Malaria an endemic disease of India caused by plasmodium species. Chloroquine, a member of quinolone group of drugs is used to treat malaria. Although it has a very safety profile as it is used during pregnancy, many adverse effects have also been reported. Here we report a case of 30-year-old male admitted with fever diagnosed to be having malaria, who developed urticaria immediately after being treated with first dose of chloroquine which was treated successfully. This is the first case reported ever in an adult having chloroquine induced urticaria.

Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of central nervous system (CNS), characterized by multifocal white matter involvement with neurological deficits and accompanied by encephalopathy. ADEM is thought to be caused by autoimmune etiology. CNS autoantigens are produced by molecular mimicry triggered by an environmental stimulus, mostly infection (viral/bacterial) or post vaccination, in genetically susceptible individuals. ADEM is sometimes referred to as post/para-infectious or post-immunization ADEM. ADEM is characterized by multifocal neurological signs and occasionally it rapidly progresses to coma. Magnetic resonance imaging (MRI) is used to confirm the diagnosis. The treatment is based on intravenous high-dose methylprednisolone, which usually leads to a rapid improvement. Recently, the use of intravenous immunoglobulins and plasma exchange (PLEX) has also been suggested. We report a case of a 6-year-old girl who was admitted for urinary tract infection but developed neurological complications which was treated successfully.

Background Pellagra is a nutritional disorder due to deficiency of vitamin B3 (niacin) which is characterized by dermatitis, dementia, diarrhea, and death. The most common site of dermatitis in pellagra is the Casal necklace; however, in this case, the presentation of dermatitis is in unusual sites. Therefore, mucocutaneous signs play a major role in diagnosing the condition. The clinical features of pellagra begin with gastrointestinal symptoms followed by neurological symptoms which are subtle and non-specific. But if misdiagnosed and untreated, it can progress to death from multiorgan failure. Case presentation A 46-year-old Indian farmer, chronic alcoholic of 20 years duration, presented to the hospital with the complaints of darkening and thickening of the skin over the left upper chest and shoulder, epigastric region, left arm and forearm, and right arm and forearm for a period of 4 months with mild cognitive decline. His blood parameters revealed moderate anemia with microcytic hypochromic blood picture and decreased MCV, MCH, and MCHC values. A diagnosis of pellagra was built clinically after exclusion of other causes and has been treated with nicotinamide and had drastic improvement on follow-up. Conclusion The unusual site of pellagra presentation is rare; however, the uncommon presentation of a common disease is always to be considered for diagnosing the disease at the early stage. The neuropsychiatric symptoms of the pellagra in a known case of chronic alcoholic are not well defined, and if untreated, it may progress to stupor and coma and ultimately death. Hence, appropriate diagnosis and earlier management helps in the prevention of various life-threatening complications of any disease.

Background: Obesity is a rising global epidemic in children which leads to pre-diabetes and overt diabetes. Identification at early stage helps in early intervention. This study was undertaken to study the prevalence of pre-diabetes in urban school going adolescents aged 11-17 years with high risk factors.Methods: This was a prospective cross-sectional study conducted in Chennai, India between December 2011 and November 2012. Overweight or obese adolescents in the age group 11-17 years, either with family history of diabetes or acanthosis nigricans or both were included. After obtaining informed consent from parents, history was obtained in pre-tested questionnaire.Results: 148 adolescents were enrolled in the study (n=148), 71.62% were females, mean weight was 59.54±10.44 kg, mean height was 150.92±8.62 cm, mean BMI was 26.19±3.23 and mean blood glucose was 82.1 mg/dl. 60.81% of subjects were overweight and others obese. Girls had statistically significant higher mean weight and mean BMI than boys. 78.37% had acanthosis nigricans, 47.29% had family history of diabetes, 12.16% had pre-diabetes and the mean blood glucose in pre-diabetics was 104.9 mg/dl. Pre-diabetes was higher in adolescents with family history of diabetes (p=0.038).Conclusions: Recognition of risk of type 2 diabetes in the asymptomatic pre-diabetes phase needs to be emphasized and targeted screening of high risk children for pre-diabetes seems to be justified. The morbidity and mortality of youth onset type 2 diabetes can be reduced only by early detection and treatment.

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