A middle-aged male patient presented with fever, polyarthralgia, polyuria, easy fatigability and weight loss for 1 month. Clinically, there was only significant pallor and a swelling over the right sternoclavicular joint. On investigation, there was anaemia, raised urea, creatinine and pus cells in urine with growth ofEscherichia coli. There were also hypercalcaemia and osteolytic lesions over the ribs, scapula, clavicle and skull along with distorted renal corticomedullary differentiation. Although the initial diagnosis was likely to be a case of multiple myeloma, serum protein electrophoresis was negative for the monoclonal band and no Bence-Jones protein was detected in urine. Bone marrow plasma cells were less than 10%, but the serum-free light chain assay revealed altered κ:λ ratio. Later in the course of the disease, a cervical lymph node appeared. The biopsy and immunohistochemistry of this lymph node revealed a CD5 positive diffuse large B-cell lymphoma, but unfortunately the patient succumbed to his illness after receiving the first cycle of Rituximab-Cyclophosphamide-Hydroxydoxorubicin-Oncovin-Prednisolone.

Background:Prednisolone and pentoxifylline (PTX) have been shown to be individually useful in severe alcoholic hepatitis with Maddrey discriminant function (MDF) score ≥32. Previous report suggests that PTX is probably superior to prednisolone alone. However the efficacy of PTX and prednisolone combination over PTX alone in the management of acute alcoholic hepatitis (MDF score ≥32) is yet unrevealed.Aim:The present study was initiated to find out the efficacy of combined pentoxifylline and prednisolone versus PTX alone in acute alcoholic hepatitis in respect of short and intermediate term outcomes.Subjects and Methods:A total of 124 patients with severe alcoholic hepatitis (MDF score ≥ 32) initially were evaluated. 62 patients who fulfilled the inclusion and exclusion criteria were randomized and divided into 2 groups. Group 1 received PTX only, whereas Group 2 received PTX plus Prednisolone. The total duration of follow-up was 12 months. Student's t-test, Chi-square test, the Kaplan-Meier methods were used for statistical analysis.Results:A total of 60 patients, 30 in each group were available for final analysis. In Group-1, 6 patients expired at the end of 1 year (5 within 3 months and another after 3 months). In Group 2, 10 patients expired at the end of 1 year (9 within 3 months and another after 3 months). Though survival probability is higher among Group 1 patients but the difference is not statistically significant.Conclusion:The combination of PTX plus Prednisolone yields no additional benefit in terms of mortality and morbidity from that of PTX monotherapy.

A 20-year-old woman presented with fever and was eventually diagnosed with splenic tuberculosis as the sole site of the disease. Laboratory data gave no specific information for diagnosis except for a raised erythrocyte sedimentation rate and mild anaemia. Abdominal ultrasonography revealed splenomegaly with multiple hypoechoic lesions within it. A diagnosis of isolated splenic tuberculosis was confirmed after CT-guided aspiration from splenic lesions showed the presence of acid-fast bacilli.

Paraneoplstic leukocytosis, seen in some solid tumors, is due to increased production of granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interleukin 6 and other cytokines by tumor cells. Though its association with malignancy of lung, ovary and bladder is not uncommon, but it is rarely seen with renal cell carcinoma. We are presenting such an association with papillary cell carcinoma of the kidney.

There are various causes of secondary nephrotic syndrome. Finding an underlying etiology in a case of nephrotic syndrome or subnephrotic range proteinuria can markedly alter the therapeutic options and disease course. We describe two cases of secondary nephrotic syndrome. The first case was a 22-year-old male with pulmonary tuberculosis with nephrotic syndrome secondary to renal amyloidosis, whereas the second case was a 17-year-old male with chronic hepatitis B-associated nephrotic syndrome. It is important, especially in developing countries, to be aware that tuberculosis and infections like hepatitis B, C, etc. continue to be part of the differential diagnosis of secondary nephrotic syndrome in adolescents and young adults.