Abstract:: Early recognition of iliopsoas abscess is important for limiting morbidity and mortality. Mycobacterium tubercu-losis remains an important cause of iliopsoas abscess in developing countries and most patients are initiated on empirical an-ti-tubercular therapy. In this context, methicillin-sensitive Staphylococcus aureus (MSSA) as a cause of iliopsoas abscess is rare in India. Four cases were diagnosed with pyogenic iliopsoas abscesses caused by MSSA. Half of the patients had typi-cal clinical triad of fever, difficulty in walking and backache. Primary iliopsoas abscesses was present in three patients. All patients were managed with percutaneous drainage and antibiotics with favourable outcome. MSSA as a cause of primary iliopsoas abscesses is rare in India. Early diagnosis of microbial aetiology also minimizes undesirable use of antibiotics and anti-tubercular therapy.

Epidemiology, clinical presentation, and outcomes for digital gangrene in connective tissue disorders (CTD) remain underreported from tropical countries like India. In this series, we aimed to explore the clinical profile and outcomes of patients who presented with digital gangrene and a diagnosis of CTD. Hospital-based longitudinal observational study. Patients with digital gangrene and underlying diagnosis of CTD presenting to our tertiary-care centre in Jodhpur, India between1 st January 2018 and 31 st June 2021 were included. Clinical outcomes including mortality, limb outcomes, functional status and other systemic involvement were assessed. Of the 312 patients registered in the rheumatology clinic during this period, 22 (7%) patients were found to satisfy the inclusion criteria. Mean age was 46 years and 90% were females. The most common underlying diagnosis was Mixed connective tissue disorder (MCTD). Digital gangrene was the presenting symptom in 13 (60%) patients. Half of the patients received only corticosteroids as immunosuppression. Two died due to systemic complications. Complete resolution occurred in 17 (85%), autoamputation in 3, and infection requiring surgical drainage in one patient. All surviving patients reported good functional limb outcome on 6 months follow-up. MCTD is an important cause of digital gangrene in rheumatology practice. In patients presenting with digital gangrene, an active search for an underlying CTD is imperative, as this could result in timely initiation of appropriate limb-saving therapy. Corticosteroids alone with rapid tapering may be an appropriate option to consider in the initial management of digital gangrene in CTD. Key Points• Mixed connective tissue disorder is an important cause of digital gangrene in rheumatology practice in western India.• In patients presenting with digital gangrene, an active search for an underlying connective tissue disorder is imperative, as this could result in timely initiation of appropriate therapy and can prove limb saving. • Corticosteroids alone with rapid tapering may be an appropriate option to consider in the initial management of digital gangrene in connective tissue disorders.

CASE REPORTprotein (40.94 mg/L) were elevated. Prothrombin time (15.1 seconds and international normalized ratio of 1.3) and activated partial thromboplastin time (18.4 seconds) were normal. Electrocardiogram was normal. Abdomen ultrasound showed normal size kidneys with altered echotexture. The patient was diagnosed with AKI secondary to rhabdomyolysis and taken up for hemodialysis. Serum phenytoin and phenobarbitone levels were available after the first session of hemodialysis. The total phenytoin level was 17 µg/mL (therapeutic level 10-20 µg/mL), and the total phenobarbitone level was 9.2 µg/mL (therapeutic level 15-40 µg/mL). His tracheobronchial aspirate culture showed Acinetobacter, for which an appropriate antibiotic was given. The patient subsequently improved with alternate-day hemodialysis and vigorous intravenous (IV) hydration