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Hyponatraemia is a common clinical problem encountered in clinical practice and has multifactorial aetiology. The presentation of hyponatremia due to hypopituitarism secondary to pituitary apoplexy is rarely seen and sometimes missed. We report the case of a 34-year-old male with a history of reduced social interaction, decreased sexual drive, fatigue, vomiting, hiccoughs and presented to the hospital with altered sensorium. Laboratory testing revealed hyponatraemia (107 mEq/L); there was reduced serum cortisol (8 AM), decrease in serum adrenocorticotropic hormone (8 AM) and pituitary hormone assay suggestive of hypopituitarism. Magnetic resonance imaging of the brain with dynamic pituitary contrast suggestive of pitutary apoplexy. The patient was managed with 3% sodium chloride infusion, hydrocortisone and thyroid supplementation.

A 19-year-old male from a rural background with no prior co-morbidities came with chief complaints of fever for 4 days, associated with chills, rigors, myalgias and high coloured urine. On general examination, pallor was present. Vitals and systemic examination were normal. Routine blood investigations were sent, and two sets of blood cultures were sent. The patient was empirically started on ceftriaxone. Complete urine examination showed >20 red blood cells (RBCs)/high-power field (HPF) with four to five RBC casts/HPF. Initial creatine phosphokinase was 3216 U/L. The patient's fever spikes continued, and antibiotic was changed to piperacillin-tazobactam after 48 h and then to meropenem. Fever spikes continued. The patient developed pancytopenia and acute respiratory distress syndrome. Final blood culture report grew Brucella melitensis. The patient was started on streptomycin and doxycycline. The patient improved clinically and discharged in clinically stable condition.

We report the case of a 55-year-old woman diagnosed with interstitial lung disease due to long-term nitrofurantoin therapy that was administered for recurrent urinary tract infection. Despite distorted pulmonary parenchymal architecture and patchy fibrosis confirmed by computed tomography of the thorax, the symptoms and radiographic findings disappeared within 3 months after the administration of prednisone. This case shows that nitrofurantoin-induced lung disease may run a benign course and respond favourably to corticosteroids, even when there is radiographic evidence of established lung fibrosis. This case report highlights the need for vigilance of pulmonary toxicity in patients taking long-term nitrofurantoin therapy.

A 48-year-old male, farmer by occupation with no prior comorbidities came with chief complaints of fever since 5 months, associated with loss of weight and loss of appetite. On general examination, pallor and clubbing were present. Blood pressures were 120/20 mmHg in both upper limbs and 200/60 mmHg in both lower limbs. Cardiovascular examination, on auscultation there was pansystolic murmur in mitral area radiating to axilla, holodiastolic murmur in aortic area. All routine blood investigations were done. Echocardiogram was suggestive of infective endocarditis of aortic valve with multiple thickened vegetations over aortic valve. Blood cultures grew Enterococcus faecium in two sets. The patient was treated with antibiotics according to culture sensitivity report. Patient improved clinically and was discharged.

Introduction: Splenic abscess is a rare entity with potentially life threatening complications. Sparse recent published data are available documenting the aetiological profile and management of patients with splenic abscess from India. Aim: To study the clinical profile of splenic abscess. Materials and Methods: We retrospectively collected data from case records of admitted patients with splenic abscesses, to Nizam’s Institute of Medical Sciences and Hospital which is a multispecialty, tertiary care referral hospital over a period of 15 months (from March 2014 to May 2015) and parameters studied were age, sex, symptoms, signs, risk factors, investigations like Ultrasound, CT scan, blood & microbiological culture, treatment and outcome. Results: Most common presenting symptom was fever (90%). Mean age was 33.5 years. Five patients (55%) had risk factors like HIV, leukaemia and diabetes. From pus culture Escherichia coli was the most common organism (22%) grown. Staphylococcus saureus, Enterococcus faecium were seen in one each, blood culture grown Cryptococcus neoformans, Pseudomonas aeroginosa in one each, Plasmodium falciparum was seen on peripheral smear in one. Three were empirically treated as disseminated koch’s. Another was treated as possible infective endocarditis. All were given antimicrobials, five (55%) were treated with antimicrobials alone, three (33%) with PCD (Per Cutaneous Drainage) and one (11%) with subtotal splenectomy. All patients recovered. Conclusion: With early diagnosis and increased use of ultrasound guided procedures like aspiration or drainage, spleenectomy can be avoided. Optimal treatment for splenic abscess is yet to be defined and customized to each patient.

Introduction: Aplastic Anaemia (AA) is a syndrome characterized by peripheral pancytopenia with hypo-cellular marrow. Acquired idiopathic AA is the most common variety, probably of an autoimmune aetiology. Bone Marrow Transplantation (BMT) is the treatment of choice but cost is the limiting factor. Antithymocyte Globulin and Cyclosporine-A is an alternative to BMT. Cyclosporine alone has been tried as a single agent in resource poor setting. Aim: The study was conducted with the aim to observe the treatment response in aplastic anaemia to Cycloserine-A. Materials and Methods: Patients who were diagnosed as AA and opted for Cyclosporine with informed consent were included in the study. All the subjects were started on 5mg/kg of Cyclosporine and were followed up for three months to see the treatment response. This study had the approval from IEC. Results: Twenty patients were enrolled in the study. Age of the patients ranged from 10 to 65 years. Maximum number (10/20) of patients was in the 2nd decade. Most of the patients presented with mucosal bleeds and breathlessness on exertion; the predominant sign was pallor. Eleven patients had severe AA, eight had non severe and one had very severe anaemia. Out of 20, three patients were lost to follow-up and one patient discontinued therapy due to renal dysfunction; finally sixteen patients’ data was analysed. Out of 16 patients, 9 responded and 7 did not respond. Complete response was observed in three patients, partial response in six patients. Seven patients had drug toxicity in the form of acute renal failure and gum hypertrophy. Conclusion: Cyclosporine seems to be a reasonable therapeutic option with good response rate and minimal side effects.

The occurrence of combined liver and renal abscess by Candida albicans in an immunocompetent patient is a rare entity. Here, we report a 40-year-old female who presented to the hospital with complaints of fever, right flank pain, vomiting and loose stools. Contrast-enhanced computed tomography (CT) of the abdomen revealed liver and renal abscess with contracted left kidney with multiple urinary calculi and bilateral mild to moderate hydroureteronephrosis. Culture of the aspirate from abscess grew C. albicans. Blood cultures and urine cultures were sterile. She was treated with tablet voriconazole and percutaneous drainage of renal and hepatic abscess was done. Fever spikes and pain abdomen subsided after 1 week of therapy. Repeat CT abdomen after 3 weeks showed resolving liver and renal abscess. [ABSTRACT FROM AUTHOR]