Introduction Hyperemesis gravidarum (HG) is said to occur when early pregnancy is complicated by excessive vomiting that leads to electrolyte imbalance, ketosis or loss of more than 5% of the bodyweight. It can be accompanied by deranged liver function tests (LFT), and most patients recover uneventfully with no fetal harm. Methods A retrospective study was conducted by evaluating records of 135 patients who were admitted or underwent day care for HG at our center over a period of 30 months. After excluding patients who were not investigated and those with another pre-existing or newly diagnosed liver disease, 63 patients were enrolled in the study. Their LFT were analyzed with the software Graphpad Prism version 8.4 (GraphPad Software, San Diego, California). The values were expressed as mean ± standard deviation and statistical analysis was done using unpaired t test and simple linear regression. Results The mean age of the study population was 26.59 ± 5.15 years and the mean period of gestation was 13.27 ± 2.48 weeks. 60.3% (38/63) of the patients had some form of abnormality on the LFT. The mean total serum bilirubin (TSB) was 1.56 ± 0.84 mg/dL, mean aspartate transaminase (AST) was 46.63 ± 30.89 U/L and mean alanine transaminase (ALT) was 51.35 ± 42.86 U/L. ALT was higher than AST with statistical significance (p<0.0001). There was no statistically significant difference in the LFT of primigravida and multigravida women. The study population included three diabetic and two hypertensive women, and two women had multiple pregnancy. All the patients were treated with anti-emetics. One patient required corticosteroid administration, and none required termination of pregnancy. Conclusion Mild liver dysfunction in HG can occur in over 50% of the patients. When diagnosis is not in doubt, no further intervention is required with regard to the LFT.

Scrub typhus is a mite-borne rickettsial infection that presents with fever and a diverse array of complications. Lately, many epidemics have been reported from the Indian subcontinent. Data from these outbreaks suggest that liver injury in scrub typhus is common and reversible. We are reporting the case of a 27-year-old pregnant female who presented with fever, encephalopathy, jaundice and seizure. She had acute liver failure and dead fetus on admission. Despite appropriate antibiotics and supportive treatment, she continued to deteriorate and developed multiorgan dysfunction, leading to her demise.

A 36-year-old female presented with lethargy, anorexia, nausea, hyperpigmentation, weight loss and amenorrhea for six months. On examination, she had hyperpigmentation of face, hands and oral mucosa. Investigations revealed adrenal insufficiency and subclinical hyperthyroidism with elevated anti-thyroid peroxidase antibodies. Adrenal insufficiency in combination with Grave's disease and/or type 1 diabetes mellitus occurs in type 2 autoimmune polyglandular syndrome. It is a polygenic disorder occurring due to mutations in the human leukocyte antigen complex on chromosome 6. The patient was treated with oral hydrocortisone which led to improvement in all the symptoms.

A 31-year-old male patient developed extrapyramidal symptoms while on treatment for depression. He was investigated and found to suffer from hypoparathyroidism. He had calcification in the brain, signs and symptoms of neuromuscular irritability, and QT prolongation on electrocardiogram. He was treated with calcium carbonate and calcitriol. Although he had marked improvement, bradykinesia persisted. This report highlights the importance of maintaining a high index of suspicion for hypocalcemia, and the importance of searching for an organic basis for psychiatric symptoms.

Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.