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A. M. El-Nuweihy, et al. 108LDL, insulin and c-peptide. The ability of adiponectin to increase insulin sensitivity in conjunction with its anti-inflammatory and anti-atherogenic properties have made this novel adipocytokine a promising therapeutic tool for the future.

Acute intermittent porphyria is one of the rare, autosomal dominant, hereditary hepatic porphyria due to deficiency of enzyme Hydroxyl Methyl Bilane synthase (HMB synthase) in the haem synthesis pathway. The condition is characterized by acute abdominal pain and neuropsychiatric manifestations. One of the precipitating causes of AIP is menstruation due to high levels of progesterone. We report an interesting case of AIP precipitated during each cycle of menstruation.

BACKGROUND A young male presented with fever, chills, neck rigidity, unsteadiness and abdominal pain. Patient had signs of chorea (hung-up reflex, exaggerated abdominal reflex), signs of meningoencephalitis (Kernig's positive, opsoclonus) generalised lymphadenopathy (involving cervical, inguinal & axillary regions)-tender & matted, eschar in right inguinal region, left UMN type of facial nerve palsy, signs of pyramidal tract (exaggerated deep tendon reflexes, right plantar extensor), signs of extrapyramidal tract (cog-wheel rigidity) and signs of cerebellar signs (hypotonia & stance and gait ataxia) were present bilaterally giving a picture of Acute Disseminated Encephalomyelitis (ADEM). ELISA for scrub typhus IgM was positive after ruling out malaria, dengue, leptospirosis, bacterial, viral and TB meningitis. ADEM is most rare and deadly presentation of Scrub typhus.

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