TB should be suspected in patients with unexplained fever post alloSCT. Active GVHD and ongoing immunosuppression/steroids are possible risk factors. Early diagnosis and treatment can salvage most patients. Hepatotoxicity following ATT is a potential concern.

Introduction Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder of unknown etiology. Usually it presents with massive painless cervical lymph node enlargement. Histologically, it shows proliferation of distinctive histiocytic cells that demonstrate emperipolesis in the background of a mixed inflammatory infiltrates. Immunohistochemically, the cells are positive for markers such as CD68 and S100. Objective To report a case of a 12-year-old patient with multiple sites of cervical lymphadenitis, which was diagnosed as RDD histopathologically as well as immunohistologically. Resumed Report A 12-year-old girl presented with multiple painless sites of cervical lymphadenitis without any systemic and other ear, nose, and throat manifestations. The biopsy report of the lymph node showed dilatation of the sinuses, filled with histiocytes having foamy cytoplasm. Many of the histiocytes were engulfing mature lymphocytes. The sinus histiocytes were strongly positive for S-100 protein. Conclusion RDD must be considered in the differential diagnosis of massive or multiple lymphadenopathies.

Background: Breast cancer is the common malignant lesion in women. Fine needle aspiration cytology has high sensitivity and specificity and is a simple, rapid and safe method to diagnose breast lesions. The aim of the study was to categorize breast lesions and correlate the Fine needle aspiration cytology diagnosis with histopatholoical findings. Materials and Methods:This was a retrospective study done in department of Pathology of Institute of medicine, Trivuwan university teaching hospital, from January 2007 to December 2010. There were 1403 FNAC cases and 469 histopathology cases. Fine needle aspiration correlation with histopathology was done in 249 cases. All the cases were categorized according to risk for cancers: Unsatisfactory sample, Inflammatory breast disease Benign proliferative breast disease without atypia, Benign proliferative breast disease with atypia, Suspicious for malignancy and Malignant lesions. Results:Benign breast lesions were common in the age group of 21-30 years and malignant breast lesion common in the age of 41-50 years of age. In our study fibroadenoma was most common benign lesion and ductal carcinoma was the most common malignant lesion. The sensitivity and specificity of FNAC for malignancy were found to be 98.2% and 98.5% respectively. Conclusion:Fine needle aspiration cytology is highly sensitive and specific technique for diagnosis of most of the malignant and benign breast lesions.

Background Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei . This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia. Case presentation Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole. Conclusion The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species . The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Background: Thyroid autoimmunity can cause several forms of thyroid disorders i.e. Grave's disease, Hashimoto's thyroiditis, atrophic autoimmune thyroiditis, post-partum thyroidits etc. Cytological diagnosis may be sometimes difficult is some cases. In such conditions, cytology along with serological tests aid at reaching a correct diagnosis. Hence, this study was undertaken to evaluate the serum level of anti-TPO antibody with respect to serum concentrations of thyroid hormones and its importance in diagnosing autoimmune thyroiditis. Results: Ninety-five thyroid FNAC was included in the study, which comprises of 16.8 % males and 83.2% females with a M: F 1: 4.9. Maximum number of cases was seen in the age range 21-30 years (25.3%), mean age being 40.4years. The cytological diagnosis comprised colloid goiter(43.2%), lymphocytic thyroiditis(25.3%), Hashimoto thyroiditis(18.9%). Out of 42 cases of autoimmune thyroiditis diagnosed cytologically, 16 (38%) were hypothyroid, 4 (9.5%) hyperthyroid, 8 (19%) sub-clinical hypothyroid and 14 (33.5%) were euthyroid. The sensitivity and specificity of positive anti TPO in correctly identifying autoimmune thyroiditis was 85.7% and 79.2% respectively. The positive and negative predictive value for the test was 76.5% and 87.5% respectively. Conclusion