Two thirds of patients with early SAP and hypotension had cardiac dysfunction, which was most commonly diastolic dysfunction. A better understanding of the nature of cardiac dysfunction in this setting may allow more accurate diagnosis, prognostication, and management.

Systemic lupus erythematosus (SLE) is a multisystem disease of autoimmune origin. Vasculitis is often seen with SLE, but is usually limited to small vessels alone. The primary pathology in SLE-related vasculitis is leukocytoclastic vasculitis. Medium- and large-vessel vasculitis in association with SLE is distinctly uncommon and is limited to occasional case reports only. In addition, reports of medium-vessel vasculitis with SLE generally describe involvement of a single vessel bed. We report a rare case of extensive vasculitis involving medium-sized vessels in a patient with SLE. Our patient presented with classic signs and symptoms of SLE and satisfied a majority of the American College of Rheumatology criteria for SLE. She also had toe gangrene at presentation and developed paraplegia during the hospital stay. Radiologic studies showed evidence of diffuse medium-sized vessel vasculitis. The patient was treated with monthly pulse cyclophosphamide and high-dose prednisolone. Follow-up showed no new features of vasculitis and improvement in the signs and symptoms of SLE. Her paraplegia showed no response to treatment. This case stresses that medium-sized vessel occlusion anywhere in the body can occasionally occur due to vasculitis in a patient with SLE.

Tuberculosis presenting with myocarditis and severe systolic dysfunction is rarely reported. So far, only a few cases were reported from India. Our aim is to report this rare presentation of a common disease that we encountered at Narayana Multispecialty Hospital, Jaipur. A 34-year-old lady having disseminated tuberculosis involving lung, lymph node, and myocardium with severe left ventricular systolic dysfunction received medical treatment in our hospital. She had elevated cardiac biomarkers, severe left ventricular regional wall hypokinesis with an ejection fraction of 25-30%, bilateral upper and middle lobe ground-glass opacities, as well as mediastinal and hilar lymphadenopathies on chest computed tomography scan and normal coronary angiogram. The patient was started with anti-tuberculosis therapy, a beta-blocker, an angiotensin-converting enzyme inhibitor, and a corticosteroid and discharged after one week in a stable condition. The third month of follow up showed recovery and improvement in cardiac function.

AbstractNeisseria meningitis is a common etiological agent in bacterial meningitis in humans. Common complications associated with meningococcal meningitis include cranial nerve palsies, hydrocephalus, seizures, stroke, cerebritis or brain abscesses. Spinal cord dysfunction is a very rare complication of meningococcal meningitis and its occurrence is limited to case reports only. We report such a case along with a review of available literature and underlying pathogenetic mechanisms. Case report: Our patient diagnosed as a case of meningococcal meningitis developed multiple cranial nerve palsies followed by flaccid paraplegia with bowel bladder involvement during the recovery phase of the disease. Spine MRI showed mild cord edema and diffuse patchy areas of altered intramedullary signal intensity in dorsal cord suggestive of myelitis. The patient was treated with antibiotics and intravenous methyl-prednisolone along with supportive physiotherapy. His neurological deficits showed marked improvement on subsequent follow up.

No abstract