Browsing by Author "Anju Dinkar"

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A case report of valproate-induced acute pancreatitis
(Regional Institute of Medical Sciences, 2017) Virendra Atam; Jitendra Singh; Kanhaiya Agrawal; Anju Dinkar; Isha Atam
Valproic acid is a branched chain aliphatic carboxylic acid which is widely used as antiepileptic drug. Valproic acid-induced acute pancreatitis is an uncommon cause of acute pancreatitis. Hereby we describe a 23-year-old unmarried female, who developed acute pancreatitis following the 12th day of valproate monotherapy prescribed for seizure disorder. Valproate was immediately stopped and replaced with levetiracetam. She improved on conservative management. © 2017 Journal of Medical Society.
A strict vegetarian diet may be harmful: bilateral macular bleeding in vitamin B12 deficiency
(Oxford University Press, 2023) Jitendra Singh; Anju Dinkar
A 35-year-old Indian male office worker presented with complaints of progressive weakness, fatigability, and diminished vision. The patient followed a strict vegetarian diet. Clinical examination revealed pallor. Fundoscopy revealed a bilateral macularbleed. Vitamin B12 deficiency was determined to be the cause based on the clinical and laboratory results. Three months later, he reported a near-normal vision in both eyes and a normal complete hemogram. The present clinical picture demonstrates an unusual facet of clinical feature in vitamin B12 deficiency, an event rarely encountered. © 2023 The Author(s). Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Adenovirus Meningoencephalitis and Neurocysticercosis Co-infection: First Case from India
(Bentham Science Publishers, 2023) Anju Dinkar; Jitendra Singh; J. Bhavya; Swati Singh; Nilesh Kumar; Kailash Kumar
Background: Adenovirus generally causes upper and lower respiratory tract infections. It is common in children and occasionally in adults. Neurological involvement is rare, which may be mild aseptic meningitis to potentially fatal acute necrotizing encephalopathy. Recently, viruses have been reported increasingly to cause CNS infections. Viral aetiology typically varies with age. Case Presentation: Here, we report an unusual adenovirus meningoencephalitis with a co-infection of neurocysticercosis in an immunocompetent adult patient. An 18-year-old healthy female student was admitted with fever and headache for 11 days and progressive altered behaviour for 5 days, followed by altered sensorium for 3 days. This variable and unusual presentation of adenoviral infection involv-ing CNS provoked diagnostic difficulties, but with the help of advanced diagnostics, especially molec-ular, exact aetiology was detected. Even with the neurocysticercosis infection in this patient, the outcome was not adversely affected. Conclusion: This unusual co-infection with a successful outcome is the first case of this type in litera-ture. © 2023 Bentham Science Publishers.
Amphotericin B Deoxycholate Treatment of Post–Kala-Azar Dermal Leishmaniasis in India
(American Society of Tropical Medicine and Hygiene, 2024) Shyam Sundar; Jaya Chakravarty; Jitendra Singh; Deepak Verma; Neha Agrawal; Anju Dinkar
Post–kala-azar dermal leishmaniasis (PKDL) is widely prevalent in the endemic regions of India, but its treatment remains unsatisfactory. The WHO recommends a 12-week treatment with oral miltefosine, but its ocular toxicities are a serious concern. The late 1980s and early 1990s saw the use of sodium stibogluconate and amphotericin B (AmB) for a brief period. Both drugs had frequent adverse events and were expensive, and the duration of treatments was unacceptably long. This retrospective study evaluated, analyzed, and reported the outcomes of PKDL patients treated with a shorter course of AmB, the most effective antileishmanial drug. The hospital records of PKDL patients treated with AmB by 30 alternate-day infusions over 60 days (instead of conventional 60–80 infusions over 100–120 days) between September 2010 and August 2016 were reviewed. Only patients with confirmed parasitological diagnosis were included. Their records were studied for treatment-related adverse events, end-of-treatment parasitological status, and 12-month follow-up results. One hundred two patients were eligible for this study between September 2010 and August 2016. After therapy, 92/102 (90.2%) patients improved; 3 (2.9%) had to cease treatment owing to severe adverse effects, and one died of severe diarrhea unrelated to AmB. Six (5.9%) patients withdrew consent before the treatment was complete. At the 12-month evaluation, 89/102 (87.3%) patients attained a final cure. A 30-infusion regimen of AmB remains highly effective in PKDL. Without a shorter, safer, and more economical regimen for the treatment of PKDL, it should be used until a better regimen is available. Copyright © 2024 American Society of Tropical Medicine and Hygiene.
Awareness and outcome of changing trends in clinical profile of dengue fever: A retrospective analysis of dengue epidemic from january to december 2014 at a tertiary care hospital
(Journal of Association of Physicians of India, 2017) Jitendra Singh; Anju Dinkar; Virendra Atam; D. Himanshu; Kamlesh Kumar Gupta; Kauser Usman; Ravi Misra
Background: Dengue fever is caused by mosquito-borne arboviral infection that has become a public health concern globally. Recently, an alarming rise of dengue has also been seen in India. Hence the study was undertaken to know profile of clinical manifestations and laboratory findings during the evolution of dengue fever. Methods: In this study, retrospective data analysis was done in 216 seropositive dengue patients admitted between January to December 2014 in department of medicine at a north Indian care hospital. The tests analyzed were blood counts, serum electrolytes, liver function tests, kidney function tests, chest x-ray and other relevant investigations. Results: Males were commonly affected and the most exposed age group was found to be18-35 years. The seropositive case rate for dengue was 56% for NS1 antigen and 36% for IgM. There was rural dominancy of cases with a peak in September. Fever was the most common clinical feature followed by headache, myalgia, backache, nausea and abdominal pain. Petechia was most common haemorrhagic manifestation. Common laboratory findings included 89.35% decreased Platelet counts (<100 000/ cmm), 67.59% increased hematocrit (>45%) and 58.33% deranged liver function test. There was no reported mortality in dengue. Conclusions: From prompt and proper treatment could prevent deaths in moderate and severe dengue. Atypical presentations of dengue should be kept in mind so as not to miss the cases. Increased community awareness and vector control measures need to be strengthened during peri-monsoon period to reduce burden of dengue cases. © 2017, Journal of Association of Physicians of India. All rights reserved.
Bilateral Periorbital Erythema and Swelling as an Initial Presentation of Systemic Lupus Erythematosus: A Rare Case
(Bentham Science Publishers, 2025) Jitendra P. Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Isha Atam
Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement due to autoantibody production and immune complex deposition. While classical cutaneous manifestations, such as malar rash, are common, atypical presentations, like periorbital erythema and swelling, are rare and pose diagnostic challenges. Early recognition is crucial to prevent disease progression and complications. Case Presentation: A 16-year-old girl presented with a three-month history of intermittent bilateral periorbital swelling. Clinical examination revealed pallor and localized alopecia with no significant systemic abnormalities. Laboratory investigations showed pancytopenia with normal renal, hepatic, and thyroid functions and unremarkable urinalysis, chest X-ray, and ECG. Autoimmune markers were positive, with a strongly positive ANA titer of 1:1000 and significantly elevated anti-dsDNA antibodies of 380 IU/mL (reference range: 0-200 IU/mL). According to the 2019 EULAR/ACR classification criteria, a diagnosis of SLE was established. The patient was treated with pulse intravenous methylprednisolone (1g daily for three days), followed by oral prednisolone (1 mg/kg/day), in a tapering regimen and hydroxychloroquine at standard doses. She showed marked improvement, with resolution of periorbital swelling, recovery of pancytopenia, and hair regrowth. At two-month follow-up, she remained asymptomatic and continued hydroxychloroquine for maintenance therapy. Conclusion: This case underscores the importance of considering SLE in patients with atypical presentations, like periorbital erythema and pancytopenia. Early diagnosis based on clinical and serological findings, followed by appropriate therapy, can achieve remission and prevent complications. The case highlights the need for heightened clinical suspicion and multidisciplinary management in young patients. © 2025 Bentham Science Publishers.
Bullous hemorrhagic dermatosis following unfractionated heparin therapy
(Wolters Kluwer Medknow Publications, 2025) Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Heparin, a commonly used anticoagulant, has been associated with several cutaneous adverse effects, including skin necrosis, bruising/ecchymosis, urticaria, angioedema, red plaques, nodular lesions, and allergic contact dermatitis. Bullous hemorrhagic dermatosis (BHD) caused by heparin is a rare skin-related side effect. A 34-year-old woman diagnosed with anti-phospholipid syndrome was recently observed to develop hemorrhagic bullous dermatosis distant from the site of intravenous unfractionated heparin. Heparin therapy was continued for 5 days, followed by daily oral warfarin 2 mg, along with aspirin 75 mg, with monitoring of lesions. Two weeks later, skin lesions resolved spontaneously. BHD is nonthreatening and typically resolves on its own without the need for extensive treatment. Clinicians should be aware of the presentations of this self-limiting illness to avoid unnecessary workups. © 2025 Indian Journal of Pharmacology.
C1 Esterase Inhibitor Deficiency in an Indian Female: A Rare Case Report and a Review of Literature with Treatment Update
(Bentham Science Publishers, 2025) Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar; Rajendra Prakash Maurya
Introduction: Hereditary Angioedema (HAE) is a rare, autosomal dominant disorder characterized by episodic, non-pruritic, non-pitting swelling of the skin, respiratory tract, and gastrointestinal system resulting from C1 esterase inhibitor (C1-INH) deficiency or dysfunction. It is frequently underdiagnosed, particularly in developing countries like India, due to its nonspecific presentation and overlap with allergic angioedema. Case Presentation: We report a case of a 28-year-old Indian woman who presented with a five- month history of progressive facial and periorbital swelling. She had no urticaria, known allergies, or systemic symptoms and did not respond to antihistamines or corticosteroids. The initial workup revealed normocytic anemia and elevated inflammatory markers, with normal renal, hepatic, thyroid, and autoimmune profiles. Radiological evaluation showed bilateral pre-septal edema. Complement C4 was normal; however, serum C1-INH level was markedly reduced, confirming type I HAE. She responded well to intravenous plasma-derived C1-INH concentrate (Cinryze). Unfortunately, she succumbed to a later episode of upper airway edema, highlighting the life-threatening potential of untreated or delayed HAE. Conclusion: This case emphasizes the need for high clinical suspicion of HAE in patients with unexplained, non-histaminergic angioedema, especially when conventional therapies fail. Early biochemical confirmation and targeted therapy are essential for effectively managing and preventing fatal complications. © 2025 Bentham Science Publishers
Case Report and Review of the Literature: Ischemic Stroke in Dengue Virus Infection
(American Society of Tropical Medicine and Hygiene, 2024) Jitendra Singh; Anshika Sinha; Anju Dinkar; Nilesh Kumar; Kailash Kumar
Dengue continues to pose a global health challenge, particularly in tropical and subtropical areas. Dengue can impact various organs, including the central nervous system, and can cause various neurological symptoms, although stroke is an uncommon complication. Among strokes, ischemic stroke is very uncommon in dengue. A 27- year-old unmarried female was referred to our institution with 8 days of fever and myalgia, 5 days of vomiting, and 3 days of altered sensorium. Small-sized bilateral pupils reacted slowly to light. Chest auscultation revealed diffuse coarse crepitation. Poor general condition and labored breathing led to intensive care unit transfer and intubation. Her contrastenhanced brain magnetic resonance image showed chronic pontine infarction. She was diagnosed with dengue fever (NS1Ag positive) complicated by bilateral pontine infarction. After a long course of illness, she was finally discharged to home in good recovery status. Clinicians need to be aware of the uncommon dengue presentation of stroke. Treatment is supportive with variable outcomes. © 2024 American Society of Tropical Medicine and Hygiene.
Clinical Profile and Severity Correlation of Acute Leptospirosis in Northern India, 2019-2023: A Tertiary Care Center-based study
(Bentham Science Publishers, 2025) Anju Dinkar; Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Ramanand Yadav
Background: Leptospirosis is a globally important zoonotic disease with substantial morbidity and mortality, yet it remains underreported in Northern India. This study aimed to evaluate the seroprevalence, clinical characteristics, and severity determinants of acute leptospirosis in a tertiary care setting. Methods: We conducted a retrospective cross-sectional analysis of 174 hospitalized leptospirosis patients from 20,162 admissions between 2019 and 2023. The diagnosis was established using Leptospira IgM ELISA testing. Clinical, haematological, and imaging parameters were systematically evaluated. Results: The incidence of leptospirosis was 0.9%, peaking at 38.5% post-monsoon. Rural residents (64.9%), males (59.2%), and individuals involved in agricultural work (62.6%) were predominantly affected. Common presentations were fever (100%), headache (70.7%), myalgia (62%), and calf pain (50%), followed by jaundice (39.7%), and reduced urine output (33.3%).. The mortality rate was 20.1%. Severity correlated significantly with nausea/vomiting, abdominal pain, cough, and complications, including diffuse alveolar haemorrhage (DAH), disseminated intravascular coagulation (DIC), multiorgan dysfunction syndrome (MODS), hepatic dysfunction, acute renal injury, and leukocytosis. Discussion: The findings emphasize the critical need for early risk stratification and timely intervention to improve clinical outcomes. Identifying clinical and laboratory predictors of severity can significantly guide early management strategies in endemic areas. Conclusion: Several clinical and laboratory parameters are significant predictors of leptospirosis severity. Early recognition and risk stratification based on these indicators are crucial to improving patient outcomes. Enhanced surveillance, preventive measures, and clinician awareness are urgently needed to address this neglected tropical disease. 2025, Bentham Science Publishers
Clinical profile of dengue fever and coinfection with chikungunya
(Wolters Kluwer Medknow Publications, 2018) Jitendra Singh; Anju Dinkar; Rana Singh; Mohammad Siddiqui; Nikhil Sinha; Sanjiv Singh
Objective: Arthropod-borne viral diseases are a major burden on the health-care system worldwide. Only a few studies have reported on coinfection of dengue fever (DF) with the chikungunya virus in North India. We investigated the seroprevalence and significance of the clinicobiochemical profile of dengue and chikungunya coinfection. Besides this, the authors try to emphasize rationalize platelets transfusion. Material and Methods: The present study was conducted at the Heritage Institute of Medical Science, Varanasi, India, from July to December 2016. A total of 1800 suspected cases with acute viral febrile illness (age >18 years) were investigated to exclude other causes of acute febrile illnesses. Of these, 121 patients (6.72%) were diagnosed as seropositive for dengue and chikungunya mono or coinfection using IgM ELISA and were included in the study. Results: The male gender was predominant. The majority were in the 20-30-year age group with cases peaking in November. There were 102 (84.29%) cases of dengue, 6 (4.95%) cases of chikungunya, and 13 (10.74%) cases positive for coinfection. Fever was present in all cases. Headache followed by nausea/vomiting and generalized weakness were the most common symptoms in patients with DF while body aches and joint pain were most common in those with chikungunya fever. Deranged liver function and leukopenia were the most common complications in dengue. Conclusion: Joint-related symptoms (pain and restricted movements) were statistically significant in chikungunya monoinfection. Two patients with DF were died. There was no significant added severity of clinical features and blood investigations in patients with coinfection with dengue and chikungunya compared to those with monoinfections. © 2018 Tzu Chi Medical Journal.
COVID-19 Associated Acute Pancreatitis: A Case Series from India
(Bentham Science Publishers, 2022) Jitendra Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Introduction: Initially, COVID-19 was typically concerned with respiratory symptoms and had a mild and asymptomatic to critical clinical course. Over time, many atypical presentations related to cardiac, hepatic, gastrointestinal, renal, musculoskeletal, and neurological features have been reported in COVID-19. Case Presentation: We present three confirmed cases of COVID-19, who developed acute pancreatitis without any other obvious discernible cause. One middle-aged 48-years old male was presented with severe abdominal pain with mild symptoms of COVID-19, who was later diagnosed with acute pancre-atitis with a positive outcome. Another 40-year-old male, hospitalized due to moderate COVID-19, developed acute pancreatitis and was managed successfully. The third 58-year-old patient with control diabetes and severe COVID-19 developed acute necrotizing pancreatitis. Unfortunately, he succumbed due to multiorgan failure while on the mechanical ventilator. Conclusion: Acute pancreatitis is uncommon in COVID-19. Although, it should be kept as a high-index clinical suspicion if abdominal pain is reported. Early diagnosis and prompt management can significantly impact the patient's outcome. © 2022 Bentham Science Publishers.
COVID-19 Associated Pancytopenia (CAP): A Clinical Impact
(Bentham Science Publishers, 2023) Jitendra Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar
Background: SARS-CoV-2 infection has mild and asymptomatic to critical clinical course affecting mainly the lungs. Few case reports of COVID-19-associated pancytopenia are reported, but a series of 18 cases is not described in the literature to date. Aims and Objectives: This study aimed to investigate pancytopenia in COVID-19 and its correlation with severity and to explore the detailed clinical and biochemical information in COVID-19-associated pancytopenia. This study also highlights pancytopenia's rarity and prognostic value among COVID-19 patients. Materials and Methods: This was a retrospective observational study conducted in a tertiary care centre at a level 3 COVID care facility that included adults of either sex having positive RT PCR for COVID-19 from October 2020 to May 2021. Data were collected from the online outpatient department and hospitalized patients. Results: A total of 18 cases were included in the study; 13 were males (72.2%). The mean age was calculated as 48.56 years. Cases were categorized as severe 13 (72.2%) and non-severe 5 (27.8%) disease on the first day of pancytopenia. The most common presentations were fever 18 (100%) and cough 18 (100%), followed by generalized weakness 16 (88.9%), breathlessness 15 (83.3%), and diarrhoea 10 (55.6%). One case died in the severe disease group. The mean of haemoglobin, leukocyte count, and platelets in severe vs non-severe disease were calculated as 8.59 vs 8.74, 2339 vs 2578, and 77769 vs 88600, respectively. Conclusion: Pancytopenia was more prevalent in severe disease and age group 40-60 years. CAP was most likely due to secondary bone marrow suppression. It has no prognostic value for disease outcomes. © 2023 Bentham Science Publishers.
Demographic, Clinical, and Investigational Characteristics of COVID-19-related Guillain-Barré Syndrome with Differences from Typical and Another Virus-related Guillain-Barré Syndrome
(Bentham Science Publishers, 2022) Jitendra Singh; Nilesh Kumar; Anju Dinkar
Backgrounds: SARS-CoV-2 infection typically presents with fever and respiratory symptoms. Besides this, COVID-19-related central and peripheral nervous system manifestations are emerging. Objectives: This study summarises the demographics, clinical profiles, laboratory findings, management strategies, and outcomes in a large number of patients with COVID-19-related GBS and its variants. We also compared its clinical profile with Zika and dengue virus-related GBS. Methods: The authors carried out a literature search up to Dec 31, 2020, in MEDLINE, PubMed, SCOPUS, Cochrane database, and Google Scholar for all published articles. Results: The study identified 54 different types of articles consisting of 70 cases from 17 countries worldwide. A maximum of 15 cases (21.4 %) were identified from Italy, followed by the USA (12; 17.1 %), Spain (11; 15.7 %), and Iran (10; 14.3 %). The age group that was more than 60 years had the most cases, i.e., 32 (45.7 %), followed by the age group 40-60 with 25 cases (35.7 %) with a male to female ratio of 2. Maximum cases were treated with IVIG infusion 58 (82.9 %), followed by Plasma exchange 13 (18.6 %) cases. Out of 70 cases, 7 (10 %) cases were manifested as Miller-Fisher syndrome. The most predominant electrodiagnostic variant was demyelinating neuropathy in 41 (73.21 %) cases. The outcome reported in 67 cases was survival in 63 (90 %) cases and death in 4 (5.7 %) cases. Conclusion: Covid-19-related GBS were reported worldwide with a better outcome. Both postinfectious and parainfectious patterns were reported. Early recognition with prompt management of GBS can prevent further severe morbidity and mortality. © 2022 Bentham Science Publishers.
Dengue Fever Related Reactive Thrombocytosis in Young Male: A Case Report and Review Literature
(Bentham Science Publishers, 2024) Jitendra Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Vikrant
Introduction: Dengue fever is prevalent in tropical nations, especially India. Leucopenia and thrombocytopenia are distinctive features of acute dengue fever that revert to normal levels after the patient's recovery. Dengue fever is associated with numerous unusual clinical manifestations of different body systems. Additionally, the emergence of severe thrombocytosis following thrombocytopenia is extremely rare. Based on our extensive knowledge, only three cases similar to this have been documented in the literature. Case Report: Here, we present a case of a 36-year-old healthy man who had acute dengue and subsequently developed severe reactive thrombocytosis. The patient was treated conservatively and discharged. Subsequently, he developed thrombocytosis. Aspirin was given for a short period to alleviate any potential repercussions. Conclusion: Thrombocytosis, a rare consequence of dengue infection, is usually asymptomatic. Nevertheless, ongoing monitoring of dengue patients is required to avoid complications. © 2024 Bentham Science Publishers.
Dengue induced reversible blindness
(Wolters Kluwer Medknow Publications, 2021) Anju Dinkar; Jitendra Singh; Virendra Atam
Dengue is spread by the bite of infected Aedes aegypti mosquito. It is usually a self-limiting viral infection but sometimes complicates to mortality. In the last few decades, literature has shown that clinical and biochemical profile of dengue is expanding due to the addition of unusual manifestation day by day. Hereby, we report a young male student suffering from dengue complicated to retinal hemorrhage and severe pancytopenia who recovered near fully on treatment. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
Dengue infection in North India: An experience of a tertiary care center from 2012 to 2017
(Wolters Kluwer Medknow Publications, 2020) Anju Dinkar; Jitendra Singh
Objective: Recently, an alarming rise of dengue has been seen in India which remains a major public health concern. This study has been designed for a comprehensive overview of the epidemiology, gender, age, area distribution, symptomology, and seasonal variability. Materials and Methods: Retrospective analysis of 900 suspected dengue cases of all age groups of either sex from 2012 to 2017 at a North Indian tertiary care hospital revealed 461 (51.22%) cases seropositive for dengue. Results: The age group of 20-30 years was the most affected group with male predominance. The urban population was more affected as 75.05%, and maximum cases were detected in October month followed by November. Common abnormal laboratory parameters were thrombocytopenia (99.1%), hepatic dysfunction (59%), and leukopenia (26.68%). Two uncommon findings, pancytopenia and pancreatic dysfunction were reported in 7 and 3 cases respectively. Conclusion: Dengue infection in India has evolved rapidly, and regular outbreaks have been observed with a changing epidemiology, as the disease is rapidly spreading from urban to rural areas with increasing atypical manifestations. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
Diagnostic Challenges of Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin Changes (POEMS) Syndrome: A Rare Case Report and Review of the Literature
(Bentham Science Publishers, 2025) Kailash Kumar; Rohit Ghanshyamdas Daga; Jitendra P. Singh; Nilesh Kumar; Anju Dinkar
Introduction: POEMS syndrome is a rare multisystem disorder associated with plasma cell dyscrasia and abnormal cytokine production, including vascular endothelial growth factor (VEGF). The mandatory criterion for its diagnosis includes polyneuropathy and monoclonal plasma cell disorder, along with other major and minor criteria. This case highlights the diagnostic and therapeutic challenges of POEMS syndrome by depicting the case of a 61-year-old male with progressive sensory-motor polyneuropathy, lymphadenopathy, and splenomegaly. Case Presentation: The patient presented with a year-long history of bilateral limb weakness and sensory disturbances, accompanied by abdominal distention, weight loss, and other systemic symptoms. Clinical examination revealed skin hyperpigmentation, splenomegaly, and a right axillary lymph node enlargement. Neurological evaluation showed distal limb hypotonia, absent reflexes, and sensory deficits. Diagnostic investigations, including nerve conduction studies, imaging, and bone marrow biopsy, confirmed POEMS syndrome based on polyneuropathy, monoclonal IgG lambda plasma cells, Castleman disease, sclerotic bone lesions, elevated VEGF, and minor criteria, such as endocrinopathy and skin changes. The treatment comprised lenalidomide and dexamethasone, resulting in significant improvement at the three-month follow-up, including normalized VEGF levels and resolution of ascites. Conclusion: This case highlights the necessity of identifying the many presentations of POEMS syndrome for prompt diagnosis and treatment. Despite its rarity and diagnostic complexity, prompt treatment can significantly improve clinical outcomes. POEMS syndrome should be considered in patients with unexplained neuropathy and systemic features, enabling better outcomes through targeted therapies. Bentham Science Publishers
Digital Gangrene Associated with Scrub Typhus: A Case Series
(American Society of Tropical Medicine and Hygiene, 2024) Jitendra Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Nidhi Tejan
Rickettsial diseases cover a broad spectrum of illnesses. Scrub typhus is present worldwide, and Orientia tsutsugamushi is the causative agent of this chigger mite–borne infectious illness. Infections exhibit a range of severity, from mild illness to the more severe manifestation of multiorgan failure. We report three cases of scrub fever (55-year-old female, 63-year-old female, and 29-year-old male), all cases developed focal or pan-digital gangrene. All cases were successfully treated by administering doxycycline and additional supportive measures. Digital gangrene is uncommon in scrub typhus. Clinical suspension for early diagnosis and appropriate treatment may avoid further complications. Copyright © 2024 American Society of Tropical Medicine and Hygiene.
Disseminated Cryptococcosis in Idiopathic CD4+ Lymphocytopenia
(Bentham Science Publishers, 2023) Ankita Dewangan; Jitendra Singh; Dinesh Kumar; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Introduction: Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non– HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3 with ambiguous natural history and prognosis. In addition, cryptococcal and nontuberculous mycobac-terial infections are reported as known opportunistic infections. Therefore, management turns around vigilant follow-up and treatment of the current clinical scenario of these patients. Case Presentation: Here, a 55-year-old lady was referred with a history of diffuse headache and in-termittent fever for two months, projectile vomiting, and altered mental status for five days. Non-pruritic maculopapular rashes and diffuse desquamation of the skin were noted. She had no significant previous medical history. Based on clinical findings and investigations, she was diagnosed with ICL having disseminated cryptococcosis. Unfortunately, the patient did not undergo specific treatment as she was recognized late, and unfortunately, she died. Conclusion: It is of paramount importance to recognize the clinical entity as early as possible to start appropriate treatment, which may positively impact the outcome. Therefore, the clinician must be aware of disseminated cryptococcosis associated with non-HIV states. © 2023 Bentham Science Publishers.