Severe scrub typhus infection among non-ICU patients is more likely to occur in elderly patients and in those with longer duration of illness prior to presentation. The subset of patients without eschar might be more prone to develop complications.

Wilson’s disease is one the rare autosomal recessive disorders of copper metabolism due to mutation in ATP7B gene located in chromosome 13. The mutations of this gene cause accumulation of copper in different tissues such as brain, liver, and eyes. The clinical presentation usually reflects this tissue distribution and varies from asymptomatic patients to those with hepatic or neuro-psychiatric manifestations. Here, we report an interesting case of Wilson’s disease which presented with mild persistent hemolysis leading to pre hepatic and post hepatic jaundice. He also had hepatocellular jaundice due to liver injury.

Background: Dengue fever is one the most common mosquito borne viral disease. Cardiac system involvement is one of the atypical manifestations in dengue fever. So this study was conducted to find out cardiac involvement in patients Dengue fever. Also, the difference in hematological parameters in primary and secondary dengue fever was studied. Materials and methodology: Patients admitted with dengue fever in Medicine Ward or Intensive Care Unit at Chettinad Hospital and Research institute, Kelambakkam were included in study from May 2014 to Feb 2015. Apart from routine laboratory investigations, these patients were subjected for cardiac evaluation in the form of ECG, Cardiac markers like Troponin I and ECHO. Results: Total number of patients included in study was 60. Mean age group involvement was between 23.97± 3.6 years and males were more involved than females. Bleeding manifestations were seen in 4.5% of primary and 33.3% of secondary dengue patients, which was statistically significant (p=0.006). Leucopenia was more in patients with primary infection, 63.6% vs 22.2% in secondary (p=0.005). With regard to thrombocytopenia, all the patients with secondary dengue had low platelets, as compared to 81.8% of primary Dengue (p=0.04). Monocytosis was observed in both primary and secondary dengue fever. However, in primary dengue fever, monocytosis was found only in 33.3% of cases, whereas in secondary dengue fever it was seen in 66.7%(p=0.01). Bradycardia was the only significant cardiac manifestation found in 71.6% of patients. Conclusion:In patients with dengue, fever with gastrointestinal symptoms and leucopenia are more likely to indicate primary infection, whereas bleeding manifestations with thrombocytopenia and monocytosis are more suggestive of secondary dengue. In our study, there was no significant cardiac involvement except bradycardia which reverted to normal after course of dengue illness.

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Scrub typhus has a wide range of clinical presentation varying from mild symptoms like fever, chills, headaches, myalgias, gastric ulcerations and hepatitis to more fatal conditions like pneumonia and encephalopathy caused by disseminated vasculitis with splenic infarct being a rare complication. We report a case of 50-years old male with scrub typhus who presented as multiple splenic infarcts.