Open Access Case Report

Interstitial Nephritis as the Initial Presentation of Sjogren’s Syndrome: A Case Report with Review of Literature

Anirban Sen, Atanu Pal, Ankit Ray, Koushik Bhattacharjee, Dipankar Sircar, Arpita Ray Chaudhury, Debabrata Sen

Asian Journal of Case Reports in Medicine and Health, Page 1-7

Primary Sjögren’s syndrome is a rare autoimmune condition affecting the exocrine glands. However, extra-glandular manifestations are not uncommon and may present as the initial symptoms of this disorder. Such cases offer a great challenge to clinicians. Here we present a case of primary Sjögren’s syndrome, which presented with incidentally detected renal dysfunction which on investigation revealed distal renal tubular acidosis and tubulointerstitial nephritis. The patient responded to combined therapy of steroid and rituximab and is currently having a stable renal function.

Open Access Case Report

Increased Arterial Stiffness in Moyamoya Disease Presenting with Hypertension and Stroke: A Novel Finding in a Very Rare Condition in Singapore

Zhang Anyi Audrey, Han Huirong, Ray Lai Tian Rui, Ashish Anil Sule

Asian Journal of Case Reports in Medicine and Health, Page 8-13

We present a rare case of a 42 year old lady who presented initially with hypertensive emergency and episodes of transient ischemic attacks who was later diagnosed to have Moyamoya disease (MMD). She continued to have hypertension after left external carotid-internal carotid bypass. We followed her case for evaluation of hypertension. She was found to have increased arterial stiffness on SphygmoCor. The prevalence of hypertension MMD is high, but most notably associated with renal artery stenosis (RAS). Case studies of hypertension in patients with MMD without RAS are rare. We did a literature search on the histopathology and genes involved in MMD. RNF213 and ACTA2 gene mutations are identified to be related to MMD. Interestingly, ACTA2 gene mutation carriers are seen to have a variety of vascular diseases. We postulate that the genes involved in causing intimal thickening and media attenuation of the intracranial vasculature seen in MMD exerts systemic implications. We think this could possibly present with increased arterial stiffness and hypertension. In summary, we would like to highlight increased arterial stiffness as a cause of hypertension in patients with MMD. We postulate that the underlying histopathological changes affecting Moyamoya vessels might also affect systemic blood vessels presenting as increased arterial stiffness.

Open Access Case Report

A Case of Megaloblastic Anaemia Complicated with Extra-Pulmonary Tuberculosis

G. A. C. Gamakaranage, C. S. Moonesinghe, D. Gunawardena, S. Wijekoon, M. K. D. A. Lakmali, U. P. Edirisinghe

Asian Journal of Case Reports in Medicine and Health, Page 14-18

Megaloblastic anaemia is known to cause elevated lactate dehydrogenase (LDH) levels due to increased cell turn over with ineffective erythropoiesis in the bone marrow, a laboratory parameter which can help in the diagnosis and monitoring the response to treatment with vitamin B12 and folate as well. Serum LDH level can get significantly elevated in many other non- neoplastic and neoplastic conditions as well, such as metastatic cancers, infections, haematological malignancies including lymphomas and conditions with haemolysis.  Elevated LDH is considered as an independent predictor of mortality and a marker of major complications in hospitalized patients [1].

This case is about a young man, a vegan who presented with features of megaloblastic anaemia,generalized lymphadenopathy, constitutional symptoms and a very high LDH level mimicking a diagnostic possibility of a high grade lymphoma, ultimately confirmed to have megaloblastic anaemia and tuberculous lymphadenitis, the latter was an unexpected finding of the lymph node biopsy done to exclude a lymphoma.

His significantly high LDH level at diagnosis which declined dramatically in response to vitamin B12 replacement therapy, can be used as a supportive diagnostic tool and also to monitor the response to therapy in megaloblastic anaemia.

Open Access Case Study

A Rare De Novo Reciprocal Translocation 46,XX,rec(7;13)(p22;q32) Karyotype

Serap Tutgun Onrat, Muhsin Elmas

Asian Journal of Case Reports in Medicine and Health, Page 19-23

Carriers of structural chromosomal rearrangements such as Robertsonian or reciprocal translocations have an increased risk of spontaneous abortion and producing offspring with genetic abnormalities. We report an women with uncommon unbalanced Reciprocal translocation carrier 46,XX,rec(7;13)(q22; q32) chromosomal constitution. While her husband and her father showed normal 46,XY karyotype, her son and her mother showed same abnormal kartotype.  Peripheral blood were taken from proband and family members, then performed with lymphocyte culture and stained by binded using Giemsa-banding method.  According to the cytogenetic study  results of first degree relatives of our proband, reciprocal translocation was maternally inherited in our case.  Uniparental dysomia (UPD) is an abnormal condition in which a homologous chromosome pair is both from one parent and not from the other parent. The maternal inheritance of translocated chromosomes is same time compatible with UPD.

Open Access Case Study

Diabetes Insipidus–Is it a Sequelae of COVID-19 Infection?

Priyanka H. Chhabra, P. K. Verma, Binita Jaiswal, Vanya Chugh, Harish Sachdeva

Asian Journal of Case Reports in Medicine and Health, Page 24-28

Introduction: COVID-19 has diverse clinical presentations. We are now quite familiar with the usual symptoms---fever, cough, breathlessness, anosmia, fatigue. Diabetes insipidus could also be a symptom related to covid-19 or it can be a post covid complication.

Case Report: This is a case of a 40 years old patient who presented to the emergency department with breathlessness and desaturation. He was treated with non-invasive ventilation and steroids. His clinical status improved subsequently and he was discharged after 1 week. After two days of discharge, he developed polyuria, hypernatremia, dehydration and hypotension. We performed a water deprivation test and confirmed a diagnosis of neurogenic diabetes insipidus.

Discussion: Diabetes insipidus is a disorder of water homeostasis characterized by polyuria. It is possible that SARS Cov-2 virus due to its predilection for ACE 2 receptors enters hypothalamus and affects the neuronal secretion of vasopressin.

Conclusion: Diabetes insipidus could be one of the delayed manifestations of the disease.It is possible that SARS-Cov2 virus has a possible endocrinopathic effect.