haemolytic anaemia in absence of any renal dysfunction or hypertension. Both the ophthalmologic and the haematologic manifestations are very rare and both responded well to oral prednisolone therapy.

Two cases of haemophagocytic syndrome (HPS) due to histoplasmosis in patients with the acquired immunodeficiency syndrome (AIDS) are described in our case studies. Both the patients presented with pancytopenia and the bone marrow aspirate showed features suggestive of haemophagocytosis and the presence of intracellular inclusions were compatible with Histoplasma capsulatum. Haemophagocytic syndrome due to disseminated histoplasmosis should be included in the differential diagnosis of pancytopenia in patients with AIDS, though it is a rare clinical entity.

New-onset seizures are frequent manifestations in patients infected with Human Immunodeficiency Virus (HIV). We describe the clinical and radiological findings in an 25yr old AIDS patient presenting with new onset seizures as the primary manifestation of cerebral toxoplasmosis and Non Tuberculous Mycobacterial [NTM] co-infection. Cranial computed tomography showed a subtle ventricular dilatation whereas magnetic resonance imaging disclosed prominent temporal horn. Toxoplasma tachyzoites and rapidly growing mycobacteria were recovered from CSF. Seizures were complex partial in nature and refractory to antiepileptic therapy.