Antiphospholipid syndrome (APS) is an autoimmune disease present most commonly in young women, characterized by the presence of antibodies against various phospholipids and culminating in alteration of the flow of blood, leading to arterial and venous thrombosis. Although it can present with a wide range of manifestations, digital gangrene is one of the important ones. We present a case of a young female with antiphospholipid syndrome who presented with acute onset bilateral upper limb symmetrical digital gangrene with prior history of multiple fetal losses. Acute onset, symmetrical gangrene, limited to the bilateral upper limbs without venous system involvement, that too in association with systemic lupus erythematosus (SLE) which does not usually manifest as such make this case a unique and interesting one.

A BSTRACT Envenoming and deaths resulting from snake bite are a particularly important public health problem in the tropical world, with the highest burden in rural areas of South East Asia and Africa. Snake bite is one of the most severe “Neglected Tropical Diseases” in the world and more importantly in this part of India. We present a case of hemotoxic snake bite where the coagulation parameters remained deranged for a longer time without any active bleeding manifestations, despite treatment with Anti-Snake Venom (ASV) as per the National Treatment Guidelines. Indian Snake Bite Management Protocol emphasizes on the Role of Whole Blood Clotting Time (WBCT) as a bedside, accessible and feasible test for assessment of coagulopathy even in rural settings. Certain scenarios where the patients present late to our hospital with Snake Bite and Venom Induced Consumption Coagulopathy (VICC), the decision regarding ASV prescription in such patients is quite tricky, and needs to be individualized.

A middle-aged male, coming from a remote hilly village of Northern India, presented to the outpatient department for optimization of his anti-diabetic medications. On routine general examination innumerable soft to firm, asymptomatic subcutaneous nodular swellings were noted over his trunk and limbs which varied from 1-4 cm in size. However, he denied any history of headache, seizures, body ache, muscle pains, fever, or systemic involvement. He stated that he occasionally consumed pork since childhood.

A BSTRACT Kimura disease is an uncommon disease entity that typically involves the lymph nodes predominantly in the head and neck region together with frequent involvement of salivary glands. Very few cases of it have been reported in literature globally, and in the context of India, it is even rare. Early suspicion of Kimura disease may prevent the patient from unnecessary invasive diagnostic tests. We present a case scenario of a 35 years old female, from a hilly area who presented with painless neck swelling for 3 months that was followed by fever, new onset pain at the site of neck swelling, and skin rashes. Diagnosis of Kimura disease was made based on histopathological findings aided by peripheral eosinophilia and elevated serum Immunoglobulin E (IgE) levels. Following the diagnosis, the patient was treated with a short course of oral steroids which produced an excellent response with a consequent decrease in the size of lymph nodes and resolution of the skin rashes.