Browsing by Author "Jitendra P. Singh"

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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
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
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
Hereditary Hemorrhagic telangiectasia: a rare familial case with delayed diagnosis despite decades of recurrent bleeding
(Oxford University Press, 2025) Ashutosh Vardhan Rahi; Abhishek Kumar; Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Hereditary Hemorrhagic Telangiectasia (HHT), or Osler-Weber-Rendu syndrome, is a rare autosomal dominant vascular disorder characterized by mucocutaneous telangiectasias and visceral arteriovenous malformations (AVMs). We report the case of a 45-year-old male with a 20-year history of recurrent spontaneous epistaxis, chronic fatigue, and iron deficiency anemia, unresponsive to repeated nasal cauterizations. A strong family history of similar bleeding episodes in his mother and son heightened clinical suspicion. Examination revealed severe pallor without visible telangiectasias. Upper gastrointestinal endoscopy demonstrated telangiectatic lesions, while imaging excluded pulmonary and cerebral AVMs. Genetic testing confirmed HHT type 2 by detecting a pathogenic ACVRL1 gene variant. The patient was managed with intravenous iron, blood transfusions, topical nasal care, and laser therapy for refractory epistaxis. This case underscores the diagnostic challenges of HHT without classical telangiectasias and highlights the importance of early genetic testing and family screening to prevent serious complications. © The Author(s) 2025. Published by Oxford University Press.
Longitudinally Extensive Transverse Myelitis (LETM) and Meningoencephalitis Following Acute Epstein-barr Virus Infection in an Immunocompetent Male: Case Report and Review Literature
(Bentham Science Publishers, 2025) Jitendra P. Singh; Anshika Sinha; Nilesh Kumar; Kailash Kumar; Anju Dinkar; Rohit Ghanshyamdas Daga
Introduction: Epstein-Barr Virus (EBV) causes heterophile-positive Infectious Mononucleosis (IM), which manifests fever, sore throat, lymphadenopathy, and atypical lymphocytosis. In the Central Nervous System (CNS), EBV can cause acute encephalitis, cerebellar ataxia, Acute Disseminated Encephalomyelitis (ADEM), myelitis, meningitis, and radiculopathy. Reports of acute transverse myelitis linked to EBV infection are limited; therefore, Longitudinally Extensive Transverse Myelitis (LETM) due to EBV infection is extremely uncommon. Case Report: An 18-year-old male, otherwise healthy, was admitted to the medicine department with ten days of fever, headache, and vomiting and five days of altered sensorium. Subsequently, his neurological test showed bilateral upper motor neuron quadriparesis, sensory impairment, and bladder-bowel involvement. Spinal T2W MRI indicated extensive cervical, thoracic, and lumbar hyperintense lesions. Laboratory investigations supported the diagnosis, which revealed a positive IgM Antibody for EBV Viral Capsid Antigen (VCA) in serum and EBV DNA PCR in Cerebrospinal Fluid (CSF). The final diagnosis was EBV-induced acute meningoencephalitis with longitudinally extensive transverse myelitis and incidental aortic coarctation. Following methylprednisolone pulse therapy, the patient recovered significantly. Conclusion: The present case report aims to share our experience by highlighting awareness of the rarity and treatment outcome of EBV-induced LETM. 2025, Bentham Science Publishers
Micronutrient and redox homeostasis contribute to Moringa oleifera-regulated drought tolerance in wheat
(Springer Science and Business Media B.V., 2023) Sahana Basu; Amlan A. Prabhakar; Surbhi Kumari; Aabha; Ravi Ranjan Kumar; Shashi Shekhar; Krishna Prakash; Jitendra P. Singh; Gyanendra P. Singh; Ram Prasad; Gautam Kumar
Global food security is being severely affected by the rapid increase in population and drastic climate change. Drought stress is the most important limiting factor for the sustainable production of several important crops, including wheat. The gradual temperature rise and reduced precipitations are likely to cause the frequent onset of droughts around the world. Therefore, alleviation of drought stress in crop plants has become an essential requirement to meet the increasing food demand. The present study explored the role of foliar application of Moringa leaf extract (MLE) in conferring drought tolerance in wheat during the anthesis stage. A wheat genotype of Indo-Gangetic Plains (HI1544) was exposed to drought stress during the anthesis of the spikes and simultaneously foliar sprayed with MLE for 10 days. The results showed the MLE treatment to improve the concentrations of macro- (K, Ca) and micronutrients (B, Cu, Fe, Mn, Zn, Si) in flag-leaves of wheat under non-stressed conditions. Application of MLE also maintained the flag-leaf nutritional contents under drought stress. The micro-nutrients, including Cu, Fe, Mn, and Zn being the co-factors of the enzymes also stimulated the antioxidant enzyme activities; eventually leading to a significant reduction in the reactive oxygen species and malondialdehyde accumulations under drought stress. Furthermore, micronutrients played a crucial role in osmotic adjustment and sustainable plant growth under drought stress. Overall, the study provided insights into the functional role of micronutrients in improving drought tolerance and also indicated the potential to commercialize MLE as an effective bio-stimulant for sustainable agriculture in drought-prone regions. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.
Post-Coronavirus Disease-2019-associated Multisystem Inflammatory Syndrome in Adults: A Case from India
(Journal of Association of Physicians of India, 2025) Anju Dinkar; Jitendra P. Singh; J. Bhavya; Saroj Kumar
Multisystem inflammatory syndrome in adults (MIS-A) is a postacute hyperinflammatory condition associated with prior SARS-CoV-2 infection. While predominantly reported in children (MIS-C), MIS-A is increasingly recognized in adults and is characterized by multiorgan dysfunction, elevated inflammatory markers, and evidence of recent COVID-19. Timely diagnosis remains challenging due to clinical overlap with other infectious and inflammatory conditions. We report a case of a 36-year-old previously healthy male from Bihar, India, who presented with severe epigastric pain, progressive dyspnea, and systemic symptoms. Clinical examination revealed tachypnea, hypotension, pedal edema, ascites, and hemorrhagic rashes over the abdomen. Laboratory evaluation showed leukocytosis, thrombocytopenia, acute kidney injury, transaminitis, coagulopathy, markedly elevated inflammatory markers, and cardiac biomarkers. Chest imaging revealed bilateral subpleural opacities and mild pleural effusions, indicating pulmonary involvement. Despite a negative SARS-CoV-2 RT-PCR result, high antibody titers confirmed a recent COVID-19 infection. Imaging of the abdomen confirmed acute interstitial edematous pancreatitis. Extensive evaluation excluded tropical, autoimmune, and other infectious etiologies. The present case was managed with high-dose corticosteroids, vasopressors, mechanical ventilation, anticoagulation, and supportive therapy. He showed gradual improvement and was discharged after 6 weeks. MIS-A should be considered in patients with recent SARS-CoV-2 exposure presenting with systemic inflammation, including respiratory and extrapulmonary organ dysfunction. Early recognition and immunomodulatory therapy are essential for favorable outcomes. © The Author(s).
Prevalence of Different Dengue Serotypes in Northern India, 2021–2022: A Tertiary Care Hospital-Based Study
(American Society of Tropical Medicine and Hygiene, 2025) Anju Dinkar; Jitendra P. Singh; Pradyot Prakash; Ranjeet Kumar Vishwakarma
Dengue fever is a substantial emerging and reemerging arboviral virus in tropical and subtropical areas that seriously threatens public health worldwide. India is experiencing rising dengue epidemics in urban and rural regions linked to all four serotypes. The objective is to examine the serotypes and genotypes of the circulating dengue virus (DENV) at a tertiary care center in eastern Uttar Pradesh, India, from 2020 to 2021. This retrospective cross-sectional observational study involved dengue patients from January 2021 to December 2022. The genetic analysis of the circulating DENV was conducted by amplifying the partial CprM (511-bp) gene using nested reverse transcriptase polymerase chain reaction (RT-PCR), followed by sequencing. Only those positive for NS1 antigen (n 5 581) were included in the study. A total of 204 cases (35.1%) were seropositive, with 96 cases (37.4%) out of 257 in 2021 and 108 cases (33.3%) out of 324 in 2022. With 119 cases (58.3%), men were most affected. The nested RT-PCR for dengue revealed three DENV-1 to DENV-3, except for DENV-4. DENV-2 and DENV-3 were the most predominant serotypes, with 98 (48%) and 94 (46%) cases, respectively. Conversely, DENV-1 was the least prevalent with cases 3 (1.6%). Unfortunately, 35 (17.2%) of the 204 cases died. DENV-2 had the highest mortality rate, with 23 deaths (65.7%). In cases with DENV-3, nine (25.7%) died. This study revealed regional disparities in DENV serotype prevalence in India. If regional differences in the most common serotypes and genotypes are identified early in the season, molecular surveillance may predict major dengue outbreaks and severity. © © 2025 American Society of Tropical Medicine and Hygiene.
Prevalence Of Nafld And Associated Factors In Moderate To Severe Hemophilia
(Green Publication, 2025) Byreddi Bhargav; A. Kumar; Ayan Pal; Anurag Vaish; Nilesh Kumar; Jitendra P. Singh; Kailash Kumar; Davesh Yadav
Hemophilia A and Hemophilia B are familial coagulopathies brought about by Factor VIII and Factor IX deficiency, respectively. Hemophiliac patients also face a threat of chronic liver disease as a result of their past infections with the Hepatitis C Virus (HCV). Nevertheless, the high incidence of non-alcoholic fatty liver disease (NAFLD) in sufferers of hemophilia has not been thoroughly studied. Since NAFLD is becoming an issue of concern all over the world, this study tries to determine its prevalence among moderate to severe hemophilia patients. This cross-sectional research was carried out at the Department of General Medicine, Banaras Hindu University. A sample size of 400 moderate to severe patients with hemophilia was taken. Information regarding Body Mass Index (BMI), metabolic conditions, and viral indicators was gathered. Liver tests were done, and ultrasonography and Fibroscan were performed on the patients with continued elevation of Alanine Aminotransferase (ALT). SPSS 20.0 was used to perform statistical analysis. Among 400 patients, 83 expressed an elevated level of ALT, and 20 (5%) were diagnosed with NAFLD. Advanced age (>40 years) was also known to have a significant correlation with NAFLD (p < 0.0001). Other risk factors that were also noticed were BMI as well as factors associated with metabolism. Hemophilia or non-cirrhotic NAFLD in moderate to severe cases, mostly among older people. Screening of the liver is advisable to avoid the progression of liver disease into chronic disease. © 2025, Green Publication. All rights reserved.
Spontaneous Lingual Bleeding and Intracerebral Hemorrhage in a Young Adult with Immune Thrombocytopenia (ITP): A Rare Case Report and Brief Recent Update on Treatment
(Bentham Science Publishers, 2025) Jitendra P. Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Ravi Ranjan; Isha Atam
Introduction: Immune thrombocytopenia (ITP) is an autoimmune condition characterized by reduced platelet counts due to increased peripheral destruction and impaired platelet generation. An estimated incidence of ITP is 2 to 5 cases per 100,000 individuals in the general population. While mucocutaneous bleeding is common, life-threatening complications, such as spontaneous lingual hematoma and intracerebral hemorrhage (ICH), are extremely rare. Rapid progression of lingual haematomas might compromise airway function and necessitate immediate medical intervention. It is well established that most patients with ITP respond to first-line therapy; however, severe bleeding events, such as intracerebral hemorrhage, occur in less than 1% of cases and are associated with significant morbidity and mortality. Case Presentation: A 21-year-old male with a 6-month history of chronic ITP and poor compliance with therapy presented with a 2-day history of progressive reddish discoloration and swelling of the tongue. The clinical examination revealed stable vital signs and a remarkable general and systemic evaluation. The relevant blood routine showed a critically low platelet count at 8×103/μL, with normal coagulation parameters. No other bleeding manifestations were noted. Four hours after admission, the patient developed generalized tonic-clonic seizures and altered sensorium. Computed tomography (CT) of the head revealed an ICH. He was managed with single-donor platelet transfusions, intravenous anti-epileptics, pulse corticosteroid therapy, eltrombopag, and supportive care. The patient demonstrated a favorable clinical response, characterized by a rising platelet count and resolution of symptoms. He was discharged in stable condition with counseling on therapy adherence. Conclusion: The present case emphasizes the rarely yet life-threatening complication of inadequately managed ITP, such as spontaneous lingual hematoma and intracranial haemorrhage. It highlights the vital significance of therapy adherence and timely interdisciplinary intervention to avert disastrous consequences. Timely detection and intervention are crucial for positive outcomes in these intricate cases. Bentham Science Publishers
Tuberculous Broncho-Esophageal Fistula in an Adult Male: A Rare Case Managed Conservatively
(Bentham Science Publishers, 2025) Jitendra P. Singh; Nilesh Kumar; Abhishek Borkotoky; Kailash Kumar; Sarvesh Verma; Anju Dinkar; Dawesh Prakash Yadav
Introduction: Tuberculosis (TB) is a widespread infectious disease caused by Mycobacterium tuberculosis. It predominantly affects the lungs but can involve any organ in the body. Tracheo-oesophageal fistula (TEF) is one of the rare extrapulmonary manifestations of TB. Case Report: A 27-year-old male, otherwise healthy, reported to our outpatient department with complaints of fever, persistent cough, and significant weight loss. Subsequently, he was diagnosed with tuberculous tracheo-oesophageal fistula and pulmonary tuberculosis. Discussion: The patient had an elevated ESR (52 mm) and underwent multiple imaging studies, including two normal barium swallow tests. Upper gastrointestinal endoscopy (UGIE) revealed two esophageal ulcers, one with a fistulous tract. Biopsy results suggested chronic esophagitis with granulomatous inflammation. Contrast-enhanced CT (CECT) of the thorax showed esophageal irregularities, air foci, and contrast extravasation into the bronchi, along with mediastinal lymphadenopathy and centrilobular nodules. Clinical and investigative findings suggested pulmonary tuberculosis with a tracheoesophageal fistula. The patient was discharged on a six-month antitubercular regimen with nutritional support via a nasogastric tube. Stent installation was planned if follow-up results were unfavorable. Conclusion: Although tuberculosis is highly prevalent in India, TEF of tuberculous origin has been infrequently documented, particularly in young, healthy, immunocompetent individuals. The patient was successfully cured after initiating antitubercular therapy and subsequent follow-up. 2025, Bentham Science Publishers