This report deals with an elderly lady with Guillain-Barre Syndrome (GBS), who presented with features of unusually severe hyponatraemia. The hyponatraemia was probably due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The hyponatraemia resolved with water restriction and infusion of hypertonic saline; GBS was treated with human immunoglobulin (IVIG). This patient's experience stresses the importance of monitoring serum sodium levels as hyponatraemia has been identified to be a marker of poor prognosis in GBS.
This paper outlines our approach to the diagnosis of Idiopathic Oedema. The patient presented illustrates some of the pertinent clinical and laboratory pointers one has to take into consideration before labelling a person as suffering from idiopathic oedema. The discussion also includes a brief review of the literature on the patho-physiology and management of this benign disorder.
This paper deals with two patients on warfarin in whom the use of topical methylsalicylate preparations led to clinically significant bleeding problems. The first patient required fresh frozen plasma to tide over the crisis while the second patient recovered spontaneously on stopping the warfarin temporarily. The possible mechanisms by which salicylates potentiate the anticoagulant effect of warfarin are briefly outlined.
We report a patient with unusual manifestations of hyperthyroidism which initially suggested lymphoma. The pathophysiology of these features in thyrotoxicosis is discussed. The need to consider thyrotoxicosis in an otherwise unexplained case of lymphoid hyperplasia will be stressed.
This report deals with the problems of a young man who was clinically euthyroid but biochemically hyperthyroid. The possibility of peripheral resistance to thyroid hormones to explain this paradoxical state is discussed. The importance of recognising this condition to avoid the erroneous diagnosis of thyrotoxicosis and inappropriate therapy is stressed.
This report deals with a middle aged man in whom the presenting symptom of the disorder was dysphagia. The clinical approach to the final diagnosis of thyrotoxic myopathy causing dysphagia is outlined and the pathophysiology of dysphagia then discussed. The need to include thyrotoxicosis in the differential diagnosis of an otherwise unexplained case of dysphagia is stressed.
This report deals with a 54-year-old man with loss of memory. His impaired memory was found to be due to the atenolol he was on and he made a complete recovery on withdrawing the beta-blocker. This patient's experience stresses the need to consider beta-blockers as a potentially reversible cause of memory impairment.
This paper deals with two patients with typhoid fever in whom hepatic manifestations were the dominant and presenting features of the illness. The ability of typhoid hepatitis to simulate other common infectious diseases in this region is highlighted. It is recommended that typhoid hepatitis should be included in the differential diagnosis of patients presenting with fever and jaundice particularly in the tropics.
This report deals with a young man who developed features of haemophogocytosis during the course of typhoid fever. The pertinent clinical and laboratory features of typhoid-associated haemophagocytosis are discussed. The need for blood component replacement therapy in addition to specific anti-microbials to treat haemophagocytosis complicating typhoid fever is stressed.
Virus associated haemophagocytic syndrome (VAHS), a distinct clinico-pathologic entity, is characterised by systemic proliferation of non-neoplastic histotiocytes showing haemophagocytosis resulting in blood cytopaenia. It has been described in relation to several viruses earlier. Here we describe a young girl who developed this reactive process during the course of dengue haemorrhagic fever (DHF).
We present three cases of Acquired Platelet Dysfunction with Eosinophilia (APDE). The importance of recognising this benign condition, which usually does not require any specific therapy, is stressed to avoid the pitfalls of diagnosing more serious bleeding disorders in children presenting with ecchymosis.
We present a young lady who satisfied the criteria for the diagnosis of toxic-shock syndrome (TSS). The differential diagnoses of TSS in the local setting are outlined. The pertinent clinical features of TSS and its increasing association with nonmenstruating females are highlighted.
The presenting features of 236 thyrotoxic patients seen in the thyroid clinic were reviewed. 18.65% of these patterns had one or more dermatological complaints at presentation. There was no specific difference in this group of patients when compared with the general hyperthyroid population with regard to age, race, sex, duration of hyperthyroidism or biochemical indices of thyrotoxicosis. The two major complaints were itching and alopecia. The prevalence of pruritus at 6.4% in our series was identical to that of other workers, but we had a much lower occurrence of alopecia at 2.6%. The diagnosis of thyrotoxicosis was delayed in two patients in whom the only major complaint was pruritus. These symptoms cleared quickly when these patients became euthyroid. However there were other patients who noted hair loss with anti-thyroid medications. The incidence of vitiligo, eczema, onycholysis in our series was much lower those quoted in the Western literature The occurrence of pretibial myoxoedema in our series is similar to that of other workers from this region. The other miscellaneous manifestations include urticaria, xanthelasma and systemic lupus erythematosis. In conclusion we feel the cutaneous manifestations of hyperthyroidism are common in our patients.
We present four cases of polymyalgia rheumatica who recently came under our care. The dramatic response of this disorder to low dose corticosteroids is well illustrated by our patients. The pertinent features of diagnostic value in this condition are highlighted.
We report a case of transient complete heart block with Stokes-Adams attack due to acute rheumatic fever. The patient was a 12-year old boy whose illness satisfied the criteria of acute rheumatic fever. A temporary transvenous cardiac pacer was necessary to tide him over the complete heart block. The rarity of this complication of acute rheumatic fever is highlighted.
This report deals with a father and his son who developed acute renal failure following multiple bee stings. The renal lesion in these patients appears to be due to rhabdomyolysis caused by the bee venom. The other mechanisms are also discussed. The need for clinicians to be aware of acute renal failure as a complication of bee stings is stressed.
This report deals with a young man having prolonged fever presenting with hypercalcaemic crisis. Subsequent investigations confirmed tuberculosis (TB) peritonitis in the absence of pulmonary involvement as the cause of his symptoms. His hypercalcaemia and fever resolved with anti-TB therapy. Abdominal TB needs to be included in the differential diagnosis of otherwise unexplained hypercalcaemia especially in our region where TB is an endemic problem and is treatable.
A 43-year-old lady with long standing non-insulin dependent diabetes mellitus on glibenclamide presented with cholestatic liver disease. Initially she was thought to have developed primary biliary cirrhosis (PBC). When she made a spontaneous recovery following the withdrawal of glibenclamide, it became obvious that the patient had been suffering from drug-induced chronic cholestasis (DICC). The subtle differences between PBC and DICC are highlighted.
Scrub typhus is an endemic problem in Malaysia. Yet its diagnosis appears to depend heavily on the Wetl-Felix test as the more sophisticated diagnostic procedures are not available routinely. We therefore reviewed our experience with scrub typhus patients treated at the Melaka General Hospital from 1983 to April 1986, to identify those clinical features which are diagnostic of this rickettsial illness. Based on the clinical presentation of our patients and the dramatic response of scrub typhus to Doxycycline, we propose a clinical approach to diagnosis until more specific and cheap diagnostic procedures become available in our laboratories. Otherwise, this rickettsial illness will continue to be under-recognised.