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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.

Primary pleural lymphoma is a rare entity that has been described in association with human immunodeficiency virus (HIV) infection or pyothorax. This paper reports on a 27 year old man with no history of HIV infection or pyothorax who presented with progressive dyspnea and heaviness of chest. Chest radiography revealed complete opacification of the left hemithorax, and contrast enhanced computed tomography showed large left pleural effusion and homogeneous, extensive thickening of the parietal pleura. CT guided biopsy of thickened pleura is suggestive of non-Hodgkin’s lymphoma-T cell lymphoblastic variety. Physicians should be aware of this rare location of primary pleural lymphoma manifested by thickening of the pleura.

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.

Acute coronary syndrome (ACS) covers a spectrum of clinical conditions ranging from unstable angina, Non-ST segment elevation myocardial infarction (NSTEMI), or ST segment elevation myocardial infarction (STEMI). This study encompasses patients with acute coronary syndrome, who were receiving the dual antiplatelet therapy of aspirin and clopidogrel. The focus of the study was to gain insight into the role of selective P2Y1 antagonism using MRS2179 in such cases as well as its effects, if any, on collagen-epinephrine interaction. All the cases showed greater potency of inhibition of the interaction when yohimbine hydrochloride (YH), a blocker of alpha2A-adrenoreceptor, was used compared to MRS2179, a P2Y1 antagonist, although there was variability in responsiveness to the antiplatelet drugs. These findings indicate that alpha2A-adrenoreceptors of platelets in this group play a major role in precipitating the interactive effect of collagen and epinephrine. The dose-response effect as studied by platelet aggregometry showed that the required molar concentration to block the interactive effect in the case of YH was less than that of MRS2179. Hence, it is postulated that although there may be an impairment of collagen-induced aggregation by MRS2179, the interactive effect of collagen-epinephrine may not be impaired by MRS2179 as efficaciously as YH.

Churg-Strauss syndrome (CSS), or allergic granulomatosis, is a rare disease manifested by tissue infiltration, hypereosinophilia and vasculitis. Renal involvement may be seen in up to 50% of cases. We report the case of a 25-year old man who presented with a history of fever for two months, tingling, numbness, and paraesthesia of the upper limbs and left lower limb, along with diarrhoea for one month and an inability to walk for the past seven days. Serial laboratory investigations helped to reach the final diagnosis of CSS with mononeuritis multiplex, and skin, pulmonary and gastrointestinal involvement with hypertension. This is due to renal involvement in the form of focal segmental glomerulosclerosis without any nephrotic range proteinuria, which is a very rare clinical entity. The patient's symptoms were relieved after the administration of an unconventional mode of therapy.

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 association between pulmonary interstitial fibrosis and the development of bronchogenic carcinoma in a patient with scleroderma has been reported rarely[1]. It is hypothesized that intense epithelial proliferation that is accompanied by the fi brotic process increases the occurrence of carcinomatous changes[2]. We report the case of a patient who presented with 3-year history of Raynaud’s phenomenon, gradual tightening of the skin which was ignored by the patient and her family members, and a 2-week history of severe respiratory distress with left shoulder and upper back pain followed by the development of paraparesis. After a series of examinations, the patient was diagnosed with scleroderma and simultaneously with bronchogenic carcinoma and multiple distant metastases.

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.

Prevalence of pediatric HIV has not been well characterized. We evaluate the prevalence, risks and contributing factors to the spread of HIV in India. This manuscript aims to describe prevalence of Pediatric HIV infection in Eastern India. We want to provide data on burden of HIV positive children visiting a tertiary care center located in the city of Kolkata, East India. Data is provided for routes of HIV exposure and occupational background and HIV status of the parents of infected children. Background: Various studies in India have documented high prevalence of HIV infection in children. Nearly 20 million babies are born each year and the number of infected babies could be >50,000 per year. According to Solomon S et al in India the prevalence of HIV among pregnant women varies widely from state to state and figures range from 0.5% to as high as 4.7% as in Namakkal, a small village in Tamilnadu. Objective: To determine and characterize the prevalence of pediatric HIV/AIDS in India Methods: This is a two year retrospective review of patients from the (with 100 beds) pediatric outpatient unit of the Medical college and Hospital, Kokata, was undertaken to determine the prevalence of pediatric HIV/AIDS in Kokata (or in North India). Results: 3,669 pediatric patients were admitted to the hospital, 437(11.9%) tested positive for HIV, 234 were males, while 203 were females (m:f=1.15:1). Children under the age of five years accounted for 81.7% of the HIV positive children. Mother-to-child transmission occurred in 73.7% of cases was the major route of transmission of HIV. Two other common routes included the use of blood/blood products (21 patients), hairdressing implements due to punctures in 4.8% each, while sexual abuse/sex activities were the probable route in 3.8% others. Most mothers of HIV children were either housewives (45.3%), or petty traders, trade that is conducted on a small scale (10.4%). Conclusion: The prevalence of pediatric HIV/AIDS was high in Eastern india. The most common mode of transmission was mother to child. Programs to work on education of prevention of this mode of transmission should be implemented by proper detection of disease in mothers,adequate counselling and administration of HAART to prevent mother to child transmission of AIDS.

A 35 year-old male presented with left sided weakness for past 3 months, along with progressive deterioration in higher mental faculties, vision and audition. Clinical and investigational information suggested the diagnosis of an acute demyelination involving various areas of the brain. He was seropisitive for HIV and had good cellular immunity at the time of our assessment. We present this case to highlight the association of Multiple Sclerosis (MS) with HIV, either during seroconversion or early during course of this infection.

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.

We aimed to compare therapeutic effects of intramuscular (IM) nandrolone decanoate and IM testosterone enanthate in male HIV patients with AIDS wasting syndrome (AWS) with placebo control.In this randomized, double-blind, placebo-controlled, 12-week trial, 104 patients with AWS who satisfied our inclusion criteria were randomly allotted in a 2:2:1 ratio to the 3 intervention groups: nandrolone, testosterone, and placebo. We administered 150 mg nandrolone and 250 mg testosterone (both IM, biweekly). The primary outcome measure was a comparison of absolute change in weight at 12 weeks between the nandrolone decanoate, testosterone, and placebo groups.Intent-to-treat analysis was done. The nandrolone group recorded maximum mean increase in weight (3.20 kg; post hoc P.01 compared to placebo). Body mass index (BMI) of subjects in the nandrolone group had a significantly greater increase (mean = 1.28) compared to both testosterone (post hoc P.05) and placebo (post hoc P.01). Waist circumference and triceps skinfold thickness of patients on nandrolone showed similar results. Nandrolone also ensured a better quality of life. Patients with low testosterone level (3 ng/mL) benefited immensely from nandrolone therapy, which increased their weight and BMI significantly compared to placebo (P.05).Our trial demonstrates the superior therapeutic effects of nandrolone in male AWS patients, including the androgen deficient.

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.